Improving Maternity Services Research Articles

Exploring perceptions of maternity services for pregnant adolescents in Indonesia: a qualitative study

Background/Aims Adolescent pregnancies are prevalent in Indonesia. This study aimed to explore perceptions from healthcare workers and pregnant adolescents of maternity services for pregnant adolescents. Methods This qualitative exploratory study involved two policymakers, 10 midwives, five doctors, and 10 pregnant adolescents. Data were collected through structured interviews in public health centre consultation rooms. The data were analysed thematically to explore factors that promoted or hindered use of maternity services for pregnant adolescents. Results The identified barriers included a lack of tailored directives, challenges in engaging adolescents, insufficient numbers of skilled healthcare professionals, adolescents' fears and compromised confidentiality. Opportunities for improvement included enhancing service quality through strategic planning and specialised training for midwives and psychologists. Conclusions The study underscores the need to improve maternity services offered for pregnant adolescents by creating a conducive working environment and sensitising healthcare workers and the community to adolescent mothers' needs. Implications for practice There is a need for guidelines in Indonesia specifically on providing care for pregnant adolescents. Healthcare professionals require specialised training and facilities should be made adolescent friendly.

The use of gender-neutral language in maternity settings: a narrative literature review

Background/Aims Midwives are vital healthcare professionals that are autonomous and passionate specialists on women, pregnancy, birthing and families. Staying up to date with contemporary issues enhances their ability to provide high-quality evidence-based care. One aspect of maternal care that is changing is the use of gender-neutral language. The aim of this review was to examine the use of gender-neutral language in maternity settings and collate the literature to expose any knowledge gaps. Methods A narrative literature review was conducted, using primary research and literature reviews from the Cochrane Library, CINAHL and MEDLINE databases. A total of 106 articles were included. Results Data analysis yielded four themes: etymology and the origins of language in maternity, the effects of language in maternity, attitudes, and social media and language. The literature identified the perspective of the lesbian, gay, bisexual, transgender, intersex, queer or questioning, asexual and other sexually or gender diverse population who have accessed maternity and childcare services. Not all literature was maternity specific, but provided insight into how to improve maternity services. Conclusions It is recommended that education be provided for healthcare professionals when working with the LGBTIQA+ community. Updating paperwork and policies at a structural level will have a vast impact holistically on LGBTIQA+ maternity consumers.

Impact of coronavirus 2019 pandemic on post-traumatic stress disorder symptoms among pregnant women in Jordan.

Objective:To examine the prevalence of psychological symptoms of the coronavirus disease 2019 outbreak among pregnant women and its association with gestational age and post-traumatic stress disorder symptoms.Methods:A cross-sectional study was conducted between June and November 2020 to assess the impact of the COVID-19 pandemic on mental health in pregnancy using the Impact of Event Scale-Revised. Pregnant women 18 years and older were recruited from antenatal and obstetrics clinics in Jordan. A total of 481 pregnant women participated in an online survey developed on Google Forms. A self-administered structured questionnaire was used to collect sociodemographic data, mental health information, and lifestyle changes. The Impact of Event Scale-Revised, the Perceived Support Scale, and the Mental Health Lifestyle Scale were administered. Variables related to sociodemographic information and dietary behavior and perception during the COVID-19 pandemic were also assessed.Results:The results showed that 58.6% of pregnant women reported the presence of post-traumatic stress disorder symptoms and women in the second trimester were more likely to show post-traumatic stress disorder symptoms compared with the first and third trimesters (p = 0.001). Moreover, a higher level of education, employment, poor dietary habits, and changes due to the pandemic were significantly associated with the Impact of Event Scale-Revised score and the presence of post-traumatic stress disorder symptoms.Conclusion:The COVID-19 pandemic was associated with high rates of psychological distress among pregnant women. Identifying mothers at risk of post-traumatic stress disorder symptoms may help improve maternity services and prevent adverse child outcomes.

