Norwegian community midwives' experience of interdisciplinary collaboration in care of pregnant women with vulnerabilities.

AIM: The aim of this study was to investigate Norwegian community midwives(CMs) experience of collaboration when caring for pregnant women with vulnerabilities. We wanted to determine which professionals and services are considered important and with whom they have written agreements and good lines of communication. Furthermore, which tools are used in collaboration and if any background factors enhance collaboration. BACKGROUND: Vulnerable pregnant women may require more than standard antenatal care, involving interdisciplinary collaboration. Outcomes can improve if vulnerable pregnant women are offered additional support. The introduction of multi-disciplinary teams in Norway has shown promising results, as in many other countries. A Norwegian report concluded that there is need for more research to improve the quality and availability of interdisciplinary care. METHODS: A cross-sectional, descriptive study, using data from a questionnaire that approximately 700 CMs in Norway were invited to answer online from May-August 2020. Data were analysed using the statistical software SPSS 26. RESULTS: One third (257) of the invited CMs participated in the survey. They reported that professionals involved in standard antenatal care, such as those at the maternity unit and PHNs, were the most important collaborative partners when caring for vulnerable pregnant women. The CMs reported poor communication with general practitioners, child welfare-, drug welfare- and mental health-services. The most frequent methods for accessing collaboration were phoning and electronically through patient record systems, while there was limited use of the personal care plan, patient coordination meetings and regular meetings with collaborative partners/services. CMs with more than ten years as a CM and "Early Start" training were more frequently involved in patient coordination meetings and counselling and debriefing sessions compared to inexperienced CMs who had not attended a special training program. CONCLUSION: Experience and completed the Early Start education/training increased the use of interprofessional collaborating meetings including CMs. This study suggests interdisciplinary training programmes to improve collaboration, which are expected to benefit vulnerable pregnant women, their babies and families. IMPLICATION FOR PRACTICE AND RESEARCH: We recommend education and training in both the educational system and among involved professionals in communities to improve collaboration in the care of vulnerable women. In order to measure the effectiveness of collaboration in the care of vulnerable pregnant women, both the targeted group and the collaborating professionals should be asked to provide feedback. More research on communication and collaboration is needed.

Experiences of Norwegian community midwives with caring for vulnerable pregnant women - A national cross-sectional study.

OBJECTIVES: The study aimed to describe Norwegian community midwives' care for vulnerable pregnant women. It assessed vulnerability factors midwives identified and the type of care they provided. Factors associated with use of identification tools and care of vulnerable pregnant women were investigated. METHOD: A quantitative, cross-sectional study. Data collected via an anonymous online survey conducted spring 2020. Of approximately 700 eligible community midwives in Norway, 257 (36.7%) participated. RESULTS: Community midwives who worked primarily in the community, in close to full-time positions (>80%) and who were responsible for >100 women a year in large community clinics were more likely to identify vulnerable pregnant women than midwives who worked in combined hospital and community posts, less than 80% in the community and at smaller community centres. Attended a training progam called 'Early Start' (Tidlig Inn) was associated with an increased use of standardized identification tools. Almost all community midwives reported providing vulnerable women with more frequent consultations, individual and culturally personalized care, and relevant information about support options. CONCLUSION: Community midwives appeared to be aware of their role as a midwife in the care of vulnerable pregnant women. They reported encountering vulnerable pregnant, identifying them by actively using methods to do so and addressing their needs in various ways. This study suggests that specific training increases midwives' ability to identify vulnerable pregnant women. Further research is needed to assess how midwives experience interdisciplinary collaboration in caring for these women.