Women and Birth最新文献_第2页

‘Every woman deserves that’: A qualitative exploration of the impact of Australia’s national maternity strategy

IF 4.4 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-01-21 DOI: 10.1016/j.wombi.2025.101871

Paula Medway , Alison M. Hutchinson , Linda Sweet

Background

Since 2019, maternity care in Australia has been guided by the national maternity policy, Woman-centred care: Strategic directions for Australian maternity services (the Strategy). The Strategy has four core values (safety, respect, choice and access), which underpin 12 principles of woman-centred care.

Aim

To describe women’s experiences of receiving maternity care in Australia and explore how their care aligned with the values and principles of the Strategy.

Methods

A qualitative descriptive approach was used. Fifty women from across Australia, including women from each of the priority populations within the Strategy, were interviewed. Data analysis was conducted using Braun and Clarke’s reflexive thematic analysis.

Findings

Women described how their care aligned and misaligned with the Strategy. Workforce shortages impacted their sense of safety, and they frequently had to self-advocate for individualised care that made them feel safe. Women wanted a holistic approach to care provision where they were listened to, heard, and their choices were respected by maternity care providers, but they felt the need to arm themselves with information to achieve this. They also expressed a desire for better care in the postnatal period to 12 months that included appropriate and affordable mental health support.

Conclusion

Receiving care that aligns with the values and principles of the Strategy is on an ad hoc basis, and maternity care provision is not consistent across Australia. A greater commitment to the implementation and adoption of the Strategy is required at a national and service level if its intent is to be fully realised.

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引用次数: 0

Bereaved parent involvement in co-designed stillbirth research: Experiences of Project Engage 失去亲人的父母参与共同设计的死产研究：参与项目的经验。

IF 4.4 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-01-01 DOI: 10.1016/j.wombi.2024.101838

Kirstin Tindal , Danielle Pollock , Brad Farrant , Nicky Robinson , Yumi Oba , Ashley Pade , Jassy Moore , Siobhan Loughnan , Vicky Flenady , Christine Andrews

Background

While benefits of involving consumers in research are well established, bereaved parents face unique challenges, and descriptions of their experiences with co-designed stillbirth research are lacking. The collective experience of ‘Project Engage’ involved co-designing resources to support bereaved parents’ involvement in research.

Methods

This study aimed to describe and evaluate the involvement of bereaved parents as co-investigators of a stillbirth research project. Descriptive and exploratory methods were used to describe the process of Project Engage, between 2021 and 2023, in which bereaved parents were involved in all aspects. Evaluation was performed through iterative review and reflection to examine barriers and enablers of co-designed stillbirth research.

Findings

The project team co-designed and published ‘Getting Involved in Stillbirth Research: A guide for bereaved parents’. Seven co-investigators completed the end-of-phase project evaluation, including five bereaved parents and two researchers without lived experience of stillbirth. Most co-investigators felt that their contribution was highly valued and that project outputs matched their expectations. Enablers of co-design included clear communication, having a shared goal, a supportive team, relevant outputs, and lived-experience researchers on the team. Barriers included research jargon, meeting logistics, support and maintaining engagement, role expectations, and institutional governance processes.

Conclusion

The co-design experience was perceived positively by both parents and researchers, with many key facilitators to the teams’ success identified. Evaluation of the experiences of bereaved parents and researchers co-designing stillbirth research is vital. The process and recommendations outlined here will guide future best practice for bereaved parent involvement in stillbirth research.

背景：虽然让消费者参与研究的好处是众所周知的，但失去亲人的父母面临着独特的挑战，并且缺乏对他们在共同设计的死产研究中的经验的描述。“参与项目”的集体经验包括共同设计资源，以支持失去亲人的父母参与研究。方法：本研究旨在描述和评估作为死产研究项目的共同调查者的丧偶父母的参与。采用描述性和探索性方法描述了2021年至2023年期间的“参与项目”过程，在这个过程中，失去亲人的父母参与了各个方面。通过反复回顾和反思来进行评估，以检查共同设计死胎研究的障碍和促进因素。研究结果：项目组共同设计并出版了《参与死产研究：丧亲父母指南》。七名共同研究人员完成了项目的最后阶段评估，其中包括五名失去亲人的父母和两名没有死产经历的研究人员。大多数共同调查人员认为他们的贡献受到高度重视，项目产出符合他们的期望。协同设计的促成因素包括清晰的沟通、共同的目标、支持性的团队、相关的产出以及团队中有实际经验的研究人员。障碍包括研究术语、满足后勤、支持和保持参与、角色期望和机构治理过程。结论：家长和研究人员都认为共同设计经验是积极的，并确定了许多促进团队成功的关键因素。评估丧失亲人的父母和研究者共同设计死产研究的经验是至关重要的。这里概述的过程和建议将指导未来参与死产研究的丧失亲人的父母的最佳做法。

