Family planning practice and women's fertility decision-making power

This paper investigates the effects of family planning practice on fertility decision-making power in South Korea. The log-linear analysis of the 1981 survey data by the Institute of Population and Health Services Research, Yonsei University, Seoul, Korea, shows that those urban and rural women who practice family planning or have experienced abortion exercise greater influence on a couple's fertility decision making than those who do not practice family planning or who have had no abortion experience. In addition, there is the interactive effect of abortion experience and contraceptive use on fertility decision making among urban women. This finding is significant because regardless of how birth control is available within a society, birth control use enhances women's decision making power where fertility is concerned.     

The influence of the birthplace and models of care on midwifery practice for the management of women in labour

This paper will examine how the settings in which midwives practice (the birthplace) and models of care affect midwives’ decision making during the management of labour. One-hundred-and-four independent, team and hospital based midwives and 100 low obstetric risk nulliparous women to whom labour care was provided were surveyed. These midwives and women resided in the Auckland metropolitan area of New Zealand. The majority of midwives who participated worked in models of care which provided women with continuity of carer and care, however, this was not found to influence the way the midwives provided labour care. Instead, practice was found to be relatively homogenous regardless of whether the midwives worked in independent, team, or hospital-based practice. The birthplace setting in which the labour care took place did influence midwifery practice. The majority of midwives provided labour care in large obstetric hospitals and identified practices dominated by the medical model of care. Practice was described as being influenced by intervention and the need for technology, however, this did not prevent the majority of women from perceiving they were actively involved in the decision making process and that they worked in partnership with their midwives. Closer examination of the midwives’ decision making processes whilst providing the labour care revealed that the midwives’ individual decisions were influenced by the needs of the women rather than the hospital protocols. What became evident was that the midwives in this study had adopted a humanistic approach to care whereby technology was used alongside relationship-centred care.     

Assisting women to make informed choices about screening for Group B Streptococcus in pregnancy: A critical review of the evidence

The approach to the prevention of early onset GBS disease in the newborn varies considerably from country to country. The Centre for Disease Control in the United States advocates universal culture based screening with the administration of intra-partum antibiotics, usually benzylpenicillin or ampicillin, to women who are colonised with GBS. National groups in the UK and New Zealand advocate a risk-based approach where intra-partum antibiotics are given to women with identified risk factors. The Canadian Taskforce on preventive health care has identified a third approach; where intra-partum antibiotics are given to women with a positive GBS culture and an identified risk factor. There are no national guidelines or consensus in Australia.The aim of this paper is to explore the evidence for screening and intrapartum prophylaxis for GBS. The three main methods of detection and management of GBS in pregnancy are described and the implications for women and midwifery practice are addressed. It is hoped that this discussion will provide women, midwives and other clinicians with a summary of the evidence, risks and benefits to enable informed decision making.     

Breech presentation management: A critical review of leading clinical practice guidelines

ProblemClinical practice guidelines are designed to guide clinicians and consumers of maternity services in clinical decision making, but recommendations are often consensus based and differ greatly between leading organisations.BackgroundBreech birth is a divisive clinical issue, however vaginal breech births continue to occur despite a globally high caesarean section rate for breech presenting fetuses. Inconsistencies are known to exist between clinical practice guidelines relating to the management of breech presentation.AimThe aim of this review was to critically evaluate and compare leading obstetric clinical practice guidelines related to the management of breech presenting fetuses.MethodsLeading obstetric guidelines were purposively obtained for review. Analysis was conducted using the International Centre for Allied Health Evidence (iCAHE) Guideline Quality Checklist and reviewing the content of each guideline.FindingsAntenatal care recommendations and indications for Caesarean Section were relatively consistent between clinical guidelines. However, several inconsistencies were found among the other recommendations in terms of birth mode counselling, intrapartum management and the basis for recommendations.DiscussionInconsistencies noted in the clinical practice guidelines have the potential to cause issues related to valid consent and create confusion among clinicians and maternity consumers.ConclusionClinical practice guidelines, which focus on the risks of a Vaginal Breech Birth without also discussing the risks of a Caesarean Section when a breech presentation is diagnosed, has the potential to sway clinician attitudes and impact birth mode decision-making in maternity consumers. To respect pregnant women’s autonomy and fulfil the legal requirements of consent, clinicians should provide balanced counselling.     

