Midwifery Model Of Care Research Articles

O59 - Measuring maternal satisfaction with continuity models of midwifery care

O59 - Measuring maternal satisfaction with continuity models of midwifery care

Examining the validity and reliability of the COMcareSS (Continuity of Midwifery Care Satisfaction Survey)

BackgroundContinuity of midwifery care has been proven to show an improvement in clinical outcomes for women and greater maternal satisfaction with maternity care. Several questionnaires have been developed to measure satisfaction with maternity services although few are suitable for continuity of midwifery maternity care models, and many have not been validated. AimsThe purpose of this study was to test the reliability and validity of the newly developed Continuity of Midwifery Care Satisfaction Survey (COMcareSS) with a cohort of women who have recently experienced continuity of midwifery care. MethodsThe COMcareSS was distributed to women in Australia who had experienced a live birth within a continuity model of midwifery care and were up to two months postpartum. Factor analysis was conducted, and Cronbach’s alpha coefficient calculated for the 34-item scale. FindingsIn total 272 completed responses were recorded. Cronbach’s alpha coefficient for the scale was 0.96 suggesting some redundancy in items. There was a lack of variation in responses. In factor analysis, only one factor could feasibly be attempted. This accounted for 76 % of variation in responses. ConclusionThe COMcareSS scale is the first to be developed to measure maternal satisfaction with continuity of midwifery led care. The 34-item scale has good internal consistency. The scale may be unidimensional though the lack of variation in responses means that other possible latent constructs, were not able to be detected. Use of a standardised scale such as the COMcareSS will facilitate benchmarking between services and, comparison and meta-analysis in research studies.

LITERATURE REVIEW: MODEL CONTINUITY OF CARE PELAYANAN KEBIDANAN DEPRESI POSTPARTUM

During the postpartum period, midwives not only assess the physical examination and breastfeeding process, but also must assess the emotional well being and social support of the postpartum mother. The Continuity of Care (CoC) midwifery care model makes mothers get to know their caregivers better, this is one of the midwifery care models that provides services to help women build relationships with their caregivers. Postpartum depression is a major health problem, having a dangerous impact on postpartum mothers, their babies, and their families. The prevalence of depression in the Southeast Asia region is 27%, while in Indonesia the prevalence of depression is 3.7% and ranks second after India at 4.5%. This study aims to determine the Continuity of Care model for midwifery services with postpartum depression. The type of research used in this research is literature review research using 5 journals from the sources used in the form of journal search studies in electronic databases such as the Directory of Open Access Journals (DOAJ), ScienceDirect and EBSCO in full text form. So it can be concluded that a strong relationship between mothers and midwives who are known for providing continuous care, results in increased trust, more personal and loving care, and better sharing of information will reduce postpartum depression. To address knowledge gaps and methodological deficiencies in the existing literature, articles on postpartum depression in Asian countries need to further explore the role of physical, biological and cultural factors.

New Approaches to Brief Intervention on Substance Use during Pregnancy

In Canada, the context for providing brief intervention on substance use during pregnancy is shifting with new opportunities for enhancing discussion of alcohol and other substances, due to the introduction of novel nicotine delivery products (e.g., vaping), the legalization of cannabis, and the crisis in the useof prescription pain medication. The midwifery model of care is very well suited for open, collaborative conversations about substance use, as there are opportunities for ongoing and supportive relationship building throughout pregnancy, labour, birth, and into the postpartum period. The purpose of this paper is to explore the ways in which brief intervention on substance use in the perinatal period can be a key component of midwifery care. This article has been peer reviewed.

'There is no other option': Exploring health care providers' experiences implementing regional multisite midwifery model of care in South Australia.

