Assessment of the implementation of the model of integrated and humanised midwifery health services in Chile

Binfa, Lorena; Pantoja, Loreto; Ortiz, Jovita; Gurovich, Marcela; Cavada, Gabriel; Foster, Jennifer

doi:10.1016/j.midw.2016.01.018

Cited by 41 publications

(48 citation statements)

References 23 publications

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“…Sample sizes ranged from 10 to 336 participants, and the views of over 1,565 stakeholders were included. [27–29,36,39–62] Stakeholders were policy makers, managers, health professionals, women, family members and community representatives. The database searches identified 8,215 studies; from CINAHL (n = 2,225), MEDLINE (n = 644), PsychINFO (n = 330), EMBASE (n = 958), Popline (n = 1,950), Global Index Medicus (n = 1,608) and African Journals Online (n = 500).…”

Section: Resultsmentioning

confidence: 99%

“…The studies investigated stakeholder views of different types of midwife staffing models [36,50,52–54]; financial strategies [28,29,43–44,48,58–60]; and organisational culture [27,40,42,46,47,49,51,55–57,61,62]. We also included two studies of social (doula) support during labour [39,41], with the decision for inclusion made by consensus, because of their positive effect on caesarean section rate reduction in the associated Cochrane review of effectiveness studies.…”

Section: Resultsmentioning

confidence: 99%

“…Women too reported observing the negative effects of power differentials between doctors and midwives. [61] In 11 studies, reported in 13 papers [42,46,47,49,50,52–54,57,58,60–62] interventions, including initiatives to promote physiological birth in Iran [57], hospital primary vaginal birth in the US [61], normal labour and birth in the UK [50,52–54] and the humanization of birth in Japan [46] and Chile, [49,62] challenged the structural balance of power between stakeholders. In UK organisations where a more equal balance of power did exist between women, midwives, family doctors, and obstetrician, there was some evidence that midwifery-led staffing interventions to keep birth normal and reduce caesarean section empowered midwives to work more autonomously [50,52–54] by “…sort of put[ting] a little tag on that woman as a way of saying ‘leave her alone’ , which I think some doctors respect , and some don’t ” ([53]:p.232).…”

Section: Resultsmentioning

confidence: 99%

“…availability of equipment, theatre access) as powerful mediators of barriers or facilitators to reducing unnecessary caesarean section. [28,36,39,40–42,46,47,49,51,55–58,61,62] In high-income countries where “quick win” changes had been made to labour and delivery rooms to encourage normal labour and birth, the priority an organisation gave to maintaining them was fundamental to their effectiveness in reducing caesarean section rates. [56,61] This included changes to in-room facilities for labour and guaranteed access to operating theatres when necessary.…”

Section: Resultsmentioning

confidence: 99%

“…[40,42,46,47,49–58,60–62]. The kind of teamwork that mattered was less about working directly on the caesarean section rate, and more about the general ethos and atmosphere of mutual respect.…”

Section: Resultsmentioning

confidence: 99%

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Non-clinical interventions to reduce unnecessary caesarean section targeted at organisations, facilities and systems: Systematic review of qualitative studies

2018

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ObjectiveWhen medically indicated, caesarean section can prevent deaths and other serious complications in mothers and babies. Lack of access to caesarean section may result in increased maternal and perinatal mortality and morbidity. However, rising caesarean section rates globally suggest overuse in healthy women and babies, with consequent iatrogenic damage for women and babies, and adverse impacts on the sustainability of maternity care provision. To date, interventions to ensure that caesarean section is appropriately used have not reversed the upward trend in rates. Qualitative evidence has the potential to explain why and how interventions may or may not work in specific contexts. We aimed to establish stakeholders’ views on the barriers and facilitators to non-clinical interventions targeted at organizations, facilities and systems, to reduce unnecessary caesarean section.MethodsWe undertook a systematic qualitative evidence synthesis using a five-stage modified, meta-ethnography approach. We searched MEDLINE, CINAHL, PsychINFO, EMBASE and grey literature databases (Global Index Medicus, POPLINE, AJOL) using pre-defined terms. Inclusion criteria were qualitative and mixed-method studies, investigating any non-clinical intervention to reduce caesarean section, in any setting and language, published after 1984. Study quality was assessed prior to data extraction. Interpretive thematic synthesis was undertaken using a barriers and facilitators lens. Confidence in the resulting Summaries of Findings was assessed using GRADE-CERQual.Results8,219 studies were identified. 25 studies were included, from 17 countries, published between 1993–2016, encompassing the views of over 1,565 stakeholders. Nineteen Summary of Findings statements were derived. They mapped onto three distinct themes:Health system, organizational and structural factors (6 SoFs); Human and cultural factors (7 SoFs); and Mechanisms of effect to achieve change factors (6 SoFs). The synthesis showed how inter- and intra-system power differentials, and stakeholder commitment, exert strong mechanisms of effect on caesarean section rates, independent of the theoretical efficacy of specific interventions to reduce them.ConclusionsNon-clinical interventions to reduce caesarean section are strongly mediated by organisational power differentials and stakeholder commitment. Barriers may be greatest where implementation plans contradict system and cultural norms.Protocol registrationPROSPERO: CRD42017059456

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Non-clinical interventions to reduce unnecessary caesarean section targeted at organisations, facilities and systems: Systematic review of qualitative studies

