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Health SA = SA Gesondheid 2024Informational continuity ensures that all health and psychosocial information of the pregnant women is available at all encounters with healthcare providers. The World...
BACKGROUND
Informational continuity ensures that all health and psychosocial information of the pregnant women is available at all encounters with healthcare providers. The World Health Organization recognised that ineffective informational continuity during birth contributed to fragmented care and duplication of services, which ultimately influenced the morbidity and mortality rates of the pregnant women.
AIM
The aim of this study was to delve into the midwives' experiences on informational continuity approaches that enable effective care coordination during birth within the primary health care setting.
SETTING
The study setting was two maternity obstetric units (MOUs) in the Western Cape, South Africa.
METHODS
A qualitative descriptive phenomenological design was used. Participants were recruited by using purposive sampling. Interviews were audiorecorded, transcribed verbatim and analysed.
RESULTS
Three themes emerged from the findings. Theme one: adequate sharing of information with women during the intrapartum period. Theme two: efficient transition of information among midwives and other healthcare providers during the intrapartum period. Theme three: challenges to informational continuity during the intrapartum period.
CONCLUSION
Communication with the women as well as with other healthcare providers during birth was effective. However, with minimal challenges, informational continuity was effectuated through communication among the midwives, the pregnant women and other healthcare providers.
CONTRIBUTION
Informational continuity approaches among the midwives, with the women and between healthcare facilities are a prerequisite to ensure continuity of care and care coordination during birth.
PubMed: 38726056
DOI: 10.4102/hsag.v29i0.2432 -
A mixed methods study on continuity and care coordination based on the obstetric near miss approach.Health SA = SA Gesondheid 2024The near-miss approach assumes that mothers facing life-threatening conditions such as severe pre-eclampsia and postpartum haemorrhage share common risk factors. Among...
BACKGROUND
The near-miss approach assumes that mothers facing life-threatening conditions such as severe pre-eclampsia and postpartum haemorrhage share common risk factors. Among these women, those who survive (near-miss cases) can offer insights into the determinants, providing valuable lessons for understanding underlying factors.
AIM
To investigate elements of continuity and coordination leading to obstetric near misses.
SETTING
A major referral hospital and its referral pathway in Kenya.
METHODS
Explanatory sequential mixed-methods design.
RESULTS
Near-miss survivors had lower continuity and coordination of care indices during antenatal visits (COCI = 0.80, = 0.0026), (modified continuity of care index [MCCI] = 0.62, = 0.034), and those with non-life-threatening morbidity in the first trimester were more likely to experience a near miss (aOR = 4.34, = 0.001). Facilities in the western region had a higher burden of near misses compared to the Eastern region. Qualitatively, three deductive themes were identified: , along with factors classified as In mixed integration, poor continuity indices were explained by quality of interpersonal relationships and woman centredness. Poor coordination was explained by inadequate teamwork between providers in referring and referral facilities and between primary health facilities and the community. Higher near-miss rates in the western region resulted from differences in human and physical resources.
CONCLUSION
Promoting woman-centred care, teamwork, improving communication and introducing innovative coordination roles like case and care managers can enhance continuity and coordination of maternal healthcare.
CONTRIBUTIONS
This study contributes to our understanding of the challenges of continuity and coordination in maternal healthcare in resource-poor settings by applying the WHO operationalisation of continuity and coordination using mixed methodology.
PubMed: 38726055
DOI: 10.4102/hsag.v29i0.2421 -
BMC Health Services Research May 2024During the first year postpartum, about 25 per cent of Swedish women with severe perineal trauma (SPT), i.e., a third- or fourth-degree perineal laceration at...
Overlooked by the obstetric gaze - how women with persistent health problems due to severe perineal trauma experience encounters with healthcare services: a qualitative study.
BACKGROUND
During the first year postpartum, about 25 per cent of Swedish women with severe perineal trauma (SPT), i.e., a third- or fourth-degree perineal laceration at childbirth, are unsatisfied with their healthcare contacts. Further, there is a lack of research on the more long-term experiences of healthcare encounters among women with persistent SPT-related health problems. This study explores how women with self-reported persistent SPT-related health problems experience their contact with healthcare services 18 months to five years after childbirth when the SPT occurred.
METHODS
In this descriptive qualitative study, a purposive sample of twelve women with self-reported persistent health problems after SPT were individually interviewed from November 2020 - February 2022. The data was analysed using inductive qualitative content analysis.
RESULTS
Our results showed a paradoxical situation for women with persistent health problems due to SPT. They struggled with their traumatised body, but healthcare professionals rejected their health problems as postpartum normalities. This paradox highlighted the women's difficulties in accessing postpartum healthcare, rehabilitation, and sick leave, which left them with neglected healthcare needs, diminished emotional well-being, and loss of financial and social status. Our results indicated that these health problems did not diminish over time. Consequently, the women had to search relentlessly for a 'key person' in healthcare who acknowledged their persistent problems as legitimate to access needed care, rehabilitation, and sick leave, thus feeling empowered.