In the past 30 years, 60% of South Australia's rural maternity units have closed. Evidence demonstrates midwifery models of care offer regional Australia sustainable birthing services. Five birthing sites within the York and Northern Region of South Australia, designed in collaboration with key stakeholders, offered a new all-risk midwifery continuity of care model (MMoC). All pregnant women in the region were allocated to a known midwife once pregnancy was confirmed. In July 2019, the pilot program was implemented and an evaluation undertaken. The study aimed to evaluate the effectiveness, acceptability, and sustainability of the new midwifery model of care from the perspective of health care providers. The evaluation utilised a mixed methods design using focus groups and surveys to explore experiences of health care providers impacted by the implementation of the MMoC. This paper reports on midwives, doctors and nurses experiences at different time points, to gain insight into the model of care from the care providers impacted by the change to services. The first round of focus groups included 14 midwives, 6 hospital nurses/midwives and 5 doctors with the overarching theme that the 'MMoC was working well.' The second round of focus groups were undertaken across the five sites with 10 midwives, 9 hospital nurses/midwives and 5 doctors. The overarching theme captured all participants commitment to the MMoC, with agreement that 'there is no other option - it has to work'. All participants reported positive outcomes and a strong commitment to navigate the changes required to implement the new model of care. Collaboration and communication was expressed as key elements for success. Specific challenges and complexities were evident including a need to clarify expectations and the workload for midwives, and for nurses who were accustomed to having midwives 24 hours a day in hospitals. This innovative model responds to challenges in providing rural maternity care and offers a sustainable model for maternity services and workforce. There is an overwhelming commitment and consensus that there is 'no other option-it has to work'.

Comparing Continuity of Midwifery Care Model with the Mother-child Health Book: Enhancing Knowledge for Adolescent Pregnancy in Indonesia

Comparing Continuity of Midwifery Care Model with the Mother-child Health Book: Enhancing Knowledge for Adolescent Pregnancy in Indonesia

Asuhan Kebidanan Pada Bayi Ny.I Di TPMB Rupi′Ah Suparman

Providing midwifery care to BBL and neonates using a midwifery management approach. Research method The midwifery care model used in this research with midwifery care management according to Hellen Varney, includes assessment subjective and objective, identification of problem diagnoses, identification of potential problem diagnoses, identification of immediate needs, planning (intervention), implementation (implementation), and evaluation. As well as monitoring visits in the form of SOAP. The results of midwifery care for newborns and neonates diagnosed the condition of Mrs. I's newborn and neonate within normal limits and there were no complications or gaps between theory and diagnosis. The care was in accordance with midwifery service standards.

How midwives facilitate informed decisions in the third stage of labour – an exploration through portraiture

ProblemMidwifery philosophy promotes informed decision-making. Despite this, midwives report a lack of informed decision-making in standard maternity care systems. BackgroundPrevious research has shown a woman's ability to make informed decisions within her maternity care significantly impacts her childbearing experience. When informed decision-making is facilitated, women report positive experiences, whereas when lacking, there is an increased potential for birth trauma. AimTo explore midwives’ experiences of facilitating informed decision-making, using third-stage management as context. MethodsFive midwives from Victoria, Australia, were interviewed about their experiences with informed decision-making. These interviews were guided by portraiture methodology whereby individual narrative portraits were created. This paper explores the shared themes among these five portraits. FindingsFive individual narrative portraits tell the stories of each midwife, providing rich insight into their philosophies, practices, barriers and enablers of informed decision-making. These are then examined as a whole dataset to explore shared themes, and include; ‘informed decision-making is fundamental to midwifery practice’ ‘the system’, and ‘navigating the system’. The system contained the sub-themes; hierarchy in hospitals, the medicalisation of birth, and the impact on midwifery practice, and ‘navigating the system’ – contained; safety of the woman and safety of the midwife, and the gold-standard of midwifery. Discussion and conclusionMidwives in this study valued informed decision-making as fundamental to their philosophy but also faced barriers in their ability to facilitate it. Barriers to informed decision-making included: power-imbalances; de-skilling in physiological birth; fear of blame, and interdisciplinary disparities. Conversely enablers included continuity models of midwifery care, quality antenatal education, respectful interdisciplinary collaboration and an aim toward a resurgence of fundamental midwifery skills.

Midwives Safeguarding Abortion Access: Establishing Medication Abortion Services.

