Health professionals’ perceptions of a midwifery model of woman-centred care implemented on a hospital labour ward

BackgroundTheoretical models as a basis for midwives’ care have been developed over recent decades. Although there are similarities between these models, their usefulness in practice needs to be researched in specific cultural contexts.AimTo explore whether, when adopted by midwives on labour wards, a midwifery model of woman-centred care (MiMo) was useful in practice from the viewpoint of a variety of health professionals.MethodsData were collected from a variety of health professionals before and after an intervention of implementating MiMo at a hospital-based labour ward in Sweden, using nine focus group interviews with a total of 43 participants: midwives (n = 16), obstetricians (n = 8), assistant nurses (n = 11) and managers (n = 8). The text from interviews was analysed using content analysis.FindingsFrom expressing no explicit need of a midwifery model of woman-centred care before the intervention, there was a shift in midwives, obstetricians and managers perceptions towards identifying advantages of using the MiMo as it gives words to woman-centred midwifery care. Such shift in perception was not found among the assistant nurses.DiscussionClarification of the various roles of health professionals is needed to develop the model. Heavy workloads and stress were barriers to implementing the model. Thus, more support is needed from organisational management.ConclusionsThe model was useful for all professional groups, except for assistant nurses. Further studies are needed in order to clarify the various professional roles and interdisciplinary collaborations in making the MiMo more useful in daily maternity care.     

Talking testing: Impact of a training intervention on midwives’ antenatal HIV,hepatitis B and hepatitis C screening practice

BackgroundMidwives play a critical role in ensuring that HIV, hepatitis B and hepatitis C screening occurs during early pregnancy, in accordance with national consensus guidelines and policies. Limited opportunities exist for midwives to gain the knowledge, skills and confidence required to initiate testing discussions at the first antenatal visit.AimTo design, deliver and evaluate a workforce education intervention to build midwives’ capacity to initiate testing for HIV and viral hepatitis.MethodVictorian midwives were invited to enrol in an intervention which comprised a pre-learning package and a one-day study day covering clinical, epidemiological and psychosocial aspects of HIV, hepatitis B and hepatitis C testing in early pregnancy. A pre-/post-test design, incorporating a survey with eight knowledge items and four confidence items, was used to measure impact.FindingsOf the 69 participating midwives, 55 completed the pre-survey, 69 completed the post-survey and 19 completed a three-month follow up survey. Participant knowledge improved across all domains, with the most significant increases in the areas of HIV and viral hepatitis testing, transmission and treatment. Midwives’ confidence levels increased following the intervention, and this was generally sustained among the smaller sample at the three-months.ConclusionOur findings demonstrate that short educational interventions, designed and delivered by content experts, result in longer-term improvements in clinical practice which are crucial to ensuring women and their partners are given adequate information and recommendations about screening for HIV, hepatitis B and hepatitis C and during pregnancy.     

The Impact of Having a Baby on the Level and Content of Women’s Well-Being

The primary objective of this study was to more fully understand the impact of having a baby on women’s well-being by attending to both the level and the content of well-being. To cover the judgemental and affective aspects of well-being we included global measures of life satisfaction and well-being and affective experience measures derived from the day reconstruction method. In a sample of 19 first-time mothers no differences between pre and postnatal reports of general life satisfaction, depression, anxiety, and experienced positive and negative affect were found, suggesting that the arrival of the newborn baby does not universally impact on women’s level of well-being. Changes in the content of well-being were studied by examining changes in the way women experience specific activities and interactions with various social partners. There appeared to be an upward shift in experienced positive affect during active leisure and a slight decrease in negative affect during time spent with relatives. The results are discussed in light of previously documented changes across the transition to motherhood in negative mood states, time use, women’s evaluation of various aspects of daily life, and relational satisfaction.     

The Impact of Paternity Leave on Fathers’ Future Earnings

Using Norwegian registry data, we investigate the effect of paternity leave on fathers’ long-term earnings. If the paternity leave increased long-term father involvement, then we should expect a reduction in fathers’ long-term earnings as they shift time and effort from market to home production. For identification, we use the Norwegian introduction of a paternity-leave quota in 1993, reserving four weeks of the total of 42 weeks of paid parental leave exclusively for the father. The introduction of the paternity-leave quota led to a sharp increase in rates of leave-taking for fathers. We estimate a difference-in-differences model that exploits differences in fathers’ exposure to the paternity-leave quota by the child’s age and year of observation. Our analysis suggests that four weeks of paternity leave during the child’s first year decreases fathers’ future earnings, an effect that persists through our last point of observation, when the child is 5 years old. A battery of robustness tests supports our results.     

