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Culturally responsive, trauma-informed, continuity of care(r) toolkits: A scoping review 文化敏感性、创伤知情、持续护理(r)工具包:范围综述。
IF 4.4 2区 医学 Q1 NURSING Pub Date : 2024-11-01 DOI: 10.1016/j.wombi.2024.101834
Ellen McEvoy , Storm Henry , Maedeh Aboutalebi Karkavandi , Jillian Donnelly , Madeleine Lyon , Natalie Strobel , Jacqui Sundbery , Helen McLachlan , Della Forster , Thiago Melo Santos , Simone Sherriff , Rhonda Marriott , Catherine Chamberlain , for the Replanting the Birthing Trees group

Background

Models of care that are culturally responsive, trauma-informed and provide continuity of care(r), are important components of care for Aboriginal and Torres Strait Islander parents during the broad perinatal period (pregnancy to 2 years after birth; first 1000 days). Many health services do aim to incorporate these concepts in care provision, but often focus on only one.

Aim

To identify practical toolkits that guide implementation of culturally responsive care, trauma-informed care, or continuity of care(r) in the perinatal period, and map the key elements.

Methods

A scoping review was conducted. Relevant databases and grey literature were searched to identify toolkits that guided implementation of any one of the aforementioned concepts in the perinatal period. Toolkit context, principles, core components and processes were extracted and synthesised.

Findings

Thirteen toolkits, from both Indigenous and non-Indigenous contexts, met the inclusion criteria. Six related to culturally responsive care, nine to trauma-informed care, and eight to continuity of care(r), with some overlap. Key principles included continuity of carer, collaboration, woman (or family) centred care, safety and holistic care. Individualised care, team work, having a safe service environment and continuity of care/r were highlighted as core components. Key processes related to planning, implementation, monitoring and evaluation, and sustainability.

Discussion

There are no available resources that support holistic implementation of all three concepts of culturally responsive, trauma-informed continuity of care(r), spanning the first 1000 days, for Aboriginal and Torres Strait Islander families. A synthesised toolkit of key principles, core components and key processes would assist implementation of this.

Statement of significance

Problem: Aboriginal and Torres Strait Islander families experience health inequalities and poorer perinatal outcomes due to a legacy of colonisation and ongoing discrimination.

What is already known

Culturally responsive care, trauma-informed care and continuity of care(r) are elements of perinatal care shown to improve outcomes and experiences.

What this paper adds

This review synthesises key aspects of culturally responsive, trauma-informed and continuity of care(r) models. It highlights the lack of resources to support services implementing models pertaining to these three concepts across the full First 1000 days, for Aboriginal and Torres Strait Islander families.
背景:在广泛的围产期(从怀孕到产后 2 年;头 1000 天)内,对土著居民和托雷斯海峡岛民的父母而言,具有文化响应性、创伤知情和提供连续性护理(r)的护理模式是护理的重要组成部分。目的:确定指导围产期文化响应护理、创伤知情护理或连续性护理(r)实施的实用工具包,并绘制关键要素图:方法:进行了范围界定审查。对相关数据库和灰色文献进行了检索,以确定在围产期指导实施上述任何一个概念的工具包。对工具包的背景、原则、核心内容和流程进行了提取和综合:符合纳入标准的工具包有 13 个,既有土著工具包,也有非土著工具包。其中六套与文化适应性护理有关,九套与创伤知情护理有关,八套与持续性护理有关,但也有一些重叠。主要原则包括护理人员的连续性、合作、以妇女(或家庭)为中心的护理、安全和整体护理。个性化护理、团队合作、安全的服务环境和护理的连续性/r 被强调为核心内容。关键过程涉及规划、实施、监测和评估以及可持续性:讨论:目前还没有可用的资源来支持针对土著居民和托雷斯海峡岛民家庭,在最初的 1000 天内,全面实施文化敏感性、创伤知情的连续性护理(r)的所有三个概念。一个包含关键原则、核心组成部分和关键流程的综合工具包将有助于这一概念的实施:问题:由于殖民化和持续歧视的遗留问题,土著居民和托雷斯海峡岛民家庭经历了健康不平等和较差的围产期结果:本文的补充内容:本综述总结了文化敏感型护理、创伤知情型护理和持续性护理(r)模式的主要方面。它强调了在为土著居民和托雷斯海峡岛民家庭提供的整个 "最初 1000 天 "服务中,缺乏资源来支持实施与这三个概念相关的模式。
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引用次数: 0
Midwives’ readiness for midwife-led care: a mixed-methods study 助产士为助产士主导的护理做好准备:一项混合方法研究
IF 4.4 2区 医学 Q1 NURSING Pub Date : 2024-11-01 DOI: 10.1016/j.wombi.2024.101840
Yvonne J. Kuipers , Valerie Bosmans , Ellen Thaels , Vanessa De Bock

Background/Problem

To integrate midwife-led care in Belgian maternity services, understanding whether midwives are primed of executing the change is needed.