2018

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Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis

Munabi‐Babigumira

Glenton

Lewin

et al. 2017

Cochrane Database of Systematic Reviews

155

158

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BackgroundIn many low- and middle-income countries women are encouraged to give birth in clinics and hospitals so that they can receive care from skilled birth attendants. A skilled birth attendant (SBA) is a health worker such as a midwife, doctor, or nurse who is trained to manage normal pregnancy and childbirth. (S)he is also trained to identify, manage, and refer any health problems that arise for mother and baby. The skills, attitudes and behaviour of SBAs, and the extent to which they work in an enabling working environment, impact on the quality of care provided. If any of these factors are missing, mothers and babies are likely to receive suboptimal care.ObjectivesTo explore the views, experiences, and behaviours of skilled birth attendants and those who support them; to identify factors that influence the delivery of intrapartum and postnatal care in low- and middle-income countries; and to explore the extent to which these factors were reflected in intervention studies.Search methodsOur search strategies specified key and free text terms related to the perinatal period, and the health provider, and included methodological filters for qualitative evidence syntheses and for low- and middle-income countries. We searched MEDLINE, OvidSP (searched 21 November 2016), Embase, OvidSP (searched 28 November 2016), PsycINFO, OvidSP (searched 30 November 2016), POPLINE, K4Health (searched 30 November 2016), CINAHL, EBSCOhost (searched 30 November 2016), ProQuest Dissertations and Theses (searched 15 August 2013), Web of Science (searched 1 December 2016), World Health Organization Reproductive Health Library (searched 16 August 2013), and World Health Organization Global Health Library for WHO databases (searched 1 December 2016).Selection criteriaWe included qualitative studies that focused on the views, experiences, and behaviours of SBAs and those who work with them as part of the team. We included studies from all levels of health care in low- and middle-income countries.Data collection and analysisOne review author extracted data and assessed study quality, and another review author checked the data. We synthesised data using the best fit framework synthesis approach and assessed confidence in the evidence using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether the factors identified by health workers in our synthesis as important for providing maternity care were reflected in the interventions evaluated in the studies in a related intervention review.Main resultsWe included 31 studies that explored the views and experiences of different types of SBAs, including doctors, midwives, nurses, auxiliary nurses and their managers. The included studies took place in Africa, Asia, and Latin America.Our synthesis pointed to a number of factors affecting SBAs’ provision of quality care. The following factors were based on evidence assessed as of moderate to high confidence. Skilled birth attendants reported that they were not always...

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Perceptions and experiences of labour companionship: a qualitative evidence synthesis

Bohren

Berger

Munthe‐Kaas

et al. 2019

Cochrane Database of Systematic Reviews

181

180

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BackgroundLabour companionship refers to support provided to a woman during labour and childbirth, and may be provided by a partner, family member, friend, doula or healthcare professional. A Cochrane systematic review of interventions by Bohren and colleagues, concluded that having a labour companion improves outcomes for women and babies. The presence of a labour companion is therefore regarded as an important aspect of improving quality of care during labour and childbirth; however implementation of the intervention is not universal. Implementation of labour companionship may be hampered by limited understanding of factors affecting successful implementation across contexts.ObjectivesThe objectives of the review were to describe and explore the perceptions and experiences of women, partners, community members, healthcare providers and administrators, and other key stakeholders regarding labour companionship; to identify factors affecting successful implementation and sustainability of labour companionship; and to explore how the findings of this review can enhance understanding of the related Cochrane systematic review of interventions.Search methodsWe searched MEDLINE, CINAHL, and POPLINE K4Health databases for eligible studies from inception to 9 September 2018. There were no language, date or geographic restrictions.Selection criteriaWe included studies that used qualitative methods for data collection and analysis; focused on women’s, partners’, family members’, doulas', providers', or other relevant stakeholders' perceptions and experiences of labour companionship; and were from any type of health facility in any setting globally.Data collection and analysisWe used a thematic analysis approach for data extraction and synthesis, and assessed the confidence in the findings using the GRADE‐CERQual approach. We used two approaches to integrate qualitative findings with the intervention review findings. We used a logic model to theorise links between elements of the intervention and health and well‐being outcomes. We also used a matrix model to compare features of labour companionship identified as important in the qualitative evidence synthesis with the interventions included in the intervention review.Main resultsWe found 51 studies (52 papers), mostly from high‐income countries and mostly describing women's perspectives. We assessed our level of confidence in each finding using the GRADE‐CERQual approach. We had high or moderate confidence in many of our findings. Where we only had low or very low confidence in a finding, we have indicated this.Labour companions supported women in four different ways. Companions gave informational support by providing information about childbirth, bridging communication gaps between health workers and women, and facilitating non‐pharmacological pain relief. Companions were advocates, which means they spoke up in support of the woman. Companions provided practical support, including encouraging women to move around, providing massage, and holding her hand. Finally, companions...

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Assessment of the implementation of the model of integrated and humanised midwifery health services in Chile

Cited by 41 publications

References 23 publications

Non-clinical interventions to reduce unnecessary caesarean section targeted at organisations, facilities and systems: Systematic review of qualitative studies

Non-clinical interventions to reduce unnecessary caesarean section targeted at organisations, facilities and systems: Systematic review of qualitative studies

Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis

Perceptions and experiences of labour companionship: a qualitative evidence synthesis

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