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Bec Jenkinson Sue Kruske Sue Kildea 《Women and birth : journal of the Australian College of Midwives》2018,31(6):433-441
Background
The right to refuse medical treatment can be contentious in maternity care. Professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy, but there is little guidance available to clinicians about the appropriate clinical responses when women decline recommended care.Objectives
We propose a comprehensive, woman-centred, systems-level framework for documentation and communication with the goal of supporting women, clinicians and health services in situations of maternal refusal. We term this the Personalised Alternative Care and Treatment framework.Discussion
The Personalised Alternative Care and Treatment framework addresses Australian policy, practice, education and professional issues to underpin woman-centred care in the context of maternal refusal. It embeds Respectful Maternity Care in system-level maternity care policy; highlights the woman’s role as decision maker about her maternity care; documents information exchanged with women; creates a ‘living’ plan that respects the woman’s birth intentions and can be reviewed as circumstances change; enables communication between clinicians; permits flexible initiation pathways; provides for professional education for clinicians, and incorporates a mediation role to act as a failsafe.Conclusion
The Personalised Alternative Care and Treatment framework has the potential to meet the needs of women, clinicians and health services when pregnant women decline recommended maternity care. 相似文献3.
Marie-Clare Balaam Gill Thomson 《Women and birth : journal of the Australian College of Midwives》2018,31(5):e341-e347
Problem
The persistence of health inequalities in pregnancy and infancy amongst vulnerable/marginalised groups in the UK.Background
During pregnancy and early motherhood some women experience severe and multiple psychosocial and economic disadvantages that negatively affect their wellbeing and make them at increased risk of poor maternal and infant health outcomes.Aim
To explore vulnerable/marginalised women’s views and experiences of receiving targeted support from a specialist midwifery service and/or a charity.Methods
A mixed-methods study was undertaken that involved analysis of routinely collected birth-related/outcome data and interviews with a sample of vulnerable/marginalised women who had/had not received targeted support from a specialist midwifery service and/or a charity. In this paper we present in-depth insights from the 11 women who had received targeted support.Findings
Four key themes were identified; ‘enabling needs-led care and support’, ‘empowering through knowledge, trust and acceptance’, ‘the value of a supportive presence’ and ‘developing capabilities, motivation and confidence’.Discussion
Support provided by a specialist midwifery service and/or charity improved the maternity and parenting experiences of vulnerable/marginalised women. This was primarily achieved by developing a provider–woman relationship built on mutual trust and understanding and through which needs-led care and support was provided — leading to improved confidence, skills and capacities for positive parenting and health.Conclusion
The collaborative, multiagency, targeted intervention provides a useful model for further research and development. It offers a creative, salutogenic and health promoting approach to provide support for the most vulnerable/marginalised women as they make the journey into parenthood. 相似文献4.
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Susan Crowther Liz Smythe Deb Spence 《Women and birth : journal of the Australian College of Midwives》2018,31(1):e59-e66
Background
Rural midwifery and maternity care is vulnerable due to geographical isolation, staffing recruitment and retention. Highlighting the concerns within rural midwifery is important for safe sustainable service delivery.Method
Hermeneutic phenomenological study undertaken in New Zealand (NZ). 13 participants were recruited in rural regions through snowball technique and interviewed. Transcribed interview data was interpretively analysed. Findings are discussed through the use of philosophical notions and related published literature.Findings
Unsettling mood of anxiety was revealed in two themes (a) ‘Moments of rural practice’ as panicky moments; an emergency moment; the unexpected moment and (b) ‘Feelings of being judged’ as fearing criticism; fear of the unexpected happening to ‘me’ fear of losing my reputation; fear of feeling blamed; fear of being identified.Conclusions
Although the reality of rural maternity can be more challenging due to geographic location than urban areas this need not be a reason to further isolate these communities through negative judgement and decontextualized policy. Fear of what was happening now and something possibly happening in the future were part of the midwives’ reality. The joy and delight of working rurally can become overshadowed by a tide of unsettling and disempowering fears.Implications
Positive images of rural midwifery need dissemination. It is essential that rural midwives and their communities are heard at all levels if their vulnerability is to be lessened and sustainable safe rural communities strengthened. 相似文献6.