CONCLUSIONS
Our study revealed that women with persistent SPT-related health problems experienced complex health challenges. Additionally, their needs for medical care, rehabilitation, and sick leave were largely neglected. Thus, the study highlights an inequitable provision of SPT-related healthcare services in Sweden, including regional disparities in access to care. Hence, the authors suggest that Swedish national guidelines for SPT-related care need to be developed and implemented, applying a woman-centered approach, to ensure equitable, effective, and accessible healthcare.
Topics: Humans; Female; Perineum; Qualitative Research; Adult; Sweden; Pregnancy; Lacerations; Health Services Accessibility; Interviews as Topic; Postpartum Period
PubMed: 38724992
DOI: 10.1186/s12913-024-11037-5 -
BMC Public Health May 2024Complications of diabetes in women have adverse effects on their self-image, quality of life, health, and other social relationships, thereby leading to sexual...
BACKGROUND
Complications of diabetes in women have adverse effects on their self-image, quality of life, health, and other social relationships, thereby leading to sexual dysfunction. maternity nurse care can play a critical role in assessing the knowledge about needs for sexual health.
AIM
The present study aims to evaluate the effect of the counseling model on female patients with diabetes regarding sexual dysfunction.
METHOD
A quasi-experimental research design was used to conduct the study at the diabetic and obstetric outpatient clinic in 2 hospitals (Al Salam Port Said General Hospital, Elzohor General Hospital), and in five centers in Port Said City (El-Kuwait Center, Othman Ibnafan Center, El-arab 1 center, El-manakh center, El-arab2 center). A purposive sample of 178 female diabetic patients was included in the study. Two tools were used for collecting data consisted of; (1 interview questionnaire sheet) including personal characteristics, medical history, and present sexual problem of the studied female patients, (and 2 female sexual function index (FSFI).
RESULTS
the current study revealed that there was a high statistical difference between female sexual function in post with mean ± SD (23.3 ± 4.1) compared to pre-educational intervention with mean ± SD (19.5 ± 3.7), while there was a high statistically significant difference among pre- & post-program application regarding female sexual function index (p > 0.001).
CONCLUSION
the counseling model had a positive effect in improving the sexual function among female patients with diabetes.
TRIAL REGISTRATION NUMBER (TRN)
The study protocol was approved by the Research Ethics Committee of the Faculty of Nursing, Port Said University (code number: NUR 12/9/2021-6).
Topics: Humans; Female; Adult; Sexual Dysfunction, Physiological; Counseling; Middle Aged; Surveys and Questionnaires; Sexual Dysfunctions, Psychological; Diabetes Complications
PubMed: 38724979
DOI: 10.1186/s12889-024-18585-9 -
PloS One 2024Qualitative research about women and birthing people's experiences of fetal monitoring during labour and birth is scant. Labour and birth is often impacted by wearable...
Qualitative research about women and birthing people's experiences of fetal monitoring during labour and birth is scant. Labour and birth is often impacted by wearable or invasive monitoring devices, however, most published research about fetal monitoring is focused on the wellbeing of the fetus. This manuscript is derived from a larger mixed methods study, 'WOmen's Experiences of Monitoring Baby (The WOMB Study)', aiming to increase understanding of the experiences of women and birthing people in Australia, of being monitored; and about the information they received about fetal monitoring devices during pregnancy. We constructed a national cross-sectional survey that was distributed via social media in May and June, 2022. Responses were received from 861 participants. As far as we are aware, this is the first survey of the experiences of women and birthing people of intrapartum fetal monitoring conducted in Australia. This paper comprises the analysis of the free text survey responses, using qualitative and inductive content analysis. Two categories were constructed, Tending to the machine, which explores participants' perceptions of the way in which clinicians interacted with fetal monitoring technologies; and Impressions of the machine, which explores the direct impact of fetal monitoring devices upon the labour and birth experience of women and birthing people. The findings suggest that some clinicians need to reflect upon the information they provide to women and birthing people about monitoring. For example, freedom of movement is an important aspect of supporting the physiology of labour and managing pain. If freedom of movement is important, the physical restriction created by a wired cardiotocograph is inappropriate. Many participants noticed that clinicians focused their attention primarily on the technology. Prioritising the individual needs of the woman or birthing person is key to providing high quality woman-centred intrapartum care. Women should be provided with adequate information regarding the risks and benefits of different forms of fetal monitoring including how the form of monitoring might impact her labour experience.
