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Maternity Care (maternity + care)
Terms modified by Maternity Care Selected AbstractsNurses and Doulas: Complementary Roles to Provide Optimal Maternity CareJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 2 2006Lois Eve Ballen Staff in maternity-care facilities are seeing an increase in doulas, nonmedical childbirth assistants, who are trained to provide continuous physical, emotional, and informational labor support. The long-term medical and psychosocial benefits are well documented. In this article, misconceptions about the doula's role are corrected, and suggestions are offered on ways to improve communication between health care providers and doulas. Together, nurses and doulas can provide birthing women with a safe and satisfying birth. JOGNN, 35, 304-311; 2006. DOI: 10.1111/J.1552-6909.2006.00041.x [source] Celeste Phillips, The Mother of Family-Centered Maternity CareJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2001Michelle Ham RN No abstract is available for this article. [source] Family-Centered Maternity Care: One Hospital's Quest for ExcellenceNURSING FOR WOMENS HEALTH, Issue 3 2007Kimberly Mullen MSN First page of article [source] Women as Consumers of Maternity Care: Measuring "Satisfaction" or "Dissatisfaction"?BIRTH, Issue 1 2008Maggie Redshaw BA ABSTRACT: The measurement of "satisfaction" has been intrinsic to the models of evaluation of health care. However, a thoughtful approach to its use has not always been evident in which this concept is understood to represent a complex group of theoretical constructs involving attitudes, expectations, and perceptions that may be both positive and critical. These constructs require investigation and evaluation using recognized and developed methodologies. At the same time the importance of listening to patients and to women and their partners in evaluating and carrying out research on maternity care cannot be underestimated if the instruments used are to have construct and face validity. Qualitative data of this kind have a dual function of contributing to a more complex picture of women's experience and of suggesting that researchers need to explore the issues related to "dissatisfaction" at least as much as those arising from a positive overall view of care. (BIRTH 35:1 March 2008) [source] Single Room Maternity Care and Client SatisfactionBIRTH, Issue 4 2000Patricia A Janssen MPH Background:Single room maternity care is the provision of intrapartum and postpartum care in a single room. It promotes a philosophy of family centered care in which one nurse cares for the family consistently throughout the intrapartum and postpartum periods. At B.C. Women's Hospital, a tertiary level obstetric teaching hospital in Vancouver, British Columbia, a seven-bed, single room maternity care unit was developed and opened as a demonstration project. As part of the evaluation of this unit, client satisfaction was compared between women enrolled in single room maternity care and those in a traditional setting.Method:The study group included 205 women who were admitted to the single room maternity care unit after meeting the low-risk criteria. Their responses on a satisfaction survey were compared with those of a historical comparison group of 221 women meeting the same eligibility criteria who were identified through chart audits 3 months before the single room maternity care unit was opened. A second, concurrent comparison group comprised 104 women who also met eligibility criteria.Results:Study group women were more satisfied than comparison groups in all areas evaluated, including provision of information and support, physical environment, nursing care, patient education, assistance with infant feeding, respect for privacy, and preparation for discharge.Conclusions:Single room maternity care was associated with a significant improvement in client satisfaction because of many factors, including the physical setting itself, avoidance of transfers, and improved continuity of nursing care. [source] Targeted group antenatal prevention of postnatal depression: a reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2003M.-P. Austin Objective:, To review the efficacy of antenatal group interventions aimed at reducing postnatal depression (PND) in ,at risk' women. Method:, Medline, Psyclit, HEALTHSTAR, EMBASE, Cochrane library, UK National Research Register and CINHAL searches were performed from 1960 to December 2001 focussing on randomized controlled trials (RCTs). Results:, As statistical synthesis of the studies was not feasible, a qualitative review is provided. All five studies reviewed suffer from substantial limitations including small numbers; unrealistic effect sizes; large attrition rates; lack of a systematic approach in identifying those ,at risk' and thus clinically heterogenous samples. Three of the studies used unvalidated interventions that were educational or supportive in approach. While one such study reported a benefit of intervention, the largest study using a structured intervention, reported no effect. A very small study using interpersonal therapy, was promising but needs replication with an adequate sample size. Conclusion:, There is currently little evidence from RCTs to support the implementation of antenatal group interventions to reduce PND in ,at risk' women. Further studies addressing the significant methodological limitations are recommended before concluding that antenatal targeted interventions have no place in maternity care. [source] Evaluating decision aids , where next?HEALTH EXPECTATIONS, Issue 2 2004Alicia O'Cathain BSc MSc MA Abstract Decision aids have been developed to help patients become involved in decision-making about