Incidence and risk factors of perineal tears of pregnant women delivering at a midwife obstetric unit South Africa

Aim: To estimate the incidence and risk factors for perineal tears of low-risk pregnant women delivering at a midwife obstetric unit.
 Methods: A retrospective study performed on perineal tear during childbirth from birth register at midwife run unit in Durban municipality, South Africa between January 2018 and October 2019. Risk factors were studied and bivariate and logistic regression done. Results are expressed with adjusted odds ratios (OR) and p-values <0.05 are considered significant.
 Results: A total of 1578 women had singleton vaginal childbirths. Half (50.6%) of them have perineal tears. The incidences of episiotomy, combined first-and second, and third-and fourth- degree (OASI) tears are 24.3%, 25.1% and 1.1% respectively. Risk factors for any perineal tears are younger mothers (teenage OR=2.9, 20-24 years OR=2.2), primipara (OR= 15.8), received antenatal care (OR=.47) and gestational age (GA) (<32 weeks OR=.05). The risk factors for episiotomy are; teenage (OR=5.4), ages 20-24 years (OR=4.2), ages 25-29 years (OR=3.0), primipara (OR=12.4), GA (£32 weeks OR=.16), GA 33-36 weeks (OR=.6) and having antenatal care (OR=.41). Birth weight <2.5 kg and between 2.5-3.0 kgs (OR=.014) and (OR=.09) are protective for OASI.
 Conclusions: Risk factors for the perineal injuries are similar to those previously reported in other studies. Training of midwives on perineal care and selection for undertaking episiotomy is urgently needed to improve maternity services at the midwife obstetric unit. Identification of those at risk may reduce obstetric perineal injury.

THE EFECT OF ACUPRESSURE ON DECREASING NAUSEA AND VOMITING IN THE FIRST TRIMESTER OF PREGNANCY IN THE WORK AREA OF THE SUKAHURIP HEALTH CENTER, GARUT REGENCY, WEST JAVA, 2020

Physical and psychological changes that afect complaints of nausea and vomiting or even hyperemesis, especially in the first trimester. Data at the Sukahurip Health Center, pregnant women who experience emesis in the first trimester is still high, namely in January-March 2020, which is as much as 70.7%. One of the non-pharmacological treatments for hyperemesis is acupressure massage. The purpose of this study was to determine the effect of acupressure on reducing nausea and vomiting (emesis) in the first trimester of pregnancy. The design of this research is quantitative research, pre-experimental approach using pre-test and post-test one-group design. The sample in this study were pregnant women in the first trimester who experienced nausea and vomiting. The data were obtained using an observation format, then analyzed by using the Paired Test. The results of this study showed that the frequency of nausea and vomiting before acupressure massage was 17.41 points, then after acupressure massage decreased to 10.47 points. The results of statistical tests using Paired test showed that there was an effect of acupressure on reducing complaints of nausea and vomiting in pregnant women with a p value of 0.000. The conclusion of this study is acupressure massage has an effect on reducing nausea and vomiting in first trimester pregnant women. Therefore, midwives can apply acupressure massage techniques to pregnant women to reduce nausea and vomiting as an effort to improve maternity services.

An exploration of migrant women\u2019s perceptions of public health messages to reduce stillbirth in the UK: a qualitative study

BackgroundStillbirth is a global public health priority. Within the United Kingdom, perinatal mortality disproportionately impacts Black, Asian and minority ethnic women, and in particular migrant women. Although the explanation for this remains unclear, it is thought to be multidimensional. Improving perinatal mortality is reliant upon raising awareness of stillbirth and its associated risk factors, as well as improving maternity services. The aim of this study was to explore migrant women’s awareness of health messages to reduce stillbirth risk, and how key public health messages can be made more accessible.MethodTwo semi-structured focus groups and 13 one to one interviews were completed with a purposive sample of 30 migrant women from 18 countries and across 4 NHS Trusts.ResultsParticipants provided an account of their general awareness of stillbirth and recollection of the advice they had been given to reduce the risk of stillbirth both before and during pregnancy. They also suggested approaches to how key messages might be more effectively communicated to migrant women.ConclusionsOur study highlights the complexity of discussing stillbirth during pregnancy. The women in this study were found to receive a wide range of advice from family and friends as well as health professionals about how to keep their baby safe in pregnancy, they recommended the development of a range of resources to provide clear and consistent messages. Health professionals, in particular midwives who have developed a trusting relationship with the women will be key to ensuring that public health messages relating to stillbirth reduction are accessible to culturally and linguistically diverse communities.