Aim

To explore Belgian midwives’ readiness for midwife-led care and understand the underlying processes.

Methods

A mixed-methods sequential study: 1) A survey including 414 practising midwives and 2) individual interviews with 12 (student) midwives. General linear model analysis was used to examine the trend between knowledge, self-efficacy and performance mean scores - indicators of midwife-led care readiness - proposed in a 27-item questionnaire. The Readiness Assessment Framework served as a template for qualitative thematic analysis.

Findings

Template analysis illustrated the underlying mechanisms of midwifery-led care readiness: Governmental and institutional steering and rule-making functions, regulation and reimbursement, awareness of midwife-led care among stakeholders, capacity to extend primary care postpartum services to antenatal and intrapartum care and healthcare professionals’ lack of awareness of available data of women’s experiences and midwife-led care efficacy in Belgium. These qualitative findings contribute to the understanding of the significant trend with decreasing function for knowledge, self-efficacy and performance mean scores of 25 midwife-led care readiness indicators, and the two non-significant indicators referring to a physiological postpartum period.

Discussion/Conclusion

In determining midwife readiness for midwife-led care, we observed adequate knowledge mean scores, associated with low self-efficacy and even lower midwife-led care performance mean scores. Our findings suggest limited readiness for MLC in antenatal and intrapartum care. Belgian midwives are the domain experts of postpartum services but face challenges in extending midwife-led care to antenatal and intrapartum services.
背景/问题要在比利时的产科服务中整合助产士主导的护理,需要了解助产士是否做好了实施变革的准备。目的探讨比利时助产士对助产士主导护理的准备情况,并了解其背后的过程:1)对 414 名执业助产士进行调查;2)对 12 名助产士(学生)进行个别访谈。采用一般线性模型分析来研究知识、自我效能和绩效平均分(助产士主导的护理准备度指标)之间的趋势。结果模板分析说明了助产士主导型护理准备就绪的基本机制:政府和机构的指导和规则制定职能、监管和报销、利益相关者对助产士主导型护理的认识、将产后初级护理服务扩展到产前和产中护理的能力,以及医疗保健专业人员对比利时妇女经验和助产士主导型护理功效的现有数据缺乏认识。这些定性研究结果有助于理解在 25 项助产士主导型护理准备度指标中,知识、自我效能和绩效平均分呈显著的递减趋势,以及两项与产后生理期有关的指标不显著。讨论/结论在确定助产士主导型护理准备度时,我们观察到知识平均分充足,但自我效能较低,助产士主导型护理绩效平均分甚至更低。我们的研究结果表明,助产士在产前和产中护理方面的准备程度有限。比利时助产士是产后服务领域的专家,但在将助产士主导的护理扩展到产前和产中服务方面面临挑战。
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引用次数: 0
Do women have a choice when it comes to fetal monitoring? Perceptions of information provided and choice of fetal monitoring in Australia: A national survey 妇女在胎儿监护方面有选择权吗?澳大利亚妇女对胎儿监护提供的信息和选择的看法:全国调查。
IF 4.4 2区 医学 Q1 NURSING Pub Date : 2024-11-01 DOI: 10.1016/j.wombi.2024.101837
Kate M. Levett , Deborah Fox , Panashe Bamhare , Kerry L. Sutcliffe , Rebecca Coddington , Liz Newnham , Vanessa Scarf

Intro

In Australia, little research has examined how women and people participate in decision-making about types of fetal monitoring, or their perceptions of information provided by caregivers.

Methods

A national cross-sectional survey, the ‘Women’s experiences Of Monitoring Baby’ (WOMB) Study, explored women’s experiences of intrapartum fetal monitoring. This study reports on selected results.

Results

There were 861 responses. Of respondents, 20 % reported receiving enough information about types of fetal monitoring from care providers and childbirth education, 35 % recalled being asked for consent, and 34 % were unaware they had a choice in monitoring. Most women (86 %) obtained information via ‘other’ sources or own reading, and where monitoring was discussed, it was most likely a ‘brief discussion’ with a midwife (43 %).
Women who were monitored via wired CTG (35 %) were more likely to report facing barriers to choosing their preferred monitoring type, (p<0.001). Wired CTG was significantly associated with hospital type and primiparity and 70 % indicated they would not choose it again (p<0.001).

