Care For Women Research Articles

Implementation of a midwifery model of woman-centered care in practice: Impact on oxytocin use and childbirth experiences.

INTRODUCTIONTheoretical models for midwifery have been developed in different countries, but few have been evaluated. This study evaluated the implementation of a midwifery model of woman-centered care (MiMo) in practice.METHODSA mixed method study based on an implementation of MiMo was carried out in a labor ward at a university hospital in Sweden, with another labor ward as a reference. The qualitative core component was a secondary analysis of focus groups with midwives after the implementation. The supplemental quantitative components were oxytocin use for augmentation of labor and women’s childbirth experiences before and after the implementation.RESULTSThe midwives viewed MiMo as a useful tool for comprehending the birthing woman holistically, and for identifying what might disturb the birth process. Hindering factors were a lack of organizational stability and time, and midwives’ unwillingness to understand the model. Oxytocin use decreased significantly only in the implementation ward (p=0.002) and a significant difference was found between wards in the post-implementation period (p=0.004). However, logistic regression analyses showed that the interaction between ward and time period, controlling for age, epidural use, and birth outcome, was not significant (p=0.304), indicating that the decrease was not significantly related to the implementation. Childbirth experience did not differ before and after the implementation.CONCLUSIONSBy using MiMo in practice, midwives have a tool for comprehending the woman holistically and identifying disturbing factors during the birth. However, more research is needed for further implementation that should focus on the potential as well as hindering factors.

Maternal mortality and the lack of women-centered care in Brazil during COVID-19: Preliminary findings of a qualitative study

Maternal mortality and the lack of women-centered care in Brazil during COVID-19: Preliminary findings of a qualitative study

Why are women considering ovarian tissue cryopreservation to preserve reproductive and hormonal ovarian function? A qualitative study protocol

IntroductionCurrent fertility preservation options available to women are oocyte cryopreservation (egg freezing) or embryo cryopreservation. A newer procedure, ovarian tissue cryopreservation (OTC), has become available in some centres, which offers...

Supporting women's reproductive capabilities in the context of childbirth: Empirical validation of a midwifery theory synthesis

ObjectiveTo conduct an empirical validation of the theoretical model of midwifery care suggested by Peters et al. (2020). DesignA qualitative deductive methodology was used to validate the theoretical model of aims and objectives of midwifery care. The existing model was validated for midwifery care before, during and after childbirth by interviewing women who had reported high satisfaction with childbirth and low fear of childbirth postpartum. SettingData were collected via interviews with women who had given birth from January to March 2018 at a middle-sized hospital in south-east Sweden. ParticipantsSwedish-speaking women aged ≥ 18 years, were invited by midwives to participate at a postpartum maternal healthcare ward, and they received oral and written information. They filled in a demographic questionnaire, a grading of their birth experience on a 0–10 numeric rating scale (NRS) and the Wijma Delivery Experience Questionnaire Version B (W-DEQ B). We used ≥7 as the cut-off for high satisfaction with childbirth (NRS), and a sum score ≤60 for low fear of childbirth (W-DEQ B). Of 172 women, 28 were eligible, of whom 20 were interviewed 8–13 months postpartum. The interviews were analysed using qualitative content analysis with a directed approach. FindingsAll of the model's levels and their aspects were found in the interviews. All women had experienced a trusting relationship, including individual and woman-centred care, communication, choice and continuity, prompt attention and an empathic attitude. A majority described midwifery in terms of promoting security, and almost all had experienced aspects of personal control. The objective of midwifery care, described as the facilitation of women's reproductive capabilities, was described as being met by half of the women. The importance of pep talks and coaching was emphasized, and partner support could be added to the model. Key conclusions and implications for practiceOur findings indicate that the theoretical model proposed by Peters et al. (2020) is mainly applicable to midwifery care of women reporting high satisfaction with their birth experience and low postpartum fear of childbirth. Our findings suggest that this model may serve as a clarification of the unique objective of midwifery care, and could be used by midwives in daily clinical work and in midwifery education programs.