Social Mitigation of the Impact of Urban Renewal on Residents’ Morale

Residents in the site of urban renewal suffer from its disturbance particularly during its demolition phase. One possible way of mitigating the suffering is assistance from kin and neighbors. The possibility rests on need fulfillment theory, which posits that needed assistance is salutary. To examine this possibility, the study surveyed 437 residents staying around urban renewal sites in Hong Kong. Results lent support to the hypothesized mitigation regarding neighbors’ help but not kin’s help. Instead, the kin’s support exhibited a significantly main positive effect on a resident’s morale. Furthermore, quality in neighborhood amenities but not in the residential environment showed a significantly main effect on morale. Results imply the merit of sustaining amenities quality and kin and neighbor assistance for mitigating the demoralizing impacts on residents during urban renewal.     

Impact of low fertility and early age at sterilisation on women’s formal education and skill development in South India

This paper examines the impact of low fertility and early age at sterilisation on women’s formal education and skill development in South India. Multilevel ordered-logit modelling of pseudo-cohort data re-organised from the three rounds of National Family Health Survey, and thematic analysis of qualitative data collected from Tamil Nadu and Kerala states showed no evidence of women’s resumption of formal education or uptake of skill development training in the post-sterilisation and post-childcare period. While resuming formal education in the post-sterilisation and post-childcare period is harder to achieve for various individual, household, community and policy reasons, there is greater preparedness and support for women to undertake skill development training. As low fertility and early age at sterilisation are widely regarded as the emerging reproductive norm in India, post-sterilisation and -childcare women will be a significant population group both in number and in proportional terms. No government policies or programs have so far recognised this group. India’s new government should consider targeted skill development programs for post-sterilisation and -childcare women appropriate to their social, economic and educational levels. An important contribution of the family planning program, particularly female sterilisation, for the economic and social development of the family and the wider society will otherwise be lost.     

The impact of three-dimensional visualisation on midwifery students’ application of knowledge of the third stage of labour to practice: Qualitative findings of a pilot randomised controlled trial

ProblemComplex physiological processes are often difficult for midwifery students to comprehend when using traditional teaching and learning approaches. Online resources for midwifery education are limited.BackgroundFace to face instructional workshops using simulation have had some impact on improving understanding. However, in the 21st century new technologies offer the opportunity to provide alternative learning approaches. Virtual and artificial realities have been shown to increase confidence in decision making during clinical practice.AimExplore the impact of using three-dimensional (3D) visualisation in midwifery education, on student’s application, when educating women about the birth of the placenta, and membranes.MethodsFace to face individual interviews were performed, to collect deep, meaningful experiences of students, learning about the third stage of labour.FindingsPrior clinical experiences impacted on student’s ability to articulate how they would discuss birth of the placenta and membranes, and the process of haemostasis with women.DiscussionThe narrative findings of this pilot study identified ways that students traditionally learn midwifery, through theory, and clinical practice. Interview narratives illustrated how midwifery students who had previous experiences of witnessing birth, had superior ability to discuss the third stage of labour with women. While students with limited birth experiences, found the 3DMVR assisted them in their understanding of the physiology of the third stage of labour.ConclusionIn an environment of increasing technological advances, clinical placements remain an essential component of midwifery education.     

Learning to be a midwife: Midwifery students’ experiences of an extended placement within a midwifery group practice

AimTo investigate the experiences, perspectives and plans of students who had a six-month placement with the midwifery group practice.MethodsFocus groups were conducted with fifteen third – year Bachelor of Midwifery students who had undertaken an extended placement at a midwifery group practice in a large tertiary referral hospital in Queensland, Australia.ResultsFour main themes were identified in the data: Expectations of the Placement; Facilitating learning within a midwifery group practice model; Transitioning between models of care and Philosophy and culture of midwifery group practice.Discussion and conclusionThird-year midwifery students valued the experience of working one-on-one for an extended placement with a midwife providing continuity of care within a caseload model. The experience was the highlight of their degree and they learned ‘how to be a midwife’. Most students found reintegrating back into the hospital system of care challenging, reporting that their developed skills of supporting women holistically and facilitating normal birth were not fully utilised when returning to the task-orientated birth suite. Students valued thoughtful, kind and supportive midwifery preceptors who supported them to transition back into the hospital.Implications and recommendationsUndertaking an extended placement within a midwifery group practice provides students with a rich and holistic learning experience and helps them develop a sense of professional identity. Student placements situated within models of care which provide continuity of midwifery care should be proactively enabled by health services and universities. Research of the longer-term impacts of an extended midwifery group practice clinical placement on midwifery graduates’ capabilities and competencies 3–5 years post registration should be conducted.     

