This study aimed to explore the existing knowledge about midwives’ views and experiences of providing care for women in the context of task shifting.
We conducted a qualitative systematic review ...using meta-ethnography to describe the views and experiences of midwives on providing care in the context of task shifting. Comparative textual analysis of published qualitative studies involved translation of first-order key concepts and meanings from included studies to generate second-and third-order concepts. A grid was made to identify core findings and compare them reciprocally.
Thirty-six qualitative studies met the inclusion criteria. The literature comprised of 32 first key concepts. Eight second-order constructs emerged, and three third-order interpretations were generated. The three overarching themes were: (1) midwives perceived themselves as providing culturally competent and high quality women-centered care; (2) they valued their profession but saw it as complex and challenging; (3) as health professionals, they reported a variety of organizational, cultural, and professional barriers to providing women-centered care.
While performing a specific task in the task shifting context, midwives perceived their crucial roles and responsibilities, along with achieved value and reward. However, due to a range of existing barriers, the caring task posed great challenges in completely implementing women-centered care. It is essential for systems to identify and eliminate these barriers early, to consider midwives’ emotional well-being, and to develop overall strategies to better support the midwifery workforce. Policy makers and administrators should establish a supportive environment to facilitate midwives to perform women-centered caring tasks in more effective and efficient ways.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Zusammenfassung
Hintergrund
Zur Sicherstellung der ambulanten Hebammenversorgung während der COVID-19-Pandemie wurden im März 2020 in Deutschland erstmals digitale Hebammenleistungen ermöglicht. Ziel ...der Studie „Digitale Hebammenbetreuung im Kontext der Covid-19-Pandemie“ war eine erste Evaluation der neu eingeführten digitalen Angebote aus Sicht von Hebammen und Müttern. In dieser Publikation werden die Ergebnisse der Mütterbefragung dargestellt.
Methode
Im Februar und März 2021 wurde die Querschnittstudie durchgeführt. Es wurden bei der BARMER versicherte Frauen, die zwischen Mai und November 2020 ein gesundes Kind geboren haben, bundesweit mithilfe eines explorativ entwickelten Online-Fragebogens zu Inanspruchnahme, Zufriedenheit und den Potenzialen der digitalen Hebammenbetreuung in Schwangerschaft und Wochenbett anonymisiert befragt.
Ergebnisse
1821 Mütter nahmen an der Befragung teil. Rund ein Drittel der antwortenden Frauen hatte in der Schwangerschaft und/oder im Wochenbett digitale Hebammenleistungen in Anspruch genommen und diese Leistungen zu über 80 % positiv bewertet. Aus Sicht der Befragten eignen sich Kurse und Beratung sehr gut, wohingegen die Wochenbettbetreuung oft die Präsenz der Hebamme erfordere. Als Vorteile wurden der Infektionsschutz sowie die Zeit- und Wegeersparnis gesehen.
Fazit
Die COVID-19-Pandemie hat auch in der Hebammenversorgung einen Digitalisierungsschub bewirkt. Die digitalen Angebote wurden von den freiberuflichen Hebammen schnell umgesetzt. Diese wurden von den Frauen gut angenommen und können die Betreuung in Präsenz sinnvoll ergänzen. Chancen und Weiterentwicklungsmöglichkeiten der digitalen Hebammenbetreuung sollten nun genutzt werden.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background and Objective: Arrhythmias are the most dangerous cause of death in cardiac patients, the purpose of this study is to investigate cardiac arrhythmias in non-cardiac surgeries with a focus ...on the type of arrhythmia and the type of surgery in Imam Khomeini (RA) hospital in Ilam city in 2021. Materials and Methods: In a retrospective study, 150 patients were selected as the sample size. A questionnaire containing demographic information and type of underlying disease, type of arrhythmia and clinical outcome of arrhythmia, type of surgery and type of anesthesia. The studied data were analyzed by SPSS software. To analyze the data, T-test and chi-square were used. Results: The most arrhythmia caused in general anesthesia was related to AF arrhythmia and tachycardia, significantly 100% (P<0.04). The results show that craniotomy had the highest (72.5%) clinical outcome of arrhythmia in the form of death, and there was a significant relationship between the type of surgery and the clinical outcome of arrhythmia. Conclusion: The results of this study generally showed that bradycardia is the most common arrhythmia and PVC arrhythmia is the least, general anesthesia has played an important role in causing cardiac arrhythmias, and the incidence of AF arrhythmia is evident at older ages and the greatest recovery is in the age range of 30-60 years and it was more in men than women, and more incidence of AF was reported in patients who underwent laparotomy. Postoperative AF is a frequent and serious complication in older patients
Midwifery services play an important role in healthcare provision, birth preparation and prevention.
