National Maternity Services Research Articles

Finding the positive in loss: stillbirth and its potential for parental empowerment

Abstract This paper reports on PhD research that investigated parental experience of stillbirth. Drawing on in-depth interviews with 10 couples and 12 mothers, it argues that while the experience of stillbirth is, to some extent, a stigmatising one – parents recount feeling like failures and report social difficulties after the loss (Murphy, 2009) – there are positives that may be taken from the experience. These, however, are more likely to emerge in the medium and longer term. Far from being ‘passive victims of prejudice’ (Shih, 2004), some parents may be empowered to take action to improve local and, in some cases, national maternity services, as well as raising people's awareness of stillbirth and breaking the silence that surrounds it.

Addressing the workplace needs of Western Australian midwives: a Delphi study

To determine the workplace needs of Western Australian midwives working in public metropolitan secondary hospitals. Using a three-round Delphi approach, Round 1 incorporated focus groups and a questionnaire. Fifteen focus groups were conducted with midwives also having the option of contributing through an open-ended questionnaire. During Round 2, 38 items reflecting seven themes were prioritised with a final ranking performed in Round 3. In total, 114 midwives participated in Round 1, 72 in Round 2 and 89 in Round 3. During Round 1, workplace needs identified as being met included: working across all areas of midwifery; ability to work in areas of interest; opportunity to work with low to moderate risk women; supportive colleagues; accessible parking; hospital close to home and friendly work atmosphere. Round 2 items revealed the five top unmet needs as: adequate midwifery staff coverage; access to maintained equipment; competitive pay scales; patient safety issues and opportunities to implement midwifery models. The top ranked needs from Round 3 included: recognising the unpredictable nature of midwifery services; provision of competent medical coverage, and adequate midwifery staff coverage. Demand for maternity services is unpredictable; however, in order to maintain a sustainable maternity workforce, WA midwives' prioritised needs would suggest health management focus upon expanding the availability of midwifery models of care, fostering flexible working conditions and ensuring collaboration between maternity health professionals occurs within clinically safe staffing levels.

Birth Centres and the National Maternity Services Review: response to consumer demand or compromise?

To explore women’s views of birth plans, and experiences of their completion and use.A qualitative, descriptive study, using Internet-mediated research methods.The discussion boards of two well-known, UK-based, online parenting forums, where a series of questions relating to birth plans were posted.Members of the selected parenting forums who had written and used, or who had chosen not to write or use, a birth plan.Women responded with a range of views and experiences relating to the completion and use of birth plans. The benefits of birth plans were described in terms of communication with healthcare professionals, potentially enhancing awareness of available options, and maintaining a sense of control during labour and birth. However, many respondents believed the idea of ‘planning’ birth was problematic, and described a reluctance to write a formal plan. The support of healthcare professionals, particularly midwives, was considered essential to the success of both writing and using birth plans.Our findings show a continued debate among women on the benefits and challenges involved in writing and using birth plans, suggesting problems for a ‘one size fits all’ approach often seen in the use of birth plan templates. In the context of maternity policy supporting women’s choice and personalised care, and as a way of acknowledging perceived problems of ‘planning’ for birth, a flexible approach to birth plans is required, including the consideration of employing alternative nomenclature.Birth plans remain a point of contention in care contexts around the world. Midwives and other healthcare providers play a central role in supporting women to discuss available options, whether or not they decide to complete a formal birth plan.

Developing a Core Competency Model and Educational Framework for Primary Maternity Services: A national consensus approach

An appropriately educated and competent workforce is crucial to an effective health care system. The National Health Workforce Taskforce (now Health Workforce Australia) and the Maternity Services Inter-Jurisdictional Committee funded a project to develop Core Competencies and Educational Framework for Primary Maternity Services in Australia. These competencies recognise the interdisciplinary nature of maternity care in Australia where care is provided by general practitioners, obstetricians and midwives as well as other professionals. Key stakeholders from professional organisations and providers of services related to maternity care and consumers of services. A national consensus approach was undertaken using consultation processes with a Steering Committee, a wider Reference Group and public consultation. A national Core Competencies and Educational Framework for Primary Maternity Services in Australia was developed through an iterative process with a range of key stakeholders. There are a number of strategies that may assist in the integration of these into primary maternity service provider professional groups' education and practice. The Core Competencies and Educational Framework are based on an interprofessional approach to learning and primary maternity service practice. They have sought to value professional expertise and stimulate awareness and respect for the roles of all primary maternity service providers. The competencies and framework described in this paper are now a critical component of Australian maternity services as they are included in actions in the newly released National Maternity Services Plan and thus have relevance for all providers of Australian maternity services.

Birth centres and the national maternity services review: Response to consumer demand or compromise?

