A grounded theory study on midwifery managers’ views and experiences of implementing and sustaining continuity of carer models within the UK maternity system

BackgroundCurrent UK health policy recommends the transition of maternity services towards provision of Midwifery Continuity of Carer (MCoCer) models. Quality of healthcare is correlated with the quality of leadership and management yet there is little evidence available to identify what is required from midwifery managers when implementing and sustaining MCoCer.AimTo develop a theoretical framework that represents midwifery managers’ experiences of implementing and sustaining MCoCer models within the UK’s National Health Service (NHS).MethodsCharmaz’s grounded theory approach was used for this study. Five experienced UK based midwifery managers were interviewed to elicit views and understanding of the social processes underlying the implementation and sustaining of MCoCer. Interviews were transcribed and analysed and focus codes developed into theoretical codes resulting in an emergent core category.FindingsThe theoretical framework illustrates the core category ‘Leading Meaningful Midwifery’. To manage MCoCer models midwifery managers require a trust and belief in woman centred philosophy of care. They need the skills to focus on non-hierarchical transformational leadership and the courage to assimilate alternative models of care into the NHS. Promoting and protecting the MCoCer model within current services is essential whilst forming a culture based on high quality, safe MCoCer.DiscussionMCoCer models that have sustained within the NHS have had supportive leadership from midwifery managers who have the necessary skills, attitudes, aptitudes and behaviours identified within the findings. Sustainable implementation of MCoCer is achieved through development of a values-based recruitment and retention policy within all areas of midwifery and encouraging midwives with previous experience in MCoCer or supportive philosophies towards it, to manage the model.ConclusionProviding the appropriate support for MCoCer is time consuming and personally demanding for midwifery managers, however, implementing and sustaining MCoCer was shown by participants who valued MCoCer models to be rewarding, bringing meaning to their midwifery leadership.     

Development and Gendered Mobilities: Narratives from the Women of Mardin,Turkey

Abstract

This paper addresses gendered mobilities in Mardin in the context of the implications of transport investments for the female labour market. I seek to illustrate that the relationship between infrastructure provision and gendered mobilities is entangled in a wider context which encompasses politics and cultural geographies. Drawing on theories of mobilities, I argue that a lack of understanding of the complementary and contradictory impacts of local context and physical infrastructure investments may undermine social and cultural conditions within communities, resulting in misguided development policies.     

A qualitative study of innovations implemented to improve transition of care from maternity to child and family health (CFH) services in Australia

BackgroundThe transition of care (ToC) from maternity services, particularly from midwifery care to child and family health (CFH) nursing services, is a critical time in the support of women as they transition into early parenting. However significant issues in service provision exist, particularly meeting the needs of women with social and emotional health risk factors. These include insufficient resources, poor communication and information transfer, limited interface between private and public health systems and tension around role boundaries. In response some services are implementing strategies to improve the transition of care from maternity to CFH services.AimThis paper describes a range of innovations developed to improve transition of care between maternity and child and family health services and identifies the characteristics common to all innovations.MethodsData reported were collected in phase three of a mixed methods study investigating the feasibility of implementing a national approach to child and family health services in Australia (CHoRUS study). Data were collected from 33 professionals including midwives, child and family health nurses, allied health staff and managers, at seven sites across four Australian states. Data were analysed thematically, guided by Braun and Clarke's six-step process of thematic analysis.FindingsThe range of innovations implemented included those which addressed; information sharing, the efficient use of funding and resources, development of new roles to improve co-ordination of care, the co-location of services and working together. Four of the seven sites implemented innovations that specifically targeted families with additional needs. Successful implementation was dependent on the preliminary work undertaken which required professionals and/or organisations to work collaboratively.ConclusionImproving the transition of care requires co-ordination and collaboration to ensure families are adequately supported. Collaboration between professionals and services facilitated innovative practice and was core to successful change.     

The political mobilities of reporting: tethering,slickness and asylum control

ABSTRACT

This paper focuses on the coerced mobilities associated with reporting, meaning the mandatory requirement to regularly check-in with authorities for the purpose of control. Drawing on recent calls for a politics of mobility and advances in carceral geographies, we attend to the forces, movements, speeds and affective materialities of reporting with a focus on deportable migrants and the UK Home Office. In doing so we develop two conceptual lenses through which to further understand the politics of mobility. First, we develop the concept of ‘slickness’ in the context of the process of becoming detained at a reporting event. We understand slickness as a property of bodies and objects that makes them easier to move. Second, we argue that reporting functions to ‘tether’ deportable migrants; thereby not only fixing them in place, but also forcing the expenditure of energy and the experience of punishment. The result is that reporting blurs the distinction between detention and ‘freedom’ by enacting the carceral in everyday spaces.     

