Essential Components of Successful Collaborative Maternity Care Models

Avery, Melissa D.; Montgomery, Owen; Brandl-Salutz, Emily

doi:10.1016/j.ogc.2012.05.010

Cited by 52 publications

(73 citation statements)

References 15 publications

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“…Interprofessional education has been shown to be an important approach to changing behavior through the acquisition of knowledge and skills that change perceptions and attitudes toward another related health profession's group . In 2011, a joint statement by the American College of Obstetricians and Gynecologists and the Association of Certified Nurse‐Midwives called for increased interprofessional education to improve health care for women and their newborns, yet few teaching programs have embraced an interprofessional model. Large, unexplained variation among hospitals is not unique to cesarean delivery overuse and increased understanding of the role of culture and attitudes in explaining variation may be highly relevant to other areas of medicine.…”

Section: Discussionmentioning

confidence: 99%

Cesarean overuse and the culture of care

VanGompel

Perez

Datta

et al. 2019

Health Services Research

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Objective To assess hospital unit culture and clinician attitudes associated with varying rates of primary cesarean delivery. Data Sources/Study Setting Intrapartum nurses, midwives, and physicians recruited from 79 hospitals in California participating in efforts to reduce cesarean overuse. Study Design Labor unit culture and clinician attitudes measured using a survey were linked to the California Maternal Data Center for birth outcomes and hospital covariates. Methods Association with primary cesarean delivery rates was assessed using multivariate Poisson regression adjusted for hospital covariates. Principal Findings 1718 respondents from 70 hospitals responded to the Labor Culture Survey. The “Unit Microculture” subscale was strongly associated with primary cesarean rate; the higher a unit scored on 8‐items describing a culture supportive of vaginal birth (eg, nurses are encouraged to spend time in rooms with patients, and doulas are welcomed), the cesarean rate decreased by 41 percent (95% CI = −47 to −35 percent, P < 0.001). Discordant attitudes between nurses and physicians were associated with increased cesarean rates. Conclusions Hospital unit culture, clinician attitudes, and consistency between professions are strongly associated with primary cesarean rates. Improvement efforts to reduce cesarean overuse must address culture of care as a key part of the change process.

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Section: Discussionmentioning

confidence: 99%

Cesarean overuse and the culture of care

VanGompel

Perez

Datta

et al. 2019

Health Services Research

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“…The assignment of a provider was identified as a facilitator of midwifery care, perhaps signaling an opportunity for health care delivery systems to consider collaborative care models that include midwifery or family physician care as the norm for routine, low-risk pregnancy care with referral systems to obstetricians or maternal fetal medicine specialists for complications that require higher acuity care (37,38). To meet the potential demand for such a model, policy makers could enhance the availability of midwifery services by supporting the training of midwives in decisions related to federal appropriations for health provider education.…”

Section: Discussionmentioning

confidence: 99%

Midwifery Care and Patient–Provider Communication in Maternity Decisions in the United States

Kozhimannil

Attanasio

Yang

et al. 2015

Matern Child Health J

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Objective To characterize reasons women chose midwives as prenatal care providers and to measure the relationship between midwifery care and patient-provider communication in the U.S. context. Methods Retrospective analysis of data from a nationally-representative survey of women who gave birth in 2011–2012 to a single newborn in a U.S. hospital (n=2400). We used multivariate logistic regression models to characterize women who received prenatal care from a midwife, to describe the reasons for this choice, and to examine the association between midwife-led prenatal care and women’s reports about communication. Results Preference for a female clinician and having a particular clinician assigned was associated with higher odds of midwifery care (AOR=2.65, 95% CI=1.70, 4.14 and AOR=1.63, 95% CI=1.04, 2.58). A woman with midwifery care had lower odds of reporting that she held back questions because her preference for care was different from her provider’s recommendation (AOR=0.46, 95% CI=0.23, 0.89) or because she did not want to be perceived as difficult (AOR=0.48, 95% CI=0.28, 0.81). Women receiving midwifery care also had lower odds of reporting that the provider used medical words were hard for them to understand (AOR=0.58, 95% CI=0.37, 0.91) and not feeling encouraged to discuss all their concerns (AOR=0.54, 95% CI=0.34, 0.89). Conclusions Women whose prenatal care was provided by midwives report better communication compared with those cared for by other types of clinicians. Systems-level interventions, such as assigning a clinician, may improve access to midwifery care and the associated improvements in patient-provider communication in maternity care.

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“…Students identified shifts away from the original ‘echelon model’ and indicated openness to such change (theme 1). As in an explorative study among clinicians, working in community practices as well as in academic practices in maternity care in the USA in 2011 [33], when students in our study indicated a preference for a specific maternity care model, the motivation was mainly related to the desire to provide the best possible maternity care.…”

Section: Discussionmentioning

confidence: 81%

Student midwives’ perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study

Warmelink

Cock

Combee

et al. 2017

BMC Pregnancy Childbirth

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BackgroundA major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system involving midwives and obstetricians at all care levels. Student midwives are the future maternity care providers and they may be entering into a changing maternity care system, so inclusion of their views in the discussion is relevant. This study aimed to explore student midwives’ perceptions on the current organisation of maternity care and alternative maternity care models, including integrated care.MethodsThis qualitative study was based on the interpretivist/constructivist paradigm, using a grounded theory design. Interviews and focus groups with 18 female final year student midwives of the Midwifery Academy Amsterdam Groningen (AVAG) were held on the basis of a topic list, then later transcribed, coded and analysed.ResultsStudents felt that inevitably there will be a change in the organisation of maternity care, and they were open to change. Participants indicated that good collaboration between professions, including a shared system of maternity notes and guidelines, and mutual trust and respect were important aspects of any alternative model. The students indicated that client-centered care and the safeguarding of the physiological, normalcy approach to pregnancy and birth should be maintained in any alternative model. Students expressed worries that the role of midwives in intrapartum care could become redundant, and thus they are motivated to take on new roles and competencies, so they can ensure their own role in intrapartum care.ConclusionsFinal year student midwives recognise that change in the organisation of maternity care is inevitable and have an open attitude towards changes if they include good collaboration, client-centred care and safeguards for normal physiological birth.The graduating midwives are motivated to undertake an expanded intrapartum skill set. It can be important to involve students’ views in the discussion, because they are the future maternity care providers.

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Essential Components of Successful Collaborative Maternity Care Models

Cited by 52 publications

References 15 publications

Cesarean overuse and the culture of care

Cesarean overuse and the culture of care

Midwifery Care and Patient–Provider Communication in Maternity Decisions in the United States

Student midwives’ perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study

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