44 results on '"Downe, Soo"'
Search Results
2. Systematic review on the management of term prelabour rupture of membranes
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Ramirez-Montesinos, Lucia, Downe, Soo, and Ramsden, Annette
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- 2023
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3. Targeted health and social care interventions for women and infants who are disproportionately impacted by health inequalities in high-income countries: a systematic review
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Khan, Zahra, Vowles, Zoe, Fernandez Turienzo, Cristina, Barry, Zenab, Brigante, Lia, Downe, Soo, Easter, Abigail, Harding, Seeromanie, McFadden, Alison, Montgomery, Elsa, Page, Lesley, Rayment-Jones, Hannah, Renfrew, Mary, Silverio, Sergio A., Spiby, Helen, Villarroel-Williams, Nazmy, and Sandall, Jane
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- 2023
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4. Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two trusts in England using the ASPIRE COVID-19 framework
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Neal, Sarah, Stone, Lucy, Moncrieff, Gill, Matthews, Zoë, Kingdon, Carol, Topalidou, Anastasia, Balaam, Marie-Clare, Cordey, Sarah, Crossland, Nicola, Feeley, Claire, Powney, Deborah, Sarian, Arni, Fenton, Alan, Heazell, Alexander E P, de Jonge, Ank, Severns, Alexandra, Thomson, Gill, and Downe, Soo
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- 2023
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5. Women’s knowledge of and attitudes towards group B streptococcus (GBS) testing in pregnancy: a qualitative study
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Constantinou, Georgina, Ayers, Susan, Mitchell, Eleanor J, Walker, Kate F, Daniels, Jane, Moore, Sarah, Jones, Anne-Marie, and Downe, Soo
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- 2023
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6. Training and expertise in undertaking assisted vaginal delivery (AVD): a mixed methods systematic review of practitioners views and experiences
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Feeley, Claire, Crossland, Nicola, Betran, Ana Pila, Weeks, Andrew, Downe, Soo, and Kingdon, Carol
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- 2021
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7. Facilitating Perinatal Access to Resources and Support (PeARS): a feasibility study with external pilot of a novel intervention
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Slade, Pauline, Dembinsky, Melanie, Bristow, Katie, Garthwaite, Kim, Mahdi, Amy, James, Annette, Rahman, Atif, and Downe, Soo
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- 2021
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8. Women’s, partners’ and healthcare providers’ views and experiences of assisted vaginal birth: a systematic mixed methods review
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Crossland, Nicola, Kingdon, Carol, Balaam, Marie-Clare, Betrán, Ana Pilar, and Downe, Soo
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- 2020
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9. Optimising the use of caesarean section: a generic formative research protocol for implementation preparation
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Bohren, Meghan A., Opiyo, Newton, Kingdon, Carol, Downe, Soo, and Betrán, Ana Pilar
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- 2019
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10. Thermal imaging applications in neonatal care: a scoping review
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Topalidou, Anastasia, Ali, Nazmin, Sekulic, Slobodan, and Downe, Soo
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- 2019
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11. Maternal plasma levels of oxytocin during physiological childbirth – a systematic review with implications for uterine contractions and central actions of oxytocin
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Uvnäs-Moberg, Kerstin, Ekström-Bergström, Anette, Berg, Marie, Buckley, Sarah, Pajalic, Zada, Hadjigeorgiou, Eleni, Kotłowska, Alicja, Lengler, Luise, Kielbratowska, Bogumila, Leon-Larios, Fatima, Magistretti, Claudia Meier, Downe, Soo, Lindström, Bengt, and Dencker, Anna
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- 2019
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12. Qualitative Evidence Synthesis (QES) for Guidelines: Paper 2 – Using qualitative evidence synthesis findings to inform evidence-to-decision frameworks and recommendations
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Lewin, Simon, Glenton, Claire, Lawrie, Theresa A., Downe, Soo, Finlayson, Kenneth W., Rosenbaum, Sarah, Barreix, María, and Tunçalp, Özge
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- 2019
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13. Qualitative Evidence Synthesis (QES) for Guidelines: Paper 3 – Using qualitative evidence syntheses to develop implementation considerations and inform implementation processes
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Glenton, Claire, Lewin, Simon, Lawrie, Theresa A., Barreix, María, Downe, Soo, Finlayson, Kenneth W., Tamrat, Tigest, Rosenbaum, Sarah, and Tunçalp, Özge
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- 2019
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14. Qualitative Evidence Synthesis (QES) for Guidelines: Paper 1 – Using qualitative evidence synthesis to inform guideline scope and develop qualitative findings statements
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Downe, Soo, Finlayson, Kenneth W., Lawrie, Theresa A., Lewin, Simon A., Glenton, Claire, Rosenbaum, Sarah, Barreix, María, and Tunçalp, Özge
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- 2019
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15. Women’s experiences of pharmacological and non-pharmacological pain relief methods for labour and childbirth: a qualitative systematic review
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Thomson, Gill, Feeley, Claire, Moran, Victoria Hall, Downe, Soo, and Oladapo, Olufemi T.