Radio: a strategic tool for development

Every country should recognize the need to fully involve media leaders in the planning and implementation of population and family planning programs. Broadcasters are the best equipped to understand the "mind-set" of the mass audience and what is needed to bring about changes therein. If there is to be involvement of the media, particularly radio professionals, in the design, development and implementation of population and family planning programs, attention must be given to the inmplications of this in terms of implementing the World Population Plan of Action. Strategies for population communication using radio as the central medium include the following: 1) development of an adequate in-country support structure; 2) development of a sound, well-researched population communication program; 3) on-air programming in the form of instruction rather than entertainment; 4) provision for substantial and continuous feedback from the audience; 5) frequent broadcasts at a prime time of day; and 6) a program commitment of from 5 to 6 years. Radio needs to be recognized as a strategic tool for development; it should be used professionally and should receive sufficient priority by funding agencies.     

Co-designing preconception and pregnancy care for healthy maternal lifestyles and obesity prevention

ProblemA recognised gap exists between current and recommended practices in the provision of lifestyle advice and weight management support for women across preconception and pregnancy care.BackgroundPreconception and pregnancy are critical stages for promoting healthy maternal lifestyles and obesity prevention. Co-design is a novel approach with the potential to strengthen existing models of care to facilitate the implementation of clinical practice guidelines promoting preconception and pregnancy health, especially in relation to preconception weight management and preventing excessive gestational weight gain.Aim and methodsThe aims of this discussion paper are to (i) define co-design in the context of preconception and pregnancy care, (ii) outline key considerations when planning co-design initiatives and (iii) describe co-design opportunities in preconception and pregnancy care for promoting women’s health and obesity prevention.DiscussionWhile several definitions of co-design exist, one critical element is the meaningful involvement of all key stakeholders. In this discussion, we specifically identified the involvement of women and expanding the role of practice nurses in primary care may assist to overcome barriers to the provision of healthy lifestyle advice and support for women during preconception. Co-designing pregnancy care will involve input from women, nurses, midwives, obstetricians, allied health and administration and management staff. Additional attention is required to co-design care for women considered most at-risk.ConclusionThere is potential to enhance current provision of preconception and pregnancy care using co-design. Nursing and midwifery professions are active across both preconception and pregnancy and therefore, they have an important role to play.     

Resistance and acceptance: Ambivalent attitudes toward the aging body and antiaging practices among older Korean migrants living in New Zealand

ABSTRACT

Using intersectionality as a conceptual framework, this study investigated how older Korean women living in New Zealand perceived their aging bodies, antiaging practices and/or products, and how they used such products. Thematic analysis identified three themes: tension between acceptance of the aging body as an inevitable process and transformation of the aging body into a healthy body, juggling between abstinence and use of antiaging products and practices, and redefining natural aging. The findings challenge binary interpretations between “acceptance” of and “resistance” to the experiences of the aging process and the use of antiaging practices.     

Midwives’ role in the provision of maternal and childhood immunisation information

ProblemInactivated influenza vaccine and diphtheria-tetanus acellular pertussis vaccine are routinely recommended during pregnancy to protect women and their babies from infection. Additionally, the hepatitis B vaccine is recommended for infants within the first week of life; however, little is known about midwives’ experiences of recommending and delivering these immunisations.BackgroundMidwives are a trusted source of vaccine information for parents and the confident provision of information about immunisation during antenatal clinic visits has been found to increase the uptake of antenatal and childhood vaccines.AimThis study aims to explore midwives’ experiences of discussing maternal and childhood immunisation with women and their partners and their confidence in answering parent’s questions.MethodsWe conducted 23 semi-structured interviews with registered Australian midwives working in public and private hospital settings, and in private practice.FindingsMidwives find negotiating the requirement to recommend immunisation within a women-centred framework challenging at times. The vast majority of midwives described their education on immunisation as inadequate and workplace issues, such as time pressure, were identified as further barriers to effective communication about immunisation.Discussion/conclusionThe provision of immunisation training within midwifery education and continued professional development is critical. Appropriately resourcing midwives with the necessary infrastructure, education and resources to fully inform parents about immunisation may have a positive impact on vaccine uptake.     

