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1.
Objective
to determine the level and determinants for utilisation of Skilled Birth Attendance (SBA).Methods
a population-based survey using a structured questionnaire was conducted in Goya and Tundunya political wards of Katsina state from May to June 2012. Four hundred women aged 15–49 years who had delivered a baby within two years prior to the study were asked about birth attendance during antenatal care (ANC), childbirth and postnatal period of their most recent birth. Logistic regression analysis was performed to obtain independent predictors of skilled birth attendance (SBA).Findings
of the 400 women recruited for the study, 145 (36.3%) received antenatal care, 52 (13%) had their births assisted by skilled personnel and 88 (22%) received postnatal care from skilled birth attendants. Of the 52 women who had their births attended by skilled birth attendants only 29 (56%) had their births in a health facility. Maternal education, husband's occupation, presence of complication and previous place of childbirth were found to be statistically significant predictors for SBA utilisation. Barriers to SBA utilisation identified included lack of health care provider, lack of equipment and supplies and poverty. Enablers mentioned included availability of staff, husband's approval and affordable service.Conclusion
women are more likely to utilise SBA with the availability of skilled personnel, strengthening of the health system and intervention to remove user fees for maternal health services. Joint effort should be made by government and community leaders to promote girl's education and to encourage men's involvement in maternal health services. 相似文献2.
Objective
this study was aimed to provide information on policies for the practice of managing the third stage of labour in Iran, including discussion of related systematic evidence.Design
this survey used a standard questionnaire to obtain information about prevention and early treatment of postpartum haemorrhage from all geographical areas in Iran, in 2010.Setting
the survey included maternity units from 23 provinces, covering 129 out of a total of 560 maternity units in Iran.Participants
at least one public hospital, one private hospital and one rural birth facility unit were included from each province. Questionnaires were completed by the unit's senior midwife with support from the unit's lead obstetrician.Findings
all the units who were approached responded to the study including 69 public hospitals, 32 private hospitals and 28 rural birth facility units. The rate of active management of the third stage of labour was 57 per cent, although answers to individual components of management indicated a higher rate for active interventions than expectant management. Ninety-four per cent of the responding centres indicated oxytocin administration, 71 per cent apply early cord clamping and 65 per cent apply controlled cord traction. A lack of standard definition for postpartum haemorrhage was reported in 18 per cent of units.Key conclusions
a high rate of active management was reported in Iran with variation in its different components which is in line with the international findings. These policies were mainly congruent with the existing systematic evidence except for timing of cord clamping.Implications for practice
there is a need for improvement in locally sensitive policy development, continuing education, establishing accurate auditing systems and ensuring access to facilities such as blood banks and products in rural units. Efforts to reduce maternal mortality and morbidity and investigations into their causes should be extended to factors beyond the third stage of labour care clinical components. 相似文献3.
4.
Objective
to explore the impacts of physical and aesthetic design of hospital birth rooms on midwives.Background
the design of a workplace, including architecture, equipment, furnishings and aesthetics, can influence the experience and performance of staff. Some research has explored the effects of workplace design in health care environments but very little research has examined the impact of design on midwives working in hospital birth rooms.Methods
a video ethnographic study was undertaken and the labours of six women cared for by midwives were filmed. Filming took place in one birth centre and two labour wards within two Australian hospitals. Subsequently, eight midwives participated in video-reflexive interviews whilst viewing the filmed labour of the woman for whom they provided care. Thematic analysis of the midwife interviews was undertaken.Findings
midwives were strongly affected by the design of the birth room. Four major themes were identified: finding a space amongst congestion and clutter; trying to work underwater; creating ambience in a clinical space and being equipped for flexible practice. Aesthetic features, room layout and the design of equipment and fixtures all impacted on the midwives and their practice in both birth centre and labour ward settings.Conclusion and implications for practice
the current design of many hospital birth rooms challenges the provision of effective midwifery practice. Changes to the design and aesthetics of the hospital birth room may engender safer, more comfortable and more effective midwifery practice. 相似文献5.