Knowledge on women's expectations, preferences and needs regarding midwifery care is crucial not ...only for clinical care during preconception and pregnancy and research, but also for educational purposes. This descriptive qualitative study aimed to investigate the expectations, preferences and the needs of women concerning midwifery care in Germany.
Experienced researcher team conducted interviews with women who have the desire to get pregnant and online focus groups with women in early and late pregnancy. A purposeful recruitment strategy with maximum variation sampling was applied to reach diversity in the sample regarding age, previous children and socioeconomic background.
A total of 26 women participated. In the qualitative content analysis according to Mayring, seven main categories were developed for both preconceptional phase and pregnancy: (a) care by midwife, (b) care by obstetrician, (c) involvement of family, (d) need for information, (e) physical aspects, (f) psychological aspects and (g) orientation in healthcare system. One additional category referenced (h) organisation and bureaucracy in pregnant women. Women appreciated the personalised experience provided by midwives leading to trust and empowerment. Women's experiences with midwifery care varied. They reported contradictory information they received about services and care options. They valued interprofessional cooperation, continuity of care, structured information and personalised counselling.
Midwives play an important role in healthcare provision, birth preparation and prevention.
In order to depict the care situation quantitatively, to personalise care and to optimise healthcare models, a tool to assess the quality of healthcare and to evaluate women's needs and benefits of midwifery care will be developed based on the findings of this study. From the public health perspective, deficits in the German healthcare system concerning insufficient intra-sectoral communication, time pressure and low remuneration should be resolved in further research steps and policy action.
•From the user's perspective, midwifery care is crucial for the preconceptional and pregnancy phases.•Women appreciated the personalised experience provided by midwives leading to trust and empowerment, reported inequalities in the information they received about services and care options.•Study participants valued interprofessional cooperation, continuity of care, more structured information and personalised counselling.•Study findings have been categorised in a more holistic approach combining interprofessional care and involving family expertise, including physical and psychological aspects and highlighting the role of the midwife as a key contact person within the continuity of care.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
•A holistic picture of midwives’ action-guiding orientation in hospital settings is presented.•Clinical midwifery is related to complex influences from different sources.•Medicalization in childbirth ...is central, yet ambiguous for midwives‘ action-guiding orientation.•Professional midwives can rely on their action-guiding knowledge and experience.