Discontinuity of Women Veterans' Care in Patient-Centered Medical Homes: Does Workforce Gender Sensitivity Matter?

Prior research has found that 25% of women veterans who are new to the Department of Veterans Affairs (VA) health care system discontinue services within 3years of initial use. Although it has been suggested that providing more gender-sensitive care might improve women veterans' health care experiences, no study has yet documented an empirical relationship between clinic and provider factors associated with the provision of gender-sensitive care and women veterans' care discontinuity. Surveys of primary care providers (n=82) and staff members (n=108) from 12 VA medical centers were linked to administrative data for women veteran patients with at least one primary care visit in 2014 and 2015 (n=9,958). Patient care discontinuity was operationalized as having no additional primary care visit within 3years after the patient's baseline visit. Key indicators of gender-sensitive comprehensive primary care included type of medical home (women's health-focused vs. general primary care), workforce gender sensitivity, team functioning, perceived quality of provider/staff communication, leadership support for medical home implementation, and other structural components of care delivery (e.g., chaperone availability). We used logistic regression to assess the association between these indicators and women's care discontinuity, measuring discontinuity for both new and continuing VA users and controlling for patient characteristics. Eleven percent of women patients discontinued primary care within 3years. Poor workforce gender sensitivity (lowest quartile vs. top three quartiles) was significantly associated with higher odds of discontinuity (odds ratio, 1.26; 95% confidence interval, 1.01-1.57); other indicators were not associated with discontinuity. This study is the first to document a relationship between workforce gender sensitivity and women veterans' care continuity. This finding underscores the need for additional attention to enhancing workforce gender sensitivity in VA.

Heutagogy: A self-determined learning approach for Midwifery Continuity of Care experiences

AimThe aim of this discussion paper is to discuss learning theories in midwifery education, as related to the Midwifery Continuity of Care Experience and to propose an original conceptual framework based on Heutagogy. BackgroundMidwifery education curricula include a number of midwifery practice experiences. One of the requirements is for students to provide Midwifery Continuity of Care. To achieve these experiences, students in Australia are required to provide care to at least ten (10) women through pregnancy, be on call for the woman’s birth and provide at least two visits post-birth. Continuity of care experiences appear to have been incorporated without sufficient consideration of the educational purpose of the experience, or how the experiences contribute to the development of the profession. Although we do know midwifery practice embraces woman-centred care as its philosophical underpinning, a learning approach that is congruent with this philosophy needs to be clearly articulated. DesignA discussion paper that compared and contrasted learning theories to align with Midwifery Continuity of Care experiences. MethodsA review of the literature on learning theories was conducted before comparing and contrasting the theories to arrive at a conceptual framework focused on learning theory and its application to the Midwifery Continuity of Care Experience. ResultsHeutagogy provides a potentially congruent educational learning approach to underpin the continuity of care experiences, in comparison to traditional learning theories of pedagogy and andragogy. With a paucity of research in the application of heutagogy to midwifery education, it’s conceptual underpinnings and the possible application to the Continuity of Care Experience, this paper explores the possible theoretical applications of heutagogy to midwifery education. ConclusionAs a learning theory, heutagogy is well - aligned with woman-centred care. Heutagogy provides a theoretical framework suitable to underpin strategies, including the conceptual framework proposed, that may assist in empowering students to participate in their own education by giving them the ability to be self-determined in both their approach to learning and to evaluate their own learning needs.

Understanding the opinion of doctors on obstetric violence in Brazil to improve women's care