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引用次数: 0

What are the experiences of Aboriginal and/or Torres Strait Islander midwifery students and midwives? A scoping review 土著和/或托雷斯海峡岛民助产学生和助产士的经历是什么？范围审查。

IF 4.4 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-01-01 DOI: 10.1016/j.wombi.2024.101856

Donna L. Hartz , Renae Coleman , Stacey Butcher , Leona McGrath , Cherisse Buzzacott , Karel Williams , Angela Coe , Machelee Kosiak

Background

Aboriginal and/or Torres Strait Islander midwives are underrepresented within the midwifery workforce and is likely compounded by lower graduate rates. This review is a part of the Midwifery Futures Project. It explores the experiences of Aboriginal and/or Torres Strait Islander midwives and midwifery students to illuminate issues impacting work and study and uncover successful strategies towards addressing current disparities.

Methods

A scoping review was guided by the Joanna Briggs Institute framework. Literature searching identified 1311 papers. Eleven papers, four qualitative research studies, and seven grey papers met the inclusion criteria: published academic journals, book publishers or key professional organisations; focused on the professional experiences of Aboriginal and/or Torres Strait Islander midwives or the learning experiences; written in English; and published 2004 onwards (inclusive). The papers were analysed using inductive thematic analysis.

Results

Three interconnected themes emerged: connection and kinship, racism and balancing responsibilities.

Conclusion

Culture, connection and kinship are foundational in providing experiences for Aboriginal and/or Torres Strait Islander midwives and midwifery students that are clinically and academically transformational, culturally safe and promote resilience for

Aboriginal and/or Torres Strait Islander midwives and midwifery students. Midwives and midwifery students need to connect with each other and value working with Aboriginal and/or Torres Strait Islander women, clinicians and academics. Strategies that balance work, study and life responsibilities promote retention and resilience. Clinical, work and study contexts must be culturally safe by respecting and embracing Aboriginal and/or Torres Strait Islander cultures and actively opposing racism in the personal, Community and organisational interfaces.

背景：土著和/或托雷斯海峡岛民助产士在助产劳动力中代表性不足，并且可能与较低的毕业生率相结合。这篇综述是助产未来项目的一部分。它探讨了土著和/或托雷斯海峡岛民助产士和助产学学生的经验，以阐明影响工作和学习的问题，并揭示解决当前差距的成功策略。方法：在乔安娜布里格斯研究所框架的指导下进行范围审查。文献检索鉴定出1311篇论文。11篇论文、4篇定性研究和7篇灰色论文符合入选标准：发表于学术期刊、图书出版商或重要专业组织；侧重于土著和/或托雷斯海峡岛民助产士的专业经验或学习经验；用英文书写；并于2004年以后出版（包括在内）。论文采用归纳主题分析法进行分析。结果：三个相互关联的主题出现了：联系和亲属关系，种族主义和平衡责任。结论：文化、联系和亲属关系是为土著和/或托雷斯海峡岛民助产士和助产学生提供临床和学术转型、文化安全并促进土著和/或托雷斯海峡岛民助产士和助产学生适应能力的基础。助产士和助产学学生需要相互联系，重视与土著和/或托雷斯海峡岛民妇女、临床医生和学者一起工作。平衡工作、学习和生活责任的策略可以提高记忆力和适应力。临床、工作和学习环境必须在文化上安全，尊重和接受土著和/或托雷斯海峡岛民文化，积极反对个人、社区和组织界面中的种族主义。

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引用次数: 0

Midwives' experience of managing emergencies during labour and birth in a community setting: a mixed-methods systematic review 助产士在社区环境中处理分娩和分娩期间紧急情况的经验：一项混合方法的系统评价。

IF 4.4 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-01-01 DOI: 10.1016/j.wombi.2024.101861

Rebecca Parker , Ethel E. Burns , Paul Carding , Rachel Rowe

Background

For women at low risk of complications during labour and birth, in the United Kingdom, planned birth in a ‘community’ setting (at home or a freestanding midwifery unit) is generally safe, and intrapartum emergencies are uncommon. Limited exposure may affect midwives’ experience of managing an emergency.

