Humanisation in pregnancy and childbirth: A concept analysis.

AIMS AND OBJECTIVES: To undertake a concept analysis of humanisation in pregnancy and childbirth. BACKGROUND: Humanisation in pregnancy and childbirth has historically been associated with women who do not require medical intervention. However, the increasing recognition of the importance of emotional and mental health and the physical outcome of pregnancy has meant that there is a need to identify clinical attributes and behaviours that contribute to a positive emotional outcome. Failure to support and protect the emotional health of the woman in pregnancy and childbirth can have effects on the long-term mental health of the mother and the long-term physical and mental health of the child. DESIGN: Concept Analysis METHODS: Eight-step method of concept analysis proposed by Walker and Avant. RESULTS: Defining attributes include being a protagonist, human being interaction and benevolence. Antecedents identified were a recognition of women's rights, birth models, professional competence and the environment. Consequences were identified for women and healthcare professionals: for women, increased feelings of confidence, satisfaction of the experience and safety; and for healthcare professionals, increased satisfaction and confidence in their job and increased esteem in their profession. CONCLUSIONS: Humanisation of pregnancy and childbirth now encompasses all women regardless of care pathway. Humanisation does not obstruct the prioritisation of life-saving procedures or the use of medical intervention where required. RELEVANCE TO CLINICAL PRACTICE: Women who are able to identify their rights when accessing maternity care will be better equipped to ensure their care planning is individualised. The identification of humanised care practices, attributes and behaviours can support healthcare professionals in the clinical area who wish to identify a pathway of humanised care in pregnancy and birth.

Midwives', obstetricians', and nurses' perspectives of humanised care during pregnancy and childbirth for women classified as high risk in high income countries: A mixed methods systematic review.

Women classified as 'high risk' or 'complicated' in pregnancy and childbirth have increased difficulty in accessing humanised care/humanisation in childbirth due to perceptions that this approach rejects the use of intervention and/or technology. Humanised care recognises the psychological and physical needs of women in pregnancy and birth. A mixed methods systematic review using a convergent segregated approach was undertaken using the Joanne Briggs Institute (JBI) methodology. The objective of the review was to identify the presence of humanisation for women with high risk pregnancy and/or childbirth in high income countries. Studies were included if they measured humanisation and/or explored the perspectives of midwives, obstetricians, or nurses on humanisation for women classified as having a high-risk or complicated pregnancy or childbirth in a high income country. Qualitative data were analysed using a meta-aggregative approach and a narrative synthesis was completed for the quantitative data. All studies were assessed for their methodological quality using the MMAT tool. Four databases were searched, and nineteen studies met the inclusion criteria. A total of 1617 participants from nine countries were included. Three qualitative findings were synthesised, and a narrative synthesis of quantitative data was completed. The integration of qualitative and quantitative data identified complimentary findings on: (i) the importance of developing a harmonised relationship with women; (ii) increased time counselling women on their choices; and (iii) fear of professional reputational damage if caring outside of protocols. Negotiating with women outside of protocols may have a wider impact on the professional than first thought. Understanding how healthcare professionals individualise care for women at risk in labour requires further investigation.

Embedding continuity of care into a midwifery curriculum in the Republic of Ireland: A historical context.

Maternity services in Ireland have historically been predominantly hospital-based and obstetric-led. Although evidence suggests midwifery-led care is safe and effective, its presence in Ireland continues to be limited in practice. An increase in the available models of maternity care for women has been recommended by the Department of Health in Ireland to promote a woman-centered approach. The latest requirement for midwifery students to have a continuity of care experience within their curriculum offers educators the opportunity to facilitate differing models of care prior to qualification as a registrant, providing an experience to explore midwifery philosophy in practice. The use of a case-loading model, adopted by a university in the East of Ireland in the final year of the program may be a successful way for students to gain midwifery skills as well as offering midwifery students the exposure to another model of care. Such experiences may also enhance their ability to drive and shape midwifery-led services in the future and also build midwifery workforce capacity in continuity of care models.

A meta-synthesis of the perspectives and experiences of healthcare professionals on the humanisation of childbirth using a meta-ethnographic approach.

PROBLEM: The humanisation of childbirth has been identified as a practice of care focusing on the physical, psychological, and emotional wellbeing of women. Healthcare professionals (HCPs) are expected to understand and embed humanised practice when supporting women in childbirth. AIM: The aim of this paper is to present a meta-synthesis of the experiences and perspectives of HCPs who undertake care for women at the time of birth regarding the humanisation of childbirth. METHODS: A systematic search of the electronic databases CINAHL, Medline, PsycINFO, and SocINDEX were conducted in July 2020. Qualitative studies exploring HCPs' experiences and perspectives of humanisation in childbirth were eligible. Studies were synthesised using a meta-ethnographic approach. FINDINGS: Fourteen studies involving 197 participants were included. Two themes were identified: 'Women at the centre' and 'Professional dissonance'. Two line of argument synthesis were identified: 'invisible boundaries' and 'unconscious undermining'. DISCUSSION: HCPs recognised that women required positive interactions which met both their emotional and physical needs. Human touch supported bonding between HCPs and women. HCPs understood humanisation as the reduction of unnecessary intervention and/or technology but had difficulties enacting this and often used disempowering language when discussing women's choices. The management of pain and the presence of a companion were considered important by HCPs. CONCLUSION: This synthesis revealed that HCPs do understand the humanisation of childbirth but have difficulties in enacting it in practice. Women classified as high risk were identified as having specific needs such as increased emotional support. Further research is required for women classified as high risk who may require technology and/or interventions to maintain a safe birth.

A blended learning perineal suturing programme for midwifery students: An evaluative descriptive study.

AIM: The purpose of this study was to examine midwifery students' views and experiences of learning perineal suturing skills through a blended learning approach. BACKGROUND: Evidence suggests that not all midwifery students are gaining sufficient experience in perineal trauma and suturing to sufficiently prepare them to achieve competency in this skill at the point of registration. DESIGN: The blended learning approach included lectures, a bespoke 'suture at home kit', online reusable learning objects, and an optional face-to-face drop-in suture clinic. Midwifery students submitted a video demonstration of the skills acquired and then attended a clinical skills laboratory in preparation for a face-to-face competency assessment on campus. RESULTS: A qualitative descriptive evaluation research design study was undertaken from 22 participants. Deductive thematic analysis was selected to analyse the qualitative data. Two themes were identified. The first theme, 'learning at home', included sub-themes of 'deliberate practice' and 'the ability to make mistakes. The second theme, 'achieving competency', included sub-themes of 'equipment' and 'bringing it all together' CONCLUSIONS: The blended learning approach of the programme applied to teach perineal suturing had a positive influence on midwifery students learning of the skill. The acquisition of knowledge using the suture at home kit gave the students confidence and prepared them for laboratory practice and assessment, and ultimately prepared them for practice placement. They identified other clinical skills suited to using an 'at home' simulation pack. The validation of the perineal suturing programme by midwifery students supports the need for a blended learning approach for this and other clinical skills. All participants expressed a positive view of the programme and found it beneficial for their learning. Midwifery students recognised that the suture at home kit gave them confidence, knowledge of the skill and preparedness for the clinical skills laboratory practice and assessment. They identified other clinical skills suited to using an 'at home' simulation pack. The positive experiences of midwifery students in this study to a blended-learning programme for perineal suturing education and training further validated the recognised need to develop and include online, and face to face learning approaches for this vital aspect of intrapartum care.