Drivers of maternity care in high-income countries: can health systems support woman-centred care?

Shaw, Dorothy; Guise, Jeanne Marie; Shah, Neel; Gemzell‐Danielsson, Kristina; Joseph, K. S.; Levy, Barbara; Wong, Fabian; Woodd, Susannah; Main, Elliott K.

doi:10.1016/s0140-6736(16)31527-6

Cited by 163 publications

(173 citation statements)

References 65 publications

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“…Furthermore, the potential of mHealth to help out is anticipated, with innovators urged not to be stifled by the fear of liability and litigation but to provide evidence-based tools for woman-centered care [18,38]. This series reinforced the findings of this review and stressed the need for further research for context-specific mobile childbirth monitoring tools.…”

Section: Discussionmentioning

confidence: 63%

Computerized Childbirth Monitoring Tools for Health Care Providers Managing Labor: A Scoping Review

Balikuddembe¹,

Tumwesigye²,

Wakholi³

et al. 2017

JMIR Med Inform

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BackgroundProper monitoring of labor and childbirth prevents many pregnancy-related complications. However, monitoring is still poor in many places partly due to the usability concerns of support tools such as the partograph. In 2011, the World Health Organization (WHO) called for the development and evaluation of context-adaptable electronic health solutions to health challenges. Computerized tools have penetrated many areas of health care, but their influence in supporting health staff with childbirth seems limited.ObjectiveThe objective of this scoping review was to determine the scope and trends of research on computerized labor monitoring tools that could be used by health care providers in childbirth management.MethodsWe used key terms to search the Web for eligible peer-reviewed and gray literature. Eligibility criteria were a computerized labor monitoring tool for maternity service providers and dated 2006 to mid-2016. Retrieved papers were screened to eliminate ineligible papers, and consensus was reached on the papers included in the final analysis.ResultsWe started with about 380,000 papers, of which 14 papers qualified for the final analysis. Most tools were at the design and implementation stages of development. Three papers addressed post-implementation evaluations of two tools. No documentation on clinical outcome studies was retrieved. The parameters targeted with the tools varied, but they included fetal heart (10 of 11 tools), labor progress (8 of 11), and maternal status (7 of 11). Most tools were designed for use in personal computers in low-resource settings and could be customized for different user needs.ConclusionsResearch on computerized labor monitoring tools is inadequate. Compared with other labor parameters, there was preponderance to fetal heart monitoring and hardly any summative evaluation of the available tools. More research, including clinical outcomes evaluation of computerized childbirth monitoring tools, is needed.

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Section: Discussionmentioning

confidence: 63%

Computerized Childbirth Monitoring Tools for Health Care Providers Managing Labor: A Scoping Review

Balikuddembe¹,

Tumwesigye²,

Wakholi³

et al. 2017

JMIR Med Inform

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“…Nevertheless, maternal mortality and especially severe maternal morbidity from such causes remain issues of serious concern and the clinical audit of such cases needs serious consideration. 21 …”

Section: Discussionmentioning

confidence: 99%

Factors Underlying the Temporal Increase in Maternal Mortality in the United States

Joseph

Lisonkova

Muraca

et al. 2017

Obstetrics &Amp; Gynecology

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OBJECTIVE To identify the factors underlying the recent increase in maternal mortality ratios (maternal deaths per 100,000 live births) in the United States. METHODS We carried out a retrospective study with data on maternal deaths and live births in the United States from 1993 to 2014 obtained from the birth and death files of the Centers for Disease Control and Prevention. Underlying causes of death were examined between 1999 and 2014 using International Classification of Diseases, Tenth Revision (ICD-10) codes. Poisson regression was used to estimate maternal mortality rate ratios (RR) and 95% confidence intervals (CI) after adjusting for the introduction of a separate pregnancy question and the standard pregnancy checkbox on death certificates, and adoption of ICD-10. RESULTS Maternal mortality ratios increased from 7.55 in 1993, to 9.88 in 1999 and to 21.5 per 100,000 live births in 2014 (RR 2014 vs 1993 2.84, 95% CI 2.49 to 3.24; RR 2014 vs 1999 2.17, 95% CI 1.93 to 2.45). The increase in maternal deaths from 1999 to 2014 was mainly due to increases in maternal deaths associated with two new ICD-10 codes (O26.8 i.e., primarily renal disease and O99 i.e., other maternal diseases classifiable elsewhere); exclusion of such deaths abolished the increase in mortality (RR 1.09, 95% CI 0.94 to 1.27). Regression adjustment for improvements in surveillance also abolished the temporal increase in maternal mortality ratios (adjusted maternal mortality ratios 7.55 in 1993, 8.00 per 100,000 live births in 2013; adjusted RR 2013 vs 1993 1.06, 95% CI 0.90 to 1.25). CONCLUSION Recent increases in maternal mortality ratios in the United States are likely an artifact of improvements in surveillance and highlight past underestimation of maternal death. Complete ascertainment of maternal death in populations remains a challenge even in countries with good systems for civil registration and vital statistics.

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“…They highlight that in the hospital the situation is fraught with anxiety, emotion, time pressures and competing priorities, and decisions are often based on unclear or incomplete information. It is acknowledged that hospitals tend to be optimised for high-risk women—with technology and staffing for close monitoring and quick access to interventions, and for low-risk women—staff monitor and tend to intervene more than is necessary [33]. This may result in avoidable harms to women and newborn while driving up the costs of maternity care.…”

Section: Discussionmentioning

confidence: 99%

Exploring the strategies that midwives in British Columbia use to promote normal birth

Butler

2017

BMC Pregnancy Childbirth

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BackgroundRates of normal birth have been declining steadily over the past 20 years, despite the evidence of the benefits to mother and baby. This is most obvious in steadily increasing caesarean section rates across countries and studies of the factors involved suggest it may be more to do with the organization of maternity care and the preferences of healthcare providers than changes in maternal or demographic conditions. The proportion of women in British Columbia (BC) receiving care from a midwife continues to grow and there is a particular focus on promoting and supporting normal pregnancy and birth in the midwifery philosophy of care. In BC, women receiving care from a midwife are less likely to have a caesarean section and other birth interventions.MethodsAn interpretive approach, based on interpretive phenomenology was used to explore the experiences of midwives in BC of normal birth and the strategies that they use to keep birth normal. Fourteen experienced midwives were purposively selected from across the range of practice, geographical, and rural/urban contexts to participate in depth interviews. Data were analyzed using Thematic Network Analysis.ResultsSeven key themes were identified in the data: working with women from the early pregnancy, informing choice, the birth environment, careful watching and waiting, managing early labour, helping the woman to cope with labour, and tools in the tool kit.ConclusionsMidwives in BC work closely with women from early pregnancy to prepare them for a normal birth, and as “instruments of care” they adopt a range of approaches to support women to achieve this. The emphasis on continuity of care in the BC model of midwifery care plays a vital role in this.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1323-7) contains supplementary material, which is available to authorized users.

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Drivers of maternity care in high-income countries: can health systems support woman-centred care?

Cited by 163 publications

References 65 publications

Computerized Childbirth Monitoring Tools for Health Care Providers Managing Labor: A Scoping Review

Computerized Childbirth Monitoring Tools for Health Care Providers Managing Labor: A Scoping Review

Factors Underlying the Temporal Increase in Maternal Mortality in the United States

Exploring the strategies that midwives in British Columbia use to promote normal birth

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