What influences women's experiences of childbirth in Flanders? - A quantitative cross-sectional analysis of the Babies Born Better survey.

OBJECTIVE: Labour and birth experiences are of great importance since these can have positive, but also negative effects on women's health and wellbeing. This is the first study, which investigated the factors that influence women's experiences of childbirth in Flanders, Belgium. DESIGN: A cross-sectional quantitative analysis was used to examine primary data obtained by the Babies Born Better project. Data collection took place via an online survey from April 2018 until August 2018 in Flanders. PARTICIPANTS: 1414 women that gave birth across all birth settings between 2013 and 2018, who speak Flemish/Dutch were included. Participants were self-selected by filling out the Babies Born Better survey in 2018. FINDINGS: The majority of the Flemish women included in this study reported a positive labour and birth experience. Analysis of the demographic variables showed that women who were single or not co-habiting reported a worse experience of labour and birth (P = 0.012). All obstetric factors included showed significant differences (P<0.01). Lastly, women were more likely to report a better experience when birth took place at home or in a midwifery unit and when the main care provider was a midwife (P<0.01). When controlled for significant variables from the univariate analysis, an impact on the birth experience was only found with the obstetric factors. A preterm (OR 0.544, 95%CI 0.362-0.817) and post term birth (OR 0.664, 95% CI 0.462-0.953) were found to reduce the chance of a good experience compared to a birth at term. In case of complications during pregnancy, women were less likely to report having had a good experience (OR 0.632, 95% CI 0.470 - 0.849). Medical interventions such as induction- (OR 0.346, 95% CI 0.241 - 0.497) and augmentation of labour (OR 0.318, 95% CI 0.218-0.463), an instrumental birth (OR 0.318, 95% CI 0.218-0.463) or a planned- (OR 0.349, 95% CI 0.205-0.596) or emergency caesarean section (OR 0.190, 95% CI 0.109-0.329) reduced the chances of women reporting to have had a good experience with care around labour and birth. KEY CONCLUSIONS: The majority of women included in this study reported a good experience of care during labour and at birth. Certain obstetric factors such as having a straightforward pregnancy without complications, a physiological onset of labour at term without the need for augmentation and to give birth vaginally (without instrument) have shown a positive impact on women's reported birth experiences. IMPLICATIONS FOR PRACTICE: Women's involvement in decision-making, especially when medical interventions are wanted or needed can improve positive birth experiences. More research is needed on how to support women and empower them, even more so in case of complications to ensure a sense of control and achievement.

Women's view on shared decision making and autonomy in childbirth: cohort study of Belgian women.

BACKGROUND: Health care providers have an important role to share evidence based information and empower patients to make informed choices. Previous studies indicate that shared decision making in pregnancy and childbirth may have an important impact on a woman's birth experience. In Flemish social media, a large number of women expressed their concern about their birth experience, where they felt loss of control and limited possibilities to make their own choices. The aim of this study is to explore autonomy and shared decision making in the Flemish population. METHODS: This is a cross-sectional, non-interventional study to explore the birth experience of Flemish women. A self-assembled questionnaire was used to collect data, including the Pregnancy and Childbirth Questionnaire (PCQ), the Labor Agentry Scale (LAS), the Mothers Autonomy Decision Making Scale (MADM), the 9-item Shared Decision Making Questionnaire (SDM-Q9) and four questions on preparation for childbirth. Women who gave birth two to 12 months ago were recruited by means of social media in the Flemish area (Northern part of Belgium). Linear mixed-effect modelling with backwards variable selection was applied to examine relations with autonomy in decision making. RESULTS: In total, 1029 mothers participated in this study of which 617 filled out the survey completely. In general, mothers experienced moderate autonomy in decision-making, both with an obstetrician and with a midwife with an average on the MADM score of respectively 18.5 (± 7.2) and 29.4 (±10.4) out of 42. The linear mixed-effects model showed a relationship between autonomy in decision-making (MADM) for the type of healthcare provider (p < 0.001), the level of self-control during labour and birth (LAS) (p = 0.003), the level of perceived quality of care (PCQ) (p < 0.001), having epidural analgesia during childbirth (p = 0.026) and feeling to have received sufficient information about the normal course of childbirth (p < 0.001). CONCLUSIONS: Childbearing women in Flanders experience moderate levels of autonomy in decision- making with their health care providers, where lower autonomy was observed for obstetricians compared to midwives. Future research should focus more on why differences occur between obstetrics and midwives in terms of autonomy and shared decision-making as perceived by the mother.