Background: Disrespect and mistreatment in childbirth are human rights violations and must be understood by everyone. However, there are many controversies in the use of the term 'obstetric violence' in Brazil. Objectives: To understand the opinion of residents and specialist doctors about obstetric violence and get a balanced view to improve women's care. Setting: Public university hospital in São Paulo, Brazil. Participants: Residents in training and specialist doctors in obstetrics and gynecology. Measurements: Participants answered an electronic form on obstetric violence opinions. Findings: Of the 60 participants, 33(45%) were specialist doctors and 27(55%) were medical residents in training. Most interviewees (60%) do not agree with the use of the term “obstetric violence” to define mistreatment and disrespectful treatment of women. Regarding situations that characterize obstetric violence, the percentage of residents who agree with the following statements as forms of obstetric violence was significantly (p<0.05) higher than the specialists in the following aspects: episiotomy without consent (78% vs. 15%), episiotomy without indication (100% vs. 64%), episiotomy without anesthesia (96% vs. 76%), not allowing a companion during childbirth (89% vs. 64%), requiring silence from the birthing woman (100% vs. 73%), undergoing vaginal examinations without consent (85% vs. 58%), not allowing the woman to choose childbirth position (82% vs. 58%) and not allowing breastfeeding in the first hour (82% vs. 58%). Conclusions and implications: The resident doctors in training are aware that the Obstetric Violence typifies the mistreatment and abuse of women during childbirth and the same is not true for specialists. Specialist doctors who completed their training longer ago should undergo training programs for a better understanding of Obstetric Violence.

Women's experiences and perceptions of women‐centered care and respectful care during facility‐based childbirth: A meta‐synthesis

The World Health Organization has recommended intrapartum care for a positive childbirth experience through respectful care based on women-centered care. This study aimed to explore women's experiences of facility-based childbirth to gain insights into their perceptions of women-centered care, including humanized childbirth and respectful maternity care during intrapartum care. Used the Joanna Briggs Institute method as the framework for this meta-synthesis, we searched the PubMed, EMBASE, CINAHL, PsycINFO, and LILCAS databases, and included qualitative studies and interviews of women's experiences and perceptions of women-centered care during facility-based childbirth published from 1990 to 2020 in English. Study quality was assessed using the Critical Appraisal Skills Programme checklist. NVivo software was used for data extraction and synthesis. There were 22 studies from 19 countries that met the established inclusion criteria. Five categories of experiences of facility-based childbirth and perceptions of women-centered care from the synthesized voices of women were generated: (i) value of women through childbirth; (ii) overwhelmed by unpleasant childbearing experiences; (iii) a sense of being respected and valued; (iv) a sense of being disrespected and abused; and (v) inadequate systems and resources. Our meta-synthesis indicated that respectful and helpful interaction between women and healthcare providers produced positive perceptions among women. This study emphasizes the importance of respectful interactions and intrapersonal experiences. Strong systems and positive environments lead to positive interactions between women and healthcare providers. Future studies need to consider cultural and economic differences in women-centered care and respectful care for childbirth in different contexts.

Exploring trust in (bio)medical and experiential knowledge of birth: The perspectives of pregnant women, new mothers and maternity care providers

ObjectiveTo explore women's and maternity care providers’ experiences of birth, and the roles of (bio)medical and experiential knowledge therein. Research design/settingIn-depth qualitative interviews were undertaken with pregnant women and new mothers (n = 14) as well as with a range of maternity care providers working for the National Health Service (n = 6) and privately (n = 7). FindingsTrust emerged as a key concept in women's and maternity care providers' narratives. It was found that women and maternity care providers placed trust in two key areas: trust in past experiences and trust in women's innate abilities and embodied knowledge of birth. Key conclusionsWomen and maternity care providers trust and utilise both (bio)medical and experiential forms of knowledge of birth in complex ways and the value an individual ascribes to (bio)medical and/or experiential knowledge is highly subjective, and not necessarily mutually exclusive. This destabilises the notion that (bio)medical knowledge is associated with experts and experiential knowledge is associated with ‘lay’ people, and that these two bodies of knowledge are distinct. Implications for practiceTrust is a key concept in maternity care. The predominance of biomedical models of birth risk reducing trust in the value of experiential based birth knowledges – both embodied and empathetic. Trust in experiential knowledge could help to facilitate woman-centred care by recognising women as valuable ‘knowers’ with unique insight to contribute, and not just receivers of medical knowledge. It may also help providers ‘tune-in’ with the women in their care if they allow their experiential knowledge to complement their (bio)medical knowledge.

Sexual violence in adult women and adolescents.

