Respectful maternity care and women's autonomy in decision making in Iceland: Application of scale instruments in a cross-sectional survey.

OBJECTIVE: To explore how maternal factors are associated with women's experiences of respect and autonomy in Icelandic maternity care. DESIGN: An online survey was developed including two measures assessing the quality of perinatal care: the Mothers on Respect Index and the Mothers' Autonomy in Decision Making Scale. Median and interquartile ranges were calculated for both scales. Logistic regression was used to calculate adjusted odds ratios and 95% confidence intervals to investigate the relationship between maternal factors and perceived low levels of respectful care and perceived low levels of autonomy in decision making. PARTICIPANTS AND SETTING: A total of 1,402 women participated. Requirements were: Age ≥ 18 years; antenatal care and childbirth in Iceland 2015-2021; and fluency in Icelandic, English or Polish. MEASUREMENTS AND FINDINGS: Perceived lower levels of respect were reported by migrant women [aOR 2.16 (1.55-3.00)], women with at least one social complication [aOR 2.52 (1.92-3.31)], primiparous women [aOR 1.72 (1.26-2.36)], women with at least one pregnancy complication [aOR 1.63 (1.22-2.18)] and those who gave birth by caesarean section [aOR 1.75 (1.25-2.45)]. Perceived lower levels of autonomy were reported by migrant women [aOR 1.42 (1.02-1.97)], women who had at least one social complication [aOR 2.12 (1.63-2.74)] and those who gave birth in a hospital setting [aOR 1.62 (1.03-2.55)]. KEY CONCLUSION: The results shed light on inequity in Icelandic maternity care and suggest that data from such surveys can provide valuable information on the changes that must be made in maternity health care services to ensure equity. IMPLICATIONS FOR PRACTICE: Action must be taken to increase provision of respectful, woman-centred maternity care with an emphasis on informed decision making. Strategies to improve services for groups that have been socially marginalized, such as migrant women and women affected by social determinants of health, should be implemented and monitored.

Paving the way for successful twinning:: Using grounded theory to understand the contribution of twin pairs in twinning collaborations.

BACKGROUND: Twinning collaborations, where two groups - from educational institutions, hospitals or towns - work together cross-culturally on joint goals, are increasingly common worldwide. Pairing up individuals, so-called twin pairs, is thought to contribute to successful collaboration in twinning projects, but as yet, there is no empirical evidence or theory that offers insight into the value of the pair relationship for twinning. AIM: To explore the contribution of one-to-one relationships between twins to twinning projects, as exemplified in projects between Dutch and Moroccan, and Dutch and Sierra Leone midwives. METHODS: We conducted thirteen in-depth interviews with midwives from two twinning collaborations. Interviews were transcribed and analysed using an iterative, grounded theory process, yielding a theoretical understanding of one-to-one twinning relationships for twinning collaborations. FINDINGS: Participant comments fell into four substantive categories: 1) Being named a twin, 2) moving beyond culture to the personal level, 3) searching for common ground to engage, 4) going above and beyond the twinning collaboration. Their interplay demonstrates the value of twin pairs in paving the way for successful twinning. DISCUSSION: A complex combination of contextual inequities, personality, and cultural differences affect the twin relationship. Trusting relationships promote effective collaboration, however, as 'trust' cannot be mandated, it must be built by coaching twins in personal flexibility and (cultural) communication. CONCLUSION: By offering original insights into the ways twinning relationships are built, our research explores how twin pairs can enhance the success of twinning projects.

From equity to power: Critical Success Factors for Twinning between midwives, a Delphi study.

AIMS: To gain consensus for Critical Success Factors associated with Twinning in Midwifery. BACKGROUND: International publications identify midwifery as important for improving maternity care worldwide. Midwifery is a team effort where midwives play a key role. Yet their power to take on this role is often lacking. Twinning has garnered potential to develop power in professionals, however, its success varies because implementation is not always optimal. Critical Success Factors have demonstrated positive results in the managerial context and can be helpful to build effective Twinning relationships. DESIGN: We approached 56 midwife Twinning experts from 19 countries to participate in three Delphi rounds between 2016 - 2017. METHODS: In round 1, experts gave input through an open ended questionnaire and this was analysed to formulate Critical Success Factors statements that were scored on a 1-7 Likert scale aiming to gain consensus in rounds 2 and 3. These statements were operationalized for practical use such as a check list in planning, monitoring and evaluation in the field. FINDINGS: Thirty-three experts from 14 countries took part in all three Delphi rounds, producing 58 initial statements. This resulted in 25 Critical Success Factors covering issues of management, communication, commitment and values, most focus on equity. CONCLUSION: The Critical Success Factors formulated represent the necessary ingredients for successful Twinning by providing a practical implementation framework and promote further research into the effect of Twinning. Findings show that making equity explicit in Twinning may contribute towards the power of midwives to take on their identified key role.