Re-examining Norms of Disrespect and Abuse in the Second Stage of Labor in Tanzanian Maternity Care

ABSTRACT Globally, the widespread occurrence of disrespect and abuse (D&A) on maternity wards is well-documented. Using ethnography and cultural consensus analysis we explore how the practice of midwives hitting women who are in the second stage of labor (pushing) has become a locally accepted form of care in Tanzania if a baby’s life appears to be at risk. This analysis interrogates the deep uncertainty of birth outcomes in this setting that may motivate abuse during this time. Seriously engaging with local discourses on abuse and care sheds light on hegemonic norms and power dynamics and is critical for improving maternity services.

Telehealth: improving maternity services by modern technology

Hypertension is considered one of the most common medical disorders causing complexities in pregnancy. It could be a newly developed pregnancy-induced hypertension (PIH) or a pre-existing hypertension developing into superimposed...

Women\u2019s experiences of midwifery care immediately before and after caesarean section deliveries at a public Hospital in the Western Region of Ghana

BackgroundChildbirth remains a uniquely multifaceted, mental-cognitive and a major life experience to women. It is composed of a variety of psycho social and emotional aspects and creates memories, sometimes bad experiences and unmet expectations which leaves the mother with lasting scars. Therefore, this study aimed at exploring post-caesarean section delivered mothers experiences of midwifery care in a public hospital in Ghana.MethodsThis descriptive exploratory qualitative research used an interpretative approach to explore mothers’ experiences of midwifery care immediately before and after caesarean section (CS). The study employed a purposive sampling technique in recruiting 22 participants who had knowledge of the phenomenon under study. Data collection was guided by an interview guide, which involved face to face individual interviews and focus group discussion at the postnatal ward and clinic. All interviews were audio-recorded and lasted 30–40 min. Audio recordings were transcribed verbatim and inductive thematic data analysis employed.ResultsFour major themes emerged from the analysis of participants’ transcripts: Support by Midwives (physical and psychological, and attitude towards patients’ pain management); Protection of mothers (provision of privacy, confidentiality and physical environment); Provision of information/communication (before caesarean section, and before a minor task) and midwives’ attitude (attitude towards delivery care).ConclusionMothers delivered by caesarean section had varied experiences of midwifery care which were both positive and negative ones. Provision of psychological support and adequate pain management were positive experiences. The challenges experienced were related to provision of information, privacy, and physical support. Participants, who underwent emergency CS in particular, were dissatisfied with the provision of information concerning the surgical procedure. Provision of privacy and physical support were also issues of great concern. We therefore, recommend supportive and sensitive midwifery care particularly for mothers undergoing emergency CS. Documenting women’s diverse experiences of midwifery care before and after CS delivery is important to healthcare providers, hospital managers and policy makers as the feedback garnered can be used to improve maternity services and inform decisions on midwifery care.

Women's satisfaction with maternity care during preterm birth.

Women's satisfaction with maternity care is strongly influenced by their sociodemographic characteristics, values, and attitudes. The arrival of a preterm baby is often a traumatic time, with unique factors involved. The Spanish Preterm Birth Experience and Satisfaction Scale (P-BESS) is a robust instrument capable of assessing women's satisfaction during preterm birth. The purpose of this study was to assess women's satisfaction with maternity care during labor and birth with preterm babies in a Spanish-speaking population. This is a cross-sectional study. Participants were 182 women who gave birth within 37weeks' gestation. Factors associated with satisfaction were studied through univariate and bivariate analyses and through multiple linear regression using the backward elimination method. Women reported high satisfaction with maternity care overall (average score of 84 out of 95). Women with a university education were generally less satisfied. Women were more satisfied if they were pregnant for the first time. Women who reported a previous premature birth or neonatal death were more satisfied, and women who had prior miscarriages were less satisfied compared with women without these experiences. The analysis confirmed that the majority of women surveyed were very satisfied with their childbirth experience. The Spanish P-BESS can be a useful way of prioritizing intervention measures, focusing on those aspects lowest scored by women, such as "information and explanations" and "confidence in staff," to improve maternity services for families experiencing preterm birth.