Hlengiwe Mohale Linda Sweet Kristen Graham 《Women and birth : journal of the Australian College of Midwives》2017,30(4):298-307
Background
Increasing global migration is resulting in a culturally diverse population in the receiving countries. In Australia, it is estimated that at least four thousand Sub-Saharan African women give birth each year. To respond appropriately to the needs of these women, it is important to understand their experiences of maternity care.Objective
The study aimed to examine the maternity experiences of Sub-Saharan African women who had given birth in both Sub-Saharan Africa and in Australia.Design
Using a qualitative approach, 14 semi-structured interviews with Sub-Saharan African women now living in Australia were conducted. Data was analysed using Braun and Clark’s approach to thematic analysis.Findings
Four themes were identified; access to services including health education; birth environment and support; pain management; and perceptions of care. The participants experienced issues with access to maternity care whether they were located in Sub-Saharan Africa or Australia. The study draws on an existing conceptual framework on access to care to discuss the findings on how these women experienced maternity care.Conclusion
The study provides an understanding of Sub-Saharan African women’s experiences of maternity care across countries. The findings indicate that these women have maternity health needs shaped by their sociocultural norms and beliefs related to pregnancy and childbirth. It is therefore arguable that enhancing maternity care can be achieved by improving women’s health literacy through health education, having an affordable health care system, providing respectful and high quality midwifery care, using effective communication, and showing cultural sensitivity including family support for labouring women. 相似文献7.
Sandra Healy Eileen Humphreys Catriona Kennedy 《Women and birth : journal of the Australian College of Midwives》2017,30(5):367-375
Background
Maternity care is facing increasing intervention and iatrogenic morbidity rates. This can be attributed, in part, to higher-risk maternity populations, but also to a risk culture in which birth is increasingly seen as abnormal. Technology and intervention are used to prevent perceived implication in adverse outcomes and litigation.Question
Does midwives’ and obstetricians’ perception of risk affect care practices for normal birth and low-risk women in labour, taking into account different settings?Methods
The research methods are developed within a qualitative framework. Data were collected using semi-structured interviews and analysed thematically. A purposive sample of 25 midwives and obstetricians were recruited from three maternity settings in Ireland. This included obstetric-led hospitals, an alongside midwifery-led unit and the community.Findings
Midwifery is assuming a peripheral position with regard to normal birth as a progressive culture of risk and medicalisation affects the provision of maternity care. This is revealed in four themes; (1) professional autonomy and hierarchy in maternity care; (2) midwifery-led care as an undervalued and unsupported aspiration; (3) a shift in focus from striving for normality to risk management; and (4) viewing pregnancy through a ‘risk-lens’.Discussion
Factors connected to the increased medicalisation of birth contribute to the lack of midwifery responsibility for low-risk women and normal birth. Midwives are resigned to the current situation and as a profession are reluctant to take action.Conclusion
Improved models of care, distinct from medical jurisdiction, are required. Midwives must take responsibility for leading change as their professional identity is in jeopardy. 相似文献8.
Emma L. Kingwell Janice Butt Gavin Leslie 《Women and birth : journal of the Australian College of Midwives》2017,30(2):e73-e77
Background
Maternity high-dependency care has emerged throughout the 21st century in Australian maternity hospitals as a distinct sub-speciality of maternity care. However, what the care involves, how and why it should be provided, and the role of midwives in the provision of such care remains highly variable.Introduction
Rising levels of maternal morbidity from non-obstetric causes have led midwives to work with women who require highly complex care, beyond the standard customary midwifery role. Whilst the nursing profession has developed and refined its expertise as a specialty in the field of high-dependency care, the midwifery profession has been less likely to pursue this as a specific area of practice.Discussion
This paper explores the literature surrounding maternity high-dependency care. From the articles reviewed, four key themes emerge which include; the need for maternity high-dependency care, maternal morbidity and maternity high-dependency care, the role of the midwife and maternity high-dependency care and midwifery education and preparation for practice. It highlights the challenges that health services are faced with in order to provide maternity high-dependency care to women. Some of these challenges include resourcing and budgeting limitations, availability of educators with the expertise to train staff, and the availability of suitably trained staff to care for the women when required.Conclusion
In order to provide maternity high-dependency care, midwives need to be suitably equipped with the knowledge and skills required to do so. 相似文献9.
