Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.876
Filtrar
2.
BMC Health Serv Res ; 19(1): 655, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31500636

RESUMO

BACKGROUND: Uganda, a low resource country, implemented the skilled attendance at birth strategy, to meet a key target of the 5th Millenium Development Goal (MDG), 75% reduction in maternal mortality ratio. Maternal mortality rates remained high, despite the improvement in facility delivery rates. In this paper, we analyse the strategies implemented and bottlenecks experienced as Uganda's skilled birth attendance policy was rolled out. These experiences provide important lessons for decision makers as they implement policies to further improve maternity care. METHODS: This is a case study of the implementation process, involving a document review and in-depth interviews among key informants selected from the Ministry of Health, Professional Organisations, Ugandan Parliament, the Health Service Commission, the private not-for-profit sector, non-government organisations, and District Health Officers. The Walt and Gilson health policy triangle guided data collection and analysis. RESULTS: The skilled birth attendance policy was an important priority on Uganda's maternal health agenda and received strong political commitment, and support from development partners and national stakeholders. Considerable effort was devoted to implementation of this policy through strategies to increase the availability of skilled health workers for instance through expanded midwifery training, and creation of the comprehensive nurse midwife cadre. In addition, access to emergency obstetric care improved to some extent as the physical infrastructure expanded, and distribution of medicines and supplies improved. However, health worker recruitment was slow in part due to the restrictive staff norms that were remnants of previous policies. Despite considerable resources allocated to creating the comprehensive nurse midwife cadre, this resulted in nurses that lacked midwifery skills, while the training of specialised midwives reduced. The rate of expansion of the physical infrastructure outpaced the available human resources, equipment, blood infrastructure, and several health facilities were not fully functional. CONCLUSION: Uganda's skilled birth attendance policy aimed to increase access to obstetric care, but recruitment of human resources, and infrastructural capacity to provide good quality care remain a challenge. This study highlights the complex issues and unexpected consequences of policy implementation. Further evaluation of this policy is needed as decision-makers develop strategies to improve access to skilled care at birth.


Assuntos
Política de Saúde , Acesso aos Serviços de Saúde/normas , Serviços de Saúde Materna/organização & administração , Tocologia/organização & administração , Enfermeiras Obstétricas/provisão & distribução , Parto Obstétrico/normas , Parto Obstétrico/estatística & dados numéricos , Feminino , Instalações de Saúde/normas , Acesso aos Serviços de Saúde/organização & administração , Humanos , Serviços de Saúde Materna/normas , Mortalidade Materna , Tocologia/normas , Tocologia/estatística & dados numéricos , Enfermeiras Obstétricas/organização & administração , Enfermeiras Obstétricas/normas , Obstetrícia/normas , Formulação de Políticas , Gravidez , Qualidade da Assistência à Saúde , Uganda
3.
J Clin Nurs ; 28(23-24): 4225-4235, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31410929

RESUMO

AIMS AND OBJECTIVES: To synthesise international research that relates to midwives' use of best available evidence in practice settings and identify key issues relating to the translation of latest evidence into everyday maternity care. BACKGROUND: Midwifery is a research-informed profession. However, a gap persists in the translation of best available evidence into practice settings, compromising gold standard maternity care and delaying the translation of new knowledge into everyday practice. DESIGN: A five-step integrative review approach, based on a series of articles published by the Joanna Briggs Institute (JBI) for conducting systematic reviews, was used to facilitate development of a search strategy, selection criteria and quality appraisal process, and the extraction and synthesis of data to inform an integrative review. METHODS: The databases CINAHL, MEDLINE, Web of Science, Implementation Science Journal and Scopus were searched for relevant articles. The screening and quality appraisal process complied with the PRISMA 2009 checklist. Narrative analysis was used to develop sub-categories and dimensions from the data, which were then synthesised to form two major categories that together answer the review question. RESULTS: The six articles reviewed report on midwives' use of best available evidence in Australia, the UK and Asia. Two major categories emerged that confirm that although midwifery values evidence-based practice (EBP), evidence-informed maternity care is not always employed in clinical settings. Additionally, closure of the evidence-to-practice gap in maternity care requires a multidimensional approach. CONCLUSION: Collaborative partnerships between midwives and researchers are necessary to initiate strategies that support midwives' efforts to facilitate the timely movement of best available evidence into practice. RELEVANCE TO CLINICAL PRACTICE: Understanding midwives' use of best available evidence in practice will direct future efforts towards the development of mechanisms that facilitate the timely uptake of latest evidence by all maternity care providers working in clinical settings.


