There is growing interest in the application of citizen participation within all areas of public sector service development, where it is increasingly promoted as a significant strand of postneoliberal policy concerned with re-imagining citizenship and more participatory forms of citizen/consumer engagement. The application of such a perspective within health services, via co-production, has both beneficial, but also problematic implications for the organisation of such services, for professional practice and education. Given the disappointing results in increasing consumer involvement in health services via 'choice' and 'voice' participation strategies, the question of how the more challenging approach of co-production will fare needs to be addressed. The article discusses the possibilities and challenges of system-wide co-production for health. It identifies the discourse and practice contours of co-production, differentiating co-production from other health consumer-led approaches. Finally, it identifies issues critically related to the successful implementation of co-production where additional theorisation and research are required.
Objective: To research the role of midwives in Australia from the perspectives of women and midwives. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care.Design: A multi-method approach with qualitative data collected from surveys from women and interviews with midwives. Setting: Participants represented each state and territory in Australia.Participants: Midwives who were randomly selected by the regulatory authorities across the country and women who were consumers of midwifery care and involved in maternity activism. Key conclusions:Midwives and women identified a series of key elements that were required of a midwife. These included: being woman centred; providing safe and supportive care; working in collaboration with others when necessary. These findings were consistent with much of the international literature. 5Implications for practice: A number of barriers to achieving the full role of the midwife were identified. These included: a lack of opportunity to practise across the full spectrum of maternity care; the invisibility of midwifery in regulation and practice; the domination of medicine; workforce shortages; the institutional system of maternity care; and the lack of a clear image of what midwifery is within the wider community. These barriers must be addressed if midwives in Australia are to be able to function according to the full potential of their role.
Main outcome measuresData were collected on onset and outcomes of labour, antenatal, intrapartum and postnatal complications, antenatal admissions to hospital and neonatal mortality and morbidity. ResultsThere was a significant difference in the caesarean section rate between the groups, 13.3% (73/550) in the STOMP group and 17.8% in the control group (96/539). This difference was maintained after controlling for known contributing factors to caesarean section (OR=0.6, 95% CI 0.4-0.9, P=0.02). There were no other significant differences in the events during labour and birth.Eighty (14.5%) neonates from the STOMP group and 102 (18.9%) from the control group were admitted to the special care nursery but this difference was not significant (OR 0.75, 95% CI 0.5-1.1, P=0.12). Eight infants died during the perinatal period (four from each group), for an overall perinatal mortality rate of 7.3 per 1,000 births. 3 ConclusionCommunity-based continuity of maternity care provided by midwives and obstetricians resulted in a significantly reduced caesarean section rate. There were no other differences in clinical outcomes.
Objective To test whether a new community-based model of continuity of care provided by midwives and obstetricians improved maternal clinical outcomes, in particular a reduced caesarean section rate. Design Randomised controlled trial.Setting A public teaching hospital in metropolitan Sydney, Australia.Sample 1089 women randomised to either the community-based model (n 550) or standard hospital-based care (n 539) prior to their ®rst antenatal booking visit at an Australian metropolitan public hospital.Main outcome measures Data were collected on onset and outcomes of labour, antenatal, intrapartum and postnatal complications, antenatal admissions to hospital and neonatal mortality and morbidity. Results There was a signi®cant difference in the caesarean section rate between the groups, 13.3% (73/550) in the community-based group and 17.8% in the control group (96/539). This difference was maintained after controlling for known contributing factors to caesarean section (OR 0.6, 95% CI 0.4±0.9, P 0.02). There were no other signi®cant differences in the events during labour and birth. Eighty babies (14.5%) from the community-based group and 102 (18.9%) from the control group were admitted to the special care nursery, but this difference was not signi®cant (OR 0.75, 95% CI 0.5-1.1, P 0.12). Eight infants died during the perinatal period (four from each group), for an overall perinatal mortality rate of 7.3 per 1000 births.Conclusion Community-based continuity of maternity care provided by midwives and obstetricians resulted in a signi®cantly reduced caesarean section rate. There were no other differences in clinical outcomes.
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