Sexual violence is a widespread phenomenon, as it has been estimated that about 35.6% of women have experienced some forms of sexual abuse, with variable prevalence estimates worldwide. Sexual violence has remarkable negative consequences on women's health and quality of life, with a specific harmful impact on women's psychological well-being and sexuality. In this narrative review, we provide an overview on the phenomenon of sexual violence against adult women and adolescents, discussing its associated multiple negative consequences with a specific focus on clinical and sexological aspects. "Women-centered care" and a multidisciplinary approach appear of pivotal importance when working with sexual violence survivors. Woman should be engaged in all the clinical activities as equal partners in the decision-making process, and should be supported by multiple and different professional figures (i.e. gynecologists, psychologists, sexologists, forensic medical doctors, lawyers) working within the framework of a cooperative integrated model.

Effect of Urogenital Infection Educational Program on Women Knowledge and Practices

Background:Urogenital infection is generally regarded as a silent epidemic. It is one of the major public health problems among women that causes a considerable proportion of gynecological morbidity and maternal mortality in developing countries.Aim:The aim of this study is to evaluate the effect of an educational program on women’s knowledge and practices about urogenital infection.Methods:A quasi-experimental research design was utilized in this study and was implemented at El Hadaka Maternity and Children’s Hospital (MCH) in Fayoum, Egypt. A purposive sample consisting of 50 women with ages ranging from 30 to 45 years old was considered for this study.Two tools were used to conduct this study: a structured interview questionnaire consisting of the respondents’ demographic characteristics, knowledge, and practices regarding urogenital infection and a scale that aimed to assess their lifestyle.Results:The results revealed that 96% of the women have unsatisfactory knowledge about urogenital infection during the pre-intervention stage, 94% of them have satisfactory knowledge post-intervention, and 90% of them have satisfactory knowledge at follow-up, with a highly statistically significant difference at p-value &lt; 0.01. The results also showed that 82% of the respondents have unsatisfactory practices at pre-intervention, 96% have satisfactory practices at post-intervention, and 98% of them have satisfactory practices at follow-up, with a highly statistically significant difference at p-value &lt; 0.01.Conclusion:There was a significant improvement in women's knowledge and practices related to urogenital infection post-intervention and at follow-up with a p-value &lt; 0.01. Likewise, a high positive correlation between total lifestyle, level of knowledge, and practices was noted during the pretest with a p-value &lt; 0.01.There is a need to provide different educational programs regarding knowledge and self-care practices for women with urogenital infection in different women's care settings.

Effect of Urogenital Infection Educational Program on Women Knowledge and Practices

Background: Urogenital infection is generally regarded as a silent epidemic. It is one of the major public health problems among women that causes a considerable proportion of gynecological morbidity and maternal mortality in developing countries. Aim: The aim of this study is to evaluate the effect of an educational program on women’s knowledge and practices about urogenital infection. Methods: A quasi-experimental research design was utilized in this study and was implemented at El Hadaka Maternity and Children’s Hospital (MCH) in Fayoum, Egypt. A purposive sample consisting of 50 women with ages ranging from 30 to 45 years old was considered for this study. Two tools were used to conduct this study: a structured interview questionnaire consisting of the respondents’ demographic characteristics, knowledge, and practices regarding urogenital infection and a scale that aimed to assess their lifestyle. Results: The results revealed that 96% of the women have unsatisfactory knowledge about urogenital infection during the pre-intervention stage, 94% of them have satisfactory knowledge post-intervention, and 90% of them have satisfactory knowledge at follow-up, with a highly statistically significant difference at p-value &lt; 0.01. The results also showed that 82% of the respondents have unsatisfactory practices at pre-intervention, 96% have satisfactory practices at post-intervention, and 98% of them have satisfactory practices at follow-up, with a highly statistically significant difference at p-value &lt; 0.01. Conclusion: There was a significant improvement in women's knowledge and practices related to urogenital infection post-intervention and at follow-up with a p-value &lt; 0.01. Likewise, a high positive correlation between total lifestyle, level of knowledge, and practices was noted during the pretest with a p-value &lt; 0.01. There is a need to provide different educational programs regarding knowledge and self-care practices for women with urogenital infection in different women's care settings.

