Sustainability of hospital-based midwife-led antenatal care consultation - a qualitative study.

BACKGROUND: All evidence-based knowledge and improvement strategies for quality care must be implemented so patients can benefit from them. In Germany, national expert standards (NES) contribute to quality care in nursing and midwifery. The NES defines for several action levels a dedicated level of quality, which is operationalized by structure, process, and outcome (SPO) criteria. An NES to promote normal childbirth was developed and implemented in 2014. The first action level involves midwife-led antenatal consultation (ML-AC) being conducted in a structured way. Most implementation processes aim to accomplish sustainability, but implementation studies rarely use definitions or a theory of sustainability, even when assessing sustainability. This lack led to the assumption that intervention sustainability after implementation is still a largely unexplored domain. The aim of this study is to investigate the sustainability of midwife-led antenatal consultation (ML-AC) implemented at two hospitals, in Germany. METHODS: In a qualitative approach, 34 qualitative interviews were conducted (between March and October 2017) using semi-structured interview guides. All interviews were transcribed verbatim, anonymized and analyzed thematically using framework method. Four groups of stakeholders in two hospitals offering ML-AC were interviewed: managers (n = 8), midwives conducting ML-AC (n = 10), pregnant women who attended ML-AC (n = 8), and physicians working in obstetrics (n = 8) at the hospitals. RESULTS: The interviewees identified key benefits of ML-AC on a personal and unit level, e.g., reduced obstetric interventions, easier admission processes. Furthermore, the participants defined key requirements that are needed for routinized and institutionalized ML-AC, such as allocating working time for ML-AC, and structural organization of ML-AC. All study participants saw a need to establish secure long-term funding. Additionally, the interviewed staff members stated that ML-AC topics need evaluating and adapting in the future. CONCLUSIONS: Implementing ML-AC in the hospital setting has led to manifold benefits. However, reimbursement through the health care system will be needed to sustain ML-AC. Hospitals implementing ML-AC will need to be aware that adaptations of the NES are necessary to accomplish routinization and institutionalization. After initial implementation, sustaining ML-AC will generally require on-going monitoring and evaluating of benefits, routinization/institutionalization and further development.

[Adherence of Antenatal Consultations by Midwives - A Quantitative Content Analysis]. / Adhärenz von Hebammensprechstunden ­ eine quantitative Dokumentenanalyse.

PURPOSE: Worldwide the use of medical interventions in childbirth is increasing, which holds true in Germany as well. In response, different approaches are being developed to enhance normal childbirth. Also, in Germany there is now an expert care standard to promote physiological childbirth, which mandates antenatal consultation conducted by midwives. The extent to which antenatal consultation based on this standard has been implemented and the degree of adherence (as intended by the developers) remain unclear. The aim of this study is to investigate who makes use of antenatal consultations, the topics and content of consultation documents and adherence to the antenatal consultation requirement in 2 hospitals. METHOD: Criteria for analyzing consultation documents were derived based on the content of the care standard and using the Delphi method by 3 experts who had participated in developing the expert care standard. A content analysis of the documents (hospital 1: n=92; hospital 2: n=62) used in antenatal consultation based on criteria identified in the standard was conducted. RESULTS: Six criteria ("worries and anxieties," "agreements," "suggested topics," "all topics," "traceability of birth plan" and "options of birth plan") for analyzing consultation documents were identified. Especially primiparae women (77.2%) avail themselves of antenatal consultation. The variety of topics covered in antenatal consultation is broad. The documents in hospital 2 show high adherence to the standard to promote normal childbirth. The documents of hospital 1 show moderate adherence. CONCLUSIONS: The investigation of adherence helps to determine implementation success and to identify areas needing revision and their modification. Implementation processes require further research to explain the differences in adherence.

Experiences of Antenatal Care Among Women Who Are Socioeconomically Deprived in High-Income Industrialized Countries: An Integrative Review.

INTRODUCTION: Socioeconomic deprivation in high-income industrialized countries is a key factor in poor perinatal outcomes. Limited access, utilization, and quality of antenatal care seem to play an important role in poor perinatal outcomes. METHODS: This integrative review aimed to explore experiences of antenatal care among women who are socioeconomically deprived in high-income industrialized countries. A search was conducted using 5 databases for articles published from 2004 to 2014. Six qualitative and 3 quantitative articles were selected. These were systematically appraised for quality independently by 3 researchers. Relevant themes were identified and organized into categories. RESULTS: The disadvantages experienced in antenatal care by women who are socioeconomically deprived start before the first contact with health care services and are notable throughout the entire pregnancy. There is disparity in choice of medical or midwifery service provision models. Six categories emerged during review: choice of service provision model, feeling valued, various types of discrimination, structural and interpersonal accessibility, comprehensibility and trustworthiness of information, and engagement and sense of responsibility. Categories underscored the importance of the woman's relationship with the antenatal care provider. DISCUSSION: Antenatal care models with women-centered approaches and continuity of care, such as midwifery models, have potential to increase the satisfaction of women with low socioeconomic status with care; this may increase antenatal care utilization and improve perinatal outcomes.

[Motherhood at the Age of 35 and Over: The Risk of Advanced Maternal Age as Perceived by Women - a Literature Study]. / Mutterschaft ab 35 Jahren: Das Altersrisiko in der Wahrnehmung von Frauen ­ eine Literaturstudie.

Background Delaying motherhood is an ongoing trend in industrialized countries worldwide. The higher the mother´s age, the greater the risks for fertility, pregnancy, childbearing, and for the newborn. The psychosocial situation of women who are conscious of pregnancy risks is thus negatively affected. This paper aims to answer the question as to how women experience the risks of age. Methodology An systematic search of the international literature was carried out between December 2015 and March 2016, using the electronic databases PubMed, CINAHL, PsycINFO, Sowiport, as well as a manual search. The inclusion criterion was the perception of reproductive age risks of motherhood at an advanced age, defined as ≥ 35 years. Results Eleven studies with different designs were evaluated. The participants were sufficiently informed about decreasing fertility rates and the increasing risk of trisomy 21, but less knowledge was shown about the remaining age-associated risks. The awareness of these risks made women feel anxious and scared. They showed various strategies for dealing with their concern: information management, associated with problems of overand misinformation and, in contrast, information avoidance. Other strategies were distraction from thinking about the risks, the need for control and good preparation, or emotional distancing from the pregnancy. The women´s personal risk assessment was complex. They related their social circumstances and their lifestyle and thought about the medical attributions in relative terms. By focusing on giving birth to a healthy child, the mothers often neglected to prepare themselves for living with the newborn. Postpartum they were overwhelmed by the care needed by the newborn child. Discussion The age risk cannot be assessed adequately by those affected. Various phenomena determined through risk research may also appear. There was a meaningful difference between the medically assessed risk and the women's perceived risk. Taking the women´s experience with ageassociated risks and the consequences of motherhood into consideration, it seems necessary to discuss the concept of age risk. Healthcare professionals should focus on health support and encourage older pregnant women to familiarize themselves with family-orientated care of a newborn family member.