The holistic maternity care needs of women with Gestational Diabetes Mellitus: A systematic review with thematic synthesis.

PROBLEM: Models of care for women with gestational diabetes mellitus (GDM) have evolved in an ad hoc way and do not meet women's needs. BACKGROUND: GDM affects 50,000 Australian women per annum with prevalence quadrupling in the last ten years. Many health services are struggling to provide a quality service. People with diabetes are calling for care that focuses on their wellbeing more broadly. AIM: To examine the holistic (emotional, social, economic, and spiritual) care needs of women with GDM. METHODS: Qualitative and mixed-methods studies capturing the healthcare experiences of women with GDM were searched for in CINAHL, Medline, Web of Science and Scopus. English-language studies published between 2011 and 2023 were included. Quality of studies was assessed using Crowe Critical Appraisal Tool and NVIVO was used to identify key themes and synthesise data. FINDINGS: Twenty-eight studies were included, representing the experiences of 958 women. Five themes reflect women's holistic needs through their journey from initial diagnosis to postpartum: psychological impact, information and education, making change for better health, support, and care transition. DISCUSSION: The biomedical, fetal-centric model of care neglects the woman's holistic wellbeing resulting in high levels of unmet need. Discontinuity between tertiary and primary services results in a missed opportunity to assist women to make longer term changes that would benefit themselves (and their families) into the future. CONCLUSIONS: The provision of holistic models of care for this cohort is pivotal to improving clinical outcomes and the experiences of women with GDM.

Job satisfaction and sustainability of midwives working in caseload models of care: An integrative literature review.

BACKGROUND: Demand for caseload midwifery care continues to outstrip supply. We know little about what sustains midwives working in caseload models of care. AIM: This review systematically identifies and synthesises research findings reporting on factors which contribute to job satisfaction, and therefore the sustainability of practice, of midwives working in caseload models of care. METHODS: A comprehensive search strategy explored the electronic databases CINAHL Plus with Full Text, MEDLINE, PubMED, Cochrane Database of Systematic Reviews, and Scopus. Articles were assessed using the Crowe Critical Appraisal Tool. Data analysis and synthesis of these publications were conducted using a narrative synthesis approach. FINDINGS: Twenty-two articles were reviewed. Factors which contribute to the job satisfaction and sustainability of practice of midwives working in caseload models are: the ability to build relationships with women; flexibility and control over own working arrangements; professional autonomy and identity; and, organisational and practice arrangements. CONCLUSION: Insights into the factors which contribute to the job satisfaction and sustainability of practice of midwives in caseload models of care enables both midwives and healthcare administrators to more effectively implement and support midwifery-led caseload models of care which have been shown to improve outcomes for childbearing women.

The relationality of maternity care: A diffractive analysis of maternity care experiences.

PROBLEM: Pervasive polemics of differing approaches to and values of maternity care limit possibilities of nuanced and productive understandings of how maternity care is experienced. AIM: To explore how maternity care identities (midwife, obstetrician, childbearing woman) are shaped by binarised conceptualisations of childbirth. METHODS: The diffractive analysis of data gathered in collective biography research groups. FINDINGS AND DISCUSSION: Maternity care identities are not complete, pre-established entities, but rather are, 'in the making', remade in every maternity care encounter. CONCLUSION: Maternity care identities are defined by their encounters with other maternity care identities, and therefore, each maternity care identity plays a role in which experiences of maternity care come into being.

Parturescence: A theorisation of women's transformation through childbirth.

PROBLEM: The potential for positive transformation through giving birth is under-acknowledged and poorly understood. AIM AND METHOD: By drawing on theories of new feminist materialism to open up ways of thinking about childbirth and maternity care, we discuss how aspects of the process of matrescence, a woman's 'mother-becoming', pertain to women's opportunities in childbirth. We introduce the term, 'parturescence', as a moniker for the opportunity for 'becoming', and therefore transformation, offered in birth giving. RESULTS AND DISCUSSION: Using Davies' interpretation of Bergson's lines of descent and ascent we suggest the conditions of a woman's parturescence (whether birth giving will result in a positive or negative transformation) is enabled by 'with woman' midwifery care. The intra-action between this care, and the materiality of birth - the pain and exhaustion women experience in labour and birth, results in a rematerialisation of who and what women are and the opportunity for women's transformation. CONCLUSION: The development of this theory of parturescence unifies disparate aspects of maternity care and birth literature, provides insight into the potential mechanisms and conditions that impact women's parturescence, and suggests that birth, including the challenging and destabilising parts, is not just for the production of a baby, but also a site of women's 'becoming'.