The abortion access landscape for patients has changed dramatically in the wake of the US Supreme Court Dobbs v. Jackson Women's Health Organization decision in June of 2022. In response, the Division of Midwifery at Baystate Medical Center in Springfield, Massachusetts, began a medication abortion service for both established patients and those who may seek care from out of state. This service increases access to abortion care now while also providing the clinical experience needed for student nurse-midwives to become future abortion providers. This article outlines the steps taken to implement a medication abortion service and ways it can be adopted by other midwifery practices. Strategies to address possible clinical, administrative, and logistical challenges are addressed. Finally, this article is a call to action because midwives are well qualified to provide high quality, safe, and comprehensive medication abortion within the midwifery model of care.

Midwifery care for a COVID-19 cohort of women in Northern Italy: two years of pandemic.

The rapid development of the COVID-19 pandemic has altered the context of healthcare around the world. SARS-CoV-2 positive pregnant and postnatal women, being at greater risk of complications, require continuous midwifery surveillance as well as specialized medical care. Scientific literature lacks studies related to midwifery care models in hospital settings during the pandemic. The aim of this work is to describe hospitalizations in an obstetric-gynecological COVID care unit and to provide a descriptive analysis of the organizational and care model adopted. A cohort retrospective descriptive study was carried out. The sample was stratified by COVID-related care complexity and by obstetric risk. The sample recruited pregnant women, postnatal women, and gynecological patients with confirmed SARS-CoV-2 infection admitted to the obstetric-gynecological COVID unit of a birth center in Northern Italy, from March 16, 2020, to March 16, 2022. A number of 1037 women were hospitalized, and of these, 551 were SARS-CoV-2 positive women. The 551 SARS-CoV-2 positive women included 362 pregnant women, 132 postnatal women, 9 gynecological patients with medical diagnosis while 17 with a surgical path, and 31 women undergoing voluntary interruption of pregnancy. The final sample included 536 women. 68.6% of women requested a low care complexity, 22.8% a medium one, and 8.6% a high care complexity. Among the obstetric women population, the majority (70.6%) showed a high obstetric risk. The COVID-19 cohort of women required different levels of care with various care complexity and levels of obstetric risk. The model adopted allowed the acquisition of new technical and professional skills as well as the sharing of responsibilities and competences according to the care model of the Buddy System. Future studies could investigate COVID-related care models adopted internationally, but also deepen the technical and professional skills developed by midwives during the pandemic in order to enrich, improve and support midwifery profession.

Home-based postnatal midwifery care facilitated a smooth succession into motherhood: A Swedish interview study.

If a family is discharged from a hospital earlier after birth, close supervision by a skilled midwife is essential. The aim was to describe mothers' overall experience receiving postnatal care in a Swedish home-based midwifery care model. A descriptive qualitative study was conducted. Mothers meeting the inclusion criteria for a new home-based postnatal care model at a hospital in Stockholm, Sweden, were included. In total, 24 healthy mothers participated in a semi-structured telephone interview, averaging 58 minutes. Data were analyzed using thematic analysis, according to Braun and Clarke. The main theme explored, 'The home-based postnatal care model facilitated a smooth succession into motherhood', is explained by the themes: 1) Mothers felt 'not left adrift' when cared for by the home-based postnatal midwives; 2) Professional midwives with authority guided the way into motherhood; and 3) The home, a safe and secure space for new mothers. Mothers valued the well-structured home-based postnatal midwifery care. Important for mothers was to receive health checks, adequate information, and that midwives have a kind and individual approach to the families. Midwives play an important role for mothers in the early days after the birth of their baby.

“But at home, with the midwife, you are a person”: experiences and impact of a new early postpartum home-based midwifery care model in the view of women in vulnerable family situations