Assuntos
Tocologia/organização & administração , Enfermeiras Obstétricas/organização & administração , Comportamento Cooperativo , Enfermagem Baseada em Evidências/métodos , Feminino , Humanos , Gravidez
4.
Nurs Outlook ; 67(6): 628-641, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31420180

RESUMO

The United Nations 2030 Agenda for Sustainable Development was implemented on January 1, 2016 and is composed of 17 Sustainable Development Goals (SDGs) and further delineated by 169 targets. This article offers background information on the 2030 Agenda as it relates to nursing and midwifery, professional organizational initiatives currently advancing the SDGs, the ethos of global citizenship, the urgency to respond to dwindling planetary health, the salience of nursing and midwifery advocacy in SDG attainment, and the myriad opportunities for nurses to lead and collaborate toward realizing these Global Goals. A US-based perspective is employed to underscore the Agenda's relevance to the US nursing workforce and healthcare system. The SDGs, with their holistic bio-psycho-social-environmental approach to health, present enormous opportunities for nurses and midwives. The SDG framework is naturally aligned with the foundational philosophy and purpose of our professions.


Assuntos
Defesa do Consumidor , Saúde Global , Tocologia/organização & administração , Cuidados de Enfermagem/organização & administração , Desenvolvimento Sustentável , Feminino , Humanos , Objetivos Organizacionais , Gravidez , Nações Unidas
5.
Nurs Outlook ; 67(6): 642-648, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31376985

RESUMO

To meet the United Nations Sustainable Development Goals (SDGs) in the United States, research by nurses and midwives has a real opportunity to make a significant impact. This paper identifies opportunities to strengthen research capacity in the United States amongst nurses and midwives in ways that will help meet the SDGs and ensure its sustainability. Research capacity means that in a country, there are individuals and teams capable of defining problems, setting priorities, establishing objectives for the goals of the research study, and following rigorous scientific procedures. By strengthening U.S. research capacity by addressing critical weaknesses in content expertise, nursing and midwifery's voices in policy dialogues, and global research initiatives will be have greater assurance of being included.


Assuntos
Saúde Global , Tocologia/organização & administração , Cuidados de Enfermagem/organização & administração , Desenvolvimento Sustentável , Fortalecimento Institucional , Feminino , Humanos , Objetivos Organizacionais , Gravidez , Nações Unidas , Estados Unidos
6.
Women Birth ; 32(5): 427-436, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31326382

RESUMO

BACKGROUND: The urban-based Malabar Community Midwifery Link Service integrates multidisciplinary wrap-around services along-side continuity of midwifery care for Aboriginal and Torres Strait Islander mothers and babies. AIM: To evaluate the Malabar Service from 1 January 2007 to 31 December 2014. METHODS: A mixed method design. Outcomes for mothers of Aboriginal and/or Torres Strait Islander babies cared for at an urban Australian referral hospital by the Malabar Service were compared to mainstream. Primary outcomes are rates of low birth weight; smoking >20 weeks gestation; preterm birth; and breastfeeding at discharge. Malabar outcomes are also compared to national and state perinatal outcomes. RESULTS: The Malabar Service (n = 505) demonstrated similar rates of preterm birth (aOR 2.2, 95% CI 0.96-4.97); breastfeeding at discharge (aOR 1.1, 95% CI 0.61-1.86); and a higher rate of low birth weight babies (aOR 3.6, 95% CI 1.02-12.9) than the comparison group (n = 201). There was a 25% reduction in smoking rates from 38.9% to 29.1%. Compared to national and state populations, Malabar outcomes were better. Women experienced greater psychosocial complexity but were well supported. Malabar Mothers (n = 9) experienced: accessibility, preparedness for birth and cultural safety. Staff (n = 13) identified going 'above and beyond' and teamwork to provide culturally safe care counterbalanced with concerns around funding and cultural support. CONCLUSIONS: Dedicated integrated continuity of midwifery care with wrap-around services for Aboriginal and/or Torres Strait Islander mothers is highly valued and is culturally safe. The service is as safe as main stream services and promotes better clinical outcomes compared to national and state outcomes.