Topics: Humans; Female; Pregnancy; Australia; Fetal Monitoring; Adult; Cross-Sectional Studies; Labor, Obstetric; Surveys and Questionnaires; Parturition; Young Adult
PubMed: 38722999
DOI: 10.1371/journal.pone.0303072 -
BMJ Open May 2024The WHO Safe Childbirth Checklist (WHO SCC) was developed to accelerate adoption of essential practices that prevent maternal and neonatal morbidity and mortality during...
INTRODUCTION
The WHO Safe Childbirth Checklist (WHO SCC) was developed to accelerate adoption of essential practices that prevent maternal and neonatal morbidity and mortality during childbirth. This study aims to summarise the current landscape of organisations and facilities that have implemented the WHO SCC and compare the published strategies used to implement the WHO SCC implementation in both successful and unsuccessful efforts.
METHODS AND ANALYSIS
This scoping review protocol follows the guidelines of the Joanna Briggs Institute. Data will be collected and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews report. The search strategy will include publications from the databases Scopus, PubMed, Embase, CINAHL and Web of Science, in addition to a search in grey literature in The National Library of Australia's Trobe, DART-Europe E-Theses Portal, Electronic Theses Online Service, Theses Canada, Google Scholar and Theses and dissertations from Latin America. Data extraction will include data on general information, study characteristics, organisations involved, sociodemographic context, implementation strategies, indicators of implementation process, frameworks used to design or evaluate the strategy, implementation outcomes and final considerations. Critical analysis of implementation strategies and outcomes will be performed with researchers with experience implementing the WHO SCC.
ETHICS AND DISSEMINATION
The study does not require an ethical review due to its design as a scoping review of the literature. The results will be submitted for publication to a scientific journal and all relevant data from this study will be made available in Dataverse.
TRIAL REGISTRATION NUMBER
https://doi.org/10.17605/OSF.IO/RWY27.
Topics: Humans; Checklist; World Health Organization; Female; Pregnancy; Parturition; Delivery, Obstetric; Research Design; Infant, Newborn
PubMed: 38719288
DOI: 10.1136/bmjopen-2024-084583 -
Acta Obstetricia Et Gynecologica... Jul 2024Maternal and infant mortality rates in Finland are among the lowest in the world, yet preventable obstetric injuries occur every year. The aim of this study was to...
INTRODUCTION
Maternal and infant mortality rates in Finland are among the lowest in the world, yet preventable obstetric injuries occur every year. The aim of this study was to describe obstetric claims, their compensation rates, and temporal trends of claims reported to the Patient Insurance center.
MATERIAL AND METHODS
A nationwide, register-based study was conducted. Data consisted of obstetric claims reported to the Patient Insurance Center between 2012 and 2022. Data analyzed included the year of injury, compensation criteria, maternal age, birth hospital, delivery method, reported causes of injury, and maternal or neonatal injury. The data were analyzed with descriptive statistics and logistic regression models.
RESULTS
A total of n = 849 obstetric claims were filed during the study period, of which n = 224 (26.4%) received compensation. The rate of claims was 0.15%, and the rate of compensation was 0.04% in relation to the total volume of births during the period. Substandard care was the most common (97.3%) criterion for compensation. There was a curvilinear increase in the claims rate and a linear increase in compensation rates from 2013 to 2019. More claims were filed and compensated for cesarean and vacuum-assisted deliveries than for unassisted vaginal deliveries. Delayed delivery (18.7%) and surgical technique failure (10.9%) were the most reported causes of injuries. Retained surgical bodies were the induced cause of injury with the highest rate of compensated claims (86.7%). The most common maternal injury was infection (17.9%) and pain (11.7%). Among neonatal injuries, severe (19.2%) and mild asphyxia (16.6%) were the most frequent. Burn injuries (93.3%) and fetal or neonatal death (60.5%) had the highest rate of compensated claims.
CONCLUSIONS
The study provided new information on substandard care and injuries in obstetric care in Finland. An increasing trend in claims and compensation rates was found. Identifying contributors to substandard care that lead to fetal asphyxia is important for improving obstetric safety. Further analysis of the association of claims and compensation rates with operative deliveries is needed to determine their causality. Frequent review of obstetric claims would be useful in providing more recent data on substandard care and preventable injuries.
Topics: Humans; Finland; Female; Registries; Pregnancy; Adult; Delivery, Obstetric; Infant, Newborn; Compensation and Redress; Birth Injuries
PubMed: 38711236
DOI: 10.1111/aogs.14869 -
BMC Anesthesiology May 2024The anesthetic management of parturients with ascending aortic aneurysm for cesarean section can be particularly challenging, primarily because of increased risk for...
BACKGROUND
The anesthetic management of parturients with ascending aortic aneurysm for cesarean section can be particularly challenging, primarily because of increased risk for aortic dissection or aneurysm rupture.