Aim

Identify and synthesise available evidence about midwives’ experiences of managing intrapartum emergencies during labour in a community setting.

Methods

A mixed-methods systematic review was undertaken, with searches conducted in April 2021 and February 2024. Studies were eligible for inclusion if they described midwives’ experience of managing intrapartum emergencies in high-income countries and if the setting(s) explicitly included community settings. Analytical themes were identified through integration of qualitative descriptive themes and a narrative summary of quantitative findings.

Findings

Ten papers were included, reporting seven studies carried out in the United Kingdom, United States of America, Australia and the Netherlands. Four inter-related themes were identified: unexpected and unpredictable nature of events; confidence and preparedness in skills and the birthing process; immediate and enduring emotional impact; and mediating effects of relationships and support.

Discussion and conclusions

Limited research exists about midwives’ experience of emergencies in community settings and much of the evidence included in this review was from studies about traumatic births, where emergencies were a subset of those studied. Further research about midwives’ experience would be valuable to inform optimal training and support.

背景：在英国，对于分娩和分娩期间并发症风险低的妇女，在“社区”环境（在家或独立的助产单位）进行计划生育通常是安全的，分娩时的紧急情况并不常见。有限的接触可能会影响助产士处理紧急情况的经验。目的：确定和综合现有的证据，助产士的经验管理分娩期间的紧急情况在社区设置。方法：采用混合方法进行系统评价，于2021年4月和2024年2月进行检索。如果研究描述了助产士在高收入国家处理产时紧急情况的经验，并且研究环境明确包括社区环境，则研究符合纳入条件。通过定性描述主题和定量结果的叙述性总结的整合来确定分析主题。研究结果：纳入了10篇论文，报告了在英国、美利坚合众国、澳大利亚和荷兰进行的7项研究。确定了四个相互关联的主题：意外和不可预测的事件性质；对技能和分娩过程的信心和准备；即时和持久的情感影响；以及人际关系和支持的中介效应。讨论和结论：关于助产士在社区环境中的紧急情况经验的研究有限，本综述中包含的大部分证据来自创伤性分娩的研究，其中紧急情况是研究的一个子集。对助产士经验的进一步研究将为最佳培训和支持提供有价值的信息。

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引用次数: 0

Insights from a publicly funded homebirth program 来自公共资助的家庭分娩计划的见解。

IF 4.4 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-01-01 DOI: 10.1016/j.wombi.2024.101864

Sheryl Sidery , Andrew Bisits , Virginia Spear , Allison Cummins

Background

There are high levels of consumer demand for homebirth in Australia, however access is limited due to a wide range of factors, including associated costs of a private midwife and the limited number of publicly funded homebirth models. Homebirth with a qualified midwife, networked into a health system, is a safe option for women with a low-risk pregnancy.

This paper has two aims. The first is to describe the implementation of a publicly funded homebirth service with an employed mentor. The second is to provide the outcomes from a matched cohort of women who received care from the same Midwifery Group Practice [MGP] who gave birth at home, compared with those who gave birth in hospital.

Methods

The retrospective comparative cohort study used routinely collected perinatal data from the hospital’s electronic database (eMaternity) from July 2018 – October 2021. The cohort of interest were women who received care through MGP. They were identically matched by parity, age, Body Mass Index (BMI), spontaneous labour and gestation of 37–42 weeks. A description of the employed midwifery mentor to implement this model of care is also provided.

Findings

100 women gave birth at home during the study period. They were more likely to have a physiological birth (p < 0.001), intact perineum (p < 0.0001), and less likely to have a postpartum haemorrhage (p < 0.0001) compared to the matched cohort of women who birthed in hospital. There were less assisted births and caesarean section births for women who transferred from home to hospital (p < 0.0001). No statistical differences were seen between groups for postpartum haemorrhage, and Apgar score of < 7 at 5 minutes.