Induction of labour: Experiences of care and decision-making of women and clinicians

BackgroundThere has been a rise in induction of labour over recent decades. There is some tension in the literature in relation to when induction is warranted and when not, with variability between guidelines and practice. Given these tensions, the importance of shared decision-making between clinicians and women is increasingly highlighted as paramount, but it remains unclear to what extent this occurs in routine care.MethodUsing a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question “What are the views, preferences and experiences of women and clinicians in relation to induction of labour more broadly, and practices of decision-making specifically?” To identify studies, the databases PubMed, Maternity and Infant Care, CINAHL and EMBASE were searched from 2008 to 2018, and reference lists of included studies were examined.Findings20 papers met inclusion criteria, in relation to (a) women’s preferences, experiences and satisfaction with IOL; (b) women’s experience of shared-decision making in relation to induction; (c) interventions that improve shared decision-making and (d) factors that influence decision-making from the perspective of clinicians. Synthesis of the included studies indicates that decision-making in relation to induction of labour is largely informed by medical considerations. Women are not routinely engaged in the decision making process with expectations and preferences largely unmet.ConclusionThere is a need to develop strategies such as decision aids, the redesign of antenatal classes, and clinician communication training to improve the quality of information available to women and their capacity for informed decision-making.     

Vaginal births after caesarean: What does Google think about it?

AimVaginal birth after caesarean (VBAC) is a relatively safe alternative to repeat caesarean birth in the proper context. This important decision to undergo an elective caesarean versus VBAC is ultimately a decision of the mother. The purpose of our study was to assess the quality of online information in relation to VBAC collected using the most common search engine: Google.MethodsThe 10 most common hit sites for the keywords “VBAC” and “Vaginal birth after caesarean” were evaluated using the search engine Google. The quality of websites was rated based on the Silberg scale for accountability, the modified Abbott's criteria for presentation and the SMOG index for readability. The content of each website was compared to the Society of Obstetricians and Gynecologists of Canada (SOGC) guidelines for VBAC.Findings13 out of 20 identified websites met the adequate criteria for accountability, with 85% of the websites indicating authorship. 11 websites were deemed aesthetically agreeable. The target audience, assessed by the readability score, was notably above the non-medical population with an average SMOG index score of 14.75. Only half of the websites contained recommendations, as detailed by the SOGC guidelines.ConclusionAlmost all sites target a higher academic level, making it beyond the comprehension of the general population. Woman friendly web-assessment tools should be provided to enable pregnant women to take an active role in their decision making.     

Using a pregnancy decision support program for women choosing birth after a previous caesarean in Japan: A mixed methods study

Background

Opportunities for women and providers to use decision aids and share decisions about birth after caesarean in practice are currently limited in Japan. This is despite known benefits of decision aids to support value-sensitive healthcare decisions.

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.     

Midwifery Job Autonomy in New Zealand: I do it all the time

IntroductionThis research aimed to identify what supports and what hinders job autonomy for midwives in New Zealand.MethodsRegistered midwives participated in an open-ended, online survey in 2019. Anonymised participants were asked to describe an incident when they felt they were using their professional judgement and/or initiative to make decisions and the resultant actions. The data was analysed thematically.FindingsThe participants identified that autonomy is embedded within midwifery practice in New Zealand. Self-employed midwives who provide continuity of care as Lead Maternity Carers, identified they practice autonomously ‘all the time’. The relationship with women and their family, and informed decision making, motivated the midwife to advocate for the woman – regardless of the midwife’s work setting. Midwifery expertise, skills, and knowledge were intrinsic to autonomy. Collegial relationships could support or hinder the midwives’ autonomy while a negative hospital work culture could hinder job autonomy.DiscussionMidwives identified that autonomous practice is embedded in their day to day work. It strengthens and is strengthened by their relationships with the woman/whanau and when their body of knowledge is acknowledged by their colleagues. Job autonomy was described when midwifery decisions were challenged by health professionals in hospital settings and these challenges could be viewed as obstructing job autonomy.ConclusionThe high job autonomy that New Zealand midwives enjoy is supported by their expertise, the women and colleagues that understand and respect their scope of practice. When their autonomy is hindered by institutional culture and professional differences provision of woman-centred care can suffer.     

Seeking and Processing Information for Health Decisions among Elderly Chinese Singaporean Women

Information behavior includes activities of active information seeking, passive acquisition of information, and information use. Guided by the Elaboration Likelihood Model, this study explored elderly Singaporean women’s health information behavior to understand how they sought, evaluated, and used health information in everyday lives. Twenty-two in-depth interviews were conducted with elderly Chinese women aged 61 to 79. Qualitative analysis of the interview data yielded three meta-themes: information-seeking patterns, trustworthiness of health information, and peripheral route of decision making. Results revealed that elderly women took both systematic and heuristic approaches to processing information but relied on interpersonal networks to negotiate health choices.     

