“But at home, with the midwife, you are a person”: experiences and impact of a new early postpartum home-based midwifery care model in the view of women in vulnerable family situations

Abstract

Background Postpartum home-based midwifery care is covered by basic health insurance in Switzerland for all families with newborns but must be self-organized. To ensure access for all, Familystart, a network of self-employed midwives, launched a new care model in 2012 by ensuring the transition from hospital to home through cooperation with maternity hospitals in the Basel area. It has particularly improved the access to follow-up care for families in vulnerable situations needing support beyond basic services. In 2018, the SORGSAM (Support at the Start of Life) project was initiated by Familystart to enhance parental resources for better postpartum health outcomes for mothers and children through offering improved assistance to psychosocially and economically disadvantaged families. First, midwives have access to first-line telephone support to discuss challenging situations and required actions. Second, the SORGSAM hardship fund provides financial compensation to midwives for services not covered by basic health insurance. Third, women receive financial emergency support from the hardship fund. Aim The aim was to explore how women living in vulnerable family situations experienced the new early postpartum home-based midwifery care model provided in the context of the SORGSAM project, and how they experienced its impact. Methods Findings are reported from the qualitative part of the mixed-methods evaluation of the SORGSAM project. They are based on the results of seven semi-structured interviews with women who, due to a vulnerable family postpartum situation at home, received the SORGSAM support. Data were analyzed following thematic analysis. Results Interviewed women experienced the early postpartum care at home, as “relieving and strengthening” in that midwives coordinated patient care that opened up access to appropriate community-based support services. The mothers expressed that they felt a reduction in stress, an increase in resilience, enhanced mothering skills, and greater parental resources. These were attributed to familiar and trusting relationships with their midwives where participants acknowledged deep gratitude. Conclusion The findings show the high acceptance of the new early postpartum midwifery care model. These indicate how such a care model can improve the well-being of women in vulnerable family situations and may prevent early chronic stress in children.

Advanced Midwifery Practice in Switzerland: Development and challenges

“…Secondly, socio-economic determinants are marked by an increased prevalence of women with a migrant background 14 , 15 , delayed maternal age at childbirth 16 , and residence in socially deprived conditions 17 , 18 . These phenomena are correlated with elevated rates of adverse maternal and neonatal outcomes.…”

“…They emphasize the need for recognizing the APN service as independent and billable to support primary healthcare sustainably 49 . In the Swiss canton of Basel, Schwind et al 18 evaluated the impact of de facto APM care within the SORGSAM (Support at the Start of Life) project in 2023 for families in vulnerable situations. The authors demonstrated how offering improved assistance to psychosocially and economically disadvantaged families enhances parental resources, leading to better postpartum health outcomes for mothers and children.…”