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.     

Social welfare grey zones: how and why subnational actors provide when nations do not?

In an era where even citizenship is not a guarantee of access to the welfare state, can non-citizens gain access to social protection? Using health care as a lens, and the United States and Spain as cases, we find that non-citizens do have access to social protection via what we call ‘grey zones’, namely points of disagreement between national and local governments that create opportunities for non-citizens. Grey zones are possible due to processes that are often seen as disenfranchising: the denationalisation of policy and the disaggregation of citizenship. In addition, they tend to open up regardless of the nature or intent of national reforms. That said, we find significant variation in the extent to which subnational governments take advantage of them. While differences are somewhat explained by partisanship, significant outliers warrant further investigation.     

Refusal of recommended maternity care: Time to make a pact with women?

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.

Screening for recommended antenatal risk factors: How long does it take?

Background

Detection and management of antenatal risk factors is critical for quality care.

Older lesbians receiving home care: formal and informal dimensions of caregiving

Older lesbians face the triple jeopardy of ageism, sexism, and heterosexism, and their experiences are largely invisible. This qualitative, exploratory study examines the formal and informal caregiving experiences of 20 lesbians, 65 and older, who had utilized home care services due to acute illness or chronic disabilities. Half of those not partnered reported some level of isolation from support networks. Nearly all study participants eventually found home care workers with whom they were satisfied and even quite connected. Practice implications are discussed in context of study participants’ views of how being lesbian affects their aging process and day-to-day lives.     

Factors that support change in the delivery of midwifery led care in hospital settings. A review of current literature

Problem

In hospital units, the network of interdependent relationships between midwives and doctors has positioned midwives within hierarchical relationships of power. Others argue that the physical layout of hospital wards created by biomedicine makes it difficult for midwives to provide midwifery led care. The aim of this review is to identify factors that support change in the delivery of the midwifery led care in hospital settings.

Women's experiences of self-reporting health online prior to their first midwifery visit: A qualitative study

Background

Information and communication technologies are increasingly used in health care to meet demands of efficiency, safety and patient-centered care. At a large Danish regional hospital, women report their physical, mental health and personal needs prior to their first antenatal visit. Little is known about the process of self-reporting health, and how this information is managed during the client-professional meeting.

It’s more than just luck: A qualitative exploration of breastfeeding in rural Australia

It’s more than just luck: A qualitative exploration of breastfeeding in rural Australia