Collaboration In Maternity Care Research Articles

Interprofessional collaboration in maternity care

African Journal of Midwifery and Women's HealthVol. 17, No. 2 EditorialInterprofessional collaboration in maternity careUnice GoshomiUnice GoshomiCorrespondence to:E-mail Address: [email protected]Social Sciences, Women's University in Africa, Harare, ZimbabweSearch for more papers by this authorUnice GoshomiPublished Online:16 Jun 2023https://doi.org/10.12968/ajmw.2023.0019AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Behruzi R, Klam S, Dehertog M et al.. Understanding factors affecting collaboration between midwives and other health care professionals in a birth center and its affiliated Quebec hospital: a case study. BMC Pregnancy Childbirth. 2017;17(1):1–4. https://doi.org/10.1186/s12884-017-1381-x Crossref, Google ScholarCharalambous C, Rampton B. Language learning, identity, and intercultural communication in contexts of conflict and insecurity. In: Jackson J (ed). The Routledge handbook of language and intercultural communication. Abingdon, Oxfordshire: Routledge; 2020 Crossref, Google ScholarKruk ME, Gage AD, Arsenault C et al.. High-quality health systems in the sustainable development goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196–e1252. https://doi.org/10.1016/S2214-109X(18)30386-3 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 April 2023Volume 17Issue 2ISSN (online): 2052-4293 Metrics History Published online 16 June 2023 Published in print 2 April 2023 Information© MA Healthcare LimitedPDF download

O34 - Labouring Together: Clinicians’ Experiences of “Working Together To Get The Best Outcomes” in Maternity Care

Multiple investigations have determined that poor interprofessional collaboration has been detrimental to the safety and experience of maternity care, as evidenced in the publication of the recent Ockenden review in the UK. The Labouring Together study was conducted to explore women's and clinicians' perceptions and experiences of collaboration in maternity care, using a conceptual theory of collaboration to identify barriers and enablers in the context of Victoria, Australia. A sequential, mixed-methods, multi-site case study approach was used to explore collaboration and shared decision-making in maternity care in four diverse case studies of public and private hospitals. Cross-sectional surveys were conducted in each case, using validated scales to determine midwives’, obstetrician’s and GPs’ assessment of organisational context and attitudes toward collaboration, followed by in-depth interviews to explore their perceptions and experiences. Participants rated the context of each case study similarly for the provision of woman-centred care, and whilst the attitudes of most participants were positive toward collaboration, midwives were found to have a significantly more positive attitude than obstetricians ( p <.001 95% CI 2.64-7.93) and GPs ( p <.001 95% CI 5.48-12.10). The conceptual framework of Working Together to Get The Best Outcomes emerged from inductive analysis, with major subthemes of ‘Organisation of care: working for the organisation’ and ‘Partnering in care: working together with women’ . Interprofessional tensions are avoided through professional altruism and positive role-modelling of interprofessional respect and trust. However, multiple barriers to effective collaboration in maternity care were identified; and whilst participants agreed that women should have autonomy for collaborative decision-making, most identified barriers to achieving this ideal. Results of the Labouring Together study indicate that although individual attitudes toward collaboration are largely positive, fundamental barriers to collaboration in maternity care remain, and shared decision-making with women is not routine practice in Victoria, Australia.

O36 - Labouring Together: Women’s Experiences of “Getting the Care that I Want and Need” in Maternity Care