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- 2019
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16. Women’s and communities’ views of targeted educational interventions to reduce unnecessary caesarean section: a qualitative evidence synthesis
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Kingdon, Carol, Downe, Soo, and Betran, Ana Pilar
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- 2018
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17. Global research priorities related to the World Health Organization Labour Care Guide: results of a global consultation.
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World Health Organization Labour Care Guide Research Prioritization Group, Abalos, Edgardo, Adanu, Richard, Bernitz, Stine, Binfa, Lorena, Dao, Blami, Downe, Soo, Hofmeyr, Justus G., Homer, Caroline S. E., Hundley, Vanora, GaladanciGogoi, Hadiza Aparajita, Lavender, Tina, Lissauer, David, Lumbiganon, Pisake, Pattinson, Robert, Qureshi, Zahida, Stringer, Jeffrey S. A., Pujar, Yeshita V., Vogel, Joshua P., and Yunis, Khalid
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MATERNAL health services ,RESEARCH evaluation ,PRIORITY (Philosophy) ,RESEARCH methodology ,WORLD health ,MEDICAL protocols ,PREGNANCY outcomes ,QUALITY assurance ,RESEARCH funding ,JUDGMENT sampling ,INTRAPARTUM care - Abstract
Background: The World Health Organization (WHO) published the WHO Labour Care Guide (LCG) in 2020 to support the implementation of its 2018 recommendations on intrapartum care. The WHO LCG promotes evidence-based labour monitoring and stimulates shared decision-making between maternity care providers and labouring women. There is a need to identify critical questions that will contribute to defining the research agenda relating to implementation of the WHO LCG. Methods: This mixed-methods prioritization exercise, adapted from the Child Health and Nutrition Research Initiative (CHNRI) and James Lind Alliance (JLA) methods, combined a metrics-based design with a qualitative, consensus-building consultation in three phases. The exercise followed the reporting guideline for priority setting of health research (REPRISE). First, 30 stakeholders were invited to submit online ideas or questions (generation of research ideas). Then, 220 stakeholders were invited to score "research avenues" (i.e., broad research ideas that could be answered through a set of research questions) against six independent and equally weighted criteria (scoring of research avenues). Finally, a technical working group (TWG) of 20 purposively selected stakeholders reviewed the scoring, and refined and ranked the research avenues (consensus-building meeting). Results: Initially, 24 stakeholders submitted 89 research ideas or questions. A list of 10 consolidated research avenues was scored by 75/220 stakeholders. During the virtual consensus-building meeting, research avenues were refined, and the top three priorities agreed upon were: (1) optimize implementation strategies of WHO LCG, (2) improve understanding of the effect of WHO LCG on maternal and perinatal outcomes, and the process and experience of labour and childbirth care, and (3) assess the effect of the WHO LCG in special situations or settings. Research avenues related to the organization of care and resource utilization ranked lowest during both the scoring and consensus-building process. Conclusion: This systematic and transparent process should encourage researchers, program implementers, and funders to support research aligned with the identified priorities related to WHO LCG. An international collaborative platform is recommended to implement prioritized research by using harmonized research tools, establishing a repository of research priorities studies, and scaling-up successful research results. [ABSTRACT FROM AUTHOR]
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- 2023
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18. Training and expertise in undertaking assisted vaginal delivery (AVD): a mixed methods systematic review of practitioners views and experiences
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Feeley, Claire Lauren, Crossland, Nicola, Betran, Ana Pila, Weeks, Andrew, Downe, Soo, Kingdon, Carol, Feeley, Claire Lauren, Crossland, Nicola, Betran, Ana Pila, Weeks, Andrew, Downe, Soo, and Kingdon, Carol
- Abstract
Background: During childbirth, complications may arise which necessitate an expedited delivery of the fetus. One option is instrumental assistance (forceps or a vacuum-cup), which, if used with skill and sensitivity, can improve maternal/neonatal outcomes. This review aimed to understand the core competencies and expertise required for skilled use in AVD in conjunction with reviewing potential barriers and facilitators to gaining competency and expertise, from the point of view of maternity care practitioners, funders and policy makers. Methods: A mixed methods systematic review was undertaken in five databases. Inclusion criteria were primary studies reporting views, opinions, perspectives and experiences of the target group in relation to the expertise, training, behaviours and competencies required for optimal AVD, barriers and facilitators to achieving practitioner competencies, and to the implementation of appropriate training. Quality appraisal was carried out on included studies. A mixed-methods convergent synthesis was carried out, and the findings were subjected to GRADE-CERQual assessment of confidence. Results: 31 papers, reporting on 27 studies and published 1985–2020 were included. Studies included qualitative designs (3), mixed methods (3), and quantitative surveys (21). The majority (23) were from high-income countries, two from upper-middle income countries, one from a lower-income country: one survey included 111 low-middle countries. Confidence in the 10 statements of findings was mostly low, with one exception (moderate confidence). The review found that AVD competency comprises of inter-related skill sets including non-technical skills (e.g. behaviours), general clinical skills; and specific technical skills associated with particular instrument use. We found that practitioners needed and welcomed additional specific training, where a combination of teaching methods were used, to gain skills and confidence in this field. Clinical mentor