Assuntos
Continuidade da Assistência ao Paciente , Serviços de Saúde do Indígena , Serviços de Saúde Materna/organização & administração , Bem-Estar Materno/etnologia , Tocologia/organização & administração , Grupo com Ancestrais Oceânicos/psicologia , Parto/etnologia , Adulto , Austrália , Características Culturais , Feminino , Humanos , Obstetrícia , Gravidez , Fumar
7.
BMC Pregnancy Childbirth ; 19(1): 206, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31286892

RESUMO

BACKGROUND: Caesarean sections (CSs) are associated with increased maternal and perinatal morbidity, yet rates continue to increase within most countries. Effective interventions are required to reduce the number of non-medically indicated CSs and improve outcomes for women and infants. This paper reports findings of a systematic review of literature related to maternity service organisational interventions that have a primary intention of improving CS rates. METHOD: A three-phase search strategy was implemented to identify studies utilising organisational interventions to improve CS rates in maternity services. The database search (including Cochrane CENTRAL, CINAHL, MEDLINE, Maternity and Infant Care, EMBASE and SCOPUS) was restricted to peer-reviewed journal articles published from 1 January 1980 to 31 December 2017. Reference lists of relevant reviews and included studies were also searched. Primary outcomes were overall, planned, and unplanned CS rates. Secondary outcomes included a suite of birth outcomes. A series of meta-analyses were performed in RevMan, separated by type of organisational intervention and outcome of interest. Summary risk ratios with 95% confidence intervals were presented as the effect measure. Effect sizes were pooled using a random-effects model. RESULTS: Fifteen articles were included in the systematic review, nine of which were included in at least one meta-analysis. Results indicated that, compared with women allocated to usual care, women allocated to midwife-led models of care implemented across pregnancy, labour and birth, and the postnatal period were, on average, less likely to experience CS (overall) (average RR 0.83, 95% CI 0.73 to 0.96), planned CS (average RR 0.75, 95% CI 0.61 to 0.93), and episiotomy (average RR 0.84, 95% CI 0.74 to 0.95). Narratively, audit and feedback, and a hospital policy of mandatory second opinion for CS, were identified as interventions that have potential to reduce CS rates. CONCLUSION: Maternity service leaders should consider the adoption of midwife-led models of care across the maternity episode within their organisations, particularly for women classified as low-risk. Additional studies are required that utilise either audit and feedback, or a hospital policy of mandatory second opinion for CS, to facilitate the quantification of intervention effects within future reviews. PROSPERO REGISTRATION: CRD42016039458 ; prospectively registered.


Assuntos
Cesárea/estatística & dados numéricos , Assistência à Saúde/organização & administração , Tocologia/organização & administração , Assistência Perinatal/organização & administração , Melhoria de Qualidade/organização & administração , Cesárea/normas , Assistência à Saúde/métodos , Feminino , Humanos , Tocologia/métodos , Modelos Estatísticos , Assistência Perinatal/métodos , Gravidez
8.
Sex Reprod Healthc ; 20: 87-92, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31084826

RESUMO

BACKGROUND: Midwifery practice is in the process of continuing developments and contemporary working conditions asking for proactive behaviour, which could increase work-efficiency, job satisfaction, commitment and coping attitudes towards stress resistance. This study aims to provide an in depth exploration of midwives' perceptions of facilitators and/or barriers of proactive behaviour in midwifery practice. METHODS: A qualitative descriptive study, using individual semi-structured interviews, was undertaken within a sample of 102 Flemish and Dutch midwives who were interviewed from September to December 2017 using a four-item topic-list. RESULTS: Six influencing factors emerged from the data consisted of the causal, contextual and conditional factors faced by the midwives in order to show proactive behaviour in midwifery practice. Midwives elaborated the need for team consultations, a safe organizational culture, an appreciative midwifery leader and an attitude of lifelong learning. Furthermore, midwives are looking for a way to deal with both challenges in healthcare and the competitive societal system. CONCLUSION: This inductive study confirmed, supported and expanded previous deductive research and provided additional insights of proactive behaviour in midwifery. Providing midwives with knowledge of the influencing factors, required to successfully effecting proactive behaviour in midwifery, this study has subsequently merit for future research in the transfer of recommendation in daily midwifery practice, education and policymaking.


