Evaluation of prenatal assistance in the point of view of puerperas and hetalth care professionals

The aim of this study was to evaluate the prenatal assistance in a public maternity hospital in the point of view of puerperas and health care professionals. Nineteen puerperas and six health professionals took part in the study. The puerperas answered a semi-structured interview and the health professionals took part in a focus group. The discourse analysis was based on in-depth hermeneutics. The main results pointed out that users showed a deep appreciation for the health professionals. Concerning the professional's view, pregnant women had a wrong knowledge of health during pregnancy. As regards the nutrition appointments, puerperas pointed out they had room for dialogue, support and encouragement. In conclusion, prenatal health education should consider that each woman is a unique individual with her own background. Bonding is of paramount importance for pregnant women to get involved with health-related issues.     

Maternity leave and children's health outcomes in the long-term

This paper assesses the impact of the length of maternity leave on children's health outcomes in the long-run. My quasi-experimental design evaluates an expansion in maternity leave coverage from two to six months, which occurred in the Federal Republic of Germany in 1979. The expansion came into effect after a sharp cutoff date and significantly increased the time working mothers stayed at home with their newborns during the first six months after childbirth. Using this cutoff date as a source of exogenous variation, I exploit German hospital registry data, which contains detailed information on the universe of inpatients’ diagnoses from 1995–2014. By tracking the health of treated and control children from age 16 up to age 35, this study provides new insights into the trajectory of health differentials over the life-cycle. I find that the legislative change generated positive long-term health effects: My intention-to-treat estimates show that children born after the implementation of the reform experience fewer hospital admissions and are less likely to be diagnosed with mental and behavioral disorders.     

Voluntary abortion and domestic violence among women attended at a public maternity hospital of Salvador-BA

Quantitative study in order to study domestic violence in women with induced abortion. Interviews were conducted with 147 women hospitalized for induced abortion in a public maternity hospital in Salvador, Bahia. The subjects are characterized by mostly women, black, poorly educated, economically dependent on spouses, experienced psychological abuse, physical and sexual abuse committed by their spouses. Almost half of the women were victims of domestic violence during the current pregnancy, and that was the reason for inducing abortion for 67% of them. The study reveals an association between experience of domestic violence and induced abortion. As mental health consequences, they developed symptoms of post trauma stress disorder. It is necessary that the health professionals consider the cues to identify domestic violence as a health problem associated with induced abortion, which requires a transformation on the training model, including domestic violence as a health issue.     

Developing strategies to gather information about the maternity experiences of indigenous women in an acute care setting

ABSTRACT: This project emerged from the concerns of health care professionals at a large acute care hospital in the Northern Territory of Australia. The aim of the project was to develop educational resources through information and experiences provided by Aboriginal and Torres Strait Islander women and health care professionals. The objectives are to optimise collaboration and participation by Indigenous and Torres Strait Islander women in sharing their maternity experiences about the birthing of their baby either in hospital, or out of hospital before arrival. Stage one of a three stage project is reported here. In stage one a modified Delphi method was used to interview ten purposefully chosen professional Indigenous women with insight into the research process and changing social arrangements. Stage two involved the development of an interview schedule and face-to-face interviews. Stage three includes the development of a questionnaire to be answered by health care professionals.
Discussion of the background to the study, reviewed literature and issues identified from interviews with the professional Indigenous women regarding best methods and appropriate data collection processes is presented. Research described here explores issues of concern for Indigenous women from the Northern Territory around their child birthing experiences in an acute care setting.     

Attitudes towards antenatal vaccination,Group B streptococcus and participation in clinical trials: Insights from focus groups and interviews of parents and healthcare professionals