Objective
to develop a scale to measure maternal satisfaction with birth to evaluate women's experiences in labour and the early postpartum period.Design
development and psychometric assessment of a multidimensional maternal satisfaction questionnaire.Setting
maternity unit of a university hospital in Istanbul.Participants
500 healthy postpartum women.Methods
five steps were taken in development of the scale: literature review, generating item pool, content validity testing, administration of draft scale and psychometric testing. Two versions of the scale were developed: the Scale for Measuring Maternal Satisfaction–normal birth and the Scale for Measuring Maternal Satisfaction–caesarean birth. Content validity was evaluated by experts. The appropriate draft scale and the Newcastle Satisfaction with Nursing Scale were administered to postpartum women before hospital discharge.Findings
content validity index scores for the vaginal and caesarean birth scales were 0.91 and 0.89, respectively. Item-total and subscale-total scores correlated significantly for each scale. Evaluation of construct validity through factor analysis yielded 10 subscales: ‘perception of health professionals’, ‘nursing/midwifery care in labour (in caesarean version: preparation for caesarean)’, ‘comforting’, ‘information and involvement in decision making’, ‘meeting baby’, ‘postpartum care’, ‘hospital room’, ‘hospital facilities’, ‘respect for privacy’ and ‘meeting expectations’. Both scales had good internal reliability, with Cronbach's α coefficients of 0.91. The scales established their convergent validity with significant correlations with the Newcastle Satisfaction with Nursing Scale.Conclusion
the scales are valid and reliable tools for evaluating Turkish women's experiences in labour and the early postpartum period.Implications for practice
the scales can contribute to the assessment of women's satisfaction with different aspects of care, the quality of care and developments in maternity services. 相似文献6.
Objective
to test the predictive value of women's self-identified criteria in place of birth decisions in the event of uncomplicated childbirth in a setting where facility based skilled birth attendants are available.Design
a retrospective, cross-sectional study was conducted in two phases. The first phase used data from in-depth interviews. The second phase used data from semi-structured questionnaires.Setting
the service area of Matlab, Bangladesh.Participants
women 18–49 years who had an uncomplicated pregnancy and delivery resulting in a live birth.Findings
a women's intention about where to deliver during pregnancy, her perception of labour progress, the availability of transportation at the time of labour, and the close proximity of a dai to the household were independent predictors of facility-based SBA use. Marital age was also significant predictor of use.Key conclusions
the availability of delivery services does not guarantee use and instead specific considerations and conditions during pregnancy and in and around the time of birth influence the preventive health seeking behaviour of women during childbirth. Our findings have implications for birth preparedness and complication readiness initiatives that aim to strengthen timely use of SBAs for all births. Demand side strategies to reduce barriers to health seeking, as part of an overall health system strengthening approach, are needed to meet the Millennium Development 5 goal. 相似文献7.
Newburn M 《Midwifery》2012,28(1):61-66
Objective and design
an ethnographic study was undertaken in a birth centre to explore the model of care provided there from the perspectives of midwives and parents.Setting
a five birthing-room, alongside, inner-city, birth centre in England, situated one floor below the hospital labour ward, separately staffed by purposively recruited midwives.Participants
around 114 hours were spent at the birth centre observing antenatal, intrapartum and postnatal care; 11 in-depth interviews were recorded with parents after their baby's birth (four with women; seven with women and men together), including three interviews with women who transferred to the labour ward, and 11 with staff (nine midwives and two maternity assistants).Findings
most women and men using the birth centre perceived it as offering the ‘best of both worlds’ based on its proximity to and separation from the labour ward. It seemed to offer a combination of biopsychosocial safety, made evident by the calm, welcoming atmosphere, the facilities, engaging, respectful care from known midwives and a clear commitment to normal birth, and obstetric safety particularly because of its close proximity to the labour ward.Key conclusions and implications for practice
this alongside birth centre provided a social model of care and appealed strongly to a group of parents; similar birth centres should be widely available throughout the NHS. 相似文献8.
Objectives
this paper explores the relationship between perceptions of prenatal control, expectations for childbirth, and experienced control in labour and birth and how they individually and collectively affect birth satisfaction.Design
a repeated measures exploratory study was conducted with 31 primiparous women between 26 and 40 weeks pregnant. Standardised interviews were conducted prior to birth to assess levels of prenatal control and expectations for control during childbirth. Six weeks after the birth, women were interviewed again to assess experiences of control and birth satisfaction.Setting
prenatal clinic, North Carolina, USA.Findings
results show experienced control to be a significant predictor of birth satisfaction, with high levels of control correlating with high satisfaction levels. However, no correlations were found between the three aspects of control, and both prenatal control and birth expectations were found to have no significant effect on birth satisfaction. Findings also indicate that women cared for by midwives have significantly higher experienced control and birth satisfaction than women whose care was provided by obstetricians, while incidence of caesarean birth did not affect either measure.Conclusions
experienced control during labour and birth is an important predictor of birth satisfaction. Health care providers should collaborate with the women they care for to use techniques that maximize the experience of control especially during labour and birth. 相似文献9.
