Factors influencing father’s antenatal and perinatal involvement in maternal health care

Background: Maternal health care refers to the better outcome of labor and reduced maternal mortality. Antenatal care utilization is an important determinant for improved maternal health care. In this study, we examine how father’s involvement influences antenatal and perinatal care utilization by mothers.

Methods: A community-based cross-sectional study was performed in the Pakistan Institute of Medical Sciences for three months. Systematic random sampling method was used for obtaining the desired sample. Safe Motherhood Questionnaire (Woman) developed by Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO) was adapted and utilized to gather the required data. Sample size for the study was calculated as 303 by the WHO calculator keeping confidence level at 95% and with an associated prevalence of 73%. The data were entered into SPSS version 21 (Chicago, IL). Frequencies and percentages were calculated for qualitative variables. Mean and standard deviation was calculated for quantitative variables.

Results: This study revealed that the father’s attitude toward antenatal care was found to be significantly (p?p?“It is not necessary for a husband/partner to accompany his wife to antenatal care visits” was 204 (67.1%), whereas those who disagreed with the statement “It is not necessary for a husband/partner to accompany his wife when she is giving birth” were 255 (83.8%). While frequency of fathers who disagreed with the statement “Giving birth is mostly a woman’s matter; Husbands/partners have little to contribute” was 267 (87.9%).

Conclusions: Our study found a positive association between father’s involvement in maternal health and factors such as paternal education level, age, income level and father’s attitude. Fathers’ antenatal involvement was associated with paternal age and income level, while their perinatal involvement was associated with paternal age and education level. Our study on father’s attitude toward presence at time of birth showed 83.8% compliance. Similarly, there was 67.1% compliance for presence during antenatal checkups.     

A systematic review of changes in women’s physical activity before and during pregnancy and the postnatal period

Objectives: To determine the magnitude and type of naturally occuring physical activity changes in women around the time of pregnancy. Background: This systematic review synthesises the results of studies examining naturally occurring physical activity in women before they become pregnant and the magnitude and type of changes during pregnancy and the postnatal period. Methods: Electronic databases were searched for relevant articles and PRISMA guidelines for selection of articles were used. Only studies examining naturally occurring, non-intervention changes in regular activity levels were included. The quality assessment was based on protocols of the Cochrane Database of Systematic Reviews. Of the initial 720 titles, 24 studies met the inclusion criteria and were included in the final review. Results: Compared to pre-pregnancy, the magnitude of physical activity decreased over the course of pregnancy and postnatally and the types of activities tended to be of lesser intensity than pre-pregnancy. The quality of the research was varied; methodological limitations included using subjective methods of assessment of physical activity (9/24), failing to report reliabilities or validity of measures used (8/24), no information on parity (13/24) or level of fitness prior to pregnancy (11/24). Conclusion: The evidence suggests a marked decrease in the amount and type of moderate to strenuous physical activity during the transition to motherhood, which does not always increase again postpartum. Patient education targeting specific physical activities at regular intervals during and after pregnancy to improve long-term maternal health is necessary.     

Women’s postnatal psychological functioning: the role of satisfaction with intrapartum care and the birth experience

Objective: To investigate the relationship between women’s postnatal psychological well-being and retrospective, self-reported satisfaction with intrapartum care and the birth experience. Background: The period immediately following childbirth can be marked by various problems that can affect a woman’s happiness and functioning. Previous research has suggested that aspects of the maternal experience of childbirth may act as predictors for specific indicators of women’s postnatal functioning. This study aimed to determine the relationship between satisfaction with labour and birth care and the general childbirth experience and a broad, comprehensive measure of subsequent psychological functioning. Methods: Data for this study was taken from relevant items in the Having a Baby in Queensland 2009 Pilot Survey. Researchers assessed maternal socio-demographic characteristics, perceptions of labour and birth care, satisfaction with labour and birth care, and perceived positivity of the birth experience. A dichotomous, composite measure of postnatal psychological functioning was derived from women’s responses to five separate survey items. Results: The multivariate logistic regression analysis showed that women who felt they were looked after ‘very well’ and women who rated their birth experience as ‘very positive’ were significantly more likely to experience high postnatal functioning than women who did not rate their intrapartum care and birth experience as highly. Conclusions: Reducing the risk factors for dissatisfaction is critical in order to improve the likelihood of high maternal postnatal functioning. The findings of this study emphasise the importance of intrapartum care in the development of positive functioning in women who have recently given birth.     

A systematic review of concepts related to women’s empowerment in the perinatal period and their associations with perinatal depressive symptoms and premature birth

Background

The perinatal period, which we here define as pregnancy and the first year postpartum, is a time in women’s lives that involves significant physiological and psychosocial change and adjustment, including changes in their social status and decision-making power. Supporting women’s empowerment at this particular time in their lives may be an attractive opportunity to create benefits for maternal and infant health outcomes such as reductions in perinatal depressive symptoms and premature birth rates. Thus, we here systematically review and critically discuss the literature that investigates the effects of empowerment, empowerment-related concepts and empowerment interventions on reductions in perinatal depressive symptoms, preterm birth (PTB), and low birthweight (LBW).

Methods

For this systematic review, we conducted a literature search in PsychInfo, PubMed, and CINAHL without setting limits for date of publication, language, study design, or maternal age. The search resulted in 27 articles reporting on 25 independent studies including a total of 17,795 women.

Results

The majority of studies found that, for the most part, measures of empowerment and interventions supporting empowerment are associated with reduced perinatal depressive symptoms and PTB/LBW rates. However, findings are equivocal and a small portion of studies found no significant association between empowerment-related concepts and perinatal depressive symptoms and PTB or LBW.

Conclusion

This small body of work suggests, for the most part, that empowerment-related concepts may be protective for perinatal depressive symptoms and PTB/LBW. We recommend that future theory-driven and integrative work should include an assessment of different facets of empowerment, obtain direct measures of empowerment, and address the relevance of important confounders, including for example, ethnicity and socioeconomic status.

     

Assessing women’s perinatal psychological health: exploring the experiences of health visitors

Objective: This study aimed to explore health visitors’ (HVs) experiences of the assessment of women with psychological distress and mental health problems across the perinatal period in clinical practice. Background: In international contexts, there is now a firm policy remit for the assessment of psychological and mental health disorder across the perinatal period. Women are in regular contact with health professionals across this time and consultations intuitively create an ideal and appropriate context in which to assess women’s psychological health. National reports and academic literature highlight that to prevent the escalation of perinatal mental illness, significant change is needed to support health professionals in detecting, discussing and dealing with mental illnesses. Methods: In a qualitative aspect of a larger mixed-method study, data were collected from two Focus Group Discussions with HVs pre and post a training session related to assessing and managing perinatal mental health problems in practice. For the purposes of this paper, the data were explicitly examined for references to recognition and assessment. Results: Four themes emerged from the data: recognising the problem; questioning and identification; so what do I do now; the importance of support to promote effective identification and assessment. Conclusion: Findings elucidate the complexities that practitioners face in assessing women’s psychological health in real world settings. HVs’ experiences highlight that the implementation of measures into practice needs to be workable and accompanied by contemporary and appropriately contextualised knowledge, adequate service provision and clear referral pathways to ensure effective assessment of women’s psychological health.     

Not identifying with postnatal depression: a qualitative study of women’s postnatal symptoms of distress and need for support

Abstract

Introduction: Diagnoses and symptoms of postnatal mental health problems are associated with adverse outcomes for women and their families. Current classification and assessment of postnatal mental health problems may not adequately address the range or combination of emotional distress experienced by mothers. This study aims to explore symptoms of mental health problems reported by new mothers and their experiences of being assessed for these.

Methods: In-depth interviews with 17 women in southeast England with a baby under 1-year old who experienced a postnatal mental health problem. Data were analyzed using inductive thematic analysis.

Results: Women described a lack of identification with the concept of postnatal depression and felt that other forms of emotional distress were not recognized by the healthcare system. Women felt that support seeking for postnatal mental health problems needed to be normalized and that support should be available whether or not women were diagnosed. Assessment needs to be well timed and caringly implemented.

Discussion: Identification and recognition of symptoms and disorders other than postnatal depression need to be improved. Awareness of multiple types of distress needs to be raised both for women experiencing such distress, and for healthcare professionals, to enable them to support women at this time. Different approaches to assessment that include the range of symptoms reported should be piloted.     

First birth and the trajectory of women’s empowerment in Egypt

Background

Women’s empowerment is often used to explain changes in reproductive behavior, but no consideration is given to how reproductive events can shape women’s empowerment over time. Fertility may cause changes in women’s empowerment, or they may be mutually influencing. Research on women’s empowerment and fertility relies on cross-sectional data from South Asia, which limits the understanding of the direction of association between women’s empowerment and fertility in other global contexts. This study uses two waves of a panel survey from a prominent Middle Eastern country, Egypt, to examine the trajectory of women’s empowerment and the relationship between first and subsequent births and empowerment over time.

Methods

Using longitudinal data from the 2006 and 2012 Egyptian Labor Market Panel Survey, a nationally representative sample of households in Egypt, for 4660 married women 15 to 49 years old, multilevel negative binomial, ordinary least squares, and logistic regression models estimate women’s empowerment and consider whether a first and subsequent births are associated with empowerment later in life. Women’s empowerment is operationalized through four measures of agency: individual household decision-making, joint household decision-making, mobility, and financial autonomy.

Results

A first birth and subsequent births are significantly positively associated with all measures of empowerment except financial autonomy in 2012. Women who have not had a birth make 30% fewer individual household decisions and 14% fewer joint household decisions in 2012 compared to women with a first birth. There is also a positive relationship with mobility, as women with a first birth have more freedom of movement compared to women with no births. Earlier empowerment is also an important predictor of empowerment later in life.

Conclusions

Incorporating the influence of life events like first and subsequent births helps account for the possibility that empowerment is dynamic and that life course experiences shape women’s empowerment. This and the notion that empowerment builds over time helps portray women’s lives more completely, demonstrates the importance of empowerment early in the life course, and addresses issues of temporality in empowerment fertility research.

     

Women’s expectations of treatment and care after an antenatal HIV diagnosis in Lilongwe,Malawi

Women in sub-Saharan Africa are increasingly learning their HIV status in prevention of mother-to-child transmission of HIV (PMTCT) programmes in the context of antenatal care. This paper examines women's decisions about HIV testing and their experience of PMTCT and HIV-related care in one clinic in Lilongwe, Malawi. It is based on qualitative, ethnographic research conducted in 2004 and 2005, including interviews and focus group discussions with 55 HIV-positive women participating in a PMTCT programme, and 21 interviews with key informants from the programme and the health system. Women's expectations from testing were consistent with the benefits for their own health and their infants' health, as communicated by nurses. However, the PMTCT programme only poorly met their expectations. Reasons for this disjuncture included the construction of women as still healthy even when they needed treatment, a focus only on infant health, health system weaknesses, lack of integrated care and timely referral, and defining HIV exclusively as a medical issue, while ignoring the social determinants of health. Women's own health was particularly marginalised within the PMTCT programme, yet good models exist for comprehensive care for women, infants and their families that should be implemented as testing is scaled up.     

How is maternal psychosocial health assessed and promoted in the early postnatal period? Findings from a review of hospital postnatal care in Victoria, Australia

OBJECTIVE: to describe how women's maternal health, particularly at a psychosocial level, is assessed and promoted during the postnatal hospital stay. DESIGN: postal survey of public hospitals providing postnatal care and interviews with care providers. SETTING: all publicly funded maternity units and selected health professionals in Victoria, Australia. PARTICIPANTS: hospital postal survey: sixty six hospital respondents; interviews: 38 maternity unit managers, clinical midwives and medical practitioners. FINDINGS: there was little consistency across the State in relation to routine observations of the mother. Physical checks were much more common than enquiring about how women felt physically. Practice in psychosocial assessment was also diverse, with care plans/maps (clinical pathways) being the main tool to guide assessment. Most participants reported that psychosocial assessment was undertaken during pregnancy. Follow-up after birth also varied. Hospital respondents reported that emotional well-being is assessed postnatally by observation and conversation with women. Participants who were interviewed reported that midwives had mixed skills in assessing and dealing with complex psychosocial issues. Three hospitals administer the Edinburgh Postnatal Depression Scale to women in the days after birth, and three hospitals provide routine sessions of structured debriefing. Survey participants reported that the busy and, at times, chaotic nature of postnatal wards affected the provision of care and the level of psychosocial support offered to women. KEY CONCLUSIONS: although one of the stated aims of early postnatal care is the promotion of maternal well-being, the diversity of practices and the routine nature of many of these practices suggest that care is often not individualised or woman-centred. The reliance of detecting and managing women with particular psychosocial issues during pregnancy results in this aspect of care being given less priority postnatally than may be ideal. IMPLICATIONS FOR PRACTICE: strategies are required to provide health professionals with guidelines and skills to enhance the detection of women who have, or have the potential to develop, health problems after birth. This requires a reorganisation of the way early postnatal care is provided in relation to the use of routine practices; the ability of caregivers to spend time with women in an environment that offers privacy and confidentiality; the structuring of care around individual needs; and opportunities for women to be cared for by caregiver/s with whom they have met before.     

Midwives’ perceptions and experiences of caring for women who experience perinatal mental health problems: An integrative review

Backgroundperinatal mental health is an important public health issue and consideration must be given to care provision for effective support and care of women in the perinatal period.Aimto synthesise primary research on midwives’ perceived role in Perinatal Mental Health (PMH).Designintegrative review.MethodsWhittemore and Knafl's (2005) framework was employed. A systematic search of the literature was completed. Studies were included if they met the following criteria: primary qualitative, quantitative and mixed methods research studies published in peer reviewed journals between January 2006 to February 2016, where the population of interest were midwives and the outcomes of interest were their perceived role in the management of women with PMH problems. The methodological quality of studies was assessed using the relevant CASP (Critical Appraisal Skills Programmes, 2014) criteria for quantitative and qualitative research studies. Data extraction, quality assessment and thematic analysis were conducted.Findingsa total of 3323 articles were retrieved and 22 papers were included in the review (15 quantitative, 6 qualitative and one mixed method study). The quality of the studies included was good overall. Two overarching themes emerged relating to personal and professional engagement. Within personal engagement four sub themes are presented: knowledge, skills, decision making and attitude. Within professional engagement four themes are presented: continuous professional development, organisation of care, referral, and support.Conclusions and implications for practicethe findings indicate midwives require continuous professional development opportunities that address knowledge, attitudes to PMH, communication and assessment skills. However educational and training support in the absence of appropriate referral pathways and support systems will have little benefit.     

Effects of assisted reproductive technology and of women’s quality of life on depressive symptoms in the early postpartum period: a prospective case-control study

Abstract

This study explored the influence of both assisted reproductive technology (ART) and reduced quality of life (QoL) during pregnancy on postpartum blues (PPB). Sixty-three sub-fertile patients who conceived through ART and 72 women who naturally conceived were enrolled in this prospective study. At 22nd and 32nd gestational weeks, women completed the Edinburgh Postnatal Depression Scale (EPDS) and the Short-Form 36 (SF-36), to investigate depressive symptoms and QoL, respectively; EPDS was again used at 15 days after birth to assess PPB. At both time points, higher EPDS scores and lower mental well-being scores (SF-36) significantly predicted PPB. The number of previous ART cycles emerged as the strongest predictor, whereas no significant effect was observed for the conceiving method. The results suggest the usefulness of assessing QoL during pregnancy and considering previous ART failures in preventing PPB.     

Italian women’s childbirth: a prospective longitudinal study of delivery predictors and subjective experience

Background: Previous research has demonstrated that negative childbirth expectations adversely influence perinatal outcomes. The current research builds on this with Italian mothers-to-be. Objective: The present study (1) explored the influence of cognitive and emotional variables on labour and delivery outcomes and (2) examined how individual characteristics, couple adjustment, and medical factors influence the childbirth experience. Method: 121 Italian primiparous women participated in a prospective longitudinal study where participants completed a set of questionnaires between the 32nd and 37th week of pregnancy and again 30–40 days post-delivery. Results: Binary logistic regression analyses revealed that women with negative childbirth expectations were three times more likely to experience an emergency C-section or an instrumental vaginal delivery. Furthermore, childbirth expectations predicted subjective birth experience. This relationship between expectations and delivery type and the subjective childbirth experience was weak while other variables (such as anxiety, depression, couple adjustment) did not significantly influence delivery type or the subjective childbirth experience. Conclusions: The weak relationship between childbirth expectations and perinatal outcomes renders it necessary to question the nature of the relationship found in previous research, especially considering inconsistencies of the literature on the subject. The current research makes it clear that further research is needed to understand better the relationship between expectations and perinatal outcomes in order to better improve the well-being of mothers-to-be during labour and delivery.     

Barriers and facilitators in antenatal settings to screening and referral of pregnant women who use alcohol or other drugs: A qualitative study of midwives’ experience

BackgroundScreening pregnant women for substance use is highly recommended in antenatal care settings. Although midwives provide routine screening for substance use and referral for treatment in pregnancy, little is known about the barriers and facilitators they experience.AimThe study explored barriers and facilitators experienced by midwives in antenatal settings to screening and referral of pregnant women who use alcohol or other drugs.Design/settingA semi-structured interview was adopted to explore barriers and facilitators experienced by midwives in screening and referring pregnant women for alcohol or other drugs specialised services. Eighteen midwives were recruited from urban, regional and rural antenatal settings in Victoria. Interviews were tape recorded and transcribed verbatim. Themes were generated by thematic analysis, the process of identifying patterns within the data.FindingsOf the seven themes identified under barriers, five could be categorised as “institution and provider-related”, namely: (i) lack of validated screening tool, (ii) inadequate support and training, (iii) discomfort in screening, (iv) lack of multidisciplinary team and specialised treatment in regional and rural areas, and (v) workload and limited consultation time. Conversely, two themes could be classified as ‘client-related’, namely (i) non- or partial-disclosure of substance use, and (ii) reluctance and non-adherence to referrals. All five themes under facilitators were “institution and provider-related.” They are (i) a woman-centred philosophy of care, (ii) evidence of harms from substance use on neonates, (iii) experience and training, (iv) continuity of care, and (v) availability of multidisciplinary team and funding.Key conclusions and implications for practiceTo the best of our knowledge, this is the first study of its kind conducted in Victoria. This study not only adds to the limited body of knowledge on barriers experienced by midwives but also identifies facilitators in antenatal settings that promote screening and referral of pregnant women who use substance. Most of the barriers and facilitators are interrelated. Despite midwives’ willingness to screen all pregnant women for substance use and provision of referral, they often felt limited in their capacity. Availability and accessibility to validated screening tool(s), in addition to regular, ongoing training for all midwives to maintain clinical competence and provide effective communication are imperative. Availability of a multidisciplinary team, funds and specialised care facilities such as detoxification and mental health services, especially in regional and rural areas, are necessary to effectively support at-risk pregnant women.     

Care providers’ views and experiences of postnatal care in private hospitals in Victoria,Australia

Objectivein Australia, as in other developed countries, women have consistently reported lower levels of satisfaction with postnatal care compared with antenatal and intrapartum care. However, in Victoria Australia, women who receive private hospital postnatal care have rated their care more favourably than women who received public hospital care. This study aimed to gain a further understanding of this by exploring care providers’ views and experiences of postnatal care in private hospitals.Designqualitative design using semi-structured interviews and thematic analysis.Settingprivate maternity hospitals in Victoria, Australia.Participantseleven health-care providers from three metropolitan and one regional private hospital including eight midwives (two maternity unit managers and six clinical midwives) and three obstetricians.Findingstwo global themes were identified: ‘Constrained Care’ and ‘Consumer Care’. ‘Constrained care’ demonstrates the complexity of the provision of postnatal care and encompasses midwives’ feelings of frustration with the provision of postnatal care in a busy environment complicated by staffing difficulties, a lack of continuity and the impact of key players in postnatal care (including visitors, management and obstetricians). ‘Consumer care’ describes care providers’ views that women often approach private postnatal care as a consumer, which can impact on their expectations and satisfaction with postnatal care. Despite these challenges, care providers, particularly midwives, highly valued (and generally enjoyed working in) postnatal care.Key conclusionsthis study, along with other Australian and international studies, has identified that hospital postnatal care is complex and characterised by multiple barriers which impact on the provision of quality postnatal care. Further research is needed to evaluate routine postnatal practices and continuity of care within the postnatal period. In-depth qualitative studies investigating women's expectations and experiences of postnatal care in both the public and private sector are also needed.     