IntroductionAntenatal vaccination has become a part of routine care during pregnancy in the UK and worldwide, leading to improvements in health for both pregnant women and their infants. However, uptake remains sub-optimal. Other antenatal vaccines targeting major neonatal pathogens, such as Group B streptococcus (GBS), the commonest cause of sepsis and meningitis in the neonatal period, are undergoing clinical trials but more information is needed on how to improve acceptance of such vaccines.MethodsQualitative study using focus groups and interviews; involving 14 pregnant women, 8 mothers with experience of GBS, and 28 maternity healthcare professionals. Questions were asked regarding antenatal vaccines, knowledge of GBS, attitudes to a potential future GBS vaccine and participation in antenatal vaccine trials.ResultsAll participants were very cautious about vaccination during pregnancy, with harm to the baby being a major concern. Despite this, the pregnant women and parents with experience of GBS were open to the idea of an antenatal GBS vaccine and participating in research, while the maternity professionals were less positive. Major barriers identified included lack of knowledge about GBS and the reluctance of maternity professionals to be involved.InterpretationIn order for a future GBS vaccine to be acceptable to both pregnant women and the healthcare professionals advising them, a major awareness campaign would be required with significant focus on convincing and training maternity professionals.     

Newborns with an impairment: discourses of hospital staff

The birth of a baby with an impairment goes against dominant cultural ideals about a happy event. Therefore, the interaction between professionals and parents is particularly important, from the hospital maternity ward to the home. In this article, the author examines both the representations of neonatal impairments constructed by professionals and the consequent subject positions for these babies with impairments. The study is based on interview data collected among 19 staff members of one Finnish county hospital. The author analyzed the data by means of qualitative discourse analysis and concludes that it would be important for health care professionals to provide many-sided elements for parents to consider in the construction of the image of their baby other than traditional tragically and negatively biased cultural interpretations.     

Improving communication between health professionals and women in maternity care: a structured review

Objective  To review trials of the effectiveness of interventions aimed at improving communication between health professionals and women in maternity care.
Search strategy  The electronic databases Medline, PsycLit, The Cochrane Library, BIDS Science and Social Science Indexes, Cinahl and Embase were searched. Final searches were carried out in April 2000.
Inclusion criteria  Controlled trials of interventions explicitly aimed at improving communication between health professionals and women in maternity care were included. Other trials were included where two reviewers agreed that this was at least part of the aim.
Data extraction and synthesis  95 potentially eligible papers were identified, read by one reviewer and checked against the inclusion criteria. The 11 included trials were read, assessed for quality and summarized in a structured tabular form.
Results  The included trials evaluated interventions to improve the presentation of information about antenatal testing, to promote informed choice in maternity care, woman-held maternity records and computer-based history taking. Four trials in which women were provided with extra information about antenatal testing in a variety of formats suggested that this was valued by women and may reduce anxiety. Communication skills training for midwives and doctors improved their information giving about antenatal tests. The three trials of woman-held maternity records suggested that these increase women's involvement in and control over their care.
Conclusions  The trials identified by this review addressed limited aspects of communication and focused solely on antenatal care. Further research is required in several areas, including trials of communication skills training for health professionals in maternity care and other interventions to improve communication during labour and in the postnatal period.     

Assessment of satisfaction of a group of elderly women and caretakers with a discharge planning

Independently of the type of quality assistance improvement model chosen in a health institution, the implementation of ways of assessing it is also necessary. This study analyze the degree of satisfaction among a group of 50 hospitalized elderly women and/or caretakers after the implementation of a discharge planning in a Emergency Medical Clinic Unit. The present paper also investigates the need for continued assistance and points out which information is considered the most important by the patient. Results show that both the elderly and caretakers were highly satisfied with the assistance provide, most of which felt confident about their ability to continue it and that the most important information was that related the main health problem of elderly patient. It is inferred from this study that a discharge planning should be adapted by the health professionals in the hospital.     