Assuntos
Atitude do Pessoal de Saúde , Comportamento , Tocologia/métodos , Adulto , Feminino , Processos Grupais , Humanos , Liderança , Masculino , Pessoa de Meia-Idade , Tocologia/educação , Tocologia/organização & administração , Cultura Organizacional , Equipe de Assistência ao Paciente/organização & administração , Pesquisa Qualitativa , Adulto Jovem
9.
Rev Lat Am Enfermagem ; 27: e3139, 2019 Apr 29.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31038633

RESUMO

OBJECTIVE: to compare, after four years of the implementation of the Stork Network, the obstetric practices developed in a university hospital according to the classification of the World Health Organization. METHOD: cross-sectional study carried out in the year of adherence to the Stork Network (377 women) and replicated four years later (586 women). Data were obtained through medical records and a structured questionnaire. The Chi-square test was used in the analysis. RESULTS: four years after the implementation of the Stork Network, in Category A practices (demonstrably useful practices/good practices), there was increased frequency of companions, non-pharmacological methods, skin-to-skin contact and breastfeeding stimulation, and decreased freedom of position/movement. In Category B (harmful practices), there was reduction of trichotomy and increased venoclysis. In Category C (practices with no sufficient evidence), there was increase of Kristeller's maneuver. In Category D (improperly used practices), the percentage of digital examinations above the recommended level increased, as well as of analgesics and analgesia, and there was decrease of episiotomy. CONCLUSION: these findings indicate the maintenance of a technocratic and interventionist assistance and address the need for changes in the obstetric care model. A globally consolidated path is the incorporation of midwife nurses into childbirth for the appropriate use of technologies and the reduction of unnecessary interventions.


Assuntos
Parto Obstétrico/enfermagem , Promoção da Saúde/organização & administração , Tocologia/organização & administração , Parto , Adulto , Brasil , Aleitamento Materno , Estudos Transversais , Parto Obstétrico/normas , Prática Clínica Baseada em Evidências , Feminino , Promoção da Saúde/normas , Hospitais Universitários , Humanos , Trabalho de Parto , Serviços de Saúde Materna , Tocologia/métodos , Tocologia/normas , Gravidez , Desenvolvimento de Programas , Fatores Socioeconômicos , Adulto Jovem
10.
Int J Gynaecol Obstet ; 146(1): 126-131, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31058318

RESUMO

After the declaration of the Millennium Development Goals in 2000 by the United Nations, many stakeholders allocated financial resources to "global maternal health." Research to expand care and improve delivery of maternal health services has exponentially increased. The present article highlights an overview, namely 10 of the health system, clinical, and technology-based advancements that have occurred in the past three decades in the field of global maternal health. The list of topics has been selected through the cumulative clinical and public health expertise of the authors and is certainly not exhaustive. Rather, the list is intended to provide a mapping of key topics arranged from broad to specific that span from the global policy level to the level of individual care. The list of health system, clinical, and technology-based advancements include: (10) Millennium Development Goals and Sustainable Development Goals; (9) Development of clinical training programs, including the potential for subspecialty development; (8) Prenatal care expansion and potential; (7) Decentralized health systems, including the use of skilled birth attendants; (6) Antiretroviral therapy for HIV; (5) Essential medicines; (4) Vaccines; (3) mHealth/eHealth; (2) Ultrasonography; and (1) Obstetric hemorrhage management. With the Sustainable Development Goals now underway, the field must build upon past successes to sustain maternal and neonatal well-being in the future global health agenda.


Assuntos
Saúde Global/normas , Saúde Materna/normas , Cuidado Pré-Natal/organização & administração , Feminino , Humanos , Mortalidade Materna , Tocologia/organização & administração , Mortalidade Perinatal , Gravidez , Desenvolvimento Sustentável , Nações Unidas
11.
PLoS One ; 14(4): e0215098, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30973919