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- 2021
19. Qualitative Evidence Synthesis (QES) for Guidelines: Paper 2 – Using qualitative evidence synthesis findings to inform evidence-to-decision frameworks and recommendations
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Lewin, Simon A, Glenton, Claire, Lawrie, Theresa A, Downe, Soo, Finlayson, Kenneth William, Rosenbaum, Sarah, Barreix, Maria, Tuncalp, Ozge, Lewin, Simon A, Glenton, Claire, Lawrie, Theresa A, Downe, Soo, Finlayson, Kenneth William, Rosenbaum, Sarah, Barreix, Maria, and Tuncalp, Ozge
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Background: WHO has recognised the need to improve its guideline methodology to ensure that guideline decision-making processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable. To help achieve this, WHO guidelines now typically enhance intervention effectiveness data with evidence on a wider range of decision-making criteria, including how stakeholders value different outcomes, equity, gender and human rights impacts, and the acceptability and feasibility of interventions. Qualitative evidence syntheses (QES) are increasingly used to provide evidence on this wider range of issues. In this paper, we describe and discuss how to use the findings from QES to populate decision-making criteria in evidence-to-decision (EtD) frameworks. This is the second in a series of three papers that examines the use of QES in developing clinical and health system guidelines. Methods: WHO convened a writing group drawn from the technical teams involved in its recent (2010–2018) guidelines employing QES. Using a pragmatic and iterative approach that included feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and using the resulting findings in guideline development. Results: We describe a step-wise approach to populating EtD frameworks with QES findings. This involves allocating findings to the different EtD criteria (how stakeholders value different outcomes, equity, acceptability and feasibility, etc.), weaving the findings into a short narrative relevant to each criterion, and inserting this summary narrative into the corresponding ‘research evidence’ sections of the EtD. We also identify areas for further methodological research, including how best to summarise and present qualitative data to groups developing guidelines, how these groups draw on different types of evidence in their decisions, and the extent to which our experie
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- 2019
20. Effectiveness of respectful care policies for women using routine intrapartum services: a systematic review
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Downe, Soo, Lawrie, Theresa A, Finlayson, Kenneth William, Oladapo, Olufemi T, Downe, Soo, Lawrie, Theresa A, Finlayson, Kenneth William, and Oladapo, Olufemi T
- Abstract
Several studies have identified how mistreatment during labour and childbirth can act as a barrier to the use of health facilities. Despite general agreement that respectful maternity care (RMC) is a fundamental human right, and an important component of quality intrapartum care that every pregnant woman should receive, the effectiveness of proposed policies remains uncertain. We performed a systematic review to assess the effectiveness of introducing RMC policies into health facilities providing intrapartum services. We included randomized and non-randomized controlled studies evaluating the effectiveness of introducing RMC policies into health facilities. We searched PubMed, CINAHL, LILACS, AJOL, WHO RHL, and Popline, along with ongoing trials registers (ISRCT register, ICTRP register), and the White Ribbon Respectful Maternity Care Repository. Included studies were assessed for risk of bias. Certainty of evidence was assessed using GRADE criteria. Five studies were included. All were undertaken in Africa (Kenya, Tanzania, Sudan, South Africa), and involved a range of components. Two were cluster RCTs, and three were before/after studies. In total, over 8000 women were included at baseline and over 7500 at the endpoints. Moderate certainty evidence suggested that RMC interventions increases women's experiences of respectful care (one cRCT, approx. 3000 participants; adjusted odds ratio (aOR) 3.44, 95% CI 2.45-4.84); two observational studies also reported positive changes. Reports of good quality care increased. Experiences of disrespectful or abusive care, and, specifically, physical abuse, were reduced. Low certainty evidence indicated fewer accounts of non-dignified care, lack of privacy, verbal abuse, neglect and abandonment with RMC interventions, but no difference in satisfaction rates. Other than low certainty evidence of reduced episiotomy rates, there were no data on the pre-specified clinical outcomes. Multi-component RMC policies appear to reduce women'
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- 2018
21. Preference for cesarean section in young nulligravid women in eight OECD countries and implications for reproductive health education
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Stoll, Kathrin H., Hauck, Yvonne L., Downe, Soo, Payne, Deborah, Hall, Wendy A., Stoll, Kathrin H., Hauck, Yvonne L., Downe, Soo, Payne, Deborah, and Hall, Wendy A.