Objective
to provide an accessible list of individual and population-based risk factors associated with very preterm birth to assist care providers in planning appropriate pregnancy care.Design
a population-based case-control study.Setting
Victoria, Australia.Participants
women were recruited from April 2002 to 2004. Cases had a singleton birth between 20 and 31+6 weeks gestation and controls were a random selection of women having a birth of at least 37 weeks gestation in the same time period as the cases.Measurements and findings
structured interviews were conducted within a few weeks postpartum with 603 cases and 796 controls. Data were collected on sociodemographic factors; obstetric and gynaecological history; and maternal health problems, both pre-existing and occurring during the index pregnancy. Risk factors were calculated.Key conclusions
when correlated, risk factors were grouped as either lifestyle or maternal health factors. The majority of the risks were obstetric or gynaecological factors. Risks occurring in pregnancy may precipitate preterm birth.Implications for practice
knowing the risk factors for very preterm birth is likely to be helpful for pregnancy care providers. The development of a risk factor checklist based on the findings presented here may enable more informed planning of care and timely intervention. 相似文献10.
Objective
to evaluate a pilot project, which used a community participatory approach to introduce birth preparedness in rural Cambodia.Design
a feasibility and outcome evaluation. This included observation, interview, document analysis and costing.Setting
the project was undertaken in 15 villages linked to five health centres in Kampong Chhnang, Cambodia.Participants
key management personnel, local midwives, village leaders, village volunteers and village members who had participated in the programme.Findings
community engagement was not only feasible but was also a successful and cost-effective way to introduce birth preparedness. A high degree of satisfaction was reported by the health staff and the community. Over the year in which the project was undertaken, there was a 22% increase in antenatal care, a 32% increase in the number of women delivered by a midwife, and a 281% increase in referrals to hospital.Implications for practice
discussion about birth preparedness should occur not only with pregnant women but also with the communities that support them. Communities that are poor and isolated are responsive to the health needs of their women as they give birth, and articulate their needs when given the opportunity. Interacting with health staff in a way in which there is shared information can lead to greater utilisation of the health services that they provide. 相似文献11.
12.
Narratives of distress about birth in South African public maternity settings: A qualitative study 总被引:1,自引:0,他引:1
Objective
to explore the factors associated with negative birth experiences in South African public maternity settings from the perspective of women's birth narratives.Design
an explorative, qualitative research study using a narrative methodological framework and unstructured interviewing.Setting
the city of Cape Town in South Africa.Participants
33 low-income women aged 18–42 years who had recently given birth to an infant in the public maternity sector.Findings
more than half of the women (n=18) narrated ‘narratives of distress’ in relation to their birth experiences. One third narrated ‘good’ birth experiences and four women told minimalistic or neutral birth narratives. This paper reports only on factors associated with women's distress narratives. Narratives of distress were associated with poor quality of intrapartum care and characterised by the following four themes, namely (1) negative interpersonal relations with caregivers, (2) lack of information, (3) neglect and abandonment and (4) the absence of a labour companion.Key conclusions and implications for practice
poor relationships with caregivers emerged as central to women's distress narratives. Interventions aimed at improving interpersonal communication, connection and rapport between caregivers and labouring women are central to improving quality of care in resource-constrained settings. 相似文献13.
14.
15.
Li Thies-Lagergren Linda J. Kvist Ann-Kristin Sandin-Bojö Kyllike Christensson Ingegerd Hildingsson 《Midwifery》2013
Objective
the aim of this study was to compare the use of synthetic oxytocin for augmentation, duration of labour and birth and infant outcomes in nulliparous women randomised to birth on a birth seat or any other position.Study design
a randomised controlled trial in Sweden where 1002 women were randomised to birth on a birth seat (experimental group) or birth in any other position (control group). Data were collected between November 2006 and July 2009. The outcome measurements included synthetic oxytocin augmentation, duration of the second stage of labour and fetal outcome. Analysis was by intention to treat.Setting
southern Sweden.Findings
the main findings of this study were that women randomised to the experimental group had a statistically significant shorter second stage of labour than women randomised to the control group. There were no differences between the groups for use of synthetic oxytocin augmentation or for neonatal outcomes.Conclusions
women allocated to the birth seat had a significantly shorter second stage of labour despite similar numbers of women subjected to synthetic oxytocin augmentation in the study groups. The adverse neonatal outcomes did not differ between groups. The birth seat can be suggested as non-medical intervention used to reduce duration of second stage labour and birth. The birth seat can be suggested as a non-medical intervention that may facilitate reduced duration of the second stage of labour. Furthermore it is recommended that caregivers, both midwives and midwifery students, should learn skills to assist women in using a variety of birth positions.Trial registration
unique Protocol ID: Dnr 2009/739 (register.clinicaltrials.gov). 相似文献16.