Empowering LGBTQ parents: How to improve maternity services and child healthcare settings for this community – ‘She told us that we are good as a family’

Parental empowerment plays an essential role in maternity and child healthcare. Professionals delivering these services are ideally placed to improve parents' empowerment and well-being. This study aims to describe the supporting factors of parental empowerment from the perspective of self-identified lesbian, gay, bisexual, trans, or queer (LGBTQ) parents in Finland. The study was conducted using a qualitative inductive design, and 22 parents participated. Interviews were conducted between July and September of 2016 and analysed using inductive content analysis. Four categories emerged: 1) Parents' willingness to create socially recognized families, 2) Parenthood support, 3) Respectful partnership with all parents, and 4) Accessible services. Services were more empowering when parents were treated with dignity. This focus requires gender-neutral communication and a clear sense of security for parents. The findings indicate more education on LGBTQ-related issues is still needed.

Midwives' evaluation of their role in crowdsourcing activities to improve the maternity experience: part 1

This is the first of two articles introducing crowdsourcing as a tool that offers creative solutions to address everyday challenges in maternity care. In this first article, crowdsourcing is defined and discussed, demonstrating how it can be used to discover many relatively low-cost ideas to improve maternity services. By engaging service users in crowdsourcing activities, quality improvement is shared and focused on issues that emerge from practice. This process has the potential to generate more innovative ways to improve maternity services and women's experiences of care. In the second article, the discussion will centre on a service evaluation project that studied midwives' involvement in a workshop as part of a quality improvement project.

A focus group study of women\u2019s views and experiences of maternity care as delivered collaboratively by midwives and health visitors in England

BackgroundResearch suggests that collaboratively delivered maternity care can positively impact health outcomes. However, women’s perspectives on models of care involving interprofessional collaboration between midwives and health visitors are not well understood. Accounts of women’s maternity care experiences are key to improving maternity services. This study considered women’s views and experiences of maternity care as collaboratively provided by midwives and health visitors in England.MethodsA qualitative focus group study with an exercise exploring women’s ideal maternity care pathway was conducted. Three focus groups were conducted in London, England between June and August 2017 with women who had had a child within 18 months prior to the study. The participants (n = 12) were recruited from two Children’s Centres in London, England. Data were analysed using thematic analysis.ResultsFour themes were identified: ‘Women’s experiences of maternity care from midwives and health visitors’, ‘Midwife-health visitor communication’, ‘Midwife-health visitor collaboration for tailored care’, and ‘Women’s ideal maternity care pathway’. Regarding women’s experiences of interprofessional collaboration between midwives and health visitors, this was rarely encountered, but welcomed by women. Women’s observations of limited tailored care and co-ordination led to several suggestions to improve maternity care, including secure, shared medical recordkeeping systems, clarity on midwives’ and health visitors’ roles, as well as increased communication.ConclusionsMaternity care that is collaboratively delivered by midwives and health visitors, from the perspectives of the women in this study, is not routinely provided. However, women recognise the potential benefits of midwife-health visitor collaboration. Future research should explore service configurations that support integrated maternity care pathways, and evaluate the impact of midwife-health visitor collaboration on health and service outcomes.