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Background: Efforts to reduce unnecessary Cesarean sections (CS) in high and middle income countries have focused on changing hospital cultures and policies, care provider attitudes and behaviors, and increasing women’s knowledge about the benefits of vaginal birth. These strategies have been largely ineffective. Despite evidence that women have well-developed preferences for mode of delivery prior to conceiving their first child, few studies and no interventions have targeted the next generation of maternity care consumers. The objectives of the study were to identify how many women prefer Cesarean section in a hypothetical healthy pregnancy, why they prefer CS and whether women report knowledge gaps about pregnancy and childbirth that can inform educational interventions. Methods: Data was collected via an online survey at colleges and universities in 8 OECD countries (Australia, Canada, Chile, England, Germany, Iceland, New Zealand, United States) in 2014/2015. Childless young men and women between 18 and 40 years of age who planned to have at least one child in the future were eligible to participate. The current analysis is focused on the attitudes of women (n = 3616); rates of CS preference across countries are compared, using a standardized cohort of women aged 18–25 years, who were born in the survey country and did not study health sciences (n = 1390). Results: One in ten young women in our study preferred CS, ranging from 7.6% in Iceland to 18.4% in Australia. Fear of uncontrollable labor pain and fear of physical damage were primary reasons for preferring a CS. Both fear of childbirth and preferences for CS declined as the level of confidence in women’s knowledge of pregnancy and birth increased. Conclusion: Education sessions delivered online, through social media, and face-to-face using drama and stories told by peers (young women who have recently had babies) or celebrities could be designed to maximize young women’s capacity to understand the physiolo
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- 2017
22. Engaging with birth stories in pregnancy: A hermeneutic phenomenological study of women's experiences across two generations
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Thomson, Gillian, Downe, Soo, Finlayson, Kenneth William, Thomson, Gillian, Downe, Soo, and Finlayson, Kenneth William
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Background: The birth story has been widely understood as a crucial source of knowledge about childbirth. What has not been reported is the effect that birth stories may have on primigravid women's understandings of birth. Findings are presented from a qualitative study exploring how two generations of women came to understand birth in the milieu of other's stories. The prior assumption was that birth stories must surely have a positive or negative influence on listeners, steering them towards either medical or midwifery-led models of care. Methods: A Heideggerian hermeneutic phenomenological approach was used. Twenty UK participants were purposively selected and interviewed. Findings from the initial sample of ten women who were pregnant in 2012 indicated that virtual media was a primary source of birth stories. This led to recruitment of a second sample of ten women who gave birth in the 1970s-1980s, to determine whether they were more able to translate information into knowledge via stories told through personal contact and not through virtual technologies. Results: Findings revealed the experience of 'being-in-the-world' of birth and of stories in that world. From a Heideggerian perspective, the birth story was constructed through 'idle talk' (the taken for granted assumptions of things, which come into being through language). Both oral stories and those told through technology were described as the 'modern birth story'. The first theme 'Stories are difficult like that', examines the birth story as problematic and considers how stories shape meaning. The second 'It's a generational thing', considers how women from two generations came to understand what their experience might be. The third 'Birth in the twilight of certainty,' examines women's experience of Being in a system of birth as constructed, portrayed and sustained in the stories being shared. Conclusions: The women pregnant in 2012 framed their expectations in the language of choice, whilst the women w
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- 2017
23. Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models
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Symon, Andrew, Pringle, Jan, Downe, Soo, Hundley, Vanora, Lee, Elaine, Lynn, Fiona, McFadden, Alison, McNeill, Jenny, Renfrew, Mary J, Ross-Davie, Mary, van Teijlingen, Edwin, Whitford, Heather, Alderdice, Fiona, Symon, Andrew, Pringle, Jan, Downe, Soo, Hundley, Vanora, Lee, Elaine, Lynn, Fiona, McFadden, Alison, McNeill, Jenny, Renfrew, Mary J, Ross-Davie, Mary, van Teijlingen, Edwin, Whitford, Heather, and Alderdice, Fiona
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Background: Antenatal care models vary widely around the world, reflecting local contexts, drivers and resources. Randomised controlled trials (RCTs) have tested the impact of multi-component antenatal care interventions on service delivery and outcomes in many countries since the 1980s. Some have applied entirely new schemes, while others have modified existing care delivery approaches. Systematic reviews (SRs) indicate that some specific antenatal interventions are more effective than others; however the causal mechanisms leading to better outcomes are poorly understood, limiting implementation and future research. As a first step in identifying what might be making the difference we conducted a scoping review of interventions tested in RCTs in order to establish a taxonomy of antenatal care models. Methods: A protocol-driven systematic search was undertaken of databases for RCTs and SRs reporting antenatal care interventions. Results were unrestricted by time or locality, but limited to English language. Key characteristics of both experimental and control interventions in the included trials were mapped using SPIO (Study design; Population; Intervention; Outcomes) criteria and the intervention and principal outcome measures were described. Commonalities and differences between the components that were being tested in each study were identified by consensus, resulting in a comprehensive description of emergent models for antenatal care interventions. Results: Of 13,050 articles retrieved, we identified 153 eligible articles including 130 RCTs in 34 countries. The interventions tested in these trials varied from the number of visits to the location of care provision, and from the content of care to the professional/lay group providing that care. In most studies neither intervention nor control arm was well described. Our analysis of the identified trials of antenatal care interventions produced the following taxonomy: Universal provision model (for all women irres
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- 2017
24. Discrimination against childbearing Romani women in maternity care in Europe: a mixed-methods systematic review
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Watson, Helen L., Downe, Soo, Watson, Helen L., and Downe, Soo
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Background: Freedom from discrimination is one of the key principles in a human rights-based approach to maternal and newborn health. Objective: To review the published evidence on discrimination against Romani women in maternity care in Europe, and on interventions to address this. Search strategy: A systematic search of eight electronic databases was undertaken in 2015 using the terms “Roma” and “maternity care”. A broad search for grey literature included the websites of relevant agencies. Data extraction and synthesis: Standardised data extraction tables were utilised, quality was formally assessed and a line of argument synthesis was developed and tested against the data from the grey literature. Results: Nine hundred papers were identified; three qualitative studies and seven sources of grey literature met the review criteria. These revealed that many Romani women encounter barriers to accessing maternity care. Even when they are able to access care, they can experience discriminatory mistreatment on the basis of their ethnicity, economic status, place of residence or language. The grey literature revealed some health professionals held underlying negative beliefs about Romani women. There were no published research studies examining the effectiveness of interventions to address discrimination against Romani women and their infants in Europe. The Roma Health Mediation Programme is a promising intervention identified in the grey literature. Conclusions: There is evidence of discrimination against Romani women in maternity care in Europe. Interventions to address discrimination against childbearing Romani women and underlying health provider prejudice are urgently needed, alongside analysis of factors predicting the success or failure of such initiatives.