their individual health care. During the evaluation of a particular decision aid in maternity care , a set of 10 ,Informed Choice' leaflets , we considered the lessons learnt for evaluation of decision aids in the future. Decision aids have been tested mainly in explanatory trials and have been found to be effective. We argue that existing decision aids should be subjected to more pragmatic trials to test their effectiveness in the real world. The small amount of evidence on their use in the real world shows that they face challenges, resulting in poor implementation. Therefore, we propose that implementation strategies are developed which take heed of the findings of research on getting evidence into practice, and in particular address structural barriers such as the lack of time available to health professionals. We recommend that these ,decision aid implementation packages' are developed in conjunction with both health professionals and patients, and identify and address potential barriers to both the delivery of patient involvement in decision-making, and the use of decision aids, in the real world. These ,packages' can then be submitted to pragmatic evaluation. [source] National review of maternity care for women with HIV infectionHIV MEDICINE, Issue 5 2006C McDonald Objective To assess adherence to the British HIV Association (BHIVA) 2001 guidelines for the management of HIV-infected pregnant women. Methods A survey and a case note review were carried out using structured questionnaires sent to providers of adult HIV care in the UK and Ireland. Participants were women with HIV infection who delivered a live or stillborn infant between October 2002 and September 2003. The main outcome measures were the appropriate use of antiretroviral therapy, the use and timing of elective Caesarean section, and support for the avoidance of breast-feeding. Results Of 186 centres, 100 (54%) responded with data on 501 eligible pregnancies. Conclusions In general, practice was in accordance with the BHIVA 2001 guidelines. However, in a number of cases Caesarean sections were planned later than the recommended 38 weeks. [source] Creating consumer satisfaction in maternity care: the neglected needs of migrants, asylum seekers and refugeesINTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 2 2007Birgit Jentsch Abstract An estimated 190 million people are now living outside their countries of birth or citizenship, and the rate of this migration is expected to remain high. The resulting growing cultural and ethnic diversity in societies adds specific challenges to the requirement of delivering public services such as health care to consumers. Globally, about half of the migrant population are women. Migrants' outcomes of pregnancy are known to be poor, showing significant disparities when compared with those of native populations. Although these disparities have been noted, knowledge is limited regarding the availability and accessibility of healthcare services, as well as the acceptability of maternity care for women with experiences of free and forced migration. Healthcare research in general, and maternity care research specifically, have often neglected this population. This paper examines the existing international guidelines intended to address inequities in health outcomes, policies which have been introduced at national levels, and the widely used concepts of ,patient-centred' and ,woman-centred' health services. The ideals implicit in those guidelines and concepts are contrasted with the available evidence of many overseas nationals' experiences with healthcare provisions in general, and maternity care in particular. This is followed by reflections on deficiencies in current studies and on those methodological problems which make research on maternity care for migrant women particularly challenging. The conclusion considers the appropriateness and relevance of guidelines currently promoting equity in maternity care and suggests a future agenda for priority research. [source] The role of user charges and structural attributes of quality on the use of maternal health services in MoroccoINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2005David R. Hotchkiss Abstract Health care decision makers in settings with low levels of utilization of primary services are faced with the challenge of balancing the sometimes competing goals of increasing coverage and utilization of maternity services, particularly among the poor, with that of ensuring the financial viability of the health system. Morocco is a case in point where this policy dilemma is currently being played out. This study examines the role of household out-of-pocket costs and structural attributes of quality on the use of maternity care in Morocco using empirical data collected from both households and health care facilities. A nested logit model is estimated, and the coefficient estimates are used to carry out policy simulations of the impact of changes in the levels of out-of-pocket fees and structural attributes of quality in order to help guide policy makers responsible for the design of pending social insurance programs. The results of the paper suggest that social insurance strategies that involve increases in out-of-pocket charges in the form of copayments could be implemented without untoward effects on appropriate use of maternity care for non-poor women, but would be contraindicated for poorer and rural households. Copyright © 2005 John Wiley & Sons, Ltd. [source] Competencies and skills for remote and rural maternity care: a review of the literatureJOURNAL OF ADVANCED NURSING, Issue 2 2007Jillian Ireland Abstract Title. Competencies and skills for remote and rural maternity care: a review of the literature Aim., This