Conclusion

This study demonstrated favourable outcomes for women receiving MGP who planned to birth at home compared to those women who chose a hospital birth. This is consistent with the existing literature that place of birth makes a difference. A description of the role of a mentor in supporting the sustainability of a publicly funded homebirth program is provided. Further research is recommended to evaluate the mentor’s role in implementing and sustaining the model.

背景：澳大利亚的消费者对在家分娩有很高的需求，但由于各种因素，包括私人助产士的相关费用和公共资助的在家分娩模式数量有限，因此获得机会有限。对于低风险怀孕的妇女来说，由合格的助产士在家中分娩并与卫生系统联网是一种安全的选择。本文有两个目的。第一个是描述一项公共资助的在家分娩服务的实施，该服务有一名受雇的导师。第二种方法是提供一组匹配的妇女的结果，这些妇女接受同一家助产机构（MGP）的护理，在家分娩，与在医院分娩的妇女进行比较。方法：回顾性比较队列研究使用从医院电子数据库（eMaternity）中常规收集的2018年7月至2021年10月的围产期数据。感兴趣的队列是通过MGP接受护理的妇女。她们在胎次、年龄、身体质量指数（BMI）、自然分娩和妊娠37-42周等方面都是相同的。还提供了雇用助产导师实施这种护理模式的描述。研究结果：100名妇女在研究期间在家分娩。他们更有可能有生理分娩(p 结论：这项研究表明，与那些选择医院分娩的妇女相比，接受MGP的妇女计划在家中分娩的结果更有利。这与现有的文献一致，即出生地点会产生影响。描述了导师在支持公共资助的家庭分娩计划的可持续性方面的作用。建议进一步的研究来评估导师在实施和维持模型中的作用。

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引用次数: 0

‘Mob aren’t staying when there’s no support’: Enablers and barriers of recruitment and retention of First Nations midwifery students – A qualitative study “没有支持，暴民不会留下来”：招募和保留第一民族助产学生的促进因素和障碍——一项定性研究。

IF 4.4 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-01-01 DOI: 10.1016/j.wombi.2024.101863

Tanisha L. Springall , Kerry Hall , Amanda G. Carter

Background

Aboriginal and Torres Strait Islander (hereafter referred to as First Nations) childbearing women report negative experiences from a lack of culturally safe maternity care. Evidence supports improved health outcomes for First Nations women and infants when cared for by First Nations midwives. There are barriers to First Nations students accessing university, particularly nursing and midwifery students, with a lack of evidence exploring the experiences of First Nations midwifery students.

Aim

This study aims to understand the impact of the current strategies to improve recruitment and retention of First Nations midwifery students and identify further innovations.

Methods

A semi-structured yarning circle was held with six Bachelor of Midwifery students at a university in Queensland, Australia.

Findings

Three key categories emerged: student recruitment, student retention and student success. Enablers included culturally appropriate recruitment, partnerships with other First Nations peoples, incorporating First Nations ways of Knowing, Being, and Doing, culturally safe support, placements and mentorship, and identification and representation. Barriers included financial impacts, experiences of racism and lack of Cultural Safety and humility.

Discussion

Overall, students felt the university provided a culturally safe environment and implemented strategies that supported students’ recruitment, retention and success in the degree. They suggested improvements to current strategies and new ideas for implementation.

Conclusion

Strategies to improve recruitment and retention of First Nations midwifery students are imperative to close the gap in educational attainment and improve health outcomes for First Nations peoples. These strategies need to be multi-layered, culturally appropriate and implement a whole of university approach.