Conclusion

Women did not know they had a choice in the type of intrapartum monitoring received, and felt they had insufficient information to make informed decisions. While monitoring via intermittent doppler and wireless CTG was preferred, women experienced barriers to receiving these, especially in public hospitals in rural/regional areas and private metropolitan hospitals. Antenatal models of care and childbirth education are underutilised avenues for providing information however, it is incumbent on maternity systems to provide adequate information resources, access to equipment and appropriate models of woman-centred and humane care.
介绍:在澳大利亚,很少有研究探讨妇女和民众如何参与有关胎儿监护类型的决策,或她们对护理人员所提供信息的看法:方法:一项名为 "妇女监测婴儿的经验"(WOMB)研究的全国性横断面调查探讨了妇女在产前胎儿监护方面的经验。本研究报告了部分结果:结果:共收到 861 份回复。在受访者中,20%的人表示从护理人员和分娩教育中获得了有关胎儿监护类型的足够信息,35%的人回忆起被征求过同意,34%的人不知道她们可以选择监护方式。大多数妇女(86%)通过 "其他 "来源或自己阅读来获取信息,在讨论监测问题时,最有可能是与助产士进行 "简短讨论"(43%)。通过有线 CTG 监测的妇女(35%)更有可能表示在选择自己喜欢的监测类型时遇到了障碍(p 结论:产妇不知道她们可以选择接受何种产前监护,并认为她们没有足够的信息来做出明智的决定。虽然间歇多普勒和无线 CTG 监测是首选,但妇女在接受这些监测时遇到了障碍,尤其是在农村/地区的公立医院和私立都市医院。产前护理模式和分娩教育是提供信息的有效途径,但产科系统有责任提供充足的信息资源、设备和适当的以妇女为中心的人性化护理模式。
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引用次数: 0
Keeping birth at home: Community and service provider visions for perinatal wellness and continued Inuit childbirth in Nunavik 保持在家分娩:社区和服务提供者对努纳维克围产期健康和因努伊特人继续生育的愿景。
IF 4.4 2区 医学 Q1 NURSING Pub Date : 2024-11-01 DOI: 10.1016/j.wombi.2024.101839
Hilah Silver , Elisapi Padlayat , Pasha Saviakjuk , Ivan Sarmiento , Richard Budgell , Anne Cockcroft , Zoua M. Vang , Neil Andersson

Problem

Childbirth on traditional territories is unattainable for many Indigenous peoples living in remote communities in Canada.

Background

In Nunavik, Inuit territory in northern Quebec, rapid population growth risks exceeding local midwifery capacity. This poses challenges to community-based childbirth in a region recognized for reclaiming Inuit midwifery and local birthing.

Aim

To explore community views on protective factors of maternal and family perinatal wellness and continued local birthing.

Methods

In ten communities, Inuit families and perinatal service providers created a total of 54 fuzzy cognitive maps on protective factors for (1) birth in a good way in Nunavik, (2) maternal and family perinatal wellness, and (3) community-based birthing in Nunavik. We used fuzzy transitive closure to examine direct and indirect connections and collated individual factors into categories using inductive thematic analysis.

Findings

Well-equipped local medical facilities and services, community birthing centres run by Inuit midwives, and Inuit perinatal traditions had the strongest influence on experiencing birth in a good way in Nunavik. Inuit youth perspectives featured instrumental and emotional support for mothers and families, along with health and self-care in pregnancy as the most influential factors on maternal and family perinatal wellness. Prominent protective factors for community birth in Nunavik included maternal-infant health and wellness, local Inuit midwifery services, and well-resourced medical facilities.

Discussion

Fuzzy cognitive mapping was helpful in informing community visioning of local childbirth and maternal and family perinatal wellness in Nunavik.