Assessment of quality of obstetric care in Zimbabwe using the standard primipara

BackgroundTo improve maternity services in any country, there is need to monitor the quality of obstetric care. There is usually disparity of obstetric care and outcomes in most countries among women giving birth in different obstetric units. However, comparing the quality of obstetric care is difficult because of heterogeneous population characteristics and the difference in prevalence of complications. The concept of the standard primipara was introduced as a tool to control for these various confounding factors. This concept was used to compare the quality of obstetric care among districts in different geographical locations in Zimbabwe.MethodsThis was a substudy of the Zimbabwe Maternal and Perinatal Mortality Study. In the main study, cluster sampling was done with the provinces as clusters and 11 districts were randomly selected with one from each of the nine provinces and two from the largest province. This database was used to identify the standard primipara defined as; a woman in her first pregnancy without any known complications who has spontaneous onset of labour at term. Obstetric process and outcome indicators of the standard primipara were then used to compare the quality of care between rural and urban, across rural and across urban districts of Zimbabwe.ResultsA total of 45,240 births were recruited in the main study and 10,947 women met the definition of standard primipara. The maternal mortality ratio (MMR) and the perinatal mortality rate (PNMR) for the standard primiparae were 92/100000 live births and 15.4/1000 total births respectively. Compared to urban districts, the PNMR was higher in the rural districts (11/1000 total births vs 19/ 1000 total births, p < 0.001). In the urban to urban and rural to rural districts comparison, there were significant differences in most of the process indicators, but not in the PNMR.ConclusionsThe study has shown that the standard primipara can be used as a tool to measure and compare the quality of obstetric care in districts in different geographical areas. There is need to explore further how the quality of obstetric care can be improved in rural districts of Zimbabwe.

\u201cFive hundred years of medicine gone to waste\u201d? Negotiating the implementation of an intercultural health policy in the Ecuadorian Andes

BackgroundIn Ecuador, indigenous women have poorer maternal health outcomes and access to maternity services. This is partly due to cultural barriers. A hospital in Ecuador implemented the Vertical Birth (VB) policy to address such inequities by adapting services to the local culture. This included conducting upright deliveries, introducing Traditional Birth Attendants (TBAs) and making physical adaptations to hospital facilities.MethodsUsing qualitative methods, we studied the VB policy implementation in an Ecuadorian hospital to analyse the factors that affect effective implementation of intercultural health policies at the local level. We collected data through observation, in-depth interviews, a focus group discussion, and documentation review. We conducted 46 interviews with healthcare workers, managers, TBAs, key informants and policy-makers involved in maternal health. Data analysis was guided by grounded theory and drew heavily on concepts of “street-level bureaucracy” to interpret policy implementation.ResultsThe VB policy was highly controversial; actors’ values (including concerns over patient safety) motivated their support or opposition to the Vertical Birth policy. For those who supported the policy, managers, policy-makers, indigenous actors and a minority of healthcare workers supported the policy, it was critical to address ethnic discrimination to improve indigenous women’s access to the health service. Most healthcare workers initially resisted the policy because they believed vertical births led to poorer clinical outcomes and because they resented working alongside TBAs. Healthcare workers developed coping strategies and effectively modified the policy. Managers accepted these as a compromise to enable implementation.ConclusionsAlthough contentious, intercultural health policies such as the VB policy have the potential to improve maternity services and access for indigenous women. Evidence-base medicine should be used as a lever to facilitate the dialogue between healthcare workers and TBAs and to promote best practice and patient safety. Actors’ values influenced policy implementation; policy implementation resulted from an ongoing negotiation between healthcare workers and managers.

Improving maternity services for Indigenous women in Australia: moving from policy to practice.

The well established disparities in health outcomes between Indigenous and non-Indigenous Australians include a significant and concerning higher incidence of preterm birth, low birth weight and newborn mortality. Chronic diseases (eg, diabetes, hypertension, cardiovascular and renal disease) that are prevalent in Indigenous Australian adults have their genesis in utero and in early life. Applying interventions during pregnancy and early life that aim to improve maternal and infant health is likely to have long lasting consequences, as recognised by Australia's National Maternity Services Plan (NMSP), which set out a 5-year vision for 2010-2015 that was endorsed by all governments (federal and state and territory). We report on the actions targeting Indigenous women, and the progress that has been achieved in three priority areas: The Indigenous maternity workforce; Culturally competent maternity care; and; Developing dedicated programs for "Birthing on Country". The timeframe for the NMSP has expired without notable results in these priority areas. More urgent leadership is required from the Australian government. Funding needs to be allocated to the priority areas, including for scholarships and support to train and retain Indigenous midwives, greater commitment to culturally competent maternity care and the development and evaluation of Birthing on Country sites in urban, rural and particularly in remote and very remote communities. Tools such as the Australian Rural Birth Index and the National Maternity Services Capability Framework can help guide this work.