背景：土著和托雷斯海峡岛民（以下简称第一民族）的育龄妇女报告了由于缺乏文化上安全的产科护理而产生的负面经历。有证据表明，由第一民族助产士护理的第一民族妇女和婴儿的健康状况有所改善。第一民族的学生，特别是护理和助产专业的学生，进入大学学习存在障碍，缺乏探索第一民族助产专业学生经历的证据。目的：本研究旨在了解当前策略对改善第一民族助产学学生的招聘和保留的影响，并确定进一步的创新。方法：以澳大利亚昆士兰一所大学的6名助产学学士学生为研究对象，进行半结构化的绕线圈研究。调查结果：出现了三个关键类别：学生招募、学生保留和学生成功。促成因素包括文化上合适的招聘、与其他第一民族的伙伴关系、融入第一民族的认识、存在和行为方式、文化上安全的支持、安置和指导，以及识别和代表。障碍包括经济影响、种族主义经历、缺乏文化安全和谦逊。讨论：总体而言，学生们认为大学提供了一个文化安全的环境，并实施了支持学生入学、留校和取得学位成功的策略。他们建议改进目前的战略和新的执行想法。结论：改善招募和保留第一民族助产学生的战略对于缩小教育程度差距和改善第一民族的健康状况至关重要。这些策略需要是多层次的，在文化上适当的，并实施整个大学的方法。

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引用次数: 0

Pathways, development needs, and clinical connections for midwifery faculty in low- and middle-income settings of the Asia Pacific region: A qualitative study. 亚太地区中低收入地区助产教师的途径、发展需求和临床联系：一项定性研究。

IF 4.4 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-01-01 DOI: 10.1016/j.wombi.2024.101841

Rachel M. Smith , Joanne E. Gray , Caroline SE Homer

Introduction

The development and strengthening of midwifery education requires a focus on midwifery faculty as an important strategy to improve quality of care provision. Despite the need for high-quality midwifery educators in all-countries, preparation and development of faculty is challenging, particularly in low- and middle-income countries.

Aim

The aim was to explore the experiences of midwifery faculty in low- and middle-income countries in the Asia Pacific region regarding their pathway to being a faculty member, programs of development and/or factors that supported their transition to faculty. We also aimed to identify barriers and enablers to continued clinical practice.

Methods

A qualitative exploratory design applying reflexive thematic analysis was used. We undertook 17 semi-structured interviews with midwifery faculty from low- and middle-income countries in the Asia Pacific region.

Findings

Key themes were 1) drawing on professional determination and personal passion, 2) transitioning from clinical to academia is challenging, 3) meeting diverse role expectations, 4) needing orientation, mentorship and training, and 5) maintaining clinical skills.

Conclusion

Identifying supportive pathways for midwifery faculty, including transitional support and ongoing development, is crucial in providing quality midwifery education. Provision of early and sustained development and support is required to ensure professional identity is developed alongside the ability to function in the diverse roles expected of midwifery faculty.

导言：助产教育的发展和加强需要将重点放在助产师资队伍上，作为提高护理质量的重要策略。尽管所有国家都需要高质量的助产教育工作者，但教师的准备和发展具有挑战性，特别是在低收入和中等收入国家。目的：目的是探讨亚太地区低收入和中等收入国家助产教师的经验，包括他们成为教师的途径、发展计划和/或支持他们过渡到教师的因素。我们还旨在确定继续临床实践的障碍和促进因素。方法：采用自反性主题分析的定性探索性设计。我们对来自亚太地区中低收入国家的助产士进行了17次半结构化访谈。研究发现：关键主题包括：1)职业决心和个人热情；2)从临床过渡到学术界具有挑战性；3)满足不同角色期望；4)需要指导、指导和培训；5)保持临床技能。结论：确定助产教师的支持途径，包括过渡支持和持续发展，对于提供高质量的助产教育至关重要。提供早期和持续的发展和支持是必要的，以确保专业身份的发展，以及在助产士所期望的不同角色中发挥作用的能力。

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引用次数: 0

Women’s preferences for care delivery during labour and birth in Dutch hospitals: A Q-methodology study 荷兰医院分娩和分娩期间妇女对护理服务的偏好：一项q方法研究。

IF 4.4 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-01-01 DOI: 10.1016/j.wombi.2024.101842

Maud van den Berg , Michael van der Voorden , Elisabeth Bossenbroek , Hiske Ernst-Smelt , Kees Ahaus , Arie Franx

Problem

Women’s preferences regarding care delivery during labour and birth remain insufficiently understood. Obtaining a clear understanding of these is important to realise a maternity care system that is future-proof and person-centred.

Background

Dutch maternity care deals with capacity issues due to staff shortages. Despite expected stable birth rates in the coming decades, this situation jeopardises the provision of care during labour and birth that is responsive to women's preferences.