The influence of women’s fear, attitudes and beliefs of childbirth on mode and experience of birth

Background

Knowledge, attitudes and practices of community members and healthcare providers in rural northern Ghana regarding clean delivery are not well understood. This study explores hand washing/use of gloves during delivery, delivering on a clean surface, sterile cord cutting, appropriate cord tying, proper cord care following delivery, and infant bathing and cleanliness.

Methods

In-depth interviews and focus group discussions were audiotaped, transcribed, and analyzed using NVivo 9.0.

Results

253 respondents participated, including women with newborn infants, grandmothers, household and compound heads, community leaders, traditional birth attendants, and formally trained health care providers. There is widespread understanding of the need for clean delivery to reduce the risk of infection to both mothers and their babies during and shortly after delivery. Despite this understanding, the use of gloves during delivery and hand washing during and after delivery were mentioned infrequently. The need for a clean delivery surface was raised repeatedly, including explicit discussion of avoiding delivering in the dirt. Many activities to do with cord care involved non-sterile materials and practices: 1) Cord cutting was done with a variety of tools, and the most commonly used were razor blades or scissors; 2) Cord tying utilized a variety of materials, including string, rope, thread, twigs, and clamps; and 3) Cord care often involved applying traditional salves to the cord - including shea butter, ground shea nuts, local herbs, local oil, or ??red earth sand.?? Keeping babies and their surroundings clean was mentioned repeatedly as an important way to keep babies from falling ill.

Conclusions

This study suggests a widespread understanding in rural northern Ghana of the need for clean delivery. Nonetheless, many recommended clean delivery practices are ignored. Overarching themes emerging from this study included the increasing use of facility-based delivery, the disconnect between healthcare providers and the community, and the critical role grandmothers play in ensuring clean delivery practices. Future interventions to address clean delivery and prevention of neonatal infections include educating healthcare providers about harmful traditional practices so they are specifically addressed, strengthening facilities, and incorporating influential community members such as grandmothers to ensure success.     

Women’s experience of care when undergoing termination of pregnancy for fetal anomaly in England

Objective: This study investigated women’s experience of care when undergoing termination of pregnancy for fetal anomaly (TOPFA) with a view to assisting healthcare professionals in providing optimum care to women. Background: Technological developments in antenatal screening and testing mean more women are given a prenatal diagnosis of fetal anomaly and confront the possibility of terminating the pregnancy. TOPFA is a psychologically significant life event, but there is limited evidence on how women perceive their termination care. Methods: A cross-sectional online survey was used to elicit qualitative data as part of a study examining women’s experience of the TOPFA procedure, in particular the choice of method. Women were asked to comment on what they had found helpful and unhelpful in their termination care. Participants were recruited from a national support organisation. A total of 361 women offered qualitative comments, which were analysed using thematic analysis. Results: Women’s experience of termination care varied. Five themes were identified as underpinning what women considered ‘good care’: being cared for in a timeframe and environment that feels right; receiving the right level of care; the role of healthcare professionals and support organisations; acknowledging women’s particular circumstances; and enabling women to make choices. Regarding the last theme, women particularly valued being offered a choice of termination method. Conclusions: The findings suggest that many women undergoing TOPFA perceived their care as lacking in some way. Recommendations on improving practice are made and areas of further research are suggested, which may deepen knowledge on how best to care for these women.     