Outcome Measure Epidemiological of Female Inmates in West Amazon, Brazil

Introduction: the prison system in the Brazilian state of Acre, located in the Western region of the Amazon, is a branch of the criminal justice system that has been suffering from issues such as overcrowding and growth in internal organized crime. The prevalence of these matters directly affects the resocialization of prisoners and inhibits the successful re-engineering of their social values and beliefs. Objective: to analyze the epidemiological profile of jailed women in the State of Acre, Brazil. Methods: in a cross-sectional descriptive study, 129 participants were recruited from female penitentiaries in the state of Acre. Conducted between August and December of 2017, data was collected through a validated questionnaire, divided into modules, using both open and closed-ended items. Results: we found that most women who participated in the study were single (n = 86, 66.7%), had brown skin (n = 93, 72.1%), had children (n=102, 79.1%), resided in the state of Acre (n=117, 90.5%). The mean age of the sample was 27.69 years. Among those participants who reported having partners (n = 40, 31%), we found that half had partners who were also incarcerated (n = 20, 50%). The study results also indicate that drug trafficking (n = 86, 66.7%) was the major cause for female incarceration, followed by homicide crime (n = 16, 12.4%). Over half of the participants were in prison for the first time (n = 75, 58.1%), with a high recidivism rate observed in the total sample (n = 54, 41.9%). A majority of the participants (n = 97, 75.2%) kept in touch with members of their families and a smaller portion (n = 15, 11.6%) received conjugal visits. With regard to social activities, slightly more than half (n = 75, 58.1%) worked and the majority (n = 114, 88.4%) did not study while jailed. Conclusion: the difficulties associated with accessing inmate data and the lack of peer-reviewed studies on inmate health in Brazil suggests that the public policies recommended by the PNSSP and the National Policy for Comprehensive Health Care for Women should be reevaluated.

Large gaps in the quality of healthcare experienced by Swedish mothers during the COVID-19 pandemic: A cross-sectional study based on WHO standards

Background and ProblemExisting healthcare systems have been put under immense pressure during the COVID-19 pandemic. Disruptions in essential maternal and newborn services have come from even high-income countries within the World Health Organization (WHO) European Region. AimTo describe the quality of care during pregnancy and childbirth, as reported by the women themselves, during the COVID-19 pandemic in Sweden, using the WHO ‘Standards for improving quality of maternal and newborn care in health facilities’. MethodsUsing an anonymous, online questionnaire, women ≥18 years were invited to participate if they had given birth in Sweden from March 1, 2020 to June 30, 2021. The quality of maternal and newborn care was measured using 40 questions across four domains: provision of care, experience of care, availability of human/physical resources, and organisational changes due to COVID-19. FindingsOf the 5003 women included, n = 4528 experienced labour. Of these, 46.7% perceived a poorer quality of maternal and newborn care due to the COVID-19. Fundal pressure was applied in 22.2% of instrumental vaginal births, 36.8% received inadequate breastfeeding support and 6.9% reported some form of abuse. Findings were worse in women undergoing prelabour Caesarean section (CS) (n = 475). Multivariate analysis showed significant associations of the quality of maternal and newborn care to year of birth (P < 0.001), parity (P < 0.001), no pharmacological pain relief (P < 0.001), prelabour CS (P < 0.001), emergency CS (P < 0.001) and overall satisfaction (P < 0.001). ConclusionConsiderable gaps over many key quality measures and deviations from women-centred care were noted. Findings were worse in women with prelabour CS. Actions to promote high-quality, evidence-based and respectful care during childbirth for all mothers are urgently needed.