New Zealand maternity and midwifery services and the COVID-19 response: A systematic scoping review

ProblemCOVID-19 guidance from professional and health organisations created uncertainty leading to professional and personal stress impacting on midwives providing continuity of care in New Zealand (NZ). The COVID-19 pandemic resulted in massive amounts of international and national information and guidance. This guidance was often conflicting and not suited to New Zealand midwifery.AimTo examine and map the national and international guidance and information provided to midwifery regarding COVID-19 and foreground learnt lessons for future similar crises.MethodsA systematic scoping review informed by Arksey and O’Malley’s five-stage framework. A range of sources from grey and empirical literature was identified and 257 sources included.FindingsFour categories were identified and discussed: (1) guidance for provision of maternity care in the community; (2) guidance for provision of primary labour and birth care; (3) Guidance for midwifery care to women/wāhine with confirmed/suspected COVID-19 infection, including screening processes and management of neonates of infected women/wāhine (4) Guidance for midwives on protecting self and own families and whānau (extended family) from COVID-19 exposure.ConclusionGuidance was mainly targeted and tailored for hospital-based services. This was at odds with the NZ context, where primary continuity of care underpins practice. It is evident that those providing continuity of care constantly needed to navigate an evolving situation to mitigate interruptions and restrictions to midwifery care, often without fully knowing the personal risk to themselves and their own families. A key message is the need for a single source of evidence-based guidance, regularly updated and timestamped to show where advice changes over time.     

Experiencing menopause in the UK: The interrelated narratives of normality,distress, and transformation

ABSTRACT

We investigated the experience and perspectives of menopause among 48 UK mothers through qualitative in-depth interviews. Interviews were analyzed thematically then explored using social science theories. Three interdependent narratives emerged: menopause as a normal, biological process, distinct from self and social transitions; menopause as struggle, an “idiom of distress” expressing upset, identity loss, shame, and social upheaval; and menopause as transformative and liberating, arising from biopsychic and relational changes. Some women followed a predictable “rite of passage” trajectory with transformation emerging from distress, but not all: Menopause arises from a complex interplay of personal predicament, somatic change, and sociocultural context.     

Digital voice recorders – A conceptual intervention to facilitate contemporaneous record keeping in midwifery practice

BackgroundThe first responder, faced with any obstetric incident, frequently finds themselves within a dichotomy of multi-tasking activities. One challenge for the midwife, is to keep accurate and contemporaneous medical records, whilst simultaneously providing immediate clinical care.AimThis paper aims to propose an innovative conceptualisation and a practical solution for maternity services, which strive to uphold best practice in creating contemporaneous and accurate medical records. The feasibility of introducing the use of voice recorders within maternity services will be explored, and offered as a mechanism to facilitate record keeping and simultaneous clinical care.MethodsA synthesised narrative review of the literature is conducted. This review academically tests the conceptual hypothesis that the implementation of voice recorders within maternity services may augment the midwife's ability to generate contemporaneous medical records. A background literature review will also explore the key drivers for this particular innovation, and the challenges facing healthcare leaders in service improvement.FindingsThis paper builds upon previous suggestions that digital voice recorders may be an effective solution to enhance overall obstetric outcomes, and focuses upon conceptual processes for implementation.ConclusionsThis paper offers the principal conclusion that the integration of voice recorders into midwifery practice for the purpose of supporting contemporaneous record keeping may be feasible within the current healthcare climate.     

The feasibility of caseload midwifery in rural Australia: A literature review

BackgroundCaseload midwifery is a continuity of care(r) model being implemented in an increasing number of Australian maternity settings. Question for review: is caseload midwifery a feasible model for introducing into the rural Australian context?MethodIntegrative literature review.FindingsFour main categories were identified and these include the evidence for caseload midwifery; applicability to the rural context; experiences of registered and student midwives and implementation of caseload midwifery models.ConclusionThere is evidence to support caseload midwifery and its implementation in the rural setting. However, literature to date is limited by small participant size and possible selection bias. Further research, including rural midwives’ expectations and experience of caseload midwifery may lead to improved sustainability of midwifery care for rural Australian women.     