Towards an integrated perinatal care pathway for vulnerable women: The development and validation of quality indicators.

OBJECTIVE: Development and validation of a set of quality indicators for vulnerable women during the perinatal period. DESIGN: A three-phase method was used. Phase 1 consisted of a literature review to identify publications for the development of care domains and potential QIs, as well as a quality assessment by the research team. In phase 2 an expert panel assessed the set of concept QIs in a modified three-round Delphi survey. Finally, semi-structured interviews with vulnerable women were conducted as a final quality assessment of a set of indicators (phase 3). Ethical approval was obtained from the ethics committee of the University Hospital Brussels and from the Ethics Committees of all the participating hospitals. SETTING: The Flemish Region and the Brussels Capital Region in Belgium. PARTICIPANTS: Healthcare and social care professionals (n = 40) with expertise in the field of perinatal care provision for vulnerable families. Vulnerable women (n = 11) who gave birth in one of the participating hospitals. FINDINGS: The literature review resulted in a set of 49 potential quality indicators in five care domains: access to healthcare, assessment and screening, informal support, formal support and continuity of care. After assessment by the expert panel and vulnerable women, a final set of 21 quality indicators in five care domains was identified. First of all, organisation of care must involve an integrated multidisciplinary approach taking account of financial, administrative and social barriers (care domain 1: access to healthcare). Second, qualitative care includes the timely initiation of care, a general screening of the various aspects of vulnerability (biological, psychological, social and cognitive) and a risk assessment for all women (care domain 2: assessment and screening). Vulnerable women benefit from intensive formal and informal support taking account of individual needs and strengths (care domain 3: formal support; care domain 4: informal support). Finally, continuity of care needs to be guaranteed in line with vulnerable woman's individual needs (care domain 5: continuity of care). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Implementing quality indicators in existing and new care pathways offers an evidence-based approach facilitating an integrated view promoting a healthy start for woman and child. These quality indicators can assist healthcare providers, organisations and governmental agencies to improve the quality of perinatal care for vulnerable women.

Development and validation of the Midwife Profiling Questionnaire assessing women's preferred perinatal care professional and knowledge of midwives' legal competences.

OBJECTIVES: Currently maternity care organisation is developing worldwide. Therefore insight in the position of the midwife is important. The 'Midwife Profiling Questionnaire' (MidProQ) measures women's preferred perinatal care professional and their knowledge of midwives' legal competences. MidProQ is based on the European legal framework and was tested in a pilot study. This study aims to determine its content and face validity. STUDY DESIGN: A two-phase validation study with a Delphi method questioning content experts (n = 10) on items relevance and clarity as well as its scale and face validity. Further semi-structured interviews were performed with lay experts (n = 10) to evaluate the questionnaire's clarity, layout, phrasing and wording. RESULTS: After round one, most questions (42/47) were considered content valid for relevance and clarity (Item Content Validity Index 0.80-1.00). Scale (Scale Content Validity Index 0.92) and face validity (Face Validity Index 0.89) of the entire instrument was obtained. Five questions were revised until item content (0.83-1.00), scale content (0.92) and face validity (1.00) were appropriate. Lay experts' suggestions for improving the readability and usability were taken into account. CONCLUSIONS: We developed a valid instrument to elicit women's preferred health professional for uncomplicated pregnancy, labour and childbirth and to determine their knowledge about midwives' legal competences. Our instrument can be valuable in identifying knowledge gaps and improving the knowledge of the general population about the midwifery profession and maternity care. Finally, the MidProQ may improve research in the domain of maternity care culture, scale up midwifery and facilitate a more women-centred care.