Conclusion

Inuit-led midwifery services are essential to continued local childbirth in the region.
问题:对于生活在加拿大偏远社区的许多原住民来说,在传统领地分娩是遥不可及的:背景:在魁北克北部的因纽特人领地努纳维克(Nunavik),人口的快速增长有可能超过当地的助产能力。目的:探讨社区对孕产妇和家庭围产期健康保护因素以及继续在当地分娩的看法:在 10 个社区中,因纽特人家庭和围产期服务提供者共绘制了 54 幅模糊认知地图,内容涉及:(1)努纳维克良好分娩方式的保护因素;(2)孕产妇和家庭围产期健康;(3)努纳维克社区分娩。我们使用模糊传递封闭法来检查直接和间接联系,并使用归纳主题分析法将各个因素归类:设备齐全的当地医疗设施和服务、因努伊特助产士运营的社区分娩中心以及因努伊特围产期传统对在努纳维克体验良好的分娩方式影响最大。从因纽特人青年的角度来看,对母亲和家庭的工具和情感支持,以及孕期健康和自我保健是对母亲和家庭围产期健康影响最大的因素。努纳维克社区分娩的主要保护因素包括母婴健康和福祉、当地因努伊特助产服务以及资源充足的医疗设施:讨论:模糊认知绘图有助于为努纳维克社区的本地分娩以及孕产妇和家庭围产期健康的愿景提供信息:因纽特人主导的助产服务对该地区继续开展本地分娩至关重要。
{"title":"Keeping birth at home: Community and service provider visions for perinatal wellness and continued Inuit childbirth in Nunavik","authors":"Hilah Silver ,&nbsp;Elisapi Padlayat ,&nbsp;Pasha Saviakjuk ,&nbsp;Ivan Sarmiento ,&nbsp;Richard Budgell ,&nbsp;Anne Cockcroft ,&nbsp;Zoua M. Vang ,&nbsp;Neil Andersson","doi":"10.1016/j.wombi.2024.101839","DOIUrl":"10.1016/j.wombi.2024.101839","url":null,"abstract":"<div><h3>Problem</h3><div>Childbirth on traditional territories is unattainable for many Indigenous peoples living in remote communities in Canada.</div></div><div><h3>Background</h3><div>In Nunavik, Inuit territory in northern Quebec, rapid population growth risks exceeding local midwifery capacity. This poses challenges to community-based childbirth in a region recognized for reclaiming Inuit midwifery and local birthing.</div></div><div><h3>Aim</h3><div>To explore community views on protective factors of maternal and family perinatal wellness and continued local birthing.</div></div><div><h3>Methods</h3><div>In ten communities, Inuit families and perinatal service providers created a total of 54 fuzzy cognitive maps on protective factors for (1) birth in a good way in Nunavik, (2) maternal and family perinatal wellness, and (3) community-based birthing in Nunavik. We used fuzzy transitive closure to examine direct and indirect connections and collated individual factors into categories using inductive thematic analysis.</div></div><div><h3>Findings</h3><div>Well-equipped local medical facilities and services, community birthing centres run by Inuit midwives, and Inuit perinatal traditions had the strongest influence on experiencing <em>birth in a good way in Nunavik</em>. Inuit youth perspectives featured instrumental and emotional support for mothers and families, along with health and self-care in pregnancy as the most influential factors on <em>maternal and family perinatal wellness</em>. Prominent protective factors for <em>community birth in Nunavik</em> included maternal-infant health and wellness, local Inuit midwifery services, and well-resourced medical facilities.</div></div><div><h3>Discussion</h3><div>Fuzzy cognitive mapping was helpful in informing community visioning of local childbirth and maternal and family perinatal wellness in Nunavik.</div></div><div><h3>Conclusion</h3><div>Inuit-led midwifery services are essential to continued local childbirth in the region.</div></div>","PeriodicalId":48868,"journal":{"name":"Women and Birth","volume":"37 6","pages":"Article 101839"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Exploring the attitudes and beliefs of women regarding the implementation of midwife-led care in India: A mixed methods study 探讨印度妇女对实施助产士主导护理的态度和信念:混合方法研究
IF 4.4 2区 医学 Q1 NURSING Pub Date : 2024-10-28 DOI: 10.1016/j.wombi.2024.101836
Marie Therese Sangy , Maria J. Duaso, Claire Feeley, Shawn Walker

Problem

Despite the recent introduction of midwifery services in India to improve maternal and newborn healthcare, there is limited research on women’s perspectives on midwife-led care.

Background

The Government of India initiated midwifery services guidelines in 2018 to improve the quality of care for pregnant women and newborns across the country. It is important to develop evidence-based strategies which can optimise the implementation of these new midwifery services.

Aim

This study explored women’s attitudes and beliefs towards the implementation of midwife-led care in two southern states of India.

Methods

A convergent mixed methods design was employed using an online questionnaire and semi-structured online interviews. Quantitative data was analysed using descriptive statistics and qualitative analysis used a framework approach. Data from both sources were then integrated through merging techniques.

Findings

A total of 307 women completed the online survey, and 23 participated in in-depth interviews. The study highlighted inadequate knowledge of midwife-led care among women. Despite this, 60 % expressed optimism about its benefits. Key factors to women’s acceptance included better understanding outcomes, having trust in midwives, receiving respectful care, and having autonomy in decision-making. They also required midwife-led birthing units would be clean, accessible, and well resourced.

Discussion

Most participants perceived midwife-led care as beneficial, valuing its skilled, responsive and compassionate services.