MAXIMISING CARE

Find out how students from London Business School worked with the NHS to improve maternity services and delivery of cancer treatment

How to Become Mother-Friendly: Policies and Procedures for Hospitals, Birth Centers, and Home Birth Services

HOW TO BECOME MOTHER-FRIENDLY: POLICIES AND PROCEDURES FOR HOSPITALS, BIRTH CENTERS, AND HOME BIRTH SERVICES Barbara Hotelling and Helen Gordon, Editors New York: Springer Publishing Compan y, 2014, 184 pp., $75.00 (paperback)The Mother-Friendly Childbirth Initiative (MFCI) is the first and only consensus document on maternity care in the United States. It was originally published in 1997 by the Coalition for Improving Maternity Services (CIMS), composed of more than 26 organizations that focused on perinatal health. CIMS intended to promote maternity care, which improves birth outcomes and reduces the costs of maternity care. The MFCI consisted of 10 evidence-based steps for birth facilities to deliver motherfriendly health care.Hotelling and Gordon's book, How to Become Mother-Friendly: Policies and Procedures for Hospitals, Birth Centers, and Home Birth Services, translates the steps of MFCI into discrete policies and procedures applicable to the environment of birth facilities. I outline the policies and procedures for each of the steps.* Step 1 ; A mother-friendly hospital, birth center, or home birth service offers all birthing mothers unrestricted access to birth companions, labor support, and professional midwifery care.* Step 2: A mother-friendly hospital, birth center, or home birth service provides accurate descriptive and statistical information to the public about the practices and procedures for birth, including measures of intervention and outcomes.* Step 3: A mother-friendly hospital, birth center, or home birth service provides culturally competent care; that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother's ethnicity and religion.* Step 4: A mother-friendly hospital, birth center, or home birth service provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.* Step 5: A mother-friendly hospital, birth center, or home birth service has clearly defined policies and procedures for collaborating and consulting with other maternity services and linking the mother and baby to appropriate community resources during both the prenatal and postpartum periods.* Step 6: A mother-friendly hospital, birth center, or home birth service does not routinely employ practices and procedures that are unsupported by scientific evidence.* Step 7: A mother-friendly hospital, birth center, or home birth service educates staff in nondrug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.* Step 8: A mother-friendly hospital, birth center, or home birth service encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.* Step 9: A mother-friendly hospital, birth center, or home birth service discourages nonreligious circumcision of the newborn. …

Correlation between manager’s leadership style and the implementation process of “ mother friendly hospital plan ” in selected hospitals in west of country Iran (kordestan, hamedan and Kermanshah provinces) in 1391.

Correlation between manager’s leadership style and the implementation process of “ mother friendly hospital plan ” in selected hospitals in west of country Iran (kordestan, hamedan and Kermanshah provinces) in 1391.

Development and Validation of Women's Satisfaction With Hospital-Based Intrapartum Care Scale in Jordan.

Measuring satisfaction with care during labor is an important way to improve maternity services for women. This study was undertaken to develop an instrument to measure women's satisfaction with intrapartum hospital-based care. A multidimensional instrument was initially developed, using three core aspects identified from the literature. An expert panel was convened to further modify the instrument. Finally, a total of 300 low-risk women who gave birth in the past 2 months were asked to complete the instrument to assess validity and reliability. The 14-item instrument was found to have content and construct validity as well as a high level of reliability (α = .88). This new instrument is a valid and reliable measure of satisfaction with intrapartum care in a Jordanian setting. The instrument can provide valuable information on the quality of services and on future planning for maternity services.