RESUMO

OBJECTIVE: To explore pregnant women's preferences for birth setting in England. DESIGN: Labelled discrete choice experiment (DCE). SETTING: Online survey. SAMPLE: Pregnant women recruited through social media and an online panel. METHODS: We developed a DCE to assess women's preferences for four hypothetical birth settings based on seven attributes: reputation, continuity of care, distance from home, time to see a doctor, partner able to stay overnight, chance of straightforward birth and safety for baby. We used a mixed logit model, with setting modelled as an alternative-specific constant, and conducted a scenario analysis to evaluate the impact of changes in attribute levels on uptake of birth settings. MAIN OUTCOME MEASURES: Women's preferences for birth setting. RESULTS: 257 pregnant women completed the DCE. All birth setting attributes, except 'time to see doctor', were significant in women's choice (p<0.05). There was significant heterogeneity in preferences for some attributes. Changes to levels for 'safety for the baby' and 'partner able to stay overnight' were associated with larger changes from baseline uptake of birth setting. If the preferences identified were translated into the real-world context up to a third of those who reported planning birth in an obstetric unit might choose a midwifery unit assuming universal access to all settings, and knowledge of the differences between settings. CONCLUSIONS: We found that 'safety for the baby', 'chance of a straightforward birth' and 'can the woman's partner stay overnight following birth' were particularly important in women's preferences for hypothetical birth setting. If all birth settings were available to women and they were aware of the differences between them, it is likely that more low risk women who currently plan birth in OUs might choose a midwifery unit.


Assuntos
Entorno do Parto/estatística & dados numéricos , Comportamento de Escolha , Tomada de Decisões , Conhecimentos, Atitudes e Prática em Saúde , Tocologia/organização & administração , Preferência do Paciente , Gestantes/psicologia , Adulto , Inglaterra , Feminino , Acesso aos Serviços de Saúde , Humanos , Gravidez , Cuidado Pré-Natal , Inquéritos e Questionários , Adulto Jovem
13.
Int J Health Plann Manage ; 34(2): e987-e994, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30945362

RESUMO

Following the World Health Organization's recommendation for developing countries to discontinue the use of Traditional Birth Attendants (TBAs) in rural areas, the government of Ghana banned TBAs from offering maternal health care services. Since this ban, community-level conflicts have intensified between TBAs, (who still see themselves as legitimate culturally mandated traditional midwives) and nurses. In this articles, we propose a partnership model for a sustainable resolution of these conflicts. This article emanates from the apparent ideological discontent between people from mainstream medical practice who advocate for the complete elimination of TBAs in the maternal health service space and individuals who argue for the inclusion of TBAs in the health sector given the shortage of skilled birth attendants and continued patronage of their services by rural women even in context where nurses are available. In the context of the longstanding manpower deficit in the health sector in Ghana, improving maternal healthcare in rural communities will require harnessing all locally available human resources. This cannot be achieved by "throwing out" a critical group of actors who have been involved in health-care provision for many decades. We propose a win-win approach that involve retraining of TBAs, partnership with health practitioners, and task shifting.


Assuntos
Serviços de Saúde Materna/normas , Tocologia/organização & administração , Melhoria de Qualidade , Serviços de Saúde Rural , Feminino , Gana , Humanos , Gravidez
14.
PLoS One ; 14(4): e0214577, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947314

RESUMO

BACKGROUND: While Nepal's maternal mortality ratio (MMR) has improved overall, the proportion of maternal deaths occurring in health facilities and attended to by skilled birth attendants (SBAs), has nearly doubled over 12 years. Although there are numerous socioeconomic, environmental and other factors at play, one possible explanation for this discrepancy between utilization of skilled maternal care services and birth outcomes lies in the quality of care being provided by SBAs. The objective of this study is to determine how competent SBAs are after training, across multiple settings and facility types in Nepal. METHODS: We used a quantitative cross-sectional analysis to evaluate a sample of 511 SBAs, all female, from 276 sub-health posts (SHP), health posts (HP), primary healthcare centers (PHC), and district and regional hospitals in the mountain, hill, and terai districts of Nepal. Any SBA actively employed by one of these health facilities was included. SBAs who had received less than three months of training were excluded. Outcomes were measured using SBAs' scores on a standardized knowledge assessment, clinical skills assessment, and monthly delivery volume, particularly as it compared with the WHO's recommendation for minimum monthly volume to maintain competence. RESULTS: SBAs on average exhibit a deficiency of both knowledge and clinical skills, failing to meet even the 80-percent standard that is required to pass training (knowledge: 75%, standard deviation 12%; clinical skills: 48%, standard deviation 15%). Moreover, SBAs are conducting very few deliveries, with only 7 percent (38/511) meeting the minimal volume recommended to maintain competence by the WHO, and a substantial fraction (70/511, 14%) performing an average of no monthly deliveries at all. CONCLUSIONS: Taken together, our findings suggest that while countries like Nepal have made important investments in SBA programs, these healthcare workers are failing to receive either effective training or sufficient practice to stay clinically competent and knowledgeable in the field. This could in part explain why institutional deliveries have generally failed to deliver better outcomes for pregnant women and their babies.