BackgroundPostpartum home-based midwifery care is covered by basic health insurance in Switzerland for all families with newborns but must be self-organized. To ensure access for all, Familystart, a network of self-employed midwives, launched a new care model in 2012 by ensuring the transition from hospital to home through cooperation with maternity hospitals in the Basel area. It has particularly improved the access to follow-up care for families in vulnerable situations needing support beyond basic services. In 2018, the SORGSAM (Support at the Start of Life) project was initiated by Familystart to enhance parental resources for better postpartum health outcomes for mothers and children through offering improved assistance to psychosocially and economically disadvantaged families. First, midwives have access to first-line telephone support to discuss challenging situations and required actions. Second, the SORGSAM hardship fund provides financial compensation to midwives for services not covered by basic health insurance. Third, women receive financial emergency support from the hardship fund.AimThe aim was to explore how women living in vulnerable family situations experienced the new early postpartum home-based midwifery care model provided in the context of the SORGSAM project, and how they experienced its impact.MethodsFindings are reported from the qualitative part of the mixed-methods evaluation of the SORGSAM project. They are based on the results of seven semi-structured interviews with women who, due to a vulnerable family postpartum situation at home, received the SORGSAM support. Data were analyzed following thematic analysis.ResultsInterviewed women experienced the early postpartum care at home, as “relieving and strengthening” in that midwives coordinated patient care that opened up access to appropriate community-based support services. The mothers expressed that they felt a reduction in stress, an increase in resilience, enhanced mothering skills, and greater parental resources. These were attributed to familiar and trusting relationships with their midwives where participants acknowledged deep gratitude.ConclusionThe findings show the high acceptance of the new early postpartum midwifery care model. These indicate how such a care model can improve the well-being of women in vulnerable family situations and may prevent early chronic stress in children.

The commitment to a midwifery centre care model in Bangladesh: An interview study with midwives, educators and students.

Midwifery-led care is a key factor in reducing maternal and new-born mortality globally. In Bangladesh, only a third of births are attended by professionals and almost 70% of births occur outside healthcare facilities. Midwifery is a relatively new profession in Bangladesh and a midwifery centre care model has only recently been introduced. This study aims to explore the willingness within the healthcare system to support a greater role for midwifery centres in maternity services. Data were collected through individual semi-structured interviews with 55 midwives, midwifery educators and final year midwifery students. Two of the midwifery educators were principals of nursing institutes involved in the government's midwifery leadership and considered as experts in the midwifery care system. The data was analysed using qualitative content analysis. The transcribed interviews comprised 150 pages. The study received ethical approval from the Directorate General of Nursing and Midwifery in Bangladesh. One main category emerged from the study: "The foundations of a midwifery centre care model need to be strengthened for the sustainable implementation of midwifery centres in Bangladesh to continue". Five additional categories were identified: 1) The midwifery centre care model is inaccessible for communities, 2) Striving for acceptable standards of care within a midwifery centre care model is not a priority 3) Respectful, woman-centred care is weak, 4) Community engagement with the midwifery centre care model is insufficient, and 5) The midwifery centre care model is not integrated into the healthcare system. These categories were supported by the identification of 11 sub-categories. The willingness to commit to a midwifery centre care model is not yet in place in Bangladesh. Advocacy, information, and education about the benefits of normal birth assisted by professional midwives is needed at all levels of Bangladeshi society.

A mixed-method study exploring barriers and facilitators to midwives’ mental health in Ontario

BackgroundThere is a paucity of information regarding the mental health of midwives working in Ontario, Canada. Many studies have investigated midwives’ mental health around the world, but little is known about how the model of midwifery care in Ontario contributes to or negatively impacts midwives’ mental health. The aim of the study was to gain a deeper understanding of factors that contribute to and negatively impact Ontario midwives’ mental health.MethodsWe employed a mixed-methods, sequential, exploratory design, which utilized focus groups and individual interviews, followed by an online survey. All midwives in Ontario who had actively practiced within the previous 15 months were eligible to participate.FindingsWe conducted 6 focus groups and 3 individual interviews, with 24 midwives, and 275 midwives subsequently completed the online survey. We identified four broad factors that impacted midwives’ mental health: (1) the nature of midwifery work, (2) the remuneration model, (3) the culture of the profession, and (4) external factors.DiscussionBased on our findings and the existing literature, we have five broad recommendations for improving Ontario midwives’ mental health: (1) provide a variety of work options for midwives; (2) address the impacts of trauma on midwives; (3) make mental health services tailored for midwives accessible; (4) support healthy midwife-to-midwife relationships; and (5) support improved respect and understanding of midwifery.ConclusionAs one of the first comprehensive investigations into midwives’ mental health in Ontario, this study highlights factors that contribute negatively to midwives’ mental health and offers recommendations for how midwives’ mental health can be improved systemically.

Communication technology practices used by midwives with pregnant women/people in Aotearoa New Zealand to ensure quality maternal and newborn care

IntroductionCommunication technology such as texting is commonly used for sending appointment reminders and reinforcing health messages. Midwives have identified concerns with privacy of information or information taken out of context within an online format. How this technology is used to ensure quality maternal care within a continuity model of midwifery care is unknown. AimTo describe midwives’ experiences of using communication technology with pregnant women/people in Aotearoa New Zealand. MethodsA mixed methods design was used to collect online survey data from Lead Maternity Carer midwives. Recruitment was through closed midwifery Facebook groups in Aotearoa New Zealand. Survey questions were informed by the Quality Maternal & Newborn Care framework & findings and an integrative literature review. Quantitative data was analysed using descriptive statistics, and qualitative comments analysed using thematic analysis. Findings104 midwives responded to the online survey. Phone calls, texting and emails were commonly used by midwives to reinforce health messages and decision making. Communication technology supported, and enhanced relationships midwives develop with their pregnant clients. Texting enhanced documentation of care and enabled midwives to work efficiently. Midwives, however identified concerns when managing expectations around urgent and non-urgent communication. DiscussionMidwives are bound by regulations to ensure they provide safe care to pregnant women/people. Negotiating and understanding expectations around use of communication technology is vitally important to ensure that communications and connections are undertaken in a safe manner.

Concepts of Midwifery Nurse's Quality care of Practice in Normal Delivery at Rajshahi Medical College Hospital

Background: The study aimed to identify and explain the variety of ways midwives managed normal labour and to see if it was possible to identify midwife concepts associated with different stage management practices. At first, the focus was on labor-specific types of midwifery care. The mechanism by which midwives develop expertise in all stage management. Materials and Methods: A qualitative approach was a comparative method utilized to collect and analyze Study was performed. Fifty (N=50) Midwives in Rajshahi Medical College Hospital, Rajshahi, Bangladesh, were interviewed from December 2020 to June 2021. with the practice midwives observed. Results: In this Study, normal labour management is needed together with an evaluation of the role of practice guidelines that attempt to standardize practice. Amount of time midwifery nurses spent with 80% yes and 20% no. they always being a midwifery nurse around if you needed one,80% yes and 20% no. Midwives' conduct delivered 88% yes and 12% no; how nurses listened to your worries and Concerns, 88% yes and 12%no. The midwives told the mother about immunization, 84% yes and 16% no. The number of information midwifery nurses gave to you About your condition and treatment,80% yes and 20% no. Midwifery Nurses' manner will deliver 92% yes, and 8% no. The way midwives explained to you about bear-down effort during the 2nd stage, 88% yes and 12% no. After delivery, the midwives give you uterine massage, 86% yes and 14% no. Decision-making in labor is a complicated process that is influenced by the learning opportunities available to midwives. Conclusion: In this Study, practice variation in all three-stage care was a reflection of the individuality of midwives and the way midwives chose to individualize the care of women. Priority was given to models of midwifery care during childbirth at the outset of this research; in normal labour management is needed, and an evaluation of the role of practice guidelines that attempt to standardize practice.

Contemporary Nurse-Midwifery Care in Colorado: A Survey of Certified Nurse-Midwife Practices in Hospital and Community Settings.

Lack of access to birth facilities and maternity care providers has contributed to rising US maternal mortality and morbidity rates, especially among women in rural areas. Evidence supports the increased use of midwives as a potential solution for access-to-care issues. This observational survey was conducted to identify the practice environment for Certified Nurse-Midwives® in Colorado for the purpose of informing future workforce expansion. Study results indicate that midwives provide services aligned with the midwifery model of care and have mostly autonomous practice in hospitals where midwifery practices are already established. However, there is limited use of midwives, as fewer than half of Colorado's 69 birthing hospitals have midwifery practices, and financial constraint created by low Medicaid reimbursement could be a limiting factor in establishing new midwifery practices. Policy recommendations based on survey results include (a) support for midwifery education and workforce development, (b) removal of hospital-level restrictions for privileges of midwives, and (c) consideration for public payment models that promote expansion of midwifery practices.

Woman-centred ethics: A feminist participatory action research

IntroductionContemporary ethical issues in the maternity system are nuanced, complex and layered. Medicalisation and the reported rise in incidence of mistreatment and birth trauma, has been described as unethical. Some authors suggest bioethical principles are limited in terms of guiding everyday care of pregnancy and birth. There is currently no known published research which explores what birthing people say is ethical. AimsThis study sought to explore women's experience of maternity care from an ethical perspective. MethodA Feminist Participatory Action Research (FPAR) was conducted over three years, in two phases. A Community Action Research Group (CARG) was formed of nine participants, and data were captured from five focus groups. A further ten participants were recruited for individual in-depth interviews, the data corpus was combined, and thematic analysis was applied. All 19 participants had experienced a midwifery model of care in Western Australia. ResultsA unique ethical perspective was described by the participants. The central theme: ‘Radical desires: Individuals values and context’ placed the woman at the centre of the care, in determining what is ethical. Two categories captured the care experienced: Woman-centred ethics or Authoritarian ethics. A conceptual model Woman-centred ethics is offered to enhance everyday ethical midwifery care. DiscussionThe participants in this study perceived care as either ethical or unethical based on the quality of the relationship, the knowledge that was shared and the manner of the care given. The Woman-centred ethics model may be a starting point for moving the field forward in ethical discussion.

Midwifery centers as enabled environments for midwifery: A quasi experimental design assessing women's birth experiences in three models of care in Bangladesh, before and during covid.

The midwifery model of care is a human rights-based approach (HRBA) that is unique and appropriate for the majority of healthy pregnant women, yet full expression may be limited within the medical model. Midwifery centers are facilities designed specifically to enable the practice of midwifery. In high resource countries, they have been shown to be cost effective, evidence-based, avoid over medicalization, and provide safe, efficient and satisfying care. A quasi-experimental design was used to assess the impact of three models of care on women's experiences of respect, and trust in maternity care provision, both before and during the pandemic in Bangladesh, as well as their fear and knowledge around COVID-19, during the pandemic. The models were: "fully enabled midwifery" ("FEM") in freestanding midwifery centers; "midwifery and medicine" ("MAM") in medical facilities with midwives working alongside nurses and doctors; and "no midwifery" ("NoM") in medical facilities without midwives. Phone survey data were collected and analyzed from all women (n = 1,191) who delivered from Jan 2020-June 2020 at seven health care facilities in Bangladesh. Comparison of means, ANOVA, post hoc Tukey, and effect size were used to explore the differences in outcomes across time periods. Pre-pandemic, women served by the FEM model reported significantly higher rates of trust and respect (p<0·001) compared to the NoM model, and significantly higher rates of trust (p<0·001) compared to MAM. During the pandemic, in the FEM model, the experiences of respect and trust did not change significantly from the pre-pandemic rates, and were significantly higher than both the MAM and NoM models (p < 0·001). Additionally, during the pandemic, women served by the FEM model had the lowest experience of COVID fear (p<0·001). Fully enabled midwifery in midwifery centers had a significantly positive effect on woman's experience of respect and trust in care compared to the other models, even in the context of a pandemic.

Hôpital Montfort's Postnatal Care-at-Home Program: An Innovative Model for Early Postnatal Care.

The Montfort Postnatal Care-at-Home (MPCH) Program is an innovative, integrated physician, nurse and midwifery model of care that offers an early hospital discharge option to families. The MPCH Program provides care and support to families throughout their transition from hospital to home. The program has the potential to improve families' experiences and maternal-newborn health outcomes, and provides a safety net to families 24/7 during the first seven days postpartum at home. This model transforms how postnatal care is delivered, and has the potential to improve the flow of the birthing unit and the unit capacity and reduce acute care hospital costs.