Continuum of care and the antenatal record in rural New South Wales

Objective: The aim of the study was to determine the effect of the woman held antenatal record card (PNC2) on the continuity of maternity care received when presenting to the acute rural setting for clinical assessment. Design: Qualitative, open‐ended questionnaires. Setting: Rural New South Wales public hospital. Subjects: Maternity consumers, 50 women who were inpatients receiving antenatal or postnatal care between August and October 1998. A stratified sample of healthcare professionals employed by the service, 12 midwives and 13 general practitioners. Main outcome measure: The self reported use of the antenatal card and the viewed effects of the card on the continuity of healthcare received. Results: The study identified a significant difference between the responding professionals (93%) positive perception of the effect of the PNC2 on the women's pregnancy continuum of care and the maternity consumer (36%), who felt it bore little impact on their care. The study findings suggested a lack of compliance and standardisation in usage of the antenatal card negated any flow on effects for the women. Conclusions: The intended purposes of the PNC2 were compromised in this rural setting. The study recommends that stakeholders in rural maternity care be accountable for examining the benefits and barriers of their antenatal practices, that the rural community's expectations of ‘continuity of maternity care’ are sought and that there should be a review of the available models of rural antenatal care. What is already known: The woman held antenatal record has been reported to be an effective approach for enabling consumers to participate in their maternity care, whilst also address the concerns of continuity, safety and information sharing. This form of medical record has been strongly supported by the National Health and Medical Research Council and NSW Health as a professional and consumer friendly strategy. The usage or the effects of the antenatal record in rural New South Wales settings have yet to be widely evaluated. What this study adds: The study's questionnaire responses identified that the antenatal record may have met the needs of rural health professionals, however, the maternity care consumers were unaware of these benefits. The study suggests that the antenatal record was operationalised at the discretion and for the convenience of the rural health care professional. Identifying rural communities perceptions of continuity of care and the need to explore models of care that promote continuity in rural areas, where significant findings of the study.     

Patients' expectations concerning childbirth care at a public maternity hospital in Rio de Janeiro, Brazil: challenges for the humanization of obstetric care

This study analyzes patients' expectations at a public maternity hospital in Rio de Janeiro, Brazil, concerning childbirth care. The methodology was based on a thematic analysis of interviews held during the eighth and ninth months of pregnancy. The study analyzed women's information on humanization of childbirth care, experience pertaining to care received during previous deliveries, their notions of ideal treatment during the current delivery, and attention received from the health care team. The results show that women's expectations focus on three main elements: speedy hospital admission, guaranteed admission to the maternity hospital, and treatment by an attentive and skilled team that cares for the patient's own health and that of her infant. Conflicting information on quality of care in the maternity hospital is a source of additional stress for these women, since in their view quality of care is more a matter of luck than routine institutional management. Based on these expectations, the authors assess the challenges for humanization of childbirth care currently under implementation in the city of Rio de Janeiro.     

Opinions of healthcare professionals regarding the maternity experiences of indigenous women in an acute care setting

ABSTRACT: This is the report of stage three of a three stage project. The aims of the overall project were to seek advice from expert Indigenous women on how to gather information from birthing Indigenous women while in hospital. Information was gathered from Indigenous women who gave birth in hospital or were admitted after the birth of their baby. The opinions of healthcare professionals on the care of these women were investigated. This paper describes the opinions and concerns of healthcare professionals regarding identified cultural, social and economical issues for Indigenous women at a large acute care hospital in the Northern Territory, Australia. The opinions of healthcare professionals are vital if the needs and concerns of Indigenous women are to be considered within the hospital setting.
Stages one and two of this project have been presented previously. Stage three, reported here, describes a survey of 18 non-Indigenous and one Indigenous healthcare professionals regarding their opinions of the maternity experiences of Indigenous women admitted to an acute care setting. The consultative process for designing the questionnaire and reflections on issues raised by Indigenous women during their interviews in the previous two stages is presented. The methodology of the survey, demographics and perceptions of healthcare professionals who participated in the project are examined and the similarities and differences between the issues raised by the healthcare professionals and the Indigenous women in stage two of the project are discussed. Suggestions made by the healthcare professionals regarding improving quality of care for Indigenous women when admitted to an acute healthcare setting are presented.     

Somali refugee women's experiences of maternity care in west London: A case study

This article reports a study of the maternity care experiences of Somali refugee women in an area of west London. This small case study formed a discrete part of a wider study of women's responses to two systems of maternity care. Qualitative research methods involving semi-structured interviews and focus groups were used. Interviews were carried out with Somali women who had recent experience of the maternity services, with health professionals who had contact with Somali women in their work, and with a Trust employee involved in the provision of language support. The findings confirmed much of the available research evidence on other ethnic minorities' contacts with the maternity services. Many of these women are not gaining equal access to maternity services due to inadequate provision of interpreting services, stereotyping and racism from health service staff, and a lack of understanding from staff of cultural differences. A further issue found to affect the Somali women was poor management of female genital mutilation (FGM) in pregnancy and labour. This article focuses particularly on communication and language support as language was found to be the single most important issue for the Somali women in their contacts with the maternity services, with communication difficulties having negative implications for all aspects of their care.     