The mechanisms mediating the effects of poverty on children’s intellectual development

Although adverse consequences of poverty for children are documented widely, little is understood about the mechanisms through which the effects of poverty disadvantage young children. In this analysis we investigate multiple mechanisms through which poverty affects a child's intellectual development. Using data from the NLSY and structural equation models, we have constructed five latent factors (cognitive stimulation, parenting style, physical environment, child's ill health at birth, and ill health in childhood) and have allowed these factors, along with child care, to mediate the effects of poverty and other exogenous variables. We produce two main findings. First, the influence of family poverty on children's intellectual development is mediated completely by the intervening mechanisms measured by our latent factors. Second, our analysis points to cognitive stimulation in the home, and (to a lesser extent) to parenting style, physical environment of the home, and poor child health at birth, as mediating factors that are affected by lack of income and that influence children's intellectual development.     

An Evaluation of the Impact of the Integrated Project on Rural Women from a Gender Perspective

In July 2000 and May and June 2001, a group of experts from China Population Information and Research Center and Nanjing College of Population Management conducted assessment surveys in Tumote Qian Banner (Inner Mongolia), Longhua (Hebei), Jinchuan (Gansu), Pingyao (Shanxi) and Minhe (Qinghai) for the International Integrated Project (FP/MCH/parasite control) that was jointly implemented by JOICFP, SFPC and China Family Planning Association. They obtained plenty of firsthand …     

Impact of demographic variables on women’s economic empowerment: An ordered probit model

The present study aimed to empirically examine the demographic variables that determine women’s economic empowerment. A sample of 500 married women between 21 and 49 years old (M_age = 35.49, SD = 7.66) was conveniently selected from district Multan (Pakistan). Control over economic resources was used as a proxy for women’s economic empowerment. Ordered probit regression was run to assess the demographic determinants (i.e., age, education, paid job, income, and property) of economic empowerment of the least empowered, moderately empowered, and highly empowered women. Paid job, age, income, and property appeared as positive and significant predictors of women’s economic empowerment. Implications of the study were also discussed.     

The Impact of Fathers’ Work and Family Conflicts on Children’s Self-Esteem: The Hong Kong Case

Work and family conflicts are always viewed as issues of human resource management or occupational health. Insufficient attention has been focused on the impact on child development and quality of parenting, especially regarding the impact of a father’s work. To examine the impact of work and family conflicts on the quality of father–child interactions in Hong Kong, a cross-sectional survey was conducted. In total, 556 pairs of working fathers and their school-aged children participated in the survey. The findings of the survey indicated that fathers’ work-to-family conflicts negatively affected the quality of father–child interactions, which in turn caused harm to children’s self-esteem. In addition to work-family conflicts, a low income level of the fathers, a larger number of children in the family, and the presence in the family of children approaching adolescence were significant risk factors to the quality of father–child interactions. The mothers’ active parental involvement and the complexity of the fathers’ occupation were significant protective factors of the quality of father–child interactions. To facilitate strong family bonding and good quality parenting, possible measures to ensure a healthy work-family balance among working fathers are discussed.     