Assuntos
Pessoal de Saúde , Serviços de Saúde Materna/organização & administração , Tocologia/organização & administração , Tocologia/normas , Parto , Qualidade da Assistência à Saúde , Adulto , Competência Clínica , Estudos Transversais , Parto Obstétrico , Feminino , Instalações de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Nepal , Enfermeiras e Enfermeiros , Gravidez , Estudos Retrospectivos , Serviços de Saúde Rural , População Rural
15.
BMC Health Serv Res ; 19(1): 166, 2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30871523

RESUMO

BACKGROUND: Nepal formulated a range of policies related to maternal and neonatal survival, especially after the year 2000. Nevertheless, Nepal's perinatal mortality remains high, particularly in disadvantaged regions. Policy analysis can uncover the underlying values, strategies and policy formulation processes that shape the potential to reduce in-country health inequities. This paper provides a critical account of the main policy documents relevant to perinatal survival in Nepal. METHODS: Six key policy documents covering the period 2000-2015 were reviewed using an adapted framework and were analyzed through qualitative content analysis. RESULTS: The analysis shows that the policies focused mainly on the system: improvement in provision of birthing facilities; targeting staff (Skilled Birth Attendants) and health service users by providing cash incentives to staff for bringing patients to services, and to users (pregnant women) to attend health institutions. Despite a growing focus on saving women and newborn babies, there is a poor policy focus and direction on preventing stillbirth. The policy documents were found to emphasize tensions between birthing at home and at health institutions on the one hand, and between strategies to provide culturally appropriate, woman-centered care in communities and medically orientated services on the other. Policies acknowledge the need to provide and address woman-centered care, equity, social inclusion, and a rights-based approach, and identify the community based approach as the mode of service delivery. Over and above this, all policy documents are aimed at the national level, and there is no specific policy direction for the separate ecological, cultural or geographic regions such as the mountainous region, which continues to exhibit higher mortality rates and has different cultural and demographic characteristics to the rest of Nepal. CONCLUSIONS: To better address the continuing high perinatal mortality rates, particularly in disadvantaged areas, national health policies should pay more attention to the inequity in healthcare access and in perinatal outcomes by integrating both stillbirth prevention and neonatal survival as policy agenda items. To ensure effective translation of policy into practice, it is imperative to tailor the strategies according to acknowledged policy values such as rights, inclusion and socio-cultural identity.


Assuntos
Assistência à Saúde Culturalmente Competente/organização & administração , Assistência Perinatal/organização & administração , Cuidado Pré-Natal/organização & administração , Feminino , Política de Saúde , Acesso aos Serviços de Saúde/organização & administração , Humanos , Recém-Nascido , Tocologia/organização & administração , Nepal , Enfermeiras Obstétricas/provisão & distribução , Assistência Centrada no Paciente/organização & administração , Mortalidade Perinatal , Formulação de Políticas , Gravidez
17.
Women Birth ; 32(1): 39-49, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29693545

RESUMO

BACKGROUND: Globally there are challenges meeting the recruitment and retention needs for rural midwifery. Rural practice is not usually recognised as important and feelings of marginalisation amongst this workforce are apparent. Relationships are interwoven throughout midwifery and are particularly evident in rural settings. However, how these relationships are developed and sustained in rural areas is unclear. AIM: To study the significance of relationships in rural midwifery and provide insights to inform midwifery education. METHODS/DESIGN: Multi-centre study using online surveys and discussion groups across New Zealand and Scotland. Descriptive and template analysis were used to organise, examine and analyse the qualitative data. FINDINGS: Rural midwives highlighted how relationships with health organisations, each other and women and their families were both a joy and a challenge. Social capital was a principal theme. Subthemes were (a) working relationships, (b) respectful communication, (c) partnerships, (d) interface tensions, (e) gift of time facilitates relationships. CONCLUSIONS: To meet the challenges of rural practice the importance of relationship needs acknowledging. Relationships are created, built and sustained at a distance with others who have little appreciation of the rural context. Social capital for rural midwives is thus characterised by social trust, community solidarity, shared values and working together for mutual benefit. Rural communities generally exhibit high levels of social capital and this is key to sustainable rural midwifery practice. IMPLICATIONS: Midwives, educationalists and researchers need to address the skills required for building social capital in rural midwifery practice. These skills are important in midwifery pre- and post-registration curricula.