paper reports a review of the literature on skills, competencies and continuing professional development necessary for sustainable remote and rural maternity care. Background., There is a general sense that maternity care providers in rural areas need specific skills and competencies. However, how these differ from generic skills and competencies is often unclear. Methods., Approaches used to access the research studies included a comprehensive search in relevant electronic databases using relevant keywords (e.g. ,remote', ,midwifery', ,obstetrics', ,nurse,midwives', education', ,hospitals', ,skills', ,competencies', etc.). Experts were approached for (un-)published literature, and books and journals known to the authors were also used. Key journals were hand searched and references were followed up. The original search was conducted in 2004 and updated in 2006. Findings., Little published literature exists on professional education, training or continuous professional development in maternity care in remote and rural settings. Although we found a large literature on competency, little was specific to competencies for rural practice or for maternity care. ,Hands-on' skills courses such as Advanced Life Support in Obstetrics and the Neonatal Resuscitation Programme increase confidence in practice, but no published evidence of effectiveness of such courses exists. Conclusion., Educators need to be aware of the barriers facing rural practitioners, and there is potential for increasing distant learning facilitated by videoconferencing or Internet access. They should also consider other assessment methods than portfolios. More research is needed on the levels of skills and competencies required for maternity care professionals practising in remote and rural areas. [source] Perinatal nursing education for single-room maternity care: an evaluation of a competency-based modelJOURNAL OF CLINICAL NURSING, Issue 1 2005Patricia A Janssen PhD Aims and objectives., To evaluate the success of a competency-based nursing orientation programme for a single-room maternity care unit by measuring improvement in self-reported competency after six months. Background., Single-room maternity care has challenged obstetrical nurses to provide comprehensive nursing care during all phases of the in-hospital birth experience. In this model, nurses provide intrapartum, postpartum and newborn care in one room. To date, an evaluation of nursing education for single-room maternity care has not been published. Design., A prospective cohort design comparing self-reported competencies prior to starting work in the single-room maternity care and six months after. Methods., Nurses completed a competency-based education programme in which they could select from a menu of learning methods and content areas according to their individual needs. Learning methods included classroom lectures, self-paced learning packages, and preceptorships in the clinical area. Competencies were measured by a standardized perinatal self-efficacy tool and a tool developed by the authors for this study, the Single-Room Maternity Care Competency Tool. A paired analysis was undertaken to take into account the paired (before and after) nature of the design. Results., Scores on the perinatal self-efficacy scale and the single-room maternity care competency tool were improved. These differences were statistically significant. Conclusions., Improvements in perinatal and single-room maternity care-specific competencies suggest that our education programme was successful in preparing nurses for their new role in the single-room maternity care setting. This conclusion is supported by reported increases in nursing and patient satisfaction in the single-room maternity care compared with the traditional labour/delivery and postpartum settings. Relevance to clinical practice., An education programme tailored to the learning needs of experienced clinical nurses contributes to improvements in nursing competencies and patient care. [source] Measuring social influence of a senior midwife on decision-making in maternity care: an experimental studyJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 2 2005Caroline Hollins Martin Abstract The document Changing Childbirth produced by the Department of Health (1993) requests provision of more choice, continuity and control for women during pregnancy and childbirth. In this context this study considers whether midwives'decisions are influenced by a senior midwife. A simple, valid and reliable scale,the Social Influence Scale for Midwifery (SIS-M),was devised to measure and score midwives' private anonymous responses to 10 clinical decisions. The SIS-M was initially administered as a self-completed postal survey by 209 midwives. Following a 9-month time gap, a stratified sample of 60 (20 E, F, G grade midwives) were invited for interview in which a senior midwife attempted to influence SIS-M responses in a conformist direction. Overall, a 3,×,2 (E, F, G grade midwives x private and interview SIS-M scores) analysis of variance (ANOVA) revealed midwives were significantly more conformist when influenced by a senior midwife, in comparison to private anonymous responses. No significant interaction between groups was found. These findings indicate that there is influence of a senior midwife on clinical decisions that should be woman-centred, according to Changing Childbirth (1993). The implication is that this influence may remove choice from women. Copyright © 2005 John Wiley & Sons, Ltd. [source] Beyond evidence-based medicine: complexity and stories of maternity careJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2010Soo Downe BA (Hons) RM MSc PhD First page of article [source] Developing interdisciplinary maternity services policy in Canada.JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2010Evaluation of a consensus workshop Abstract Context, Four maternity/obstetrical care organizations, representing women, midwives, obstetricians and family doctors conducted interdisciplinary policy research under auspices of four key stakeholder groups. These projects teams and key stakeholders subsequently collaborated to develop consensus on strategies for improved maternity services in Ontario. Objectives, The objective of this study is to evaluate a 2-day research synthesis and consensus building conference to answer policy questions in relation to new models of interdisciplinary maternity care organizations in different settings in Ontario. Methods, The evaluation consisted of a scan of individual project activities and findings as were presented to an invited audience of key stakeholders at the consensus conference. This involved: participant observation with key informant consultation; a survey of attendees; pattern processing and sense making of project materials, consensus statements derived at the conference in the light of participant observation and survey material as pertaining to a complex system. The development of a systems framework for maternity care policy in Ontario was based on secondary analysis of the material. Findings, Conference participants were united on the importance of investment in maternity care for Ontario and the impending workforce crisis if adaptation of the workforce did not take place. The conference participants proposed reforming the current system that was seen as too rigid and inflexible in relation to the constraints of legislation, provider scope of practice and remuneration issues. However, not one model of interdisciplinary maternity/obstetrical care was endorsed. Consistency and coherence of models (rather than central standardization) through self-organization based on local needs was strongly endorsed. An understanding of primary maternity care models as subsystems of networked providers in complex health organizations and a wider social system emerged. The patterns identified were incorporated into a complexity framework to assist sense making to inform policy. Discussion, Coherence around core values, holism and synthesis with responsiveness to local needs and key stakeholders were themes that emerged consistent with complex adaptive systems principles. Respecting historical provider relationships and local history provided a background for change recognizing that systems evolve in part from where they have been. The building of functioning relationships was central through education and improved communication with ongoing feedback loops (positive and negative). Information systems and a flexible improved central and local organization of maternity services was endorsed. Education and improved communication through ongoing feedback loops (positive and negative) were central to building functioning relationships. Also, coordinated central organization with a flexible and adaptive local organization of maternity services was endorsed by participants. Conclusions, This evaluation used an approach comprising scoping, pattern processing and sense making. While the projects produced considerable typical research evidence, the key policy questions could not be addressed by this alone, and a process of synthesis and consensus building with stakeholder engagement was applied. An adaptive system with local needs driving a relationship based network of interdisciplinary groupings or teams with both bottom up and central leadership. A complexity framework enhanced sense making for the system approaches and understandings that emerged. [source] Uptake of prenatal screening for chromosomal anomalies: impact of test results in a previous pregnancyPRENATAL DIAGNOSIS, Issue 13 2002Kevin Spencer Abstract Aim To assess whether the uptake of prenatal screening for trisomy 21 in a subsequent pregnancy is influenced by being classified in the ,increased risk' or ,not at increased risk' group in the first pregnancy. Setting District General Hospital Maternity Unit. Methods Amongst a group of women attending for maternity care at this hospital, the maternity records were examined to find women having at least two pregnancies. Any prenatal screening record for each pregnancy was retrieved from the prenatal screening database. Prenatal screening for trisomy 21 was by a combination of maternal serum ,-fetoprotein (AFP) and free ,-human chorionic gonadotrophin (,-hCG) in the second trimester and by maternal serum free ,-hCG and pregnancy-associated plasma protein-A (PAPP-A) and fetal nuchal translucency (NT) thickness in the first trimester. Women were stratified according to their trisomy 21 risk into an ,increased risk' group (1: <250 in the second trimester and 1: <300 in the first trimester) or ,not at increased risk' group based on their first pregnancy. In a second pregnancy, the records were examined to see if the mother accepted prenatal screening in the second pregnancy. The rate of acceptance of screening in a subsequent pregnancy, depending on whether ,at increased risk' or ,not at increased risk' in the first pregnancy, was examined using chi square tests. Results In the second trimester study, 4601 women were identified with two pregnancies during the study period. Of these, 4559 women had prenatal screening in a subsequent pregnancy. Initially, 273 women were identified in the high-risk group, and of these 252 (92.3%) elected to have prenatal screening in a subsequent pregnancy. This compared with 4307 of 4328 (99.5%) women in the low-risk group. In the first trimester study, 1077 women were identified with two pregnancies during the study period. Of these, 1072 had prenatal screening in a subsequent pregnancy. Initially, 60 women were identified in the high-risk group, and of these 56 (93.3%) elected to have prenatal screening in a subsequent pregnancy. This compared with 1016 of 1017 (99.9%) in the low-risk group. Statistically, there was no difference between the rate of declining prenatal screening in a second pregnancy amongst those in the high-risk group in a first pregnancy or those in the low-risk group (p = 0.429 for second trimester screening and p = 0.794 for first trimester screening). Similarly, no difference could be demonstrated between rates when screening in the first or second trimester (p = 0.961) for those in the high-risk group. Conclusion Despite the understandable anxiety associated with being identified in the high-risk group (as a false positive finding) in a previous pregnancy, this did not seem to deter women from accepting prenatal screening in a subsequent pregnancy. Copyright © 2002 John Wiley & Sons, Ltd. [source] Original Article: Audit of severe acute maternal morbidity describing reasons for transfer and potential preventability of admissions to ICUAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2010Beverley A. LAWTON Background:, Maternal mortality is a rare event in the developed world. Assessment of severe acute maternal morbidity (SAMM) is therefore an appropriate measure of the quality of maternity care. Aims:, The aim of the study was to conduct a retrospective audit of SAMM cases (pregnant women admitted to a New Zealand Intensive Care Unit) to describe clinical, socio-demographic characteristics, pregnancy outcomes and preventability. Methods:, Severe acute maternal morbidity cases were reviewed by a multidisciplinary panel to determine reasons for admission to ICU, to classify organ-system dysfunction and to determine whether the SAMM case was preventable or not. Inclusion criteria were: admission to ICU between 2005 and 2007 during pregnancy or within 42 days of delivery. Results:, Twenty-nine SAMM cases were reviewed, of which 10 (35%) were deemed preventable. The most common reasons for transfer to ICU were: the need for invasive vascular monitoring, hypotension and disseminated intravascular coagulation. The most frequent types of preventable events were: inadequate diagnosis/recognition of high-risk status, inappropriate treatment, communication problems and inadequate documentation. All five SAMM cases of septicaemia were deemed preventable. Of the ten preventable cases, three were Maori (50% of the Maori in total audit), four were Pacific (67% of the Pacific in total audit) and three were women of ,other' ethnicities (17.6%, 3 of 17 in the audit). Conclusions:, An audit of SAMM cases describing reasons for transfer to ICU and preventability is feasible. We recommend that a prospective national SAMM audit process be introduced in New Zealand as a quality of care measure. [source] Role of general practitioners in primary maternity care in South Australia and VictoriaAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009Georgina SUTHERLAND Background:, Recent policy debates about the challenges facing maternity services in Australia provide an opportunity to reflect on current care practices. Aims:, To identify the provision of primary maternity care models in two Australian states: South Australia (SA) and Victoria. Methods:, All public and private hospitals with maternity facilities in SA and Victoria were mailed a survey requesting information about the organisation and provision of maternity care. Results:, All hospitals in SA (35) and 99% (75/76) in Victoria completed the survey. Among public hospitals, approximately 50% (14/30 in SA and 29/56 in Victoria) reported primary care arrangements where all antenatal care is provided by medical practitioners working in the community. The vast majority of hospitals offering this type of care were located outside metropolitan areas. Twenty per cent of public hospitals in SA (6/30) and 36% in Victoria (20/59) reported offering primary midwifery models, such as team, caseload and/or birth centre care. In SA, hospitals offering these models were located in both metropolitan and regional areas. In Victoria, 60% of hospitals offering women primary midwifery care were large hospitals with more than 1000 births per annum. Conclusions:, This study shows that community-based medical practitioners, general practitioners in particular, are major providers of maternity care despite the emergence of primary midwifery models of care. With 25% of the population living outside metropolitan areas in both states, providing access to choice and continuity of care for women living in regional and rural areas will be a challenge for maternity reform. [source] CONTINUUM OF CARE AND THE ANTENATAL RECORD IN RURAL NEW SOUTH WALESAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2003Karen Patterson ABSTRACT Objective: The aim of the study was to determine the effect of the woman held antenatal record card (PNC2) on the continuity of maternity care received when presenting to the acute rural setting for clinical assessment. Design: Qualitative, open-ended questionnaires. Setting: Rural New South Wales public hospital. Subjects: Maternity consumers, 50 women who were inpatients receiving antenatal or postnatal care between August and October 1998. A stratified sample of healthcare professionals employed by the service, 12 midwives and 13 general practitioners. Main outcome measure: The self reported use of the antenatal card and the viewed effects of the card on the continuity of healthcare received. Results: The study identified a significant difference between the responding professionals (93%) positive perception of the effect of the PNC2 on the women's pregnancy continuum of care and the maternity consumer (36%), who felt it bore little impact on their care. The study findings suggested a lack of compliance and standardisation in usage of the antenatal card negated any flow on effects for the women. Conclusions: The intended purposes of the PNC2 were compromised in this rural setting. The study recommends that stakeholders in rural maternity care be accountable for examining the benefits and barriers of their antenatal practices, that the rural community's expectations of ,continuity of maternity care' are sought and that there should be a review of the available models of rural antenatal care. [source] Women as Consumers of Maternity Care: Measuring "Satisfaction" or "Dissatisfaction"?BIRTH, Issue 1 2008Maggie Redshaw BA ABSTRACT: The measurement of "satisfaction" has been intrinsic to the models of evaluation of health care. However, a thoughtful approach to its use has not always been evident in which this concept is understood to represent a complex group of theoretical constructs involving attitudes, expectations, and perceptions that may be both positive and critical. These constructs require investigation and evaluation using recognized and developed methodologies. At the same time the importance of listening to patients and to women and their partners in evaluating and carrying out research on maternity care cannot be underestimated if the instruments used are to have construct and face validity. Qualitative data of this kind have a dual function of contributing to a more complex picture of women's experience and of suggesting that researchers need to explore the issues related to "dissatisfaction" at least as much as those arising from a positive overall view of care. (BIRTH 35:1 March 2008) [source] What Is It About Antenatal Continuity of Caregiver That Matters to Women?BIRTH, Issue 4 2005DipAppSc, Mary-Ann Davey RN, PGDipSoc ABSTRACT:,Background:Continuity of care and of caregiver are thought to be important influences on women's experience of maternity care. The aim of this study was to analyze the influence of two aspects of continuity of caregiver in the antenatal period on women's overall rating of antenatal care: the extent to which women saw the same caregiver throughout pregnancy, and the extent to which women thought that their caregiver knew and remembered them and their progress from one visit to the next. Methods:An anonymous, population-based postal survey was conducted of 1,616 women who gave birth in a 14-day period in September 1999 in Victoria, Australia. Multivariate methods were used to analyze the data. Results:Most women saw the same caregiver at each antenatal visit (77%), and thought that caregivers got to know them (65%). This finding varied widely among different models of maternity care. Before adjustment, women were much more likely to describe their antenatal care as very good if they always or mostly thought the caregiver got to know them (OR 5.86, 95% CI 4.3, 7.9), and if they always or mostly saw the same caregiver at each visit (OR 2.91, 95% CI 2.0, 4.3). Adjusting for sociodemographic factors, parity, risk status of the pregnancy, and several specific aspects of antenatal care revealed that seeing the same caregiver was no longer associated with rating of care (adjusted OR 0.65, 95% CI 0.3,1.2), but women who thought that caregivers got to know and remember them remained much more likely to rate their care highly (adjusted OR 3.18, 95% CI 2.0, 5.1). Conclusions:These findings suggest that changing the delivery of antenatal care to increase women's chances of seeing the same caregiver at each visit is not by itself likely to improve the overall experience of care, but time spent personalizing each encounter in antenatal care would be well received. The analysis also confirmed the importance that women place on quality interactions with their doctors and midwives. (BIRTH 32:4 December 2005) [source] Childbearing in U.S. Military Hospitals: Dimensions of Care Affecting Women's Perceptions of Quality and SatisfactionBIRTH, Issue 1 2005Erica M. Harriott MHSA Information is lacking about how well the military health system has adopted patient-centered approaches for promoting individual choice and preference in a bureaucratically structured military hospital. The purpose of this study was to examine women's evaluations of maternity care with respect to decision-making, confidence, trust in health care providers, and treatment within the military hospital. Methods: The Department of Defense Inpatient Childbirth Survey was mailed to a simple stratified random sample of beneficiaries who received maternity care at a military hospital between July 1 and September 30, 2001. Data for 11 dimensions of women's care and experiences were examined from self-reported assessments of 2,124 respondents who gave birth at one of 44 military hospitals. A multiple logistic regression model was estimated to determine which dimensions of care predicted beneficiaries' likelihood to recommend the military hospital to family and friends. Result: Less than 50 percent of respondents would recommend the military hospital to family and friends. Significantly associated with women's willingness to recommend their specific military hospital to others were courtesy and availability of staff, confidence and trust in provider, treatment with respect and dignity, information and education, physical comfort, involvement of friends and family, continuity and transition, and involvement in decision-making. Conclusions: In a military population, obstetric patients who are treated with respect, courtesy, and dignity, are involved in decisions about their care, and have established trusting relationships with their practitioners are significantly more likely to recommend the military hospital to others. It is important for military health care leaders to establish a proactive program of patient-centered maternity care. Continuous care, education, support services, and a multidisciplinary approach should be integrated to retain and recapture obstetric patients who are served in military hospitals in the United States. [source] Single Room Maternity Care and Client SatisfactionBIRTH, Issue 4 2000Patricia A Janssen MPH Background:Single room maternity care is the provision of intrapartum and postpartum care in a single room. It promotes a philosophy of family centered care in which one nurse cares for the family consistently throughout the intrapartum and postpartum periods. At B.C. Women's Hospital, a tertiary level obstetric teaching hospital in Vancouver, British Columbia, a seven-bed, single room maternity care unit was developed and opened as a demonstration project. As part of the evaluation of this unit, client satisfaction was compared between women enrolled in single room maternity care and those in a traditional setting.Method:The study group included 205 women who were admitted to the single room maternity care unit after meeting the low-risk criteria. Their responses on a satisfaction survey were compared with those of a historical comparison group of 221 women meeting the same eligibility criteria who were identified through chart audits 3 months before the single room maternity care unit was opened. A second, concurrent comparison group comprised 104 women who also met eligibility criteria.Results:Study group women were more satisfied than comparison groups in all areas evaluated, including provision of information and support, physical environment, nursing care, patient education, assistance with infant feeding, respect for privacy, and preparation for discharge.Conclusions:Single room maternity care was associated with a significant improvement in client satisfaction because of many factors, including the physical setting itself, avoidance of transfers, and improved continuity of nursing care. [source] Team Midwifery Care in a Tertiary Level Obstetric Service: A Randomized Controlled TrialBIRTH, Issue 3 2000Mary Anne Biró RN Background:In 1996 a new model of maternity care characterized by continuity of midwifery care from early pregnancy through to the postpartum period was implemented for women attending Monash Medical Centre, a tertiary level obstetric service, in Melbourne, Australia. The objective of this study was to compare the new model of care with standard maternity care.Methods:In a randomized controlled trial, 1000 women who booked at the antenatal clinic and met the eligibility criteria were randomly allocated to receive continuity of midwifery care (team care) from a group of seven midwives in collaboration with obstetric staff, or care from a variety of midwives and obstetric staff (standard care). The primary outcome measures were procedures in labor, maternal outcomes, neonatal outcomes, and length of hospital stay.Results:Women assigned to the team care group experienced less augmentation of labor, less electronic fetal monitoring, less use of narcotic and epidural analgesia, and fewer episiotomies but more unsutured tears. Team care women stayed in hospital 7 hours less than women in standard care. More babies of standard care mothers were admitted to the special care nurseries for more than 5 days because of preterm birth, and more babies of team care mothers were admitted to the nurseries for more than 5 days with intrauterine growth retardation. No differences occurred in perinatal mortality between the two groups.Conclusions:Continuity of midwifery care was associated with a reduction in medical procedures in labor and a shorter length of stay without compromising maternal and perinatal safety. Continuity of midwifery care is realistically achievable in a tertiary obstetric referral service. [source] Marriage still protects pregnancyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2005Kaisa Raatikainen Objective To assess the risk factors and outcome of pregnancy outside marriage in the 1990s, in conditions of a high percentage of extramarital pregnancies and high standard maternity care, used by the entire pregnant population. Design Hospital-based cohort study. Setting A university-teaching hospital in Finland. Population The 25,373 singleton pregnancies of known marital and cohabiting status. Methods Odds ratios (ORs) with 95% confidence intervals were calculated to estimate the effect of extramarital childbearing on pregnancy outcome. Multiple logistic regression analyses were conducted to control for confounding maternal risk factors. Main outcome measures Small-for-gestational age (SGA) infants, preterm birth (less than 37 completed weeks), low birthweight (LBW; under 2500 g). Results Of the study population, 67.5% were married and 32.5% were unmarried; 24.2% of all mothers were cohabiting. Unmarried status was strongly associated with social disadvantage and particular risk factors, specifically unemployment, smoking and previous pregnancy terminations, which in turn had an impact on obstetric outcome. There were significantly more SGA infants among unmarried mothers (P < 0.001), with an absolute difference of 45%; more preterm deliveries (P= 0.001), with an absolute difference of 17.5%; and more LBW infants (P < 0.001), with an absolute difference of 26%. The differences in adverse pregnancy outcomes between study groups (i) all unmarried women, (ii) cohabiting women and (iii) single women, remained significant after multivariate analysis at adjusted ORs of 1.11, 1.11 and 1.07 for SGA, 1.17, 1.15 and 1.21 for LBW and 1.15, 