Conclusion

Insights from this study have implications for the implementation of midwife-led care which should consider the informational needs, safety standards and cultural contexts of women and their families living in both urban and rural areas of India.
问题尽管印度最近引入了助产服务以改善孕产妇和新生儿的医疗保健,但有关妇女对助产士主导的护理的看法的研究却很有限。背景印度政府于 2018 年启动了助产服务指南,以改善全国孕妇和新生儿的护理质量。本研究探讨了印度南部两个邦的妇女对实施助产士主导型护理的态度和信念。方法采用聚合混合方法设计,使用在线问卷和半结构化在线访谈。定量数据采用描述性统计方法进行分析,定性分析采用框架方法。共有 307 名妇女完成了在线调查,23 名妇女参加了深度访谈。研究结果表明,妇女对助产士主导的护理认识不足。尽管如此,仍有 60% 的妇女对其益处表示乐观。妇女接受的关键因素包括更好地了解结果、信任助产士、接受尊重的护理以及拥有决策自主权。讨论大多数参与者认为助产士主导的护理是有益的,她们重视助产士提供的技术娴熟、反应迅速和富有同情心的服务。结论本研究的观点对实施助产士主导的护理具有启示意义,实施助产士主导的护理应考虑生活在印度城市和农村地区的妇女及其家庭的信息需求、安全标准和文化背景。
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引用次数: 0
Evaluating the roles of workload and practice climate in workforce retention across the midwifery career lifespan: A latent profile analysis of early-, mid-, and late-career US midwives 评估工作量和实践氛围在助产士职业生涯中对劳动力保留的作用:对美国早期、中期和晚期助产士的潜在特征分析
IF 4.4 2区 医学 Q1 NURSING Pub Date : 2024-10-26 DOI: 10.1016/j.wombi.2024.101833
E. Brie Thumm , Denise Smith , Zach Giano

Problem

Retention of midwives across the career lifespan is essential to address workforce shortages.

Background

While workplace factors are demonstrated to affect job satisfaction and turnover intention, there is little research investigating how workplace factors affect midwives at different career stages. Aim: To examine the effects of workload and practice climate on job satisfaction and turnover intention at different career stages.

Methods

In a secondary analysis, we split a sample of US midwives into early-, mid-, and late-career stages. We used latent profile analysis to create profiles (called “classes”) of workload (volume of women/individuals receiving care and acuity) and practice climate. Job dissatisfaction and turnover intention were compared between classes by career stages.

Findings

Across all career stages, classes with negative practice climates had significantly higher turnover intention and job dissatisfaction, regardless of patient volume or acuity. Among early career midwives, high workload was not associated with high turnover intention or job dissatisfaction in the context of positive practice climates. The highest proportion of mid- career participants were in the class with high turnover intention and job dissatisfaction, while in the early career subsample the largest proportion was in the class with low dissatisfaction and low turnover intention.

Discussion

Across all career stages, the practice climate was the primary driver of turnover intention and job dissatisfaction. Practice climate is particularly important for early-career midwives working in high-volume settings. Mid-career midwives are an under-studied group at risk of leaving the profession.

Conclusion

Efforts to retain the midwifery workforce would benefit from tailoring retention strategies to midwives at different career stages.
背景虽然工作场所因素被证明会影响工作满意度和离职意向,但很少有研究调查工作场所因素如何影响处于不同职业阶段的助产士。目的:研究不同职业阶段的工作量和实践氛围对工作满意度和离职意向的影响。方法在一项二次分析中,我们将美国助产士样本分为早期、中期和晚期职业阶段。我们使用潜特征分析法创建了工作量(接受护理的妇女/个人数量和严重程度)和实践氛围的特征(称为 "类别")。在所有职业阶段中,无论病人数量或严重程度如何,工作氛围消极的班级的离职意向和工作不满意度都明显较高。在早期职业生涯的助产士中,在积极的工作氛围下,高工作量与高离职意愿或工作不满意度无关。在职业生涯中期的参与者中,高离职意愿和工作不满意度的比例最高,而在职业生涯早期的子样本中,低不满意度和低离职意愿的比例最高。执业环境对在高工作量环境中工作的早期职业助产士尤为重要。结论针对不同职业阶段的助产士量身定制挽留策略将有助于留住助产士队伍。
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引用次数: 0
How does place impact intrapartum practice for midwives and obstetricians? 地方如何影响助产士和产科医生的产前实践?
IF 4.4 2区 医学 Q1 NURSING Pub Date : 2024-10-25 DOI: 10.1016/j.wombi.2024.101829
Christine Mellor, Marion Hunter, Elizabeth Smythe

Background

Rising rates of labour and birth interventions are causing concern, having the potential to cause harm if used inappropriately. International evidence demonstrates that place itself influences birth outcomes, but evidence is limited as to how. In New Zealand there are differences in the rates of spontaneous vaginal births by place, along with differences when benchmarking uncomplicated primiparae birthing in hospital maternity facilities throughout the country.