Assuntos
Tocologia/organização & administração , Serviços de Saúde Rural/organização & administração , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Nova Zelândia , Gravidez , População Rural , Escócia
18.
Women Birth ; 32(1): 58-63, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29773474

RESUMO

AIM: Having a known midwife at birth is valued by women across the world, however it is unusual for women with fear of childbirth to have access to this model of care. The aim of this study was to describe the prevalence and factors related to having access to a known midwife for women referred to counseling due to childbirth fear. We also wanted to explore if women's levels of childbirth fear changed over time. METHODS: A pilot study of 70 women referred to counseling due to fear of birth in 3 Swedish hospitals, and where the counseling midwife, when possible, also assisted during labour and birth. RESULTS: 34% of the women actually had a known midwife during labour and birth. Women who had a known midwife had significantly more counseling visits, they viewed the continuity of care as more important, were more satisfied with the counseling and 29% reported that their fear disappeared. Fear of birth decreased significantly over time for all women irrespective of whether they were cared for in labour by a known midwife or not. CONCLUSIONS: Although the women in the present study had limited access to a known midwife, the results indicate that having a known midwife whom the women met on several occasions made them more satisfied with the counseling and had a positive effect on their fear. Building a trustful midwife-woman relationship rather than counseling per se could be the key issue when it comes to fear of birth.


Assuntos
Medo , Tocologia/organização & administração , Parto/psicologia , Adulto , Feminino , Humanos , Projetos Piloto , Gravidez
19.
Women Birth ; 32(1): e77-e87, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29803611

RESUMO

BACKGROUND: In Australia, the provision of homebirth services by unregulated birthworkers (doulas, ex-registered midwives, traditional midwives and lay workers) has increased. Accessing a homebirth with a registered midwife via mainstream services is limited. Concern is growing that new legislation aimed at prohibiting unregulated birthworkers practice may result in homebirth going underground. AIM: To explore the role, practice and training of unregulated birthworkers in Australian and establish what they would do if legislation prohibited their practice. METHODS: This study used a mixed methods sequential exploratory design to explore the practice, training and role of unregulated birthworkers in Australia. In phase one, four unregulated birthworkers were interviewed in-depth and the findings informed the development of a survey in phase two. This was distributed nationally through two consumer websites, social media, Facebook and email. Data from both phases were integrated. FINDINGS: Unregulated birthworkers in Australia provide homebirth services to women with high and low-risk pregnancies when this choice is unavailable or unacceptable within mainstream services. They operate covertly to protect their practice and avoid the scrutiny of authorities. Unregulated birthworkers can be experienced and trained in childbirth care and practice, much like a midwife working within a holistic paradigm of care. CONCLUSION: Unregulated birthworkers believe they provide women with the homebirth service they want but cannot access. Mainstream service providers need to listen to consumer criticisms, as women seek answers outside the system. Change is needed to improve and align services with women's expectations of homebirth.


Assuntos
Tocologia/organização & administração , Austrália , Feminino , Humanos , Tocologia/educação , Gravidez , Papel Profissional
20.
Women Birth ; 32(1): 3-5, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29602689

RESUMO

BACKGROUND: Exposure to alcohol prenatally can result in a child being diagnosed with fetal alcohol spectrum disorder. Affected infants experience lifelong impairments that can involve, physical, cognitive, behavioural and emotional difficulties that impact on their functional capacity. Effective prevention of fetal alcohol spectrum disorder is critically needed in Australia. Reduction in the prevalence of this disorder will only be possible if we prevent alcohol consumption during pregnancy. AIM: This paper provides an overview of fetal alcohol spectrum disorder and discusses the role of caseload midwifery as part of a multi-level prevention approach. FINDINGS: Drawing on previous research, caseload midwifery has potential to support the prevention of fetal alcohol spectrum disorder through continuity of care. CONCLUSION: Prevention of fetal alcohol spectrum disorder will be more likely if women experience a supportive relationship with a known midwife, who has received appropriate training and can enable women to feel comfortable in discussing and addressing alcohol use.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Tocologia/organização & administração , Austrália , Feminino , Humanos , Gravidez
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA