‘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.     

Relationship Between Hospital‐Level Percentage of Midwife‐Attended Births and Obstetric Procedure Utilization

Introduction

Research has shown good outcomes among individual low‐risk women who receive perinatal care from midwives, yet little is known about how hospital‐level variation in midwifery care relates to procedure use and maternal health. This study aimed to document the association between the hospital‐level proportion of midwife‐attended births and obstetric procedure utilization.

Methods

This analysis used 2 data sources: Healthcare Cost and Utilization Project State Inpatient Database data for New York in 2014, and New York State Department of Health data on the percentage of midwife‐attended births at hospitals in the state in 2014. Using logistic regression, we estimated the association between the hospital‐level percentage of midwife‐attended births and 4 outcomes among low‐risk women: labor induction, cesarean birth, episiotomy, and severe maternal morbidity.

Results

Hospital‐level percentage of midwife‐attended births was not associated with reduced odds of labor induction or severe maternal morbidity. Women who gave births at hospitals with more midwife‐attended births had lower odds of giving birth by cesarean (eg, adjusted odds ratio [aOR], 0.70; 95% confidence interval [CI], 0.59‐0.82 at a hospital with 15% to 40% of births attended by midwives, compared to no midwife‐attended births) and lower odds of episiotomy (eg, aOR, 0.41; 95% CI, 0.23‐0.74 at a hospital with more than 40% of births attended by midwives, compared to no midwife‐attended births).

Discussion

Our results indicate that hospitals with more midwife‐attended births have lower utilization of some obstetric procedures among low‐risk women; this raises the possibility of improving value in maternity care through greater access to midwifery care.     

New‐Onset Graves’ Disease in the Postpartum Period

During routine evaluation for lactation failure, hyperthyroidism was discovered in a postpartum woman. Although postpartum thyroiditis and Hashimoto's disease are relatively more common than Graves’ disease during the postnatal period, this young woman was found to have new‐onset Graves’ disease. Distinguishing between normal postpartum symptoms and thyroid disorders can be challenging. Utilizing history, physical examination, and laboratory testing, the provider can identify the etiology of hyperthyroidism during the postpartum period. Treatment options differ depending on the cause of the thyroiditis and include antithyroid medications and beta‐blockers for relief of symptoms.     

“I Wasn't Alone”—A Study of Group Prenatal Care in the Military

The military has recognized that health and quality of life for service members are closely tied to the resources for their families, including how they are cared for during pregnancy and childbirth. However, there has been little examination of women's experience with different models of prenatal care (PNC) in military settings. The purpose of this article is to describe the results of a qualitative study of women's experiences with the CenteringPregnancy model of group PNC compared to individual PNC in two military health care settings. This clinical trial enrolled 322 women who were randomized into group or individual PNC at two military treatment facilities. Qualitative interviews were completed with 234 women during the postpartum period. Interpretative narrative and thematic analysis was used to identify three themes: 1) “I wasn't alone”—the experience with group PNC; 2) “I liked it but…”—recommendations to improve group PNC; and 3) “They really need to listen”—general concerns across the sample about PNC. Greatest concerns of women in individual PNC included lack of continuity and time with the provider. Our military families must be assured that their health care system meets their needs through personal and family‐centered care. Group PNC offers the potential for continuity of provider while also offering community with other women. In the process, women gain knowledge and power as a health care consumer.     

Parents’ experiences of midwifery students providing continuity of care

Objective

the aim of this study was to gain knowledge and a deeper understanding of the value attached by parents to relational continuity provided by midwifery students to the woman and her partner during the childbearing process. The focus of the study was on the childbirth and the postnatal home visit.

Design/setting

in this pilot project by researchers at Sør-Trøndelag University College, Norway, six midwifery students provided continuity of care to 58 women throughout their pregnancy, birth and the postnatal period. One group interview of eight women and two group interviews of five men, based on the focus group technique, were conducted at the end of the project. Qualitative data were analysed through systematic text condensation.

Findings

the findings included two main themes: ‘trusting relationship’ and ‘being empowered’. The sub-themes of a ‘trusting relationship’ were ‘relational continuity’ and ‘presence’. For the women, relational continuity was important throughout the childbearing process, but the men valued the continuous presence during birth most highly. ‘Being empowered’ had two sub-themes: ‘individual care’ and ‘coping’. For the women, individual care and coping with birth were important factors for being empowered. The fathers highlighted the individual care as necessary to feel empowered for early parenting. The home visit of the student was highly appreciated. The relationship with the midwifery student could be concluded, and they had the opportunity to review the progression of the birth with the student who had been present during the birth. During the home visit, the focus was more on the experiences of pregnancy and birth than on what lay ahead.

