Maternity care experiences of women with physical disabilities: A systematic review.

OBJECTIVE: Fifteen percent of the world's population has some form of disability, the most common form being a physical disability. Ten percent of women with disabilities are of childbearing age; however, because women with disabilities are often deemed less likely to have children, accessibility to maternity care is limited. Women with disabilities experience problems during pregnancy and childbirth due to physical barriers and barriers to information, problems with communication and the attitude of providers. A recent World Health Organization statement calls for more action, dialogue, research and advocacy on disrespectful treatment during childbirth. To give substance to this, an overview of the experiences of women with a physical disability is essential. Therefore, the aim of this systematic review is to identify and provide an overview of reported maternity care experiences of women with physical disabilities, including sensory disabilities. DESIGN: This systematic review was conducted using a meta-aggregation approach for synthesis and the steps of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The search strategy focused on qualitative studies in the databases PubMed, Embase and CINAHL. The Critical Appraisal Skills Programme checklist was used to evaluate methodological quality, and a best-evidence synthesis was performed. FINDINGS: Of the 4,486 studies screened, ten were included. The methodological quality of the studies ranged from high to moderate. The results indicated that women experience barriers related to accessibility of facilities, adapted equipment, lack of knowledge, and healthcare providers' dismissals of their concerns and unwillingness to assist. In contrast, support has a positive influence on women's experiences. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: There is evidence that women with physical disabilities continue to encounter barriers in accessing maternity care related to inaccessible care settings, lack of knowledge and the attitude of healthcare providers. Healthcare providers should be trained to be aware of women's special needs and to improve clinical practice.

First-time fathers' experiences and needs during childbirth: A systematic review.

OBJECTIVE: Fathers have been increasingly involved in childbirth since 1990. Attendance at childbirth is considered to benefit fathers' health as well as that of their partner and children. However, childbirth is a life event that parents may experience differently. First-time fathers' experiences have been barely studied and may differ from those of fathers who have already had a child. In order to adapt support and care during childbirth to the needs of first-time fathers, a deeper insight must be gained into their experiences and needs during childbirth. DESIGN: A systematic review of qualitative studies was conducted using PubMed, Embase and CINAHL as well as the snowball method. Quality appraisal was performed and evaluated using the Critical Appraisal Skills Programme. A thematic best evidence synthesis was performed. FINDINGS: Of 821 articles, eight qualitative studies and the qualitative data of one mixed methods study were included. amongst other feelings, fathers experience a lack of knowledge and a need to be better prepared. First-time fathers want to be more involved and need guidance, information and honest answers to help them fulfil a supportive role. Fathers disregard their own needs to focus on the needs of the mother. Meeting the baby for the first time changes the focus from the mother to the child, and fathers need time and privacy for this special moment. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: To adapt support and care during childbirth to the needs of first-time fathers, professionals must be aware of their needs. Professionals must realise the significant influence of their professional behaviour on first-time fathers' experiences. Care for first-time fathers should be formalised. Follow-up research must be conducted on integrating the preparation of first-time fathers into prenatal care. Education and training of professionals must be improved.

Parents' experiences of VOICE: A novel support programme in the NICU.

BACKGROUND: Admission of an infant to a neonatal intensive care unit (NICU) is often a stressful experience for parents and can be associated with feelings of inadequacy to fulfil the desirable parental role. The values, opportunities, integration, control, and evaluation (VOICE) programme was developed to engage parents in care, to decrease stress, and to increase empowerment. AIM: To explore the experiences of parents regarding involvement in the VOICE programme during admission of their infant to the NICU. DESIGN: The VOICE programme includes at least five personal structured meetings between parents, nurses, and other health care professionals throughout the pathway from birth, NICU, and follow up. A qualitative design was adopted using semi-structured interviews. Interviews with 13 parents of 11 infants born at <27 weeks' gestational age were conducted: nine mothers and two couples of father and mother. Thematic analysis was deployed. RESULTS: The findings have been described in one overarching theme: "parental empowerment." Parents felt strengthened and were empowered in the development of their role as primary caretaker by the VOICE programme. The parental empowerment theme emerged from four related interpretive themes that were derived: (a) involvement in care, (b) personalized information and communication, (c) transition to a parental role, and (d) emotional support. CONCLUSION: The VOICE programme can be a structured approach used to implement family support in a NICU to empower parents to become a partner in the care of their infant and feel confident. RELEVANCE TO CLINICAL PRACTICE: This study encourages health care professionals to provide parental support through a structured intervention programme, which contributes to the empowerment of parents in the NICU and encouraged them to participate in care and decision-making.

Factors Influencing Implementation of Family-Centered Care in a Neonatal Intensive Care Unit.

Background: Approximately 10% of all births worldwide are preterm. Often these infants are admitted at a Neonatal Intensive Care Unit (NICU). The NICU environment with periods of unnatural light, noise and repeated disturbances is very stressful for infants admitted to the NICU. In addition separation of parents causes stress for both infant and parents. A way to support and include parents in the care for their infants is Family-Centered Care (FCC). FCC is an approach of planning, delivery and evaluation of healthcare, based on a partnership between healthcare professionals and families of patients. Parents of infants who were admitted to an FCC unit were less stressed compared to parents at a Standard Care unit. Aim: Although FCC is beneficial to families and patients, implementation can be challenging. Therefore it is important to know which factors can contribute or withhold the implementation of FCC. This study explored factors that influence implementation of FCC in NICU's according to healthcare professionals that work in a NICU with the concept FCC. Method: A descriptive generic qualitative design with semi-structured interviews and inductive thematic analyses was used. This international multi-center study was conducted in three hospitals in three European countries: Sweden, Norway, and The Netherlands. Results: Seven neonatal care nurses, one nurse assistant, five neonatologists, and three managers participated in this study. Four aspects were identified, when analyzing the data, namely: Behavioral change in staff, Family needs, Environment, and Communication. Most important is that almost all healthcare professionals described that the mind-set of the professional influences the implementation of FCC. Conclusion: The mind-set of healthcare professionals in seeing parents as primary caregiver influences the way FCC is practiced and how parents are involved in the care for their infant.