Objective
identify research examining the effect of culture on maternal mortality rates.Design
literature review of CINAHL, Cochrane, PsychInfo, OVID Medline and Web of Science databases.Setting
developing countries with typically higher rates of maternal mortality.Participants
women, birth attendants, family members, nurse midwives, health-care workers, and community members.Measurements and findings
reviews, qualitative and mixed-methods research have identified components of culture that have a direct impact on maternal mortality. Examples of culture are given in the text and categorised according to the way in which they impact maternal mortality.Key conclusions
cultural customs, practices, beliefs and values profoundly influence women's behaviours during the perinatal period and in some cases increase the likelihood of maternal death in childbirth. The four ways in which culture may increase MMR are as follows: directly harmful acts, inaction, use of care and social status.Implications for practice
understanding the specifics of how the culture surrounding childbirth contributes to maternal mortality can assist nurses, midwives and other health-care workers in providing culturally competent care and designing effective programs to help decrease MMR, especially in the developing world. Interventions designed without accounting for these cultural factors are likely to be less effective in reducing maternal mortality. 相似文献17.
Objective
to explore the experiences of a small group of first-time mothers giving birth at home or in hospital.Design
a grounded theory methodology was used. Data were generated from in-depth interviews with women in their own homes.Setting
Sydney, Australia.Participants
19 women were interviewed. Seven women who gave birth for the first time in a public hospital and seven women who gave birth for the first time at home were interviewed, and their experiences were contrasted with two mothers who gave birth for the first time in a birth centre, one mother who gave birth for the first time in a private hospital and two women who had given birth more than once.Results
these women shared common experiences of giving birth as ‘novices’. Regardless of birth setting, they were all ‘reacting to the unknown’. As they entered labour, the women chose different levels of responsibility for their birth. They also readjusted their expectations when the reality of labour occurred, reacted to the ‘force’ of labour, and connected or disconnected from the labour and eventually the baby.Implications for practice
knowing that first-time mothers, irrespective of birth setting, are essentially ‘reacting to the unknown’ as they negotiate the experience of birth, could alter the way in which care is provided and increase the sensitivity of midwives to women's needs. Most importantly, midwives need to be aware of the need to help women adjust their expectations during labour and birth. Identifying the ‘novice’ status of first-time mothers also better explains previous research that reports unrealistic expectations and fear that may be associated with first-time birthing. 相似文献18.
19.
Objective
the goal of women-centred care (WCC) is respect, safety, holism, partnership and the general well-being of women, which could lead to women's empowerment. The first step in providing WCC to all pregnant women is to describe women's perceptions of WCC during pregnancy in different health facilities. The objectives of this study were to ask (a) what are the perceptions and comparison of WCC at Japanese birth centres, clinics, and hospitals and (b) what are the relationships between WCC and three dimensions of women's birth experience: (1) satisfaction with care they received during pregnancy and birth, (2) sense of control during labour and birth, and (3) attachment to their new born babies.Design
this was a cross-sectional study using self-completed retrospective questionnaires.Setting
three types of health facility: birth centres (n=7), clinics (n=4), and hospitals (n=2).Participants
participants were women who had a singleton birth and were admitted to one of the study settings. Women who were seriously ill were excluded. Data were analysed on 482 women.Measurements
instrumentation included: a researcher-developed WCC-pregnancy questionnaire, Labour Agentry Scale, Maternal Attachment Questionnaire, and a researcher-developed Care Satisfaction Scale.Findings
among the three types of settings, women who delivered at birth centres rated WCC highly and were satisfied with care they received compared to those who gave birth at clinics and hospitals. WCC was positively associated with women's satisfaction with the care they received.Key conclusions
women giving birth at birth centres had the most positive perceptions of WCC. This was related to the respectful communication during antenatal checkups and the continuity of care by midwives, which were the core elements of WCC.Implications for practice
health-care providers should consider the positive correlation of WCC and women's perception of satisfaction. Every woman should be provided continuity of care with respectful communication, which is a core element of WCC. 相似文献20.