The woman's birth experience—The effect of interpersonal relationships and continuity of care

Objective

the aim of the present study was to gain a deeper understanding of how relational continuity in the childbearing process may influence the woman's birth experience.

Research design/setting

a Q-methodological approach was chosen, as it allows the researcher to systematically assess subjectivity. 23 women were invited to sort a sample of 48 statements regarding their subjective view of birth experience after having participated in a pilot project in Norway, where six midwifery students provided continuity of care to 58 women throughout the childbearing process. The sorting patterns were subsequently factor-analysed, using the statistical software ‘PQ’ which reveals one strong and one weaker factor. The consensus statements and the defining statements for the two factors were later interpreted.

Findings

both factors seemed to represent experiences of psychological trust and a feeling of team work along with the midwifery student. Both factors indicated the importance of quality in the relation. Factor one represented experiences of presence and emotional support in the relationship. It also represented a feeling of personal growth for the women. Factor two was defined by experiences of predictability in the relation and process, as well as the feeling of interdependency in the relation. According to quality in the relation, women defining factor two experienced that the content, not only the continuity in the relation, was important for the birth experience.

Key conclusions

relational continuity is a key concept in the context of a positive birth experience. Quality in the relation gives the woman a possibility to experience positivity during the childbearing process. Continuity in care and personal growth related to birth promote empowerment for both the woman and her partner. Relational continuity gives an opportunity for midwives to provide care in a more holistic manner.     

Current practice of preconception care by primary caregivers in the Netherlands

Objectives: Over the past decade the value of preconception care (PCC) consultations has been acknowledged. Investments have been made to promote delivery and uptake of PCC consultations in the Dutch primary care setting. We assessed current activities, perceptions and prerequisites for delivery of PCC in primary care. Methods: A questionnaire was compiled and distributed by mail or e-mail among 1682 general practitioners (GPs) and 746 midwives in the Netherlands between 2013 and 2014. Results: The questionnaire was completed by 449 GPs and 250 midwives. While GPs and midwives were frequently asked about preconception risks, explicit requests by patients for a PCC consultation were less frequent. Although caregivers gave information on preconception risk factors, only a minority recommended PCC in the form of a dedicated consultation. Such consultations occurred infrequently. Risk factor assessment varied between GPs and midwives. Respondents’ perceptions of PCC consultations, however, were generally positive. A small proportion believed that PCC medicalised pregnancy, and recognised barriers in actively raising the topic of patients’ pregnancy wishes. More training, staff, promotion of PCC and adequate reimbursement were prerequisites for future delivery. GPs differed in their opinion of whether they or midwives were primarily responsible for PCC consultations. Midwives, however, saw themselves as responsible for providing PCC consultations. Conclusions: Primary care is underserving prospective parents with regards to PCC consultations. Targets to increase delivery of systematic PCC are: (1) promotion during routine care; (2) increased use of tools; (3) increased collaboration among primary caregivers; (4) reduction of caregivers’ negative perceptions; and (5) tailoring PCC consultations to suit women’s preferences.     

Initial management of infertility: an audit of pre-referral investigations and exploration of couples' views at the interface of primary and secondary care

This study aimed to audit pre-referral investigations in primary care, and survey patients' views on the referral process from primary to secondary care. Referral letters and case notes of 250 consecutive couples referred to the Aberdeen Fertility Centre were audited in order to establish whether mid-luteal serum progesterone, rubella status and semen analysis had been performed. Couples attending a specialist hospital clinic for the first time completed a questionnaire on their experience of the referral process and consultation. Mid-luteal progesterone was performed in 105 (51%) cases, rubella status checked in 42 (20%) cases and semen analysis arranged in 70 (34%) cases. Overall, 274 (93%) patients were satisfied or very satisfied with the hospital consultation compared to 216 (84%) who utilisedthe general practitioner (GP) consultation (p ≤ 0.001); 79 (59%) women and 91 (68%) men wanted the current system of GP referral to continue (p < 0.001); and 74 (56%) women and 69 (52%) men (p < 0.001) favoured the option of direct self-referral.

Conclusions: Despite high levels of satisfaction among couples, there is scope for further improvement in terms of pre-referral fertility investigations. Further evaluation of the referral process is needed, and potential changes to the existing system should be considered.     

Role of receipt of antenatal care in subsequent contraceptive use at primary health care centres serving slum areas of Cairo,Egypt

Abstract

Objectives: Information on family planning and use of antenatal care services is vital for understanding the main influences on fertility and evaluating the success of national family planning programmes. This study aimed to explore contraceptive use and its relation to use of antenatal care services in Egypt.

Methods: A cross-sectional survey was conducted among women attending three primary health care centres serving different slum areas of Cairo.

Results: Most of women who used antenatal care services obtained contraception from the state sector. Although the number of antenatal care visits was not significantly associated with contraceptive use, it was a significant determining factor for the type of method used. Reasons given for non-use of contraception were related to reproductive health concerns or disapproval of contraceptive use.