Aim

To systematically study a variety of women’s preferences for care delivery during labour and birth in Dutch hospitals using Q-methodology.

Methods

Q-methodology is a mixed methods approach. Thirty individual interviews were conducted with women living in the south-western Netherlands, during which they ranked 29 statements about their labour and birth preferences from least to most important. By-person factor analysis was performed to identify factors (viewpoints). Interpretation of the viewpoints was done using the qualitative interview data.

Findings

Four viewpoints emerged from the study sample: 1) The personal approach, 2) The empowering approach, 3) The expert approach and 4) The needs-based approach. Consensus statements show a shared preference for respectful interaction. The study cohort emphasises continuity of adequate information provision, while continuity of care professional is deemed less important.

Discussion

Our study was the first to apply Q-methodology to capture women’s preferences for care delivery during labour and birth in Dutch hospitals. Although preferences are individual, they share commonalities in four viewpoints.

Conclusion

The viewpoints provide valuable guidance for the allocation of scarce resources to ensure a maternity care system that is responsive to women’s preferences.

问题：妇女在分娩和分娩过程中对护理服务的偏好仍未得到充分了解。对这些问题有一个清晰的认识，对于实现一个面向未来、以人为本的产妇保健系统是很重要的。背景：由于工作人员短缺，荷兰的产妇保健处理能力问题。尽管预计未来几十年的出生率将保持稳定，但这种情况危及在分娩和分娩期间提供符合妇女偏好的护理。目的：采用q -方法学系统地研究荷兰医院分娩和分娩期间妇女对护理服务的各种偏好。方法：q -方法学是一种混合方法。研究人员对居住在荷兰西南部的女性进行了30次个人访谈，在此期间，她们对29项关于分娩和生育偏好的陈述从最不重要到最重要进行了排序。通过个人因素分析来确定因素（观点）。对观点的解释是使用定性访谈数据完成的。研究发现：从研究样本中出现了四种观点：1)个人方法，2)授权方法，3)专家方法和4)基于需求的方法。共识声明显示了对尊重互动的共同偏好。研究队列强调充分信息提供的连续性，而护理专业人员的连续性被认为不太重要。讨论：我们的研究是第一个应用q方法来捕捉荷兰医院分娩和分娩期间妇女对护理服务的偏好。尽管偏好是个体的，但它们在四个观点上有共同点。结论：这些观点为稀缺资源的配置提供了有价值的指导，以确保产妇保健系统响应妇女的偏好。

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引用次数: 0

Midwives perspectives of barriers and facilitators for the practice of promoting women’s positive childbirth experience in China: A qualitative study 助产士对促进中国妇女积极分娩经验的障碍和促进因素的看法：一项定性研究。

IF 4.4 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-01-01 DOI: 10.1016/j.wombi.2025.101867

Yaxuan Xu , Yuhan Tang , Mengxue Wang , Xiaoyue Wang , Wenli Xu , Fengying Zhang , Lihua Zhou

Background

Women-centered care for positive childbirth experiences is currently a global trend. However, there are some barriers to promoting women’s positive childbirth experiences in practice. This study explored midwives’ perspectives on the barriers and facilitators to promoting women's positive childbirth experience in practice.

Methods

Qualitative semi-structured interviews were undertaken with 18 midwives in the birth unit of four tertiary care hospitals in Hefei, Anhui Province, China. Thematic analysis was used to code the interviews with deductive codes, and we organized findings according to levels of influence within the Dahlgren and Whitehead rainbow model, a socioecological model of health.

Result

Midwives reported barriers to women’s positive childbirth experience were identified on four levels: individual factors included psychological barriers and childbirth expectations (micro level), social and community and organization factors included interpersonal violence, medical mistrust and obstetric violence and outcome (meso level), healthcare system factors included midwife shortage and hospital environment (macro level). Facilitators for a positive birth experience include antenatal education, community continuum of care, and respectful and understanding care.

Conclusion

This study indicated that midwives experienced several barriers and facilitators in providing positive childbirth experience care to women in the Chinese context. The findings will help maternity care providers and policymakers develop multi-level implementation strategies at the individual, social, community, organization, and healthcare system levels.