The state of the art of twinning, a concept analysis of twinning in healthcare.

BACKGROUND: Inequities in health have garnered international attention and are now addressed in Sustainable Development Goal 3 (SDG3), which seeks to 'promote well-being for all'. To attain this goal globally requires innovative approaches, one of which is twinning. According to the International Confederation of Midwives, twinning focusses on empowering professionals, who can subsequently be change-agents for their communities. However, twinning in healthcare is relatively new and because the definition and understanding of twinning lacks clarity, rigorous monitoring and evaluation are rare. A clear definition of twinning is essential for the development of a scientific base for this promising form of collaboration. METHOD: We conducted a Concept Analysis (CA) of twinning in healthcare using Morse's method. A qualitative study of the broad literature was performed, including scientific papers, manuals, project reports, and websites. We identified relevant papers through a systematic search using scientific databases, backtracking of references, and experts in the field. RESULTS: We found nineteen papers on twinning in healthcare. This included twelve peer reviewed research papers, four manuals on twinning, two project reports, and one website. Seven of these papers offered no definition of twinning. In the other twelve papers definitions varied. Our CA of the literature resulted in four main attributes of twinning in healthcare. First, and most frequently mentioned, was reciprocity. The other three attributes were that twinning: 2) entails the building of personal relationships, 3) is dynamic process, 4) is between two named organisations across different cultures. The literature also indicated that these four attributes, and especially reciprocity, can have an empowering effect on healthcare professionals. CONCLUSIONS: Based on these four attributes we developed the following operational definition: Twinning is a cross-cultural, reciprocal process where two groups of people work together to achieve joint goals. A greater understanding and a mature definition of twinning results in clear expectations for participants and thus more effective twinning. This can be the starting point for new collaborations and for further international studies on the effect of twinning in healthcare.

'Twin2twin' an innovative method of empowering midwives to strengthen their professional midwifery organisations.

BACKGROUND: midwives need professional support from a national midwifery organisation to be able to provide the services that are by regulatory mechanisms and accreditation expected of them. Not all midwives in the world are united in a professional organisation. The aim of this project was to strengthen the midwifery organisations of Sierra Leone and the Netherlands. During the process of the project it was realised that the development of a platform of exchange at organisational level would be enhanced by introducing personal exchange between individual midwives. In response to this new insight the original project plan was adjusted by incorporating the twin2twin method. METHOD: twin2twin is a feminist methodology of mutual exchange between twenty pairs of midwives from different organisations (in this case Sierra Leone and the Netherlands). The method can be distinguished by 10 specific steps. It was developed, used and (re)evaluated through focus group discussions, storytelling and written evaluations. FINDINGS: twinning of organisations was strengthened by adding a human component to the process. With the use of the 'twin2twin' method, midwives were encouraged to invested in a professional and personal bond with their 'twin sister'. This bond was independent and went beyond the relatively short four year project period. Through personal engagement and mutual exchange of knowledge and skills, midwives empowered each other to build and strengthen their midwifery organisations both in Sierra Leone and the Netherlands. (Empowerment refers to the expansion in people's ability to make strategic life choices in a context where this ability was previously denied to them (Narayan, 2005); organisational empowerment includes processes and structures that enhance members' skills and provides them with the mutual support necessary to effect community level change (Zimmerman, 1995).). CONCLUSION AND IMPLICATIONS FOR PRACTICE: despite challenges we are convinced that twin2twin can be of additional benefit for the success of other projects involved in strengthening midwifery organisations in the long term. It can be used independently or alongside other forms of (co)development not only in midwifery but also in other professions.