Following the “call for action to research”, various aspects of maternity care should be examined so that perinatal care can be improved based on evidence. Clinical midwifery is the most common way of attending births in high-income countries. Midwives are the experts for normal labor and birth and play a central role in caring for women giving birth in a hospital setting. The aim of this scoping review was to explore midwives’ action-guiding orientation in their care provision during hospital births in high-income countries. Four databases (CINAHL, PubMed, MEDLINE and PSYNDEX) were searched systematically for studies in English or German on midwives’ action-guiding orientation during hospital labor and birth, published between 2000 and February 2022. Only studies from peer-reviewed journals were included. Reporting followed the PRISMA-ScR statement for scoping reviews. From a total of 1572 studies, 26 studies with 4 different research designs were included in the narrative synthesis. The synthesis shows 7 central concepts that emerge in the studies: medicalization of birth versus woman-centered care; midwives’ knowledge and experience; midwives’ professional identity; midwives’ confidence or autonomy in practice; intra-professional and multi-professional relations; continuity of care and relationship with the woman; and working conditions and cultural context. The central concept most reflective of midwives' action-guiding orientation was “medicalization of birth versus woman-centered care.” Other elements that affect midwives' action-guiding orientation and represent influencing factors at the micro, meso, and macro levels of obstetric care must be considered if one is to understand the profession and work of midwives.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background: Midwifery management process has been used as a guideline in clinical learning in midwifery. However, the management process that is used until currently has still been literally adopted ...from foreign sources which are not necessarily compatible with the understanding of most student midwives in Indonesia.
Purpose: this ADDIE study was therefore intended to formulate steps in the thinking process of clinical midwifery care. From this series of research steps, Nine Steps of J.M. Metha had been successfully composed.
Methods:This ADDIE (Analyze, Design, Develop, Implement, Evaluate) study was to formulate a clinical management mindset in midwifery. In the ‘develop’ section, R&D was used to create a product that could be used, for example, in the clinical learning of student midwives. In the ‘implement’ part, snow-ball sampling was used to extract the same anticipated data from the increasing number of participants. Finally, through FGD, participants’ opinions, which were selected from 3 people because of data saturation, were analyzed using a phenomenological approach to see the phenomena that existed in the use of the created products.
Results: The Nine Steps of J.M. Metha were formulated, i.e., See who comes, Listen to the client, Examine the client, Asses the client’s condition, Inform the client about their condition, Plan actions for care, Implement care having planned, Evaluate the care having implemented, and Return to number 1. Based on the opinions of the respondents, these nine steps had already resembled the real midwifery sequences in daily practices. It is then necessary to disseminate this simple, easy to apply midwifery thinking process for the sake of better quality of student midwives and midwifery practitioners.
Conclusion: These Nine Steps of J.M. Metha is likely to be suitable for use on the thinking process for midwifery care measures. A further study is therefore recommended with a larger scope of place and participants.
Women who present at hospital labour wards in early labour must often meet measurable diagnostic criteria before admission.
Early labour is a phase of neurohormonal, emotional, and physical changes ...that are often not measurable. When admission to birthplace is based on results of diagnostic procedures, women’s embodied knowledge may be disregarded.
To describe the early labour experience of women with spontaneous onset of labour in a free-standing birth centre, as well as midwifery care when women arrived in labour.
An ethnographic study was conducted in 2015 in a free-standing birth centre after receiving ethics approval. The findings for this article were drawn from a secondary analysis of the data, which included interview data with women and detailed field notes of midwives’ activities related to early labour.
The women in this study were instrumental in the decision-making process to stay at the birth centre. Observational data showed that vaginal exams were rarely conducted when women arrived at the birth centre and were not a deciding factor in admission.
The women and midwives co-constructed early labour based on the lived experience of women and the meaning that this experience held for both.
Given the growing concern about the need for respectful maternity care, this study provides examples of good practice in listening to women, as well as an illustration of the consequences of not doing so.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
•Women choosing home-based postpartum care: a group of healthy women and newborns.•Home-based postnatal care: safe among carefully selected mother-newborn pairs.•Few readmissions after giving birth ...and discharged early from hospital.
At St. Olav’s University Hospital in Trondheim, Norway, “Midwife Home” (MH) is an integrated home-based postnatal service for mothers who want early discharge (i.e. 6–24 h) after giving birth. The purpose of our study was to evaluate MH by (1) describing the characteristics of mother–newborn pairs followed up by MH to investigate whether the service has an appropriate target group; (2) describing the number and causes of possible readmissions for safety; (3) investigating whether MH follows the criteria set for the service; and (4) exploring whether the service facilitates continuity of care.
