Midwifery
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A maternity service in Australia recently implemented an 'Enhanced recovery after Elective Caesarean' pathway, which includes antenatal preparation and facilitates an active role in postnatal recovery such as encouraging mobility and early cessation of fasting. The pathway includes next day discharge for women and their babies after elective caesarean section and safely transitions maternity care from hospital to home with community midwifery care. While enhanced recovery has been implemented in a number of surgical procedures to reduce hospital stay and to improve patient outcomes it has only been considered for elective caesarean sections in more recent years. Given this, enhanced recovery is not well established or researched in obstetric contexts. Furthermore, women's experiences with reduced hospital stays post-caesarean, particularly next day discharge, is limited. A qualitative explorative descriptive study of women's experiences with the pathway and the associated early transition home will help to inform clinical practice and the research evidence base. ⋯ This study takes a woman-centred perspective adding to both literature and practice.
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Screening 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. ⋯ To 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.
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The overall study aim was to explore the relationship between the emotional wellbeing of UK midwives and their work environment. Specific research questions were to: assess levels of burnout, depression, anxiety and stress experienced by UK midwives; compare levels of burnout, depression, anxiety and stress identified in this sample of UK midwives, with levels reported in Australia, New Zealand and Sweden; identify demographic and work-related factors associated with elevated levels of burnout, depression, anxiety and stress. ⋯ Many UK midwives are experiencing high levels of stress, burnout, anxiety and depression, which should be of serious concern to the profession and its leaders. NHS employed clinical midwives are at much greater risk of emotional distress than others surveyed, which has serious implications for the delivery of high quality, safe maternity care. It is also of serious concern that younger, more recently qualified midwives recorded some of the highest burnout, stress, anxiety and depression scores, as did midwives who self-reported a disability. There is considerable scope for change across the service. Proactive support needs to be offered to younger, recently qualified midwives and midwives with a disability to help sustain their emotional wellbeing. The profession needs to lobby for systems level changes in how UK maternity care is resourced and provided. Making this happen will require support and commitment from a range of relevant stakeholders, at regional and national levels.
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To explore women's reasons for requesting an elective cesarian birth without medical indication and to describe the factors that affect their decision to choose a cesarian birth. ⋯ The women's reasons for choosing cesarian birth without medical indication and the factors influencing the women's decision-making process were complex and interrelated and reflect a lack of appropriate informed choice about elective cesarian. The findings therefore suggest that healthcare policy makers need to attend to the reasons and the factors that influence women's decision-making about cesarian birth in order to promote the trend of women having a vaginal birth. Evidence-based knowledge and strategies to reduce elective caesareans should be disseminated to healthcare providers in maternity settings. Future explorations of this issue should address obstetricians' and midwives' views and attitudes about cesarian birth without medical indication.
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Effective antenatal care is important for the health and wellbeing of pregnant women and infants. However, in Saudi Arabia, attendance rates are low, increasing the risk of negative birth outcomes. The aim of this research is to understand the beliefs of pregnant women and health professionals about the factors leading to these low attendance rates. ⋯ Barriers for women attending antenatal healthcare must be addressed in order to increase attendance rates. Specific practice-based interventions may involve changing the time or location of services and exploring changes to staff communication with women.