Conclusion: Contraceptive use is widespread in Egypt, regardless of age and level of education. Antenatal care is no longer viewed with suspicion. Antenatal care visits are an opportunity for health care providers (HCPs) to encourage the use of contraception. Repeated antenatal care visits help to engender a relationship of trust between women and HCPs. Incorporation of family planning programmes into antenatal care programmes would be an opportunity to promote modern contraceptive use.     

The effects of live therapeutic music on patient's affect and perceptions of care: A randomized field study

AimThis article examines the effects of live therapeutic music (LTM) on patients in a hospital setting. LTM was hypothesized to directly increase patients' positive affect and to indirectly influence their perceptions of the care they received.MethodOne hundred patients participated in a two group (fifty per group), quasi-experimental design in which they completed a very brief questionnaire assessing their affect and perceptions of care. Half of the participants were exposed to LTM at the bedside. The other half served as a comparison group. A structural equation model was used to test the hypothesized effects of LTM.ResultsThe model explained 63% of the variance in patient's affect and 10% of the variance in perceptions of care.ConclusionsPatients respond to LTM with increased positive affect and by assigning higher ratings to the care they receive. LTM could be used as a viable means to improve patient outcomes and satisfaction.     

‘What is could indeed be better’—Swedish women’s perceptions of early postnatal care

Background

studies have shown that women are more likely to be satisfied with intrapartum rather than postpartum care. The structure and organisation of care seems to be a barrier to good-quality postpartum treatment

Objective

to explore the perceived reality and the subjective importance of early postnatal care provided in hospital, and to study women’s satisfaction with different models of early postnatal care and the factors that are most strongly associated with being ‘very satisfied’ with the postnatal care received.

Method

a regional survey was conducted with 1240 women recruited in mid-pregnancy and followed-up two months after childbirth.

Results

a statistically significant difference existed between the subjective importance and the perceived reality for all studied variables, with a greater subjective importance than perceived reality for all statements. The length of postnatal stay and the content of care were related to satisfaction, while the model of postnatal care was not. The most important variables for being ‘very satisfied’ with postnatal care were that the infant received the best possible check-ups/medical care, and that the woman received sufficient support from staff.

Conclusion

further studies are needed to assess the best model of postnatal care that gives the best opportunities to provide satisfactory care for women and their families.     

Elective abortion as a primary health service in rural India: experience with manual vacuum aspiration

India allows abortion up to 20 weeks of pregnancy but places restrictions on abortion facilities and providers. Abortion services are especially deficient in rural areas. Although vacuum aspiration is safer, sharp curettage continues to be used by providers as they lack relevant training. This paper describes the provision of first trimester abortion services using manual vacuum aspiration (MVA) in a rural clinic in the state of Rajasthan over a four-year period. Non-use of anaesthesia increased safety and allowed women to return early to a normal routine. Of 534 women, none suffered major complications; 16 required repeat evacuation and the procedure failed in two. We recommend that models based on MVA and including medical methods be piloted in rural areas of a number of states of the country, to establish the feasibility of delivering first trimester abortion as a primary health service. Ways to increase access to second trimester procedures are also required. Current requirements for certification of private facilities are excessive and the process of obtaining certification is arduous. The law in India does not extend these norms to government facilities, which remain under-equipped and lack trained providers. We recommend that certification of facilities be liberalized and applied equally to government and private institutions. There is also a need to rapidly increase training capacity across the country.     

Investigation of infertility management in primary care with open access hysterosalpingography (HSG): a pilot study

Infertility affects one in seven couples in the United Kingdom. The National Institute for Clinical Excellence (NICE) issued guidance on the management of the infertile couple in February 2004, which included the statement “for the assessment of tubal damage, women not known to have co-morbidities (pelvic inflammatory disease, endometriosis or previous ectopic pregnancy) should be offered hysterosalpingography (HSG)”. We made HSG available to six general practices in Newcastle upon Tyne as an open access investigation. Our aim was to evaluate the uptake of open access HSG, speed of access to specialist services and the quality of the information recorded in the referral letter. Using hospital clinical records we tracked the outcome of all infertile couples from the six pilot practices over a nine-month period. Of the 39 referrals identified, 10 women were eligible for open access HSG, of which six HSGs were organized by GPs. Couples who had open access HSG reached a diagnosis and management plan four weeks earlier than those who were referred directly (mean difference 4.0 weeks, 95% confidence interval (CI) ?8.8 to 0.4 weeks). The information recorded in the referral letter was generally poor. However, all referrals made via the open access HSG service had the prerequisite tests done. Open access HSG allowed prompter access to specialist services with more complete information passed on in the referral letter. Open access HSG was used in 15% of all infertile couples and 60% of those who fitted the criteria for its use. Open access HSG together with semen analysis and endocrine blood tests may allow GPs to manage the initial stages of the infertile couple and make a diagnosis.     