Poor collaboration has been identified as detrimental to the safety and experience of maternity care. The Labouring Together study was conducted to explore women's and clinicians' perceptions and experiences of collaboration in maternity care in Victoria, Australia. Underpinned by well-established conceptual theories of collaboration and shared decision-making (SDM), a sequential, mixed-methods, multi-site case study approach was used to explore women’s perceptions and experiences of maternity care in four diverse case studies of public and private hospitals. Women's preferred and experienced role for SDM were quantified using the Control Preferences Scale (CPS) and analysed using chi-square analyses by case and socio-demographic characteristics. In depth interviews were conducted to explore preferences and experiences reported by women. Most women indicated that they preferred an autonomous or collaborative role for SDM, however 24.4% of women reported experiencing a passive decision-making role during their maternity care. Statistically significant differences were identified between the preferences and experiences of decision-making among women who chose private obstetric care compared to public maternity care. The conceptual framework of Getting the Care that I Want and Need emerged from inductive analysis of qualitative data. Impacts upon women’s autonomy over decision-making in maternity care included: access to midwifery models of care, access to relational continuity of care; understanding of the rights of the woman; and models information sharing for risks and benefits of all options and proposed interventions. Bureaucratic style decision-making based upon a dominant discourse of risk avoidance was identified as a major barrier, with power to ultimately veto the woman’s choice The Labouring Together study findings provide evidence to support women to use SDM processes to enable decision-making in maternity care. However, fundamental barriers were identified to hinder collaboration; and shared decision-making with women is not routine practice in Victoria, Australia.

Labouring Together: Women's experiences of “Getting the care that I want and need” in maternity care

ObjectivePoor interprofessional collaboration and lack of decision-making with women have been identified as being detrimental to the quality, safety, and experience of maternity care. The aim of the Labouring Together study was to explore childbearing women's preferences for and experiences of collaboration and control over decision-making in maternity care. DesignA sequential, mixed-method, multi-site case study approach was used to explore the perceptions and experiences of childbearing women regarding collaboration and decision-making. Women's preferred role for decision-making compared to the actual experiences, and the influences upon their preferences and experiences of collaboration were explored using semi-structured interviews. An inductive approach was used for qualitative analysis of interviews, and cross-case analyses were conducted using replication logic. SettingPostnatal wards of 1 private and 3 public maternity services in both metropolitan and regional Victoria, Australia. ParticipantsPostnatal women, over the age of 18 years (n=182). FindingsHalf (48.3%) of the participants indicated a preference for a shared decision-making role and 35% preferred an active role. Only 16.7% participants indicated a preference for a passive role, however 24.4% of women reported experiencing a passive decision-making role during their maternity care. Statistically significant differences were also identified between preferences for and experiences of decision-making among women who chose the private obstetrician model of maternity care compared to the public maternity care system. Negative impacts upon women's autonomy over decision-making included: poor access to midwifery models of care; poor access to relational continuity of care; poor understanding of the rights of the woman; inadequate information for women about the risks and benefits of all proposed interventions; and a bureaucratic style of decision-making based upon a dominant discourse of risk avoidance that could ultimately veto the woman's choice. Key conclusionsDespite evidence of the benefits for women of having autonomy over decision-making in their own care, fundamental barriers were identified that hindered women's participation in collaboration in maternity care. Shared decision-making with childbearing women is not routine practice in maternity care in Victoria, Australia. Implications for practiceRelational continuity of care is imperative to promote the autonomy of childbearing women and an environment conducive to women's active engagement in maternity care and participation in shared decision-making.

The paradoxes of communication and collaboration in maternity care: A video-reflexivity study with professionals and parents

BackgroundResearch on maternity care often focuses on factors that prevent good communication and collaboration and rarely includes important stakeholders – parents – as co-researchers. To understand how professionals and parents in Dutch maternity care accomplish constructive communication and collaboration, we examined their interactions in the clinic, looking for “good practice”. MethodsWe used the video-reflexive ethnographic method in 9 midwifery practices and 2 obstetric units. FindingsWe conducted 16 meetings where participants reflected on video recordings of their clinical interactions. We found that informal strategies facilitate communication and collaboration: “talk work” – small talk and humour – and “work beyond words” – familiarity, use of sight, touch, sound, and non-verbal gestures. When using these strategies, participants noted that it is important to be sensitive to context, to the values and feelings of others, and to the timing of care. Our analysis of their ways of being sensitive shows that good communication and collaboration involves “paradoxical care”, e.g., concurrent acts of “regulated spontaneity” and “informal formalities”. DiscussionAcknowledging and reinforcing paradoxical care skills will help caregivers develop the competencies needed to address the changing demands of health care. The video-reflexive ethnographic method offers an innovative approach to studying everyday work, focusing on informal and implicit aspects of practice and providing a bottom up approach, integrating researchers, professionals and parents. ConclusionGood communication and collaboration in maternity care involves “paradoxical care” requiring social sensitivity and self-reflection, skills that should be included as part of professional training.