Factors associated with the use of social workers for assistance with lifetime and 12-month behavioral health disorders

ABSTRACT

This study examined the use of social workers for assistance with a behavioral health disorder. Data were from the Collaborative Psychiatric Epidemiology Surveys. The analytic sample included respondents who reported using professional services for assistance with a behavioral health disorder during their lifetime (n = 5,585). Logistic regression was used to examine the use of a social worker during the respondent’s lifetime or 12 months prior to the interview. Ten percent of respondents visited a social worker for help with a behavioral health disorder during their lifetime and 3% did so in the 12 months prior to the interview. Women were less likely than men to report using a social worker. Those who visited a social worker tended to also use other professionals for a behavioral health disorder although overall respondents reported visiting social workers less frequently for this reason than other types of professionals.     

Factors that interfere in the parturient women's behavior: focus on ethnonursing

This study aimed to understand the behavior of pregnant women in labor and delivery. Seven parturient women who had their children through normal delivery in a public maternity in Fortaleza, Ceará. Data collection was carried out in June to August, 2003. The research method used for the collection and analysis of data was the etnonursing. The data studied showed us through the categories: experiencing pregnancy and assistance in the maternity. We concluded that there are several factors that justify the woman's behavior during the experience of labor and delivery and that the health professionals' assistance should be always aimed at the humanistic care linking cultural and scientific knowledge.     

Investigating women's preferences for intrapartum care: home versus hospital births

There is an increasing amount of evidence to suggest that the clinical outcomes associated with a home birth for low risk women are at least as good, if not better than, the clinical outcomes associated with giving birth in hospital. If it is the case that there is little or no difference in clinical outcomes between the two modes of delivery, then traditional measures of benefit used in health economics, e.g. quality adjusted life years (QALYs), would detect little or no difference between the alternative modes of delivery. From this, the conclusion would be that the utility values associated with each mode of delivery are similar. However, women may still have clearly defined preferences relating to the way in which maternity care is provided. This paper uses the economic technique of conjoint analysis to assess the relative value attached to several main characteristics associated with the process of maternity care during the intrapartum stage for women who have actively chosen to give birth at home relative to women who have given birth in hospital. It was found that respondents who had chosen a home birth valued continuity of carer, a homely environment and the ability to make their own decisions about what happens during labour and delivery. In contrast, hospital birth respondents placed a relatively high value on access to an epidural for pain relief and not needing to be transferred to another location during labour if a problem arose. The results of the study suggest that women have clearly defined preferences for characteristics associated with the process of intrapartum care that would be unlikely to be detected by traditional benefit measures used in health economics. This finding is important where policy issues relating to aspects of maternity care service delivery are being considered.     

An Australian hospital's training program and referral pathway within a multi‐disciplinary health–justice partnership addressing family violence

Objective : An innovative health–justice partnership was established to deliver legal assistance to women experiencing family violence who attended an Australian hospital. This paper reports on a multifaceted response to build capacity and willingness of health professionals to identify signs of family violence and engage with referral pathways to on‐site legal assistance. Methods : A Realistic Evaluation analysed health professionals’ knowledge and attitudes towards identification, response and referral for family violence before and after training; and use of referral pathways. Results : Of 123 health professionals participating in training, 67 completed baseline and follow‐up surveys. Training improved health professionals’ self‐reported knowledge of, and confidence in, responding to family violence and understanding of lawyers’ roles in hospitals. Belief that patients should be referred to on‐site legal services increased. Training did not correspond to actual increased referrals to legal assistance. Conclusion : The program built capacity and willingness of health professionals to identify signs of, and respond to, family violence. Increase in referral rates to legal assistance was not shown. Potential improvements include better data capture and greater availability of legal services. Implications for public health : Strong hospital system supports and reliable recording of family violence referrals need to be in place before introducing such partnerships to other hospitals.