Aim

To develop understanding of how place influenced midwives’ and obstetricians’ practice in relation to supporting physiological birth.

Method

For this Hermeneutic Phenomenological study participants were purposively selected and consisted of nine midwives (employed and self-employed) and three obstetricians, all practising in midwifery led units or hospital maternity facilities. Data was collected using semi-structured interviews. The method of analysis involved writing and rewriting to surface interpretive insights, drawing on philosophical notions from Heidegger and Gadamer.

Findings

The findings revealed that place influences what practitioners are attuned to, what is easier for them to achieve, and their ability to provide woman-centred care. Competing tensions and pressures within place can blur the perceived relationship between normality and risk, influencing what is considered to be safe.

Summary

Place is not neutral; it influences how midwives and obstetricians practise and shapes how they support physiological labour and birth. The findings of this research contribute to a deeper understanding of the barriers and enablers to supporting physiological birth within place.
背景:分娩和分娩干预率的上升引起了人们的关注,如果使用不当,有可能造成伤害。国际证据表明,地方本身会影响分娩结果,但如何影响的证据却很有限。在新西兰,不同地区的阴道自然分娩率存在差异,全国各地医院产科设施的无并发症初产妇分娩率也存在差异。目的:了解不同地区如何影响助产士和产科医生支持生理分娩的做法:在这项诠释现象学研究中,有目的性地选择了 9 名助产士(受雇和自雇)和 3 名产科医生作为研究对象,她们都在助产士领导的单位或医院产科设施中工作。数据收集采用半结构式访谈。分析方法包括书写和改写,以便借鉴海德格尔和伽达默尔的哲学概念,得出解释性见解:研究结果表明,地点影响着从业人员所关注的内容、他们更容易做到的事情以及他们提供以妇女为中心的护理的能力。地点之间相互竞争的紧张关系和压力会模糊正常与风险之间的感知关系,从而影响被认为是安全的护理。本研究的结果有助于加深对在地方支持生理分娩的障碍和促进因素的理解。
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引用次数: 0
Discovering the invisible: Transformative learning experiences of midwifery students to support physiological birth during continuity of care placements in Québec's freestanding birth centres 发现无形:助产士学生在魁北克省独立分娩中心连续性护理实习期间支持生理分娩的变革性学习经历。
IF 4.4 2区 医学 Q1 NURSING Pub Date : 2024-10-24 DOI: 10.1016/j.wombi.2024.101835
Julie Ouellet, Sabina Abou Malham, Christine Loignon

Background

Despite international consensus advocating a physiological approach to childbirth, there are inconsistent opinions on how to acquire the competencies needed to successfully carry out this approach. While continuity of care experiences (CoCE) within placements is a valued educational strategy, there are limited studies that focus on the learning experiences to support physiological birth.

Aim

To describe and understand the learning experiences related to physiological birth, as well as the transformations required to become a midwife who supports physiological birth, during the CoCE placement process in a birth centre.

Methods

An interpretive description study design was adopted. Data were collected through audio diaries (n=126) with midwifery students and preceptors (n=14) across four level of placements in birth centres, in Québec, Canada, and discussion groups with students who kept the audio diaries.

Results

Three main themes were identified: 1) appropriating culture: relational autonomy; 2) developing competencies: acknowledging attitude, enabling behaviours and narrative skills; 3) constructing identity: coherence and resistance.

Discussion

The findings demonstrated the importance of CoCE, along with the continuity of preceptorship and a low-tech environment as optimal educational strategies for the acquisition of a culture and competencies that promote physiological childbirth. Resistance is part of identity transformation and represents an opportunity for critical questioning and safe feedback.