Key conclusions

when midwifery students provided continuous care during pregnancy, birth and the postnatal period, both women and men experienced a trusting relationship. Relational continuity was important for women in the entire process, but for the men this was mostly important during childbirth. Individual care and coping with birth and early parenting enhanced empowerment. The limited sample size in this study means that it cannot be generalised without caution, and further research is needed.     

Association of public versus private health care utilization and prevalence of <Emphasis Type="Italic">Trichomonas vaginalis</Emphasis> in Maringá, Paraná, Brazil

Objectives  To determine the association of public versus private health care utilization and prevalence of Trichomonas vaginalis in Maringá, Paraná, Brazil. Methods  A retrospective study on the results of 133,966 cytology examinations of patients from the Brazilian Public Health System (better socio-economic status, SES) and from the Private Network (low SES) done by the Souza Anatomy Laboratory in Maringá, Brazil, from 2004 to 2007. Results  In patients using the SUS, the prevalence of trichomoniasis was 1.44% (n = 782), higher (P < 0.0001) than for RP users (0.18%, n = 147). The infection predominated in age ranges of the 30–39 years and 40–49 years old from the SUS (P < 0.0001) and in ages ranges from 40 to 49 years old from the RP (P < 0.0001). The infection prevalence and age range did not vary among the 4 years (P > 0.05). Conclusions  The prevalence of Trichomonas spp. was low and stable in both populations in the 4 years, indicating an equilibrium in terms of numbers of this agent in Maringá, Paraná, Brazil. The results corroborate the hypothesis that SES may influence the epidemiology of trichomoniasis. The prevalence of the infection increases with age, a phenomenon not observed with other sexually transmitted infections, such as gonorrhoea or Chlamydia trachomatis.     

Obstetrics services - womens' perspectives

To obtain women's views of obstetric care 400 randomly selected mothers were interviewed postnatally. Since family planning is a constitutional right and all related services free of charge and virtually 100% of pregnant women attend the antenatal clinic, the questions asked were mainly oriented to evaluation of existing obstetric practice. Women were generally satisfied with labor and delivery care (71.2%), but as many as 88.2% of them expressed their dissatisfaction with postnatal care practice. Our women opted for optimal hospital perinatal care — a home-like postnatal care, possibilities for better bonding between mothers and newborn infants and more open, individually oriented communication with medical staff.     

Filling the Gap for Early‐Stage Breast Cancer Follow‐Up: An Overview for Primary Care Providers

Earlier detection and newer treatments now make breast cancer highly survivable, and breast cancer survivors are the largest female cancer survivor group in the United States. With earlier detection, more women are being diagnosed with early‐stage breast cancer and need follow‐up care. With the increasing number of breast cancer survivors, there is a projected shortage in the workforce of oncology specialists to care for these women. The American Society of Clinical Oncology recommends that breast cancer follow‐up care can be provided by an oncologist or primary care provider, as long as the primary care provider has spoken to the oncologist about appropriate follow‐up care. Several studies have shown that primary care providers and oncologists have comparable outcomes for follow‐up care of women with early‐stage breast cancer. The National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines) are considered the gold standard for breast cancer treatment and follow‐up. These guidelines are clear and straightforward. Using knowledge of the NCCN Guidelines, primary care providers can fill the gap for follow‐up care of women with early‐stage breast cancer.     

Institutional Processes and Individual Responses: Women’s Experiences of Care in Relation to Cesarean Birth

Abstract: Background: Cesarean section is an increasingly common mode of birth, and although clinical care has improved and the risks reduced, less attention has been paid to the effect of the procedure and the care received. The aim of this study was to gain a better understanding by investigating individual women’s recent experiences and reflections on their care. Methods: Views of women who had recently undergone cesarean birth were obtained in a study in which a random sample of women was selected by means of birth registrations in England and invited to complete a questionnaire 3 months after the birth. Text responses to open‐ended questions about care during labor and birth, the postnatal period in hospital, and anything else women wished to say about their maternity care were analyzed using qualitative methods. Results: A response rate of 63 percent was achieved; 23 percent of women (n = 682) had a cesarean section birth, 53 percent of which were because of unforeseen problems in labor. A total of 66 percent of women who had a cesarean section responded to one or more open questions. Anticipated themes that were confirmed related to expectations, uncertainty, emotional reactions, pain and discomfort, explanations, support, and adjustment. Emerging themes included “being heard,”“how it might have been different,”“wasted effort,”“just another mother,”“wounds and hurt feelings,” and “needing to talk.” Conclusions: Women responded as individuals and despite different clinical circumstances, the role of the staff and the institutions in which care was provided were key factors in the way most women constructed their cesarean section experience. The themes described present a powerful argument and reminder about why health professionals working in maternity care need to continue to listen to women. (BIRTH 37:2 June 2010)