Following a cross-sectional design, we collected data from medical records at St. Olav’s University Hospital.
In the 212 mother–newborn pairs investigated, most mothers had a high level of education, were multiparous, had vaginal delivery, did not experience postpartum haemorrhage exceeding 500 mL, experienced first-degree or no perineal tear and started breastfeeding before discharge from hospital. Most newborns had a birthweight of 3000–4000 g and an APGAR score exceeding 7 after 5 min. Within the first six weeks postpartum, 1.4 % of the mothers and 2.3 % of the newborns were readmitted.
Mothers who choose follow-up by MH represent a homogeneous group of healthy, highly educated multiparous mothers with uncomplicated births and healthy newborns. The low number of readmissions imply that MH is a safe service, and that the target group is appropriate.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
There is limited research into the effects of the birth environment on birth outcomes.
To investigate the effect of a hospital birthing room designed to encourage mobility, self-determination and ...uptake of upright maternal positions in labour on the rate of vaginal births.
The multicentre randomised controlled trial Be-Up, conducted from April 2018 to May 2021 in 22 hospitals in Germany, included 3719 pregnant women with a singleton pregnancy in cephalic position at term. In the intervention birthing room, the bed was removed or covered in a corner of the room and materials were provided to promote upright maternal positions, physical mobility and self-determination. No changes were made in the control birthing room.
The primary outcome was probability of vaginal births; secondary outcomes were episiotomy, perineal tears degree 3 and 4, epidural anaesthesia, “critical outcome of newborns at term”, and maternal self-determination (LAS). Analysis: intention-to-treat.
The rate of vaginal births was 89.1 % (95 % CI 87.5–90.4%; n = 1836) in the intervention group and 88.5 % (95 % CI 87.0–89.9 %; n = 1863) in the control group. The risk difference in the probability of vaginal birth was + 0.54 % (95 % CI − 1.49 % to 2.57 %), the odds ratio was 1.06 (95 % CI 0.86–1.30). Neither the secondary endpoints nor serious adverse events showed significant differences. Regardless of group assignment, there was a significant association between upright maternal body position and maternal self-determination.
The increased vaginal birth rates in both comparison groups can be explained by the high motivation of the women and the staff.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
ObjectiveTo clarify the latest evaluation indices and employed scales capable of systematically evaluating patient education material to utilize these in the evaluation of “Midwifery Guidelines for ...Pregnant Women Giving Birth and Their Families.”Subjects and MethodsA search of the literature was conducted using the web version of Igaku Chuo Zasshi and PubMed. Papers describing the evaluation of patient education material were extracted based on titles, abstracts, and whole manuscripts. The extracted papers were sorted according to the type of patient education material, evaluators, evaluated domains, and evaluated items.ResultsTwelve papers were extracted, of which 3 were regarding the evaluation of audiovisual education material and 10 were regarding the evaluation of text-based education material. One paper evaluated both audiovisual and text-based education materials. The evaluations of patient education material differed in the evaluated domain and scale used according to the type of education material. In particular, the evaluations of the readability of text-based patient education material involved scores such as the Flesch Reading Ease, Flesch-Kincaid, and Simple Measure of Gobbledygook (SMOG), while other domains were evaluated using the DISCERN instrument, the LIDA instrument, the Patient Education Materials Assessment Tool (PEMAT-P), and the Visual Aesthetics of Websites Inventory (VisAWI). Evaluations were performed by two evaluators for all of the papers. In the evaluations of text-based education materials, evaluation from multiple domains using scales according to the purpose of the patient education material was found to be necessary, in addition to evaluating readability.ConclusionsWe will further examine the use of readability evaluation scales and the Japanese version of the PEMAT, which can evaluate comprehensibility and ease of actions, for the purpose of evaluating “midwifery guidelines for pregnant women giving birth and their families.”
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NUK, OILJ, UL, UM, UPUK, VSZLJ
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