Zoe Bradfield Ravani Duggan Yvonne Hauck Michelle Kelly 《Women and birth : journal of the Australian College of Midwives》2018,31(2):143-152
Background
Midwives being ‘with woman’ is embedded in professional philosophy, standards of practice and partnerships with women. In light of the centrality of being ‘with woman’ to the profession of midwifery, it is timely to review the literature to gain a contemporary understanding of this phenomenon.Aim
This review synthesises research and theoretical literature to report on what is known and published about being ‘with woman’.Methods
A five step framework for conducting an integrative literature reviews was employed. A comprehensive search strategy was utilised that incorporated exploration in electronic databases CINAHL, Scopus, Proquest, Science Direct and Pubmed. The initial search resulted in the retrieval of 2057 publications which were reduced to 32 through a systematic process.Findings
The outcome of the review revealed three global themes and corresponding subthemes that encompassed ‘with woman’: (1) philosophy, incorporated two subthemes relating to midwifery philosophy and philosophy and models of care; (2) relationship, that included the relationship with women and the relationship with partners; and (3) practice, that captured midwifery presence, care across the childbirth continuum and practice that empowers women.Conclusion
Research and theoretical sources support the concept that being ‘with woman’ is a fundamental construct of midwifery practice as evident within the profession’s philosophy. Findings suggest that the concept of midwives being ‘with woman’ is a dynamic and developing construct. The philosophy of being ‘with woman’ acts as an anchoring force to guide, inform and identify midwifery practice in the context of the rapidly changing modern maternity care landscapes. Gaps in knowledge and recommendations for further research are made. 相似文献10.
Magdalena Ohaja Jo Murphy-Lawless 《Women and birth : journal of the Australian College of Midwives》2017,30(4):e165-e171
Background
Despite the promotion of hospital-based maternity care as the safest option, for less developed countries, many women particularly those in the rural areas continue to patronise indigenous midwives or traditional birth attendants. Little is known about traditional birth attendants’ perspectives regarding their pregnancy and birth practices.Aim
To explore traditional birth attendants’ discourses of their pregnancy and birthing practices in southeast Nigeria.Method
Hermeneutic phenomenology guided by poststructural feminism was the methodological approach. Individual face to face semi-structured interviews were conducted with five traditional birth attendants following consent.Findings
Participants’ narratives of their pregnancy and birth practices are organised into two main themes namely: ‘knowing differently,’ and ‘making a difference.’ Their responses demonstrate evidence of expertise in sustaining normal birth, safe practice including hygiene, identifying deviation from the normal, willingness to refer women to hospital when required, and appropriate use of both traditional and western medicines. Inexpensive, culturally sensitive, and compassionate care were the attributes that differentiate traditional birth attendants’ services from hospital-based maternity care.Conclusion
The participants provided a counter-narrative to the official position in Nigeria about the space they occupy. They responded in ways that depict them as committed champions of normal birth with ability to offer comprehensive care in accordance with the individual needs of women, and respect for cultural norms. Professional midwives are therefore challenged to review their ways of practice. Emphasis should be placed on what formal healthcare providers and traditional birth attendants can learn from each other. 相似文献11.
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Sophie D. Hickey Sarah-Jade Maidment Kayla M. Heinemann Yvette L. Roe Sue V. Kildea 《Women and birth : journal of the Australian College of Midwives》2018,31(4):263-268
Problem
There is increasing demand for capacity building among the Aboriginal and Torres Strait Islander (Indigenous) maternal and infant health workforce to improve health outcomes for mothers and babies; yet few studies describe the steps taken to mentor novice Indigenous researchers to contribute to creating a quality evidence-base in this space.Background
The Indigenous Birthing in an Urban Setting study is a partnership project aimed at improving maternity services for Indigenous families in South East Queensland.Aim
To describe our experience setting up a Participatory Action Research team to mentor two young Indigenous women as research assistants on the Indigenous Birthing in an Urban Setting study.Methods
Case study reflecting on the first six months.Findings
Participatory Action Research was a very effective method to actively mentor and engage all team members in reflective, collaborative research practice, resulting in positive changes for the maternity care service. The research assistants describe learning to conduct interviews and infant assessments, as well as gaining confidence to build rapport with families in the study. Reflecting on the stories shared by the women participating in the study has opened up a whole new world and interest in studying midwifery and child health after learning the difficulties and strengths of families during pregnancy and beyond.Discussion
We encourage others to use Participatory Action Research to enable capacity building in the Aboriginal and Torres Strait Islander midwifery workforce and in health research more broadly. 相似文献13.
