An Evaluation of Social Support Intervention with Depressed Mothers in Child and Family Care

Correspondence to Professor Michael Sheppard, Department of Social Policy and Social Work, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA, UK. Summary The significance of maternal depression to social work practicein child and family care has become increasingly apparent inrecent years. Social support, furthermore, is a concept (aswell as a reality) which provides a major focus for social workpractice. Indeed, social support, it is also clear, is of considerableimportance in helping prevent depression. This paper seeks toexamine social support work carried out by social workers inrelation to depressed mothers in child and family care. In particularit seeks to evaluate the quality of that intervention in thelight of key problem areas associated with high levels of supportneeds, the extent to which social workers target support needsthrough direct, indirect and informal supports, and the extentto which particular interventions are associated with a higheradequacy of support experienced by these depressed women. Thepaper finds a certain degree of haphazardness in social workers’targeting of support needs, although in some areas of indirectsupport, in particular, their targeting is reasonably accurate.There is little evidence of any one form of intervention beingassociated with more adequate support with one significant exception,relief care of children. The paper concludes that social workersneed to develop a keener awareness of support deficits so thatthey are targeted better; they need to monitor more carefullyinterventions carried out by other agencies and professionals;and they should look to relief care of children as a major formof intervention to support these women.     

Using concept mapping to identify opportunities for HPV vaccination efforts: Perspectives from the Midwest and West Coast

Human papillomavirus (HPV) infection significantly contributes to the burden of cancer in the United States, despite the existence of a highly effective vaccine. While numerous interventions to address vaccination uptake exist, vaccination rates remain low. We conducted a concept mapping exercise to solicit perspectives on barriers and facilitators to HPV vaccination from state-level stakeholders in five states in the Midwest and West Coast of the U.S. We identified 10 clusters of barriers and facilitators based on participants’ statements. For rural areas specifically, clusters rated as most important included education and provider influence; those rated as most feasible were education and coordinated/consistent messaging. Our results suggest that a combination of important (but potentially more difficult to implement) strategies, combined with those rated as most feasible (but potentially less impactful) may be beneficial. Our findings highlight similarities across diverse states, suggesting that states can learn from each other and work together to improve HPV vaccination rates. Using concept mapping proved to be an efficient way to collect information from diverse, stakeholders in different locations, and is a methodology that could be used for program planning in areas beyond HPV vaccination.     

Using epidemiological and health economic measures to inform maternity staffing decisions: A guide

BackgroundThere is growing concern around unnecessary intervention (particularly caesarean section) at birth in high-income countries. Caseload midwifery care aims to offset this, but is perceived to be costly to health services.AimTo use epidemiological and health economic techniques to estimate health outcomes and cost-savings of different levels of equivalent full time (EFT) midwives working in caseload midwifery care.MethodsTwo simulations were conducted — one assuming 10 EFT midwives working in a caseload model, with 35 women per caseload, and one assuming 50 EFT midwives working in a caseload model, with 45 women per caseload. Both were based on a sample of 5000 women. The main model inputs included rates of health outcomes for women (caesarean section, epidural anaesthesia, and episiotomy) and infants (low birthweight and admissions to special care nursery (SCN) or neonatal intensive care unit (NICU)), and the cost savings associated with health outcome avoidance.FindingsThe first simulation estimated 27 fewer caesarean sections, 12 fewer epidurals, 12 fewer episiotomies, 10 fewer low birthweight births, and 23 fewer infants admitted to SCN or NICU annually, at a total cost saving of AU$1,874,715. The second simulation estimated 173 fewer caesarean sections, 76 fewer epidurals, 76 fewer episiotomies, 65 fewer low birthweight births, and 150 fewer infants admitted to SCN or NICU annually, at a total cost saving of AU$12,051,741.ConclusionThis study provides local-level decision-makers with a decision-tool to calculate the potentially avoidable health outcomes and cost savings associated with implementing caseload midwifery care in their own service.     

Large gaps in the quality of healthcare experienced by Swedish mothers during the COVID-19 pandemic: A cross-sectional study based on WHO standards

Background and ProblemExisting healthcare systems have been put under immense pressure during the COVID-19 pandemic. Disruptions in essential maternal and newborn services have come from even high-income countries within the World Health Organization (WHO) European Region.AimTo describe the quality of care during pregnancy and childbirth, as reported by the women themselves, during the COVID-19 pandemic in Sweden, using the WHO ‘Standards for improving quality of maternal and newborn care in health facilities’.MethodsUsing an anonymous, online questionnaire, women ≥18 years were invited to participate if they had given birth in Sweden from March 1, 2020 to June 30, 2021. The quality of maternal and newborn care was measured using 40 questions across four domains: provision of care, experience of care, availability of human/physical resources, and organisational changes due to COVID-19.FindingsOf the 5003 women included, n = 4528 experienced labour. Of these, 46.7% perceived a poorer quality of maternal and newborn care due to the COVID-19. Fundal pressure was applied in 22.2% of instrumental vaginal births, 36.8% received inadequate breastfeeding support and 6.9% reported some form of abuse. Findings were worse in women undergoing prelabour Caesarean section (CS) (n = 475). Multivariate analysis showed significant associations of the quality of maternal and newborn care to year of birth (P < 0.001), parity (P < 0.001), no pharmacological pain relief (P < 0.001), prelabour CS (P < 0.001), emergency CS (P < 0.001) and overall satisfaction (P < 0.001).ConclusionConsiderable gaps over many key quality measures and deviations from women-centred care were noted. Findings were worse in women with prelabour CS. Actions to promote high-quality, evidence-based and respectful care during childbirth for all mothers are urgently needed.     

Analysis of the bovine spongiform encephalopathy maternal cohort study, revisited

The bovine spongiform encephalopathy (BSE) maternal cohort study provided robust evidence of an enhanced risk of developing BSE for offspring of BSE-affected dams. We present for the first time, but in retrospect, an interim analysis of the BSE maternal cohort study and set it in historical context, some of which has only been revealed through the BSE inquiry. We also consider the implications for design of extending the BSE maternal cohort study once an enhanced risk to exposed calves had been established, to assess the risk to calves born further from the clinical onset of BSE in the dam than those in the original study. We demonstrate that, if a data monitoring committee had been established, conclusions similar to those based on the final results could have been drawn several years before the completion of the BSE maternal cohort study. Further, we conclude that an extension of the cohort study is unlikely to have been commissioned because of the substantial financial investment required, yet low power, and practical difficulties associated with implementation of any worthwhile extension.