Women and Birth最新文献

Objective

Design

Setting

Results

Conclusions

Problem

Background

Methods

Findings

Conclusion

Background

Objective

Methods

Results

Conclusion

Problem

Background

Question

Methods

Findings

Discussion

Conclusion

Problem

Background

Aim

Methods

Findings

Discussion

Conclusion

Background

Shared decision-making supports women’s autonomy in antenatal care, but several barriers to shared decision-making have been identified in practice. Women with high body mass index experience a higher rate of interventions, which could provide more opportunities for shared decision-making in antenatal care. However, weight stigma may exist as a barrier to shared decision-making, limiting access to collaborative care.

Aim

To explore how shared decision-making is implemented and whether body mass index influences maternity clinicians' use of shared decision-making when providing antenatal care for women.

Methods

Maternity clinicians were recruited via purposive sampling from two sites in metropolitan Melbourne, Australia. Semi-structured interviews were audio recorded, transcribed, and analysed using reflexive thematic analysis.

Findings

Twelve maternity clinicians consented to participate. Three themes and ten sub-themes were identified. The themes were: 1) Whose choice is it anyway? 2) Pregnancy as risky 3) Excess weight as a diseased state.

Discussion

Maternity clinicians in this study view pregnancy through a risk management lens that complicates women’s involvement in decision-making, demonstrating inherent beliefs that may further limit options for women with high body mass index.

Conclusion

Shared decision-making is difficult to implement in the current antenatal clinic setting and requires significant structural consideration to become a reality for women. Clinicians may inadvertently limit meaningful opportunities to engage in shared decision-making with women with high body mass index due to preconceived perceptions of risk and stigmatising beliefs about women with high body mass index.

Background

Internationally, traditional medicine approaches are used to support humanised childbirth practices. Labour support issues in low- and middle-income countries (LMICs), include limited resources, staffing, and escalating pharmaceutical interventions. There is a strong interest in evidence-based acupressure programs, however, training and experience to implement them is limited. Maternity professionals at the Fernandez Foundation (FF) including associated hospitals in the Hyderabad region, India, sought training in acupressure to support humanised childbirth.

Aims

To evaluate the implementation of the ‘Acupressure for childbirth training program’ at FF hospitals, up to 6-months post-training, including barriers and facilitators, as well as determining pregnancy and labour conditions for which the techniques are most useful.

Methods

Pre- and post-training, and 6-month surveys, were distributed to participants.

Results

Participants included a diverse group of 88 midwives, doulas, physiotherapists, educators and obstetricians. There were significant improvements in participant skills and knowledge, which persisted up to 6-months post-training (p<0.01). Participants indicated they were ‘highly satisfied’ with the training, and found it valuable, easy to implement, and reported extremely positive responses from women and support people. Facilitators to implementation included ‘strategies and ideas’, ‘effectiveness of pain relief’, and ‘aiding labour progress’. Barriers included ‘other staff and institutional challenges’, ‘needing more training’, ‘women’s attitudes’.

Conclusion

Acupressure training as part of a humanised approach to childbirth, demonstrates significant skill and knowledge gain, usefulness of training and skills, ease of implementation, and a highly positive reception within the clinical environment. Implementation of these practices should be widespread and supported by policy makers and clinicians.

Aim

To explore the benefit and engagement of undergraduate students’ use of H5P interactive books for student learning.

Design

An evaluation study of technology enabled learning for first year undergraduate Bachelor of Midwifery students in Australia.

Methods

Students were invited to complete an online evaluation survey of their use and engagement with H5P interactive books. The survey included the long form User Engagement Scale which has four subscales of focused attention, aesthetic appeal, reward factor and perceived usability scored on a 5-point Likert scale. Content analysis was used to analyse the text comments given to five open text questions.

Results

There were 21 students who completed the survey. There was a high overall User Engagement Scale score of 73.1 % with aesthetic appeal and reward factor being the highest scoring subscales. The content analysis showed students found the interactive books engaging and easy to navigate. Areas for improvement identified were not including a large amount of content and providing downloadable content.

Conclusions

This study demonstrates the valuable and engaging use of H5P Interactive Books for undergraduate students in higher education. Students who used H5P Interactive Books identified their ease of use, organised layout and engaging format.

Background

Global and national frameworks for midwifery education recognise and prioritise the provision of midwifery continuity of care. Previous studies report that learning is enhanced when students have professional experience placements within these models, however there remains wide variation in midwifery students’ access to placements within these models in Australia.

Aim

To evaluate Bachelor of Midwifery students’ experiences in midwifery continuity of care models within two local health districts in New South Wales, Australia.

Method

A mixed methods design was used: qualitative data collected through interviews, and quantitative data collected via an online survey using the Midwifery Student Evaluation of Practice (MidSTEP) tool. Thematic analysis of qualitative data and descriptive analysis of quantitative data was undertaken.

Results

Sixteen students responded, four students were interviewed, and 12 students completed the survey. The MidSTEP mean scores for all sub-scales rated above 3.0/4.0. Participants rated ‘work across the full scope of midwifery practice’ and five out of eight subscales of Philosophy of Midwifery Practice at 100 %. ‘Experiences prepare me to be a change agent for maternity service reform’ rated the lowest (67 %). Three qualitative themes emerged: care versus carer model; learning experience; and future career as a caseload midwife.

Conclusion

A mixed method approach using a validated tool to measure student experiences, contributes to the evidence that students value professional experience placements within midwifery continuity of care models. Currently this is not an option for all midwifery students and as midwifery continuity of care models expand, these findings will inform further implementation of student professional experience placement within these models.

Purpose

Rural women and their babies experience poorer perinatal outcomes than their urban counterparts and this inequity has existed for decades. This study explored the barriers and enablers that exist for rural women in Australia in accessing perinatal care.

Methods

A qualitative descriptive design, using reflexive thematic analysis, was employed. Semi-structured interviews were conducted in 2023 with women who had recently given birth in rural Victoria, Australia (n=19). A purposive sampling strategy was used, recruiting women via social media platforms from rural communities across the state. The Socioecological Model (SEM) was used as a framework to organise the findings.

Results

Study participants reported multilevel barriers and enablers to accessing perinatal care in their own communities. Intrapersonal factors included financial resources, transportation, self-advocacy, health literacy, rural stoicism, personal agency, and cost of care. Interpersonal factors included factors such as ineffective relationships, poor communication, and care provider accessibility. Organisational factors included inequitable distribution of services, under-resourcing of perinatal services in rural areas, technology-enabled care models and access to continuity of care. Community factors included effective or ineffective interprofessional or interorganisational collaboration. Policy factors included centralisation of perinatal care, lack of funded homebirth and midwifery care pathways and access to free perinatal care.

Conclusion

Participants in this study articulated several key barriers influencing access to perinatal care in rural areas. These factors impede help-seeking behaviour and engagement with care providers, compounding the impact of rurality and isolation on perinatal outcomes and experience of care. Key enablers to accessing perinatal care in rural communities were also identified and included personal agency, health literacy, social capital, effective collaboration and communication between clinicians and services, technology enabled care and free perinatal care.