How good is collaboration between maternity service providers in the Netherlands?

AimsTo examine the experiences of inter-professional collaboration of maternity service providers in the Netherlands and to identify potential enhancing and inhibiting factors for inter-professional collaboration within maternity care in the Netherlands.BackgroundGood collaboration between health care professionals is a key element of safe, effective care, but creating a collaborative culture can be challenging. Good collaboration requires, among other things, negotiating different professional orientations and the organizational constraints of hierarchies and scheduling. Good collaboration is especially important in maternity care. In the Netherlands, suboptimal collaboration has been cited as a significant factor in maternal deaths and in adverse incidents occurring in hospitals during evenings, nights, and weekends. In spite of its importance for effective maternity care, little is known about the nature and quality of collaboration between maternity care professionals. In order to fill this gap, we examined the inter-professional collaboration within multi-disciplinary teams (MDTs) providing maternity services in the Netherlands.MethodsOnline survey of MDTs (consisting of hospital and PCMs, doctors, and carers) involved in the provision of maternity services in the Netherlands. We used a validated measure of collaboration (the Leiden Quality of Work Questionnaire) to analyze the attitudes of those involved in the provision of maternity services about multi-disciplinary collaboration in their work. We used descriptive and inferential statistics to assess differences between the groups.Results40% of all respondents were not satisfied with collaboration within their MDT. Overall, mean collaboration scores (MCS) were low. We found significant differences in MCS between professional groups. Midwives – community and hospital based – were pessimistic about collaboration in future models of maternity care.DiscussionIn the Netherlands, collaboration in maternity care is less than optimal. Poor collaboration is associated with negative consequences for patient safety and quality of care. Strategies to address suboptimal collaboration exist; however, no one-size-fits-all approach is identified in the literature.ConclusionSuboptimal collaboration exists within the midwifery model of care in the Netherlands and the relationship between care providers is under pressure. This could affect patient safety and quality of care, according to the literature.PrécisThis paper presents an in-depth examination of the nature of, and attitudes about, collaboration between members of the MDT involved in the provision of maternity services in the Netherlands.

Mapping Collaboration Across Birth Settings in the United States: Access, Equity, and Outcomes [2R

INTRODUCTION: Lack of coordination of care across birth settings (home-hospital, rural-urban) has been associated with adverse maternal-fetal outcomes. The US Birth Place Mapping Study examines associations between regulation, scope of practice, interprofessional collaboration with maternal-newborn outcomes, and equitable care for at-risk populations. METHODS: We populated a 50-state database with published regulatory data on scope of practice across birth settings. A nationwide survey of 92 regulatory experts verified the “on the ground” relevance, importance, and realities of collaboration. Content validation led to a 49-item weighted integration scoring system (item scores range 1-4). Composite summary scores were then used to rank states on the regulatory and practice environment for midwives and physicians across home, birth centers and hospitals. Higher scores indicate more integration and collaboration across all providers and all settings. Using CDC, Area Resource and CMS data, we calculated correlation coefficients between integration scores and selected outcomes (eg. SVD, VBAC, breastfeeding, cesarean, induction, neonatal mortality, LBW) in each state, controlling for race and type of provider. RESULTS: Integration scores ranged from 17-59, (North Carolina lowest – 17, Washington highest – 59). We report results through 4 interactive data maps, displaying quartiles for level of integration, linked to optimal and adverse outcomes, and access to care, by state. Rates of birth by race, Medicaid coverage, and location are displayed both by region and by individual states. CONCLUSION: This scoring system identifies barriers to collaboration in maternity care, and can inform health human resource planning and policy to improve regional access to high quality maternity care.

The struggle for inter-professional teamwork and collaboration in maternity care: Austrian health professionals' perspectives on the implementation of the Baby-Friendly Hospital Initiative.

BackgroundThe health benefits of breastfeeding for mothers and babies are well documented in the scientific literature. Research suggests that support of breastfeeding during pre- and postnatal maternity care is an important determinant of breastfeeding initiation and duration. To support and promote breastfeeding on maternity units, the Baby-Friendly Hospital Initiative (BFHI) was launched in 1991. In Austria, however, less than one fifth of hospitals with a maternity unit are currently BFHI-certified. Implementation of BFHI and adjunct changes in work practices seem to represent a major challenge to maternity units. This article builds upon previous research that has identified a number of facilitators of and barriers to BFHI implementation in Austria. A major barrier has been the lack of intra- and inter-professional collaboration. Therefore, this article investigates the ways in which different healthcare professionals struggle to work together to successfully integrate the BFHI into practice.MethodsIn this study, a qualitative research approach was used. Thirty-six semi-structured interviews with 11 midwives, 11 nurses, 13 physicians, and one quality manager, working across three maternity units, were interviewed on-site. Data analysis followed thematic analysis.ResultsMidwives, nurses, and physicians had diverse approaches to childbirth and breastfeeding (medicalization vs. naturalness) and worked along different jurisdictions that became manifest in strict spatial divisions of maternity units. In their engagement within the BFHI, midwives, nurses, and physicians pursued different strategies (safeguarding vs. circumvention strategies). These differences hindered inter-professional teamwork and collaboration and, therefore, the integration of BFHI into practice.ConclusionsDiffering approaches to childbirth and breastfeeding, deep seated professional jurisdictions, as well as spatial constraints, challenge inter-professional teamwork and collaboration on maternity units. Inter-professional teamwork and collaboration are widely espoused goals of contemporary healthcare improvement strategies. Yet, critical debate on how these goals can be integrated into practice is needed. To enable collaboration and facilitate the implementation of programs such as BFHI, the different perspectives of health professionals should be brought together and the potential for integrating different forms of knowledge and practices should be considered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1336-3) contains supplementary material, which is available to authorized users.

PERCEPTIONS OF PRIVATE SECTOR MIDWIVES AND OBSTETRICIANS REGARDING COLLABORATIVE MATERNITY CARE IN THE EASTERN CAPE, SOUTH AFRICA

The World Health Organization states that no region in the world is justified in having a caesarean section rate greater than 10 to 15% of the total number of live births. However, there has been an international increase in the rate of caesarean section deliveries and this is a concern to midwives globally. The increase is evident in South Africa and especially in the private sector and where it has been shown to be as high as 70% of the total number of live births per year. As a result, the South African public often perceives giving birth surgically as ‘normal’ and ‘safer’ than vaginal delivery. The lack of direct involvement of midwives in the care of pregnant women in the private sector is noted as one of the reasons related to the high caesarean section delivery rates. Hence, the objectives of the study were to explore and describe the perceptions of private sector midwives and obstetricians regarding the feasibility of collaboration in maternity care. The study followed a qualitative, exploratory, descriptive, contextual design. The research population included midwives and obstetricians in the private sector in the Eastern Cape. Non-probability, purposive sampling was employed using semi-structured one-to-one interviews for data collection. The study showed that midwives and obstetricians perceived a collaborative working relationship as being beneficial to maternity care. However, there are critical impediments that need to be addressed in order to achieve such a partnership. In conclusion, participants saw it possible for collaboration in midwifery care services with positive benefits to the women being attended to.

The experiences of midwives and nurses collaborating to provide birthing care: a systematic review.

Collaboration has been associated with improved health outcomes in maternity care. Collaborative relationships between midwives and physicians have been a focus of literature regarding collaboration in maternity care. However despite the front line role of nurses in the provision of maternity care, there has not yet been a systematic review conducted about the experiences of midwives and nurses collaborating to provide birthing care. The objective of this review was to identify, appraise and synthesize qualitative evidence on the experiences of midwives and nurses collaborating to provide birthing care.Specifically, the review question was: what are the experiences of midwives and nurses collaborating to provide birthing care? This review considered studies that included educated and licensed midwives and nurses with any length of practice. Nurses who work in labor and delivery, postpartum care, prenatal care, public health and community health were included in this systematic review.This review considered studies that investigated the experiences of midwives and nurses collaborating during the provision of birthing care. Experiences, of any duration, included any interactions between midwives and nurses working in collaboration to provide birthing care.Birthing care referred to: (a) supportive care throughout the pregnancy, labor, delivery and postpartum, (b) administrative tasks throughout the pregnancy, labor, delivery and postpartum, and (c) clinical skills throughout the pregnancy, labor, delivery and postpartum. The postpartum period included the six weeks after delivery.The review considered English language studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.This review considered qualitative studies that explored the experiences of collaboration in areas where midwives and nurses work together. Examples of these areas included: hospitals, birth centers, client homes, health clinics and other public or community health settings. These settings were located in any country, cultural context, or geographical location. A three-step search strategy was used to identify relevant published and unpublished studies. English papers from 1981 onwards were considered. The following databases were searched: Anthrosource, CENTRAL (The Cochrane Library), CINAHL, EMBASE, PsycINFO, PubMed, Social Services Abstracts and Sociological Abstracts. In addition to the databases, several grey literature sources were searched. Papers that were selected for retrieval were independently assessed for inclusion in the review by two JBI-trained reviewers. The two reviewers used a standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Qualitative data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Once qualitative studies were assessed using the the Joanna Briggs Institute Qualitative Assessment and Review Instrument critical appraisal tool, findings of the included studies were extracted. These findings were aggregated into categories according to their similarity in meaning. These categories were then subjected to a meta-synthesis to produce a comprehensive set of synthesized findings. Five studies were included in the review. Thirty-eight findings were extracted from the included studies and were aggregated into five categories. The five categories were synthesized into two synthesized findings. The two synthesized findings were:Synthesized finding1: Negative experiences of collaboration between nurses and midwives may be influenced by distrust, lack of clear roles, or unprofessional or inconsiderate behavior.Synthesized finding 2: If midwives and nurses have positive experiences collaborating thenthere is hope that the challenges of collaboration can be overcome. Qualitative evidence about the experiences of midwives and nurses collaborating to provide birthing care was identified, appraised and synthesized. Two synthesized findings were created from the findings of the five included studies. Midwives and nurses had negative experiences of collaboration which may be influenced by: distrust, unclear roles, or a lack of professionalism or consideration. Midwives and nurses had positive experiences of teamwork which can be a source of hope for overcoming the challenges of sharing care.There is clearly a gap in the literature about the collaborative experiences of midwives and nurses, given that only five studies were located for inclusion in the systematic review. More qualitative research exploring collaboration as a process and the interactional dynamics of midwives and nurses in a variety of practice and professional contexts is required.Distrust, unclear roles, and lack of professionalism and consideration must all be addressed. Strategies that address and minimize the occurrences of these three elements need to be developed and implemented in an effort to reduce negative collaborative experiences for midwives and nurses. Postive experiences of teamwork must be acknowleged and celebrated, and the challenges that sharing care present must be understood as a part of the collaborative process.More qualitative research is required to explore the collaborative process between midwives and nurses. Further exploration of their interactional dynamics, their relationship between power and collaboration, and the experiences of collaboration in a variety of professional and practice contexts is recommended.

What Makes for Good Collaboration and Communication in Maternity Care? A Scoping Study

BACKGROUND: Good communication and collaboration are critical to safe care for mothers and babies.OBJECTIVE: To identify factors associated with good collaboration and communication among maternity care professionals and between both professionals and parents.METHOD: Scoping study. We searched PubMed and Web of Science for peer reviewed, quantitative and qualitative, original, primary research in Western societies on communication and collaboration in maternity care among professionals (Search 1) and between professionals and parents (Search 2).FINDINGS: The 40 studies (14 in Search 1; 26 in Search 2) that met our selection criteria highlighted several factors associated with good communication and collaboration. We grouped these factors into 6 categories: Expertise, Partnership, Context, Attitude, Trust, and Communication style. Studies of communication and collaboration among professionals foregrounded work-related aspects, whereas studies examining collaboration between professionals and parents paid more attention to interpersonal aspects. Before 2012, few studies covered positive aspects of communication and collaboration. We also found an underrepresentation of parents in study populations.CONCLUSION: Our study is part of a growing trend of identifying the positive aspects of communication and collaboration in maternity care. As the study of collaboration in practice continues, researchers need to be sure to involve all stakeholders, including parents.

An empirical investigation into beliefs about collaborative practice among maternity care providers

To investigate agreement with the National Health and Medical Research Council (NHMRC) definition of collaboration in maternity care by care providers, and to examine their preferences for models of care in order to shed light on the lack of success in implementing collaborative practice. Maternity care providers completed a survey in Queensland. The final sample consisted of 337 participants, including 281 midwives (83.38%), 35 obstetricians (10.39%), and 21 general practitioners (6.23%). Ninety-one percent of the participants agreed with the NHMRC definition of collaboration: Midwives (M=5.97, s.d.=1.2) and doctors (obstetricians and general practitioners: M=5.7, s.d.=1.35) did not differ significantly in their level of agreement with definition (t (332)=-1.8, P=.068). However, 72% of doctors endorsed a doctor-led model of care, whereas only 6.8% of midwives indicated agreement with it. Fewer (56%) doctors agreed with the midwife-led model of care, whereas 99.3% of midwives endorsed it. The concept of collaboration does not recognise the different interpretations by midwives and doctors of its impact on their roles and behaviours. Successful collaborative practice requires the development of guidelines that recognise these differences and specify the communication behaviour that would assist midwives and doctors to practice collaboratively.

Creating a Collaborative Culture in Maternity Care

Effective collaboration between professional groups is increasingly seen as an essential element in good quality and safe health care. This is especially important in the context of maternity care, where most women have straightforward labour and birth experiences, but some require rapid transfer between care providers and settings. This article presents current accounts of collaboration--or lack of it--in maternity care in the United Kingdom, United States, and Australia. It then examines tools designed to measure collaboration and teamwork within general health care contexts. Finally, a set of characteristics are proposed for effective collaboration in maternity care, as a basis for further empirical work in this area.

Re: Collaboration in maternity care. A response to ‘what do I think of midwife‐led units?’

<i>Re: Collaboration in maternity care. A response to ‘what do I think of midwife‐led units?’</i>

Collaboration in maternity care: a randomised controlled trial comparing community-based continuity of care with standard hospital care

Objective To test whether a new community-based model of continuity of care provided by midwives and obstetricians improved maternal clinical outcomes, in particular a reduced caesarean section rate. Design Randomised controlled trial. Setting A public teaching hospital in metropolitan Sydney, Australia. Sample 1089 women randomised to either the community-based model ( n=550) or standard hospital-based care ( n=539) prior to their first antenatal booking visit at an Australian metropolitan public hospital. Main outcome measures Data were collected on onset and outcomes of labour, antenatal, intrapartum and postnatal complications, antenatal admissions to hospital and neonatal mortality and morbidity. Results There was a significant difference in the caesarean section rate between the groups, 13.3% (73/550) in the community-based group and 17.8% in the control group (96/539). This difference was maintained after controlling for known contributing factors to caesarean section (OR=0.6, 95% CI 0.4–0.9, P=0.02). There were no other significant differences in the events during labour and birth. Eighty babies (14.5%) from the community-based group and 102 (18.9%) from the control group were admitted to the special care nursery, but this difference was not significant (OR 0.75, 95% CI 0.5-1.1, P=0.12). Eight infants died during the perinatal period (four from each group), for an overall perinatal mortality rate of 7.3 per 1000 births. Conclusion Community-based continuity of maternity care provided by midwives and obstetricians resulted in a significantly reduced caesarean section rate. There were no other differences in clinical outcomes.