Maternal cytomegalovirus infection prevention: The role of Dutch primary care midwives

Objectiveto assess the knowledge of cytomegalovirus (CMV) infection among Dutch primary care midwives, and clinical approaches to informing women about CMV.Designcross-sectional study, using self-administered questionnaires.Participants330 Dutch primary care midwives.Settingprimary midwifery care practices across the Netherlands.Main outcomeMidwives׳ knowledge of CMV transmission routes and maternal symptoms, and clinical practice behaviours regarding CMV, the information typically provided or reasons for not informing pregnant women about CMV.Findingsthe overall median knowledge score was 8.0 out of a maximum possible score of 13.0. Of all participants, 10.6% reported always informing pregnant women about CMV infection prevention and 41.0% reported never informing pregnant women. The main reason indicated for not informing pregnant women was lack of knowledge about preventive methods (45.7%).ConclusionDutch primary care midwives have limited knowledge of CMV infection. Improvement in providing education to pregnant women about strategies to prevent CMV is necessary.     

Nullified: Women's perceptions of being abused in health care

Objective. In a study performed with The NorVold Abuse Questionnaire (NorAQ) among Nordic gynecological patients, the prevalence of lifetime abuse in health care (AHC) was 13 – 28%. In the present study we chose a qualitative approach. Our aim was to develop a more in-depth understanding of AHC; as experienced by female Swedish patients.

Study design. Qualitative interviews with 10 Swedish gynecological patients who had experienced AHC. The interviews were analyzed through Grounded Theory.

Results. Saturation was reached after six interviews. In the analyses four categories emerged which explain what AHC meant to the participating women: felt powerless, felt ignored, experienced carelessness, and experienced non-empathy. To be nullified is the core category that theoretically binds the four categories together. The women's narratives described intensive current suffering even though the abusive event had taken place several years ago.

Conclusions. The fact that AHC exists is a critical dilemma for an institution that has the society's commission to cure and/or to alleviate pain and suffering. In their narratives, women described the experience of ‘being nullified’, a core category that embodies AHC.     

The use of midwife-led primary antenatal care by obese women in The Netherlands: An explorative cohort study

Objectiveto study the effect of body mass index (BMI) on the use of antenatal care by women in midwife-led care.Designan explorative cohort study.Setting11 Dutch midwife-led practices.Participantsa cohort of 4421 women, registered in the Midwifery Case Registration System (VeCaS), who received antenatal care in midwife-led practices in the Netherlands and gave birth between October 2012 and October 2014.Findingsthe mean start of initiation of care was at 9.3 (SD 4.6) weeks of pregnancy. Multiple linear regression showed that with an increasing BMI initiation of care was significantly earlier but BMI only predicted 0.2% (R²) of the variance in initiation of care. The mean number of face-to- face antenatal visits in midwife-led care was 11.8 (SD 3.8) and linear regression showed that with increasing BMI the number of antenatal visits increased. BMI predicted 0.1% of the variance in number of antenatal visits. The mean number of antenatal contacts by phone was 2.2 (SD 2.6). Multiple linear regression showed an increased number of contacts by phone for BMI categories 'underweight' and 'obese class I'. BMI categories predicted 1% of the variance in number of contacts by phone.Key conclusionsBMI was not a relevant predictor of variance in initiation of care and number of antenatal visits. Obese pregnant women in midwife-led practices do not delay or avoid antenatal care.Implications for practiceTaking care of pregnant women with a high BMI does not significantly add to the workload of primary care midwives. Further research is needed to more fully understand the primary maternal health services given to obese women.     

Yoga in primary health care: A quasi-experimental study to access the effects on quality of life and psychological distress

Backgroundand purpose: Yoga is growing in popularity, but its benefits and integration into primary care remain uncertain. Here, we determine yoga effects on quality of life and psychological distress, and evaluate the feasibility of introducing yoga at primary care level.Materials and methodsThis is a prospective, longitudinal, quasi-experimental study, with an intervention (n = 49) and a control group (n = 37). Yoga group underwent 24-weeks program of one-hour sessions. Our primary endpoint was quality of life and psychological distress, as well as satisfaction level and adherence rate.ResultsParticipants reported a significant improvement in all domains of quality of life and a reduction of psychological distress. Linear regression analysis showed that yoga significantly improves psychological quality of life (p = 0.046).ConclusionYoga in primary care is feasible, safe and has a satisfactory adherence, as well as a positive effect on psychological quality of life of participants.     

Prenatal screening and diagnosis: a survey of health care providers' knowledge and attitudes

AIM: To survey the knowledge and attitudes of health care providers in Western Australia, Australia towards prenatal screening and diagnostic procedures for fetal anomalies. DESIGN: A self-administered mail survey. SAMPLE: 30 obstetricians and 313 general practitioners (GPs). RESULTS: Overall, relative to GPs, obstetricians expressed more positive attitudes towards prenatal tests. Moreover, GPs felt they had a greater need for additional information. Further group differences were found in attitudes towards the value of the tests and confidence in the availability and ease of coordination of follow-up services according to geographical area. Female health care providers were significantly more confident about the availability of follow-up services and had higher knowledge scores. They were also more likely to practice in the metropolitan area. Further group differences were found in attitudes according to participation in professional development. CONCLUSION: Overall, health care providers felt antenatal screening and diagnostic tests were valuable and they felt they could benefit from further information. Knowledge was high, however, it is unclear whether this knowledge is being communicated to women. Given that antenatal practices are rapidly evolving, continuing education and ongoing professional development is critical.