Conclusion

This study contributes to the understanding of the nature of the competencies developed and the transformations experienced to support physiological childbirth. It recognises the primacy of CoCE within extended placements, embedded in a workplace culture and environment that support relational autonomy.
背景:尽管国际社会一致提倡生理分娩,但对于如何获得成功实施生理分娩所需的能力,人们的看法并不一致。目的:描述并了解与生理分娩相关的学习经历,以及在分娩中心的 CoCE 实习过程中,成为一名支持生理分娩的助产士所需的转变:方法:采用解释性描述研究设计。方法:采用解释性描述研究设计,通过对加拿大魁北克省助产士学生和训导员(14 人)在分娩中心四级实习期间的录音日记(126 人)收集数据,并与记录录音日记的学生进行小组讨论:结果:确定了三大主题:1) 适应文化:关系自主;2) 培养能力:承认态度、有利行为和叙事技巧;3) 构建身份:一致性和抵制:讨论:研究结果表明,作为获得促进生理分娩的文化和能力的最佳教育策略,CoCE 以及连续性戒律和低技术环境非常重要。阻力是身份转变的一部分,也是批判性质疑和安全反馈的机会:本研究有助于理解为支持生理分娩而培养的能力和经历的转变的性质。这项研究认识到,在支持关系自主的工作场所文化和环境中,CoCE 在扩展实习中的首要地位。
{"title":"Discovering the invisible: Transformative learning experiences of midwifery students to support physiological birth during continuity of care placements in Québec's freestanding birth centres","authors":"Julie Ouellet,&nbsp;Sabina Abou Malham,&nbsp;Christine Loignon","doi":"10.1016/j.wombi.2024.101835","DOIUrl":"10.1016/j.wombi.2024.101835","url":null,"abstract":"<div><h3>Background</h3><div>Despite international consensus advocating a physiological approach to childbirth, there are inconsistent opinions on how to acquire the competencies needed to successfully carry out this approach. While continuity of care experiences (CoCE) within placements is a valued educational strategy, there are limited studies that focus on the learning experiences to support physiological birth.</div></div><div><h3>Aim</h3><div>To describe and understand the learning experiences related to physiological birth, as well as the transformations required to become a midwife who supports physiological birth, during the CoCE placement process in a birth centre.</div></div><div><h3>Methods</h3><div>An interpretive description study design was adopted. Data were collected through audio diaries (n=126) with midwifery students and preceptors (n=14) across four level of placements in birth centres, in Québec, Canada, and discussion groups with students who kept the audio diaries.</div></div><div><h3>Results</h3><div>Three main themes were identified: 1) appropriating culture: relational autonomy; 2) developing competencies: acknowledging attitude, enabling behaviours and narrative skills; 3) constructing identity: coherence and resistance.</div></div><div><h3>Discussion</h3><div>The findings demonstrated the importance of CoCE, along with the continuity of preceptorship and a low-tech environment as optimal educational strategies for the acquisition of a culture and competencies that promote physiological childbirth. Resistance is part of identity transformation and represents an opportunity for critical questioning and safe feedback.</div></div><div><h3>Conclusion</h3><div>This study contributes to the understanding of the nature of the competencies developed and the transformations experienced to support physiological childbirth. It recognises the primacy of CoCE within extended placements, embedded in a workplace culture and environment that support relational autonomy.</div></div>","PeriodicalId":48868,"journal":{"name":"Women and Birth","volume":"37 6","pages":"Article 101835"},"PeriodicalIF":4.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Birth houses in Australia: Discovery of safe, transformative birthplaces 澳大利亚的分娩之家:发现安全、变革性的分娩场所。
IF 4.4 2区 医学 Q1 NURSING Pub Date : 2024-10-19 DOI: 10.1016/j.wombi.2024.101831
Rowena Shakes , Mary Sidebotham , Roslyn Donnellan-Fernandez

Background

Institutionalised birth settings do not meet the needs or wishes of all women. Current literature has reported on women’s experiences of alternative birthplaces, however there is no published data on Australian birth houses. Birth houses are low-technology home-like birthplaces where women receive care from endorsed private practice midwives. Knowledge of women’s perspectives and experiences of birth houses is unreported.

Aims

To gain understanding of women’s motivations for accessing and experiences of birth houses; and develop insight into the role of birth houses within Australian maternity services.

Methods

A qualitative descriptive study was conducted in 2020. This methodology was chosen to centre women’s voices of their experiences. Women who had utilised birth houses for labour and birth were invited to participate. Those who responded completed a brief questionnaire to support diversity in participant selection. Interviews were conducted via video-link, based on semi-structured open-ended questions. These were transcribed verbatim and thematically analysed.

Findings

Ten women who utilised any of three known birth houses in Australia for labour and/or birth were interviewed. Four themes were revealed: “I knew there must be another way”, “The best of both worlds”, “Discovering a safe space” and “Transformation” with safety interwoven through each of these.

Discussion

Women sought birthplaces and care congruent with their values and knowledge. Birth houses offered women a level of agency unavailable within hospital-based maternity care. While proximity to medical facilities was important, women’s definitions of safety transcended biomedical perspectives to incorporate emotional and psychosocial wellbeing. Women described their experiences in birth houses as transformational, highly satisfying, and positive influences for future birthplace choices.