In February 2009 the Improving Maternity Services in Australia - The Report of the Maternity Services Review (MSR) was released and recommended improving women's access to and availability of birth centres. It was unclear if this was in response to an overwhelming request for birth centres in the submissions received by the commonwealth or a compromise for excluding homebirth from the maternity service reforms. The aim of this paper was to examine what was said in the submissions to the MSR about birth centres. Data for this study comprised 832 submissions to the MSR that are publicly available on the Commonwealth of Australia Department of Health and Ageing website. All 832 submissions were downloaded, and read for any mention of the words 'birth centre', 'birth center'. Content analysis was used to categorise and report the data. Of the 832 submissions to the MSR 197 (24%) mentioned birth centres while 470 (60%) of the submissions mentioned homebirth. Only 31 (4%) of the submissions to the Maternity Review mentioned birth centres without mentioning home birth also. Most of the submissions emphasised that 'everything should be on the menu' when it came to place of birth and care provider. Reasons for choosing a birth centre were identified as: 'the best compromise available, 'the right and natural way' and 'the birth centre as safe'. Women had certain requirements of a birth centre that included: 'continuity of carer', 'midwife led', 'a sanctum from medicalised care', 'resources to cope with demand', 'close to home', and 'flexible guidelines and admission criteria'. Women weighed up a series of requirements when deciding whether to give birth in a birth centre. The recommendation by the MSR to expand birth centres and ignore home birth is at odds with the strong view expressed that 'everything should be on the menu'. The requirements women described of birth centre care are also at odds with current trends. If there is to be an expansion of birth centres, service providers need to make sure that women's views are central to the design. Women will not cease having homebirths due to expanded birth centre options.

Profiling children’s health services in england

A unique exercise to develop a profile of children’s health services in England will be underway by the end of 2005. The first project of its kind in the world, the ‘National Child Health and Maternity Services Mapping’ will be an annual data collection exercise based on a survey of the commissioning and provision of children’s health services within primary care trusts (PCTs) and secondary care providers. The Department of Health and the Department for Education and Skills are undertaking the project as part of the implementation programme for the Children’s NSF and Every Child Matters, commonly referred to as Change for Children. A summary of the project is presented here and updates can be accessed at www.childhealthmapping.org.uk. There have been previous mapping exercises of this type in adult mental health and child and adolescent mental health but not within children’s health services. However, the web-based database developed over a number of years within mental health has been found to transfer well into the child health field. Thirty-four sites across England reflecting a broad range of geography and commissioning and provision arrangements for children are involved in a pilot exercise, providing data to update the database ready for roll out nationally in November 2005.

Strategic planning of obstetric services: the United Kingdom way.

From 1944 when the first British Report on a National Maternity Service was published until 1989 there have been seven publications on the Maternity Services. Against this background the Shearman Report is described in comparison with its British counterparts. There has however been much debate in the UK since 1989 with a redesign of the National Health Service. A sub committee of the House of Commons (Winterton) advocated major changes in maternity services and the Government responded with a detailed critique announcing the appointment of an Expert Maternity Group (Cumberlege) which has just published its recommendations for widespread consultation. The three Royal Colleges have published a joint report and in the next year Government policy will be published. Scotland however has developed an independent view and has progressed further an analysis and rational planning. The fate of the Shearman report will be awaited with interest.

A study of the BMA-TUC Joint Committee on Medical Questions, 1935-1939.

The BMA (British Medical Association)-TUC (Trades Union Congress) Joint Committee on Medical Questions, established in 1936, was an experiment in consensus. It was the first attempt to cross the barriers in medical politics. In the 1930s the strategy of 'administration rather than advocacy' prompted the co-operation of the TUC with the BMA on medical questions of mutual interest. The operation of the partnership is explored here in the formulation of a scheme for a national maternity service acceptable to both parties. However, the reality of co-operation at the level of specific proposals was an insistence by the BMA on its own point of view. The TUC had to decide whether a joint scheme was worth the price. Although a scheme was eventually produced, as an experiment in consensus the committee had failed. To some extent the war obscured this failure, but the consensus itself was wrecked by the intransigence of the BMA and the hostility of the Labour movement, which was angry at the extent of the concessions which the TUC had made for a national maternity scheme.

A National Maternity Service

A National Maternity Service

A National Maternity Service

A National Maternity Service

National Maternity Service

National Maternity Service

National Maternity Service

National Maternity Service

National Maternity Service

National Maternity Service

National Maternity Service

National Maternity Service

National Maternity Service

National Maternity Service

National Maternity Service

National Maternity Service

National Maternity Service

National Maternity Service

A National Maternity Service, by J. M. MUNRO KERR, M.D., Regius Professor of Midwifery, University of Glasgow

A National Maternity Service, by J. M. MUNRO KERR, M.D., Regius Professor of Midwifery, University of Glasgow

A National Maternity Service, by ETHEL CASSIE, M.D., D.P.H. (Edin.), Assistant Medical Officer of Health for Maternity and Child Welfare, Birmingham

A National Maternity Service, by ETHEL CASSIE, M.D., D.P.H. (Edin.), Assistant Medical Officer of Health for Maternity and Child Welfare, Birmingham