Weighing up the risks — Vaccine decision-making in pregnancy and parenting

BackgroundImmunisation is universally accepted as one of the most significant health initiatives in recent times. However, vaccine hesitancy is increasing in Australia and other high- and middle-income countries. There is evidence to suggest that many parents, even those who elect to immunise, may have a degree of vaccine hesitancy. The recommendation of a healthcare professional is a predictor for vaccine uptake.AimThe purpose of this study was to explore the values, beliefs and choices made by vaccine hesitant parents and pregnant women, regarding their decision not to vaccinate their child or children. The aim being to determine the factors that influence this decision making and to give a voice to vaccine hesitant parents.MethodsA qualitative exploratory online survey of 106 vaccine hesitant parents and pregnant women was conducted in 2021. The survey utilised closed and open-ended questions.FindingsPregnant women and parents obtained most of their immunisation education from nurses, midwives, and general practitioners. Vaccine decision-making was however, influenced by multiple factors including vaccine safety concerns, the sources of information accessed, and a previous negative immunisation experience. Other influential factors included the use of alternative therapies, diet, and lifestyle factors.DiscussionAlong with general practitioners, nurses and midwives are a popular, respected and a vital source in the provision of accurate and timely immunisation education. However, further education is required at an undergraduate level to adequately prepare them for their role of listening to and educating vaccine hesitant pregnant women and parents.     

Decision-making in Swiss home-like childbirth: A grounded theory study

Background

Decision-making in midwifery, including a claim for shared decision-making between midwives and women, is of major significance for the health of mother and child. Midwives have little information about how to share decision-making responsibilities with women, especially when complications arise during birth.

Industrialization,family and fertility: A structural-psychological analysis of the Brazilian case

This paper addresses itself to some linkages between macro-social structure (industrialization, social class), social psychological variables (husband-wife decision making), psychological variables (attitudes), and fertility. A total of 726 currently mated women with proven fertility in five Brazilian communities were interviewed to determine various attitudes, their work experience, their participation in family decisions, their fertility ideals, and actual fertility. The five communities were selected along a rural-urban-industrialization continuum to include a village, two non-industrial cities, and two industrial cities (one of which was Sao Paulo). Family size in the industrial cities was small in all social strata, while in the non-industrial cities family size was large in the lower strata and declined in the upper strata. Further analysis revealed that smaller family size is associated with generally higher levels of status among women—higher educational levels, greater social contacts and more skilled employment, and equality in family decision making. Our analysis supports the hypotheses that industrialization influences fertility through shifts in the social status of women, both in their work and at home. New education and work opportunities facilitate the emergence of modern conceptions of the role of women in society and egalitarian decision making in the family. These attitudes and patterns of husband-wife interaction are related to smaller family size ideals and lower fertility.     

Older women public sector workers in Ireland: Decisions about retirement timing

Older women workers’ decision making around retirement is increasingly important given the increasing involvement of older women in paid employment. This article explores influences on the retirement decision making of older women workers in Ireland. It is based on a case study of 57 interviews with women in the Irish civil service exploring work-life decision making. It finds that retirement choices vary according to initial socioeconomic resources and/or life-course trajectories and are particularly affected by gendered caring norms, employment policy, job tenure, and place in organizational hierarchies. Those women with interrupted careers and low pay have fewer choices around retirement timing.     

Cross-National Comparison on Family Satisfaction: Super-Specialization Versus Super-Equality

Research has documented that women still assume the main burden of domestic tasks and childcare within the household, despite the recent changes towards a greater equality. This division of labor has clear implications in satisfaction with family life. However, little research has combined other domestic responsibilities, such as decision making and care of dependent relatives with housework to study satisfaction, from a comparative perspective. In this article, data from the International Social Survey Programme (ISSP)-2012 are used to explore the effects of a proposed index on balance in the couple, for women and men separately, through different multilevel models. The results suggest that the empowerment that could be assumed from a leading role in decision making does not improve satisfaction and that super-equality is the option yielding the highest levels of satisfaction, regardless their hours of paid-work. Differences by countries persist after controlling for individual and contextual variables, with the Latin American countries being those with the most satisfied populations.

     

Worry and Bother: Factors in Rural Women’s Health Decision Making

This exploratory study examined older rural women’s health decision making. Thirty-three rural women were recruited to participate in semistructured qualitative interviews. Major themes emerged that focused on rural women’s comments regarding their concerns about not worrying or bothering their children with personal health matters. Themes were discussed in the context of an ethic of care. Results suggest that it is important for mental health professionals, family physicians, social workers, and other practitioners to be aware of the sense of worry and concern for others that older rural women bring to bear in decision making about personal health issues.     