Everyday racism and the denial of migrant African women’s good caring in aged care work

AbstractThere is, in the global north, a “care crisis,” a shortfall in the capacity to provide care for an aging population. Migrant care workers have been positioned as a solution to this crisis, but this positioning sits in tension with research highlighting the widespread racism that questions or denies the skills and commitment of migrant care workers. This study draws on the experiences of 30 migrant African women working in the Australian aged care sector to interrogate the implications of this tension. The authors describe how everyday racism perpetrated by clients and colleagues denied the possibility that migrant African women carers were able or welcome to undertake “good caring.” Applying Tronto's conceptualization of caring as relational, the authors argue that everyday racism symbolically denies African migrant women's participation in key phases of the caring process: “caring about,” “caregiving,” and “care‐receiving.” Everyday racism thus rejects migrant African women's care work at the individual level and reinforces care as a set of practices and dispositions that are unavailable to them.

How clinicians can support women in making decisions about psychopharmacological treatments in pregnancy

How clinicians can support women in making decisions about psychopharmacological treatments in pregnancy

Special Considerations in the Care of Women With Advanced Heart Failure

Special Considerations in the Care of Women With Advanced Heart Failure

HIV counselling and testing experiences of expectant mothers in the prevention of vertical transmission programme: implications for policy and service delivery.

Objectives:This study explored the HIV counselling and testing (HCT) experiences of women who were diagnosed positive in the current pregnancy in a district hospital within the Sekondi-Takoradi Metropolis in Ghana following the implementation of the ‘opt out’ testing policy.Methods:Adopting a qualitative explorative descriptive design, 12 mothers were sampled purposively and in-depth interviews were conducted. Thematic analysis using Colaizzi’s approach was applied to unearth the experiences of the participants.Results:Three key themes emerged: The Pre-test Counselling Experience; The Test; and After Talk: Post-test Counselling. Provider-initiated testing was offered to all the participants at antenatal booking. Most counsellors were silent about the ‘opt-out’ option of testing while pretest counselling focused on preventing vertical transmission and not on the health of the woman. Attitudes towards pretest counselling was mainly indifference or anxiety which affected the women’s initial acceptance of a positive result. All the women took a confirmatory test after the initial positive results which aided them in accepting their diagnosis. Of the women who tested, all received post-test counselling that focused on enrolling on antiretroviral therapy (ART).Conclusion:Attitudes towards pretest counselling impacts the mothers’ reaction to a positive test result. HIV counselling that does not solicit voluntary testing may be effective in increasing testing but may affect uptake of treatment. It is recommended that midwives providing HCT be trained periodically to enhance service delivery while focus on women-centred care and improving women’s agency in the prevention of vertical transmission services should be the paramount.

Health and State Making: The Expansion of State Health Services During the War of Resistance Against Japan (1937–1945)

Wars frequently instigate the expansion of health services, a key component of state building. China first witnessed rapid growth in military and civilian health services during the War of Resistance against Japan (1937–1945). This essay explores two factors that enabled this development: low-paid medical work of women and an influx of charitable donations from overseas. It centers gender and women's care work in its analysis and argues that attention to the interpersonal and affective facets of state making shows that atypical state agents can emerge as formidable state-builders in an extraordinary time. As with other facets of the Communist state, health administration owed much to Nationalist-era growth and innovation.

TERRITÓRIOS, SABERES E PESQUISA: A INTERCONEXÃO COMUNIDADE-UNIVERSIDADE POR MEIO DA CURRICULARIZAÇÃO DA EXTENSÃO

This article presents the actions developed in the context of extension involving women in a situation of socioeconomic vulnerability assisted at the Reference Center for Women's Care (CRAM) of the José Alexandre Zachia neighborhood in the city of Passo Fundo-RS. The actions stem from the activities of two extension projects linked to the chemistry courses at the University of X, as well as from the process of curricularization of extension and research. Thus, the actions involved the academics, professors and extension students and women assisted in CRAM. The actions allowed for some reflections about the role of educational institutions as promoters of citizenship and human rights, in the specific case of contributing to the guarantee and advances related to the confrontation of female social vulnerability, which involves providing alternatives that include training and professionalization. The actions at CRAM involved the production of soap and handmade candles using "frying oil", through a dialogical process of interaction between the subjects, (re)signifying the knowledge.