Conclusion

Women sought birth houses for safety, convenience, agency and autonomy. This study demonstrated these needs were met within birth houses, highlighting these birthplaces as a middle ground between home and hospital. High levels of satisfaction illustrate the validity of birth houses and reiterate the call for greater birthplace choice for all women.
背景:机构化的分娩场所并不能满足所有妇女的需求或愿望。目前的文献报道了妇女在其他分娩场所的经历,但还没有关于澳大利亚分娩屋的公开数据。产房是技术含量较低的家庭式分娩场所,妇女在产房接受经认可的私人助产士的护理。目的:了解妇女使用产房的动机和体验;深入了解产房在澳大利亚产科服务中的作用:2020 年进行了一项定性描述性研究。选择这种方法的目的是集中了解妇女的经历。曾使用产房分娩的妇女应邀参加了研究。回复者填写了一份简短的调查问卷,以支持参与者选择的多样性。访谈通过视频链接进行,以半结构化开放式问题为基础。访谈内容逐字记录并进行主题分析:十名妇女接受了访谈,她们曾在澳大利亚三家已知的产房中的任何一家分娩和/或生产。共揭示了四个主题:"我知道一定还有其他办法"、"两全其美"、"发现一个安全的空间 "和 "转变",每一个主题都与安全交织在一起:妇女寻求与其价值观和知识相符的分娩场所和护理。产房为妇女提供了医院产科护理所没有的自主权。虽然靠近医疗设施很重要,但妇女对安全的定义超越了生物医学的视角,纳入了情感和社会心理健康。妇女们认为,她们在产房的经历是一种转变,令人非常满意,并对未来的分娩场所选择产生了积极影响:妇女选择产房是为了安全、方便、能动性和自主性。本研究表明,分娩室满足了这些需求,突出了分娩室作为家庭和医院之间的中间地带的作用。高满意度说明了产房的有效性,并再次呼吁为所有妇女提供更多的分娩场所选择。
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引用次数: 0
The acceptability of implementation of group B Streptococcus testing: Perspectives from women and health professionals in the GBS3 trial: A qualitative study 实施 B 群链球菌检测的可接受性:GBS3 试验中妇女和医疗专业人员的观点:定性研究
IF 4.4 2区 医学 Q1 NURSING Pub Date : 2024-10-16 DOI: 10.1016/j.wombi.2024.101832
Georgina Constantinou , Susan Ayers , Eleanor J. Mitchell , Kate F. Walker , Soo Downe , Ann-Marie Jones , Sarah Moore , Jane P. Daniels , GBS3 Collaborative Group

Objective

To determine the acceptability of different methods of routine testing for group B Streptococcus (GBS) colonisation to pregnant women and health care professionals (HCPs), and to examine barriers and facilitators to their implementation.

Design

Qualitative study, embedded in a cluster randomised trial

Setting

Four NHS maternity units participating in the GBS3 Trial: two conducting routine antenatal enriched culture medium (ECM) testing; and two using routine rapid intrapartum testing.
Sample
39 women and 25 HCPs purposively sampled to ensure representation of women with various birthing experiences and different professions.
Methods
Women were interviewed approximately 12 weeks postpartum by telephone or online video call, using a semi-structured topic guide. HCPs were interviewed during the testing period of the trial. Interviews were transcribed for thematic analysis and summarised using the framework method.

Results

Four categories of interest emerged: (1) views of routine testing; (2) acceptability of the testing procedure; (3) preferences on the types of test; (4) improving the testing procedure. Routine GBS testing was well received by both women and HCPs. Most participants found the procedure acceptable and were willing to receive the offer of testing in the future. Preferences for different testing methods varied, with participants emphasising the importance of evidence and informed choice.

Conclusions

Routine GBS testing is acceptable to most women and HCPs. Areas for consideration and the practicalities of implementing testing in maternity services are highlighted.
目标确定孕妇和医疗保健专业人员 (HCP) 对不同的 B 群链球菌 (GBS) 定植常规检测方法的接受程度,并研究实施这些方法的障碍和促进因素。方法通过电话或在线视频通话对产后约 12 周的妇女进行访谈。方法采用半结构化主题指南,通过电话或在线视频通话对产后约 12 周的妇女进行访谈。在试验测试期间对保健医生进行了访谈。访谈内容经誊写后进行主题分析,并采用框架法进行总结。结果出现了四个关注类别:(1) 对常规检测的看法;(2) 检测程序的可接受性;(3) 对检测类型的偏好;(4) 改进检测程序。常规 GBS 检测受到了妇女和保健医生的欢迎。大多数参与者认为该程序可以接受,并愿意在今后接受检测。对不同检测方法的偏好各不相同,参与者强调了证据和知情选择的重要性。强调了在产科服务中实施检测需要考虑的领域和实际情况。
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引用次数: 0
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Women and Birth
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