Obstetric fistula and sociocultural practices in Hausa community of Northern Nigeria

Background

Obstetric Fistula is a childbirth injury that disproportionately affects women in sub-Saharan Africa. Although poverty plays an important role in perpetuating obstetric fistula, sociocultural practices has a significant influence on susceptibility to the condition.

Understanding staff views and experiences of a clinical practice change to reduce stillbirth in South Asian women: A cross-sectional survey

BackgroundIn July 2017, Victoria’s largest maternity service implemented a new clinical practice guideline to reduce the rates of term stillbirth in women of South Asian background.AimTo capture the views and experiences of clinical staff following the implementation of the new clinical guideline.MethodsCross sectional survey of clinical staff providing maternity care in August 2018, 12 months post implementation. Staff were asked to provide their agreement with ten statements assessing: perceived need for the guideline, implementation processes, guideline clarity, and clinical application. Open-ended questions provided opportunities to express concerns and offer suggestions for improvement. The frequency of responses to each question were tabulated. Open ended responses were grouped together to identify themes.FindingsA total of 120 staff completed the survey, most (n = 89, 74%) of whom were midwives. Most staff thought the rationale (n = 95, 79%), the criteria for whom they applied (83%, n = 99), and the procedures and instructions within the guideline were clear (74%, n = 89). Staff reported an increase in workload (72%, n = 86) and expressed concerns related to rationale and evaluation of the guidelines, lack of education for both staff and pregnant South Asian women, increased workload and insufficient resources, patient safety and access to care. Challenges relating to shared decision making and communicating with women whose first language is not English were also identified.DiscussionThis study has identified key barriers to and opportunities for improving implementation and highlighted additional challenges relating to new clinical guidelines which focus on culturally and linguistically diverse women.     

Working in caseload midwifery care: The experience of midwives working in a birth centre in North Queensland

BackgroundPregnancy, birth and child rearing are significant life events for women and their families. The demand for services that are family friendly, women focused, safe and accessible is increasing. These demands and rights of women have led to increased government and consumer interest in continuity of care and the establishment in Australia of birth centres, and the introduction of caseload midwifery models of care.AimThe aim of this research project was to uncover how birth centre midwives working within a caseload model care constructed their midwifery role in order to maintain a positive work–life balance.MethodsA Grounded Theory study using semi-structured individual interviews was undertaken with seven midwives who work at a regional hospital birth centre to ascertain their views as to how they construct their midwifery role while working in a caseload model of care.FindingsThe results showed that caseload midwifery care enabled the midwives to practice autonomously within hospital policies and guidelines for birth centre midwifery practice and that they did not feel too restricted in regards to the eligibility of women who could give birth at the centre. Work relationships were found to be a key component in being able to construct their birth centre midwifery role. The midwives valued the flexibility that came with working in supportive partnerships with many feeling this enabled them to achieve a good work–life balance.ConclusionThe research contributes to the current body of knowledge surrounding working in a caseload model of care as it shows how the birth centre midwives construct their midwifery role. It provides information for development and improvement of these models of care to ensure that sustainability and quality of care is provided to women and their families.     

The overuse of intrapartum cardiotocography (CTG) for low-risk women: An actor-network theory analysis of data from focus groups

BackgroundThere is an overuse of cardiotocography for intrapartum fetal monitoring for low-risk women in high-income countries, despite recommendations from evidence-based guidelines.AimTo understand why midwives use cardiotocography for low-risk women despite evidence-based recommendations and to understand the roles of the cardiotocograph machine.MethodThis qualitative study used focus groups for data collection. Thirty-one midwives and three student midwives participated from four different countries: New Zealand, Australia, Denmark, and Norway. Constant comparative analysis, informed by an actor-network theory framework, was the method of data analysis.FindingsCardiotocography was multifaceted and influenced all attendants in the birth environment. The cardiotocograph itself is assigned different roles within the complex networks surrounding childbirth. The cardiotocograph’s roles were as a babysitter, the midwives’ partner, an agent of shared responsibility, a protector that ‘covers your back’, a disturber of normal birth, and a requested guest.DiscussionThe application of the actor-network theory enabled us to understand how midwives perceive cardiotocography. The assigned roles of the cardiotocograph shape its everyday use more than evidence-based guidelines. Discussion of these inconsistencies must inform the use of cardiotocography in the care of women with low-risk pregnancies.ConclusionWe found that the cardiotocograph is a multifaceted actant that influences practice by performing different roles. Drawing on this study, we suggest that actor-network theory could be a helpful theoretical perspective to critically reflect upon the increasing use of technologies within maternity care.