A. Rota L. Antolini E. Colciago A. Nespoli S.E. Borrelli S. Fumagalli 《Women and birth : journal of the Australian College of Midwives》2018,31(4):313-318
Background
Hospitalization of women in latent labour often leads to a cascade of unnecessary intrapartum interventions, to avoid potential disadvantages the recommendation should be to stay at home to improve women’s experience and perinatal outcomes.Aim
The primary aim of this study was to investigate the association between hospital admission diagnosis (latent vs active phase) and mode of birth. The secondary aim was to explore the relationship between hospital admission diagnosis, intrapartum intervention rates and maternal/neonatal outcomes.Methods
A correlational study was conducted in a large Italian maternity hospital. Data from January 2013 to December 2014 were collected from the hospital electronic records. 1.446 records of low risk women were selected. These were dichotomized into two groups based on admission diagnosis: ‘latent phase’ or ‘active phase’ of labour.Findings
52.7% of women were admitted in active labour and 47.3% in the latent phase. Women in the latent phase group were more likely to experience a caesarean section or an instrumental birth, artificial rupture of membranes, oxytocin augmentation and epidural analgesia. Admission in the latent phase was associated with higher intrapartum interventions, which were statistically correlated to the mode of birth.Conclusions
Women admitted in the latent phase were more likely to experience intrapartum interventions, which increase the probability of caesarean section. Maternity services should be organized around women and families needs, providing early labour support, to enable women to feel reassured facilitating their admission in labour to avoid the cascade of intrapartum interventions which increases the risk of caesarean section. 相似文献14.
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Clemence Due Kate Obst Damien W. Riggs Catherine Collins 《Women and birth : journal of the Australian College of Midwives》2018,31(4):331-338
Background
Despite increased awareness of the psychological impact of pregnancy loss, a lack of recognition continues with regards to women’s experiences. Healthcare professionals have an important role to play in supporting women following a pregnancy loss, yet to date only a relatively small body of research has examined women’s experiences with healthcare providers.Aim
This paper seeks to contribute to the literature on women’s engagement with healthcare professionals by exploring the experiences of an Australian sample.Method
Fifteen heterosexual women living in South Australia were interviewed about their experiences of pregnancy loss. A thematic analysis was undertaken, focused on responses to one interview question that explored experiences with healthcare professionals.Findings
Three themes were identified. The first theme involved negative experiences with healthcare providers, and included four subthemes: (1) ‘confusing and inappropriate language and communication’, (2) ‘the hospital environment’, (3) ‘lack of emotional care’, and (4) ‘lack of follow-up care’. Under the second theme of positive experiences, the sub-themes of (1) ‘emotionally-engaged and present individual staff’, and (2) ‘the healthcare system as a whole’ were identified. Finally, a third theme was identified, which focused holistically on the importance of healthcare professionals.Conclusion
The paper concludes by discussing the importance of training for healthcare professionals in supporting women who experience a pregnancy loss, and the need for further research to explore the experiences of other groups of people affected by pregnancy loss. 相似文献16.
Carolyn M. Bailey Jennifer M. Newton Helen G. Hall 《Women and birth : journal of the Australian College of Midwives》2018,31(5):414-421
Background
Midwives use telephone triage to provide advice and support to childbearing women, and to manage access to maternity services. Telephone triage practises are important in the provision of accurate, timely and appropriate health care. Despite this, there has been very little research investigating this area of midwifery practice.Aim
To explore midwives and telephone triage practises; and to discuss the relevant findings for midwives managing telephone calls from women.Methods
A five-stage process for conducting scoping reviews was employed. Searches of relevant databases as well as grey literature, and reference lists from included studies were carried out.Findings
A total of 11 publications were included. Thematic analysis was used to identify key concepts. We grouped these key concepts into four emergent themes: purpose of telephone triage, expectations of the midwife, challenges of telephone triage, and achieving quality in telephone triage.Discussion
Telephone triage from a midwifery perspective is a complex multi-faceted process influenced by many internal and external factors. Midwives face many challenges when balancing the needs of the woman, the health service, and their own workloads. Primary research in this area of practice is limited.Conclusion
Further research to explore midwives’ perceptions of their role, investigate processes and tools midwives use, evaluate training programs, and examine outcomes of women triaged is needed. 相似文献17.
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Jeni Stevens Virginia Schmied Elaine Burns Hannah G. Dahlen 《Women and birth : journal of the Australian College of Midwives》2018,31(6):453-462