‘Home is Never Fully Achieved … Even When We Are In it’: Migration,Belonging and Social Exclusion within Punjabi Transnational Mobility

ABSTRACT

Drawing upon transnational research in the UK and India, primarily over 150 semi-structured interviews in Newcastle, UK and Doaba, Punjab, as well as the ‘mobilities turn’ within contemporary social science, this paper examines the pursuit of ‘home’ within a diasporic British Indian Punjabi community. It is argued that this transnational pursuit of home is significantly shaped by the dynamic social context of South Asia, in particular processes of social inclusion and exclusion therein. Thus, returning Punjabi migrant attempts to distinguish themselves from the resident population through conspicuous consumption, and simultaneous attempts from Punjabi residents to exclude Non-Resident Indians from ‘real’ Indian status, lead to a continual reprocessing of home across different sites of mobility, as well as demonstrating the ‘never fully achieved’ nature of home.     

Professional responses to post bureaucratic hospital reforms and their impact on care provision

BackgroundPost bureaucracy is increasingly shaping how health care professionals work. Within hospital settings, post bureaucracy is frequently connected to loss of professional autonomy and protocol-based care. However, this development also affects relationships between care providers and care receivers.QuestionTo explore experiences of post bureaucratic hospital reforms and their impact on care provision.MethodData builds on nine mini group interviews with midwives (n = three), nurses (n = three) and physiotherapists (n = three), in all thirty participants. Data was analysed using existing theories of professionalism and post bureaucracy.FindingsTwo overarching themes were identified: ‘Time, tasks and institutional duties’ which referred to transformations in care practices, increased use of screening procedures, efficiency requirements and matching linear time to the psychosocial needs of patients. ‘Managerial control of work’ which described rising administrative demands, engaging in protective measures, younger professionals pressured by documentation obligations and fear of disciplinary procedures.ConclusionThe institutional context appears to play a key role shaping care practices. Although midwives, nurses and physiotherapists share similar experiences of post bureaucratic hospital reforms, changes in care provision can impact these professions in different ways. As a discipline, midwifery is founded on relationships between women and midwives. Standardised clinical care, performativity demands, litigation risks and rising administrative obligations are liable to challenge the provision of woman centred care. These changes may also result in increased inequity in maternity care by affecting some groups of women more than others.     

Optimising the continuity experiences of student midwives: an integrative review

BackgroundIn several countries, midwifery students undertake continuity of care experiences as part of their pre-registration education. This is thought to enable the development of a woman-centred approach, as well as providing students with the skills to work in continuity models. A comprehensive overview of factors that may promote optimal learning within continuity experiences is lacking.AimTo identify barriers and facilitators to optimal learning within continuity experiences, in order to provide a holistic overview of factors that may impact on, modify and determine learning within this educational model.MethodsAn integrative literature review was undertaken using a five-step framework which established the search strategy, screening and eligibility assessment, and data evaluation processes. Quality of included literature was critically appraised and extracted data were analysed thematically.FindingsThree key themes were identified. A central theme was relationships, which are instrumental in learning within continuity experiences. Conflict or coherence represents the different models of care in which the continuity experience is situated, which may conflict with or cohere to the intentions of this educational model. The final theme is setting the standards, which emerged from the lack of evidence and guidance to inform the implementation of student placements within continuity experiences.ConclusionThe learning from continuity experiences must be optimised to prepare students to be confident, competent and enthusiastic to work in continuity models, ultimately at the point of graduation. This will require an evidence-based approach to inform clear guidance around the intent, implementation, documentation and assessment of continuity experiences.     

Security and Belonging: Reconceptualising Aboriginal Spatial Mobilities in Yamatji Country,Western Australia

Abstract

Since British colonisation of Australia began, Aboriginal mobility practices have been poorly understood within the Anglo‐Australian consciousnesses. This paper examines current discourses and conceptualisations of Aboriginal mobilities in Yamatji country, Western Australia. Finding none of these explanations and interpretations singularly sufficient to encompass the diverse spatial practices of Aboriginal people in the region, the paper proposes an alternative framework for interpreting and understanding these population dynamics. The central tenet of this reconceptualisation is that contemporary Aboriginal spatialities – including spatial distribution, movements, and immobility – are iteratively shaped by the processes of procuring, contesting, and cultivating security and belonging. In a conscious shift away from generalised and pejorative interpretations of Aboriginal mobility, this more holistic framework considers historical and geographical context, cultural identity, and individual aspirations.