Panamanian women׳s experience of vaginal examination in labour: A questionnaire validation

Aimto validate a tool that allows healthcare providers to obtain accurate information regarding Panamanian women׳s thoughts and feelings about vaginal examination during labour that can be used in other Latin-American countries.Methodsvalidation study based on a database from a cross-sectional study carried out in two tertiary care hospitals in Panama City, Panama. Women in the immediate postpartum period who had spontaneous labour onset and uncomplicated deliveries were included in the study from April to August 2008. Researchers used a survey designed by Lewin et al. that included 20 questions related to a patient׳s experience during a vaginal examination.Findingsfive constructs (factors) related to a patient׳s experience of vaginal examination during labour were identified: Approval (Alpha Cronbach׳s 0.72), Perception (0.67), Rejection (0.40), Consent (0.51), and Stress (0.20).Conclusionit was demonstrated the validity of the scale and its constructs used to obtain information related to vaginal examination during labour, including patients’ experiences with examination and healthcare staff performance.Implications for practiceutilisation of the scale will allow institutions to identify items that need improvement and address these areas in order to promote the best care for patients in labour.     

Survey of women׳s experiences of care in a new freestanding midwifery unit in an inner city area of London,England – 1: Methods and women׳s overall ratings of care

Objective

to describe and compare women?s choices and experiences of maternity care before and after the opening of the Barkantine Birth Centre, a new freestanding midwifery unit in an inner city area.

Design

telephone surveys undertaken in late pregnancy and about six weeks after birth in two separate time periods, Phase 1 before the birth centre opened and Phase 2 after it had opened.

Setting

Tower Hamlets, a deprived inner city borough in east London, England, 2007–2010.

Participants

620 women who were resident in Tower Hamlets and who satisfied the Barts and the London NHS Trust?s eligibility criteria for using the birth centre. Of these, 259 women were recruited to Phase 1 and 361 to Phase 2.

Measurements and findings

women who satisfied the criteria for birth centre care and who booked antenatally for care at the birth centre were significantly more likely to rate their care as good or very good overall than corresponding women who also satisfied these criteria but booked initially at the hospital. Women who started labour care in spontaneous labour at the birth centre were significantly more likely to be cared for by a midwife they had already met, have one to one care in labour and have the same midwife with them throughout their labour. They were also significantly more likely to report that the staff were kind and understanding, that they were treated with respect and dignity and that their privacy was respected.

Key conclusions and implications for practice

this survey in an inner city area showed that women who chose the freestanding midwifery unit care had positive experiences to report. Taken together with the findings of the Birthplace Programme, it adds further weight to the evidence in support of freestanding midwifery unit care for women without obstetric complications.     

Statistics,not memories: what was the standard of care for administering antenatal steroids to women in preterm labor between 1985 and 2000?

We determined the frequency of antenatal corticosteroid use for mothers with threatened premature delivery in 1985, 1990, 1995, and 2000. We next compared published data to the surveyed recollections of 302 obstetricians who were practicing during these years. Two points emerged. First, published reports reveal that the use of antenatal corticosteroids increased steadily, from 8% in 1985 to 20% in 1990, 52% in 1995, and 75% in 2000 (P <.001). Second, "expert" opinions derived from the recollections of practicing obstetricians consistently overestimated the actual use of antenatal corticosteroids during the year in question-31% versus 8% for 1985, 56% versus 20% for 1990, 78% versus 52% for 1995, and 92% versus 72% for 2000 (all Ps <.001). The use of antenatal corticosteroids by obstetricians in the past 15 years reveals a phenomenon that is widely recognized elsewhere-retrospective memories are often wrong, and when they are wrong they are not randomly wrong. Rather, recollections are systematically skewed toward an outcome that, in hindsight, is considered desirable (the "Monday morning quarterback" phenomenon). We offer a simple proposal. In determining the "standard of medical care," the legal system should rely on statistical data about doctors' performance rather than the recollections of experts about doctors' performance. The fallible memories of isolated experts are a crude second-best, far inferior to the data that they approximate. Widespread adoption of this view by professional physician organizations would dramatically increase the rationality of expert testimony in medical malpractice tort law.