CASE PRESENTATION
We present some aspects of the anesthetic management of two parturients with ascending aortic aneurysm for cesarean sections; amongst, the use of remifentanil with its effects on patient and newborn. We emphasize the importance of a cardio-obstetric team in the context of preoperative planning of such patients. Also, we reviewed some literature on the anesthetic management with its effect on peri-operative hemodynamic stability.
CONCLUSION
Maintaining hemodynamic stability is paramount in the prevention of the rupture or dissection of ascending aortic aneurysm during labor of parturient.
Topics: Humans; Female; Cesarean Section; Pregnancy; Adult; Anesthesia, Obstetrical; Aortic Aneurysm; Pregnancy Complications, Cardiovascular; Remifentanil; Piperidines; Infant, Newborn; Aneurysm, Ascending Aorta
PubMed: 38711027
DOI: 10.1186/s12871-024-02553-2 -
The Pan African Medical Journal 2024effective COVID-19 vaccines for the prevention of severe illness have been available for more than one year now. This study was carried out to ascertain vaccine...
INTRODUCTION
effective COVID-19 vaccines for the prevention of severe illness have been available for more than one year now. This study was carried out to ascertain vaccine hesitancy and its associations among pregnant women receiving antenatal care in Port Harcourt, a large cosmopolitan town in Nigeria.
METHODS
we conducted a cross-sectional online survey over 2 months among consenting pregnant women receiving antenatal care in the 3 largest obstetric service centers in Port Harcourt to evaluate COVID-19 vaccine hesitancy and its associations.
RESULTS
the prevalence of vaccine hesitancy was 669 (72.2%). Of the respondents, 27 (2.9%) had been infected or had a close family member infected with SARS-CoV-2, and 897 (96.8%) of them had heard of the COVID-19 vaccine; however, only 133 (14.4%) had been vaccinated against COVID-19. The safety of the mother in 260 (32.8%) and the safety of the unborn baby in 114 (14.4%) of the respondents were the reasons for vaccine hesitancy. A small proportion of women 7(0.9%) were hesitant on religious grounds. Tertiary education, use of childhood immunization for previous infants delivered, and availability of COVID-19 vaccine in the antenatal clinic at no cost to the women, were statistically significant predictors of vaccine uptake among the respondents.
CONCLUSION
the prevalence of vaccine hesitancy among pregnant women in Port Harcourt was 72.2%. Higher academic achievement and availability of the COVID-19 vaccine in the antenatal clinic were predictors of vaccine uptake, while reasons for hesitancy were mostly due to safety concerns for the mother and unborn baby.
Topics: Humans; Female; Cross-Sectional Studies; Nigeria; Pregnancy; Adult; COVID-19 Vaccines; COVID-19; Prenatal Care; Young Adult; Pregnancy Complications, Infectious; Surveys and Questionnaires; Vaccination Hesitancy; Patient Acceptance of Health Care; Adolescent; Vaccination; Pregnant Women
PubMed: 38708131
DOI: 10.11604/pamj.2024.47.72.37446 -
BMJ Open May 2024To investigate the status of the midwifery workforce and childbirth services in China and to identify the association between midwife staffing and childbirth outcomes.
OBJECTIVE
To investigate the status of the midwifery workforce and childbirth services in China and to identify the association between midwife staffing and childbirth outcomes.
DESIGN
A descriptive, multicentre cross-sectional survey.
SETTING
Maternity hospitals from the eastern, central and western regions of China.
PARTICIPANTS
Stratified sampling of maternity hospitals between 1 July and 31 December 2021.The sample hospitals received a package of questionnaires, and the head midwives from the participating hospitals were invited to fill in the questionnaires.
RESULTS
A total of 180 hospitals were selected and investigated, staffed with 4159 midwives, 412 obstetric nurses and 1007 obstetricians at the labour and delivery units. The average efficiency index of annual midwifery services was 272 deliveries per midwife. In the sample hospitals, 44.9% of women had a caesarean delivery and 21.4% had an episiotomy. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery (adjusted β -0.032, 95% CI -0.115 to -0.012, p<0.05) and episiotomy (adjusted β -0.171, 95% CI -0.190 to -0.056, p<0.001).
CONCLUSION
The rates of childbirth interventions including the overall caesarean section in China and the episiotomy rate, especially in the central region, remain relatively high. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery and episiotomy, indicating that further investments in the midwifery workforce could produce better childbirth outcomes.
Topics: Humans; China; Cross-Sectional Studies; Female; Pregnancy; Midwifery; Adult; Cesarean Section; Delivery, Obstetric; Pregnancy Outcome; Surveys and Questionnaires; Personnel Staffing and Scheduling; Hospitals, Maternity; Episiotomy; Maternal Health Services; Workforce
PubMed: 38692722
DOI: 10.1136/bmjopen-2023-082527