背景：以妇女为中心的积极分娩经历护理目前是全球趋势。然而，在实践中促进妇女积极的分娩经历存在一些障碍。本研究探讨了助产士在实践中促进妇女积极分娩体验的障碍和促进因素的观点。方法：对安徽省合肥市四所三级医院产房的18名助产士进行定性半结构化访谈。我们使用主题分析对访谈进行演绎编码，并根据Dahlgren和Whitehead彩虹模型（一种健康的社会生态模型）的影响程度对调查结果进行组织。结果：助产士报告妇女积极分娩体验的障碍分为四个层面：个体因素包括心理障碍和分娩期望（微观层面），社会和社区组织因素包括人际暴力、医疗不信任和产科暴力及其结果（中观层面），医疗保健系统因素包括助产士短缺和医院环境（宏观层面）。促进积极分娩体验的因素包括产前教育、社区连续护理以及尊重和理解护理。结论：本研究表明，助产士在为中国妇女提供积极的分娩体验护理时遇到了一些障碍和促进因素。研究结果将有助于产妇保健提供者和政策制定者在个人、社会、社区、组织和医疗保健系统层面制定多层次的实施策略。

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引用次数: 0

Factors influencing women's and men's place of birth decisions in rural Western Highlands Province of Papua New Guinea: A qualitative descriptive study 巴布亚新几内亚西部高地省农村地区影响妇女和男子出生地决定的因素：一项定性描述性研究。

IF 4.4 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-01-01 DOI: 10.1016/j.wombi.2024.101862

Paula Zebedee Aines , Kristen Graham , Linda Sweet

Background

Evidence shows that birthing with a skilled birth provider improves maternal and neonatal health outcomes. However, whilst most women in the Western Highlands Province of Papua New Guinea seek skilled health care during pregnancy in a health facility, more than half give birth at home or in the village without a skilled birth provider.

Aim

To explore the factors influencing women's and men's decisions about place of birth in rural Western Highlands Province of Papua New Guinea.

Method

A qualitative-descriptive study was conducted. Semi-structured, in-depth interviews were conducted with 20 participants (16 women who were pregnant or recently given birth and four men whose partners were pregnant or recently gave birth). Interviews were audio-recorded and transcribed verbatim. The data was thematically analysed.

Results

Three key themes associated with the place of birth decision factors were identified from the study findings: (1) health service accessibility and availability, (2) socio-cultural influences, and (3) previous maternity care experiences. Participant experiences influenced their choice of place of birth, resulting in many giving birth at home in their village without a skilled birth provider.

Conclusion

Maternal and child health services need to be appropriately tailored to improve accessibility and meet the unmet needs of pregnant women in Papua New Guinea. Additionally, health education programs should address socio-cultural factors influencing the uptake of healthcare services, especially in rural areas where health disparities are more evident. Further research is required to explore health worker perspectives, patriarchal control, and respectful care regarding health service utilisation in this study context.

背景：有证据表明，由熟练的助产人员接生可改善孕产妇和新生儿的健康状况。然而，虽然巴布亚新几内亚西部高地省的大多数妇女在怀孕期间在保健机构寻求熟练的保健服务，但一半以上的妇女在家中或没有熟练接生人员的村庄分娩。目的：探讨巴布亚新几内亚西部高地省农村妇女和男子选择出生地的影响因素。方法：采用定性描述性研究。对20名参与者进行了半结构化的深度访谈（16名怀孕或最近分娩的女性和4名伴侣怀孕或最近分娩的男性）。采访录音并逐字抄写。对数据进行了专题分析。结果：从研究结果中确定了与分娩地点决定因素相关的三个关键主题：(1)卫生服务的可及性和可获得性；(2)社会文化影响；(3)以前的产科护理经验。参与者的经历影响了他们对出生地的选择，导致许多人在没有熟练接生人员的情况下在村里的家中分娩。结论：需要适当调整妇幼保健服务，以改善可及性，满足巴布亚新几内亚孕妇未满足的需求。此外，健康教育计划应解决影响医疗保健服务吸收的社会文化因素，特别是在健康差距更为明显的农村地区。在本研究背景下，需要进一步的研究来探索卫生工作者的观点、父权制控制和对卫生服务利用的尊重。

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引用次数: 0