Survey of Australian maternity hospitals to inform development and implementation of a stillbirth prevention ‘bundle of care’

Background‘Bundles of care’ are being implemented to improve key practice gaps in perinatal care. As part of our development of a stillbirth prevention bundle, we consulted with Australian maternity care providers.ObjectiveTo gain the insights of Australian maternity care providers to inform the development and implementation of a bundle of care for stillbirth prevention.MethodsA 2018 on-line survey of hospitals providing maternity services included 55 questions incorporating multiple choice, Likert items and open text. A senior clinician at each site completed the survey. The survey asked questions about practices related to fetal growth restriction, decreased fetal movements, smoking cessation, intrapartum fetal monitoring, maternal sleep position and perinatal mortality audit. The objectives were to assess which elements of care were most valued; best practice frequency; and, barriers and enablers to implementation.Results227 hospitals were invited with 83 (37%) responding. All proposed elements were perceived as important. Hospitals were least likely to follow best practice recommendations “all the time” for smoking cessation support (<50%), risk assessment for fetal growth restriction (<40%) and advice on sleep position (<20%). Time constraints, absence of clear guidelines and lack of continuity of carer were recognised as barriers to implementation across care practices.ConclusionsAreas for practice improvement were evident. All elements of care were valued, with increasing awareness of safe sleeping position perceived as less important. There is strong support from maternity care providers across Australia for a bundle of care to reduce stillbirth.     

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.     

Children of Migrants: The Cumulative Impact of Parental Migration on Children’s Education and Health Outcomes in China

Since the end of 1990s, approximately 160 million Chinese rural workers migrated to cities for work. Because of restrictions on migrant access to local health and education systems, many rural children are left behind in home villages to grow up without parental care. This article examines how exposure to cumulative parental migration affects children’s health and education outcomes. Using the Rural-Urban Migration Survey in China (RUMiC) data, we measure the share of children’s lifetime during which parents were away from home. We instrument this measure of parental absence with weather changes in their home villages when parents were aged 16–25, when they were most likely to initiate migration. Results show a sizable adverse effect of exposure to parental migration on the health and education outcomes of children: in particular, boys. We also find that the use of the contemporaneous measure for parental migration in previous studies is likely to underestimate the effect of exposure to parental migration on children’s outcomes.     

Is Leave for Fathers Pronatalist? A Mixed-Methods Study of the Impact of Fathers’ Uptake of Parental Leave on Couples’ Childbearing Intentions in South Korea

Population Research and Policy Review - While many countries with low birth rates have implemented policies incentivizing fathers to take parental leave with the anticipation that it will...     

Evaluation of a regional midwifery caseload model of care integrated across five birthing sites in South Australia: Women’s experiences and birth outcomes

IntroductionThe ongoing closure of regional maternity services in Australia has significant consequences for women and communities. In South Australia, a regional midwifery model of care servicing five birthing sites was piloted with the aim of bringing sustainable birthing services to the area. An independent evaluation was undertaken. This paper reports on women’s experiences and birth outcomes.AimTo evaluate the effectiveness, acceptability, continuity of care and birth outcomes of women utilising the new midwifery model of care.MethodAn anonymous questionnaire incorporating validated surveys and key questions from the Quality Maternal and Newborn Care (QMNC) Framework was used to assess care across the antenatal, intrapartum and postnatal period. Selected key labour and birth outcome indicators as reported by the sites to government perinatal data collections were included.FindingsThe response rate was 52.6% (205/390). Women were overwhelmingly positive about the care they received during pregnancy, birth and the postnatal period. About half of women had caseload midwives as their main antenatal care provider; the other half experienced shared care with local general practitioners and caseload midwives. Most women (81.4%) had a known midwife at their birth. Women averaged 4 post-natal home visits with their midwife and 77.5% were breastfeeding at 6–8 weeks. Ninety-five percent of women would seek this model again and recommend it to a friend. Maternity indicators demonstrated a lower induction rate compared to state averages, a high primiparous normal birth rate (73.8%) and good clinical outcomes.ConclusionThis innovative model of care was embraced by women in regional SA and labour and birth outcomes were good as compared with state-wide indicators.     

Impact of Gender Binarism on Hijras’ Life Course and Their Access to Fundamental Human Rights in Pakistan

This study adds to the growing body of knowledge on gender nonconformity aspects of heteronormativity by examining its impact on the life course of hijras and their access to fundamental human rights in Pakistan. Drawing on 50 semistructured interviews conducted in two sites, the findings suggest that the participants’ lived experiences associated with gender nonconformity significantly influenced the direction of their life course and their ability to have access to human rights. These experiences spanned from childhood to elderhood across a wide range of settings, such as family, school, guru dera (residence headed by a hijra guru), workplace, and interactions with authorities. The participants’ human rights were not recognized, resulting in abuse, social stigma, discrimination against them, and their exclusion from mainstream society. Finally, implications are drawn for public policy and future research on third gender concerns in Pakistan and elsewhere.