1.15 and 1.29 for the preterm births, respectively. Conclusion Even in the 1990s when cohabitation was already common, pregnancy outside marriage was associated with an overall 20% increase of adverse outcomes, and free maternity care did not overcome the difference. [source] Do maternity care provider groups have different attitudes towards birth?BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2004Birgit Reime Objective To compare family physicians', obstetricians' and midwives' self-reported practices, attitudes and beliefs about central issues in childbirth. Design Mail-out questionnaire. Setting/Population All registered midwives in the province, and a sample of family physicians and obstetricians in a maternity care teaching hospital. Response rates: 91% (n= 50), 69% (n= 97) and 89% (n= 34), respectively. Methods A postal survey. Main outcome measures Twenty-three five-point Likert scale items (strongly agree to strongly disagree) addressing attitudes toward routine electronic fetal monitoring, induction of labour, epidural analgesia, episiotomy, doulas, vaginal birth after caesarean section (VBACs), birth centres, provision educational material, birth plans and caesarean section. Results Cluster analysis identified three distinct clusters based on similar response to the questions. The ,MW' cluster consisted of 100% of midwives and 26% of the family physicians. The ,OB' cluster was composed of 79% of the obstetricians and 16% of the family physicians. The ,FP' cluster was composed of 58% the family physicians and 21% the obstetricians. Members of the ,OB' cluster more strongly believed that women had the right to request a caesarean section without maternal/fetal indications (P < 0.001), that epidurals early in labour were not associated with development of fetal malpositions (P < 0.001) and that increasing caesarean rates were a sign of improvement in obstetrics (P < 0.001). The ,OB' cluster members were more likely to say they would induce women as soon as possible after 41 3/7 weeks of gestation (P < 0.001) and were least likely to encourage the use of birth plans (P < 0.001). The ,MW' cluster's views were the opposite of the ,OBs' while the ,FP' cluster's views fell between the ,MW' and ,OB' clusters. Conclusions In our environment, obstetricians were the most attached to technology and interventions including caesarean section and inductions, midwives the least, while family physicians fell in the middle. While generalisations can be problematic, obstetricians and midwives generally follow a defined and different approach to maternity care. Family physicians are heterogeneous, sometimes practising more like midwives and sometimes more like obstetricians. [source] Maternity care options influence readmission of newbornsACTA PAEDIATRICA, Issue 5 2008Lotta Ellberg Abstract Aim: To analyse morbidity and mortality in healthy newborn infants in relation to various routines of post-natal follow-up. Design: cross-sectional study. Setting: maternity care in Sweden. Population: healthy infants born at term between 1999 and 2002 (n = 197 898). Methods: Assessment of post-natal follow-up routines after uncomplicated childbirth in 48 hospitals and data collected from the Swedish Medical Birth Register, Hospital Discharge Register and Cause-of-Death Register. Main outcome measure: neonatal mortality and readmission as proxy for morbidity. Results: During the first 28 days, 2.1% of the infants were readmitted generally because of infections, jaundice and feeding-related problems. Infants born in hospitals with a routine neonatal examination before 48 h and a home care programme had a readmission rate [OR, 1.3 (95% CI, 1.16,1.48)] higher than infants born in hospitals with routine neonatal examination after 48 h and 24-h care. There were 26 neonatal deaths. Conclusion: Post-delivery care options and routines influence neonatal morbidity as measured by hospital readmission rate. A final infant examination at 49,72 h and an active follow-up programme may reduce the risk of readmission. [source] CONTINUUM OF CARE AND THE ANTENATAL RECORD IN RURAL NEW SOUTH WALESAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2003Karen Patterson ABSTRACT Objective: The aim of the study was to determine the effect of the woman held antenatal record card (PNC2) on the continuity of maternity care received when presenting to the acute rural setting for clinical assessment. Design: Qualitative, open-ended questionnaires. Setting: Rural New South Wales public hospital. Subjects: Maternity consumers, 50 women who were inpatients receiving antenatal or postnatal care between August and October 1998. A stratified sample of healthcare professionals employed by the service, 12 midwives and 13 general practitioners. Main outcome measure: The self reported use of the antenatal card and the viewed effects of the card on the continuity of healthcare received. Results: The study identified a significant difference between the responding professionals (93%) positive perception of the effect of the PNC2 on the women's pregnancy continuum of care and the maternity consumer (36%), who felt it bore little impact on their care. The study findings suggested a lack of compliance and standardisation in usage of the antenatal card negated any flow on effects for the women. Conclusions: The intended purposes of the PNC2 were compromised in this rural setting. The study recommends that stakeholders in rural maternity care be accountable for examining the benefits and barriers of their antenatal practices, that the rural community's expectations of ,continuity of maternity care' are sought and that there should be a review of the available models of rural antenatal care. [source] | |||||||||||||||||||||||||||||||