The experiences of last-year student midwives with High-Fidelity Perinatal Simulation training: A qualitative descriptive study.

BACKGROUND: Simulation training is a powerful and evidence-based teaching method in healthcare. It allows students to develop essential competences that are often difficult to achieve during internships. High-Fidelity Perinatal Simulation exposes them to real-life scenarios in a safe environment. Although student midwives' experiences need to be considered to make the simulation training work, these have been overlooked so far. AIM: To explore the experiences of last-year student midwives with High-Fidelity Perinatal Simulation training. METHODS: A qualitative descriptive study, using three focus group conversations with last-year student midwives (n=24). Audio tapes were transcribed and a thematic content analysis was performed. The entire data set was coded according to recurrent or common themes. To achieve investigator triangulation and confirm themes, discussions among the researchers was incorporated in the analysis. FINDINGS: Students found High-Fidelity Perinatal Simulation training to be a positive learning method that increased both their competence and confidence. Their experiences varied over the different phases of the High-Fidelity Perinatal Simulation training. Although uncertainty, tension, confusion and disappointment were experienced throughout the simulation trajectory, they reported that this did not affect their learning and confidence-building. CONCLUSION: As High-Fidelity Perinatal Simulation training constitutes a helpful learning experience in midwifery education, it could have a positive influence on maternal and neonatal outcomes. In the long term, it could therefore enhance the midwifery profession in several ways. The present study is an important first step in opening up the debate about the pedagogical use of High-Fidelity Perinatal Simulation training within midwifery education.

A concept analysis of proactive behaviour in midwifery.

AIM: To report an analysis of the concept of proactive behaviour and apply the findings to midwifery. BACKGROUND: Proactive behaviour is a universal phenomenon generalizable to multiple professions. The purpose of this work was to establish a link with midwifery. DESIGN: Concept analysis by Walker and Avant's method. DATA SOURCES: Literature was searched in PubMed, ERIC, NARCIS, Emerald and reference lists of related journal articles with a timeline of 1990 - April 2015 in the period of November 2014 - June 2015. Next key words were combined by the use of Boolean operators: 'proactive behaviour', 'midwifery', 'midwife', 'proactivity' and 'proactive'. Fifteen studies were included. METHODS: A focused review of scientific publications in midwifery, health care, healthcare education and social sciences, which highlighted the concept of proactive behaviour. RESULTS: In the studied literature, several attributes of proactive behaviour were cited. These attributes were narrowed by applying it on a midwifery model case, borderline case and contrary case. Related concepts were elaborated and distinguished of the concept of proactive behaviour in midwifery. Proactive behaviour is triggered by different individual and contextual antecedents and has consequences at multiple levels. CONCLUSION: A midwife who behaves proactive would not look at changes as a boundary, persistently improves things she experienced as wrong, anticipates future barriers and looks for viable alternatives to carry out her work as efficiently and effectively as possible. Various individual and/or contextual antecedents trigger proactive behaviour in midwifery, and this behaviour could cause multiple future benefits for the constant evolving reproductive health care.

Inter-professional Perinatal Simulation training: A valuable educational model to improve competencies amongst student midwives in Brussels, Belgium.

Simulation training is a powerful and evidence-based teaching method for students and healthcare professionals. The described educational model of Inter-professional Perinatal Simulation training is the result of a collaborative project with the Erasmus University College Brussels, the Medical School of the Vrije Universiteit Brussel (VUB) and the University Hospital Brussels. This model enhances student midwives to acquire competencies in all fields of midwifery according to national and European legislation and to the International Confederation of Midwives Global Standards for Midwifery Education. In our educational program, simulation training enhanced the achievement of decision-making and inter-professional communication competences.