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- 2017
25. Protocol for the development of a salutogenic intrapartum core outcome set (SIPCOS)
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Smith, Valerie, Daly, Deirdre, Lundgren, Ingela, Eri, Tine, Begley, Cecily, Gross, Mechthild M., Downe, Soo, Alfirevic, Zarko, Devane, Declan, Smith, Valerie, Daly, Deirdre, Lundgren, Ingela, Eri, Tine, Begley, Cecily, Gross, Mechthild M., Downe, Soo, Alfirevic, Zarko, and Devane, Declan
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Background: Maternity intrapartum care research and clinical care more often focus on outcomes that minimise or prevent adverse health rather than on what constitutes positive health and wellbeing (salutogenesis). This was highlighted recently in a systematic review of reviews of intrapartum reported outcomes where only 8% of 1648 individual outcomes, from 102 systematic reviews, were agreed as being salutogenically-focused. Added to this is variation in the outcomes measured in individual studies rendering it very difficult for researchers to synthesise, fully, the evidence from studies on a particular topic. One of the suggested ways to address this is to develop and apply an agreed standardised set of outcomes, known as a ‘core outcome set’ (COS). In this paper we present a protocol for the development of a salutogenic intrapartum COS (SIPCOS) for use in maternity care research and a SIPCOS for measuring in daily intrapartum clinical care. Methods: The study proposes three phases in developing the final SIPCOSs. Phase one, which is complete, involved the conduct of a systematic review of reviews to identify a preliminary list of salutogenically-focused outcomes that had previously been reported in systematic reviews of intrapartum interventions. Sixteen unique salutogenically-focused outcome categories were identified. Phase two will involve prioritising these outcomes, from the perspective of key stakeholders (users of maternity services, clinicians and researchers) by asking them to rate the importance of each outcome for inclusion in the SIPCOSs. A final consensus meeting (phase three) will be held, bringing international stakeholders together to review the preliminary SIPCOSs resulting from the survey and to agree and finalise the final SIPCOSs for use in future maternity care research and daily clinical care. Discussion: The expectation in developing the SIPCOSs is that they will be collected and reported in all future studies evaluating intrapartum interven
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- 2017
26. Midwifery-led antenatal care models: mapping a systematic review to an evidence-based quality framework to identify key components and characteristics of care
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symon, A, pringle, J, Cheyne, H, Downe, Soo, Hundley, V, Lee, E, Lynn, Fiona, McFadden, A, McNeill, J, Renfrew, M, J, Ross-Davie, M, van Teijlingen, E, Whitford, H, Alerdice, F, symon, A, pringle, J, Cheyne, H, Downe, Soo, Hundley, V, Lee, E, Lynn, Fiona, McFadden, A, McNeill, J, Renfrew, M, J, Ross-Davie, M, van Teijlingen, E, Whitford, H, and Alerdice, F
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Background: Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportunity to identify systematically the characteristics of care delivery that may be generalizable across contexts, thereby enhancing implementation. Our objective was to map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to a new evidence-based framework for quality maternal and newborn care; thus facilitating the identification of characteristics of effective care. Methods: A systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of these models’ characteristics to the QMNC framework using data extraction and scoring forms derived from the five framework components. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria. Results: From 13,050 citations initially retrieved we identified 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each). QMNC framework scores ranged from 9 to 25 (possible range 0–32), with most models reporting fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was lacking in many studies, but was better reported for the intervention arms. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported. Conclusions: The QMNC framework facilitates assessment of the characteristics of antenatal care models. It i
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- 2016
27. Childbirth and consequent atopic disease: emerging evidence on epigenetic effects based on the hygiene and EPIIC hypotheses
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Dahlen, H. G., Downe, Soo, Wright, M. L., Kennedy, H. P., Taylor, J. Y., Dahlen, H. G., Downe, Soo, Wright, M. L., Kennedy, H. P., and Taylor, J. Y.
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Background: In most high and middle income countries across the world, at least 1:4 women give birth by cesarean section. Rates of labour induction and augmentation are rising steeply; and in some countries up to 50 % of laboring women and newborns are given antibiotics. Governments and international agencies are increasingly concerned about the clinical, economic and psychosocial effects of these interventions. Discussion: There is emerging evidence that certain intrapartum and early neonatal interventions might affect the neonatal immune response in the longer term, and perhaps trans-generationally. Two theories lead the debate in this area. Those aligned with the hygiene (or ‘Old Friends’) hypothesis have examined the effect of gut microbiome colonization secondary to mode of birth and intrapartum/neonatal pharmacological interventions on immune response and epigenetic phenomena. Those working with the EPIIC (Epigenetic Impact of Childbirth) hypothesis are concerned with the effects of eustress and dys-stress on the epigenome, secondary to mode of birth and labour interventions. Summary: This paper examines the current and emerging findings relating to childbirth and atopic/autoimmune disease from the perspective of both theories, and proposes an alliance of research effort. This is likely to accelerate the discovery of important findings arising from both approaches, and to maximize the timely understanding of the longer-term consequences of childbirth practices.
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- 2016
28. From grief, guilt pain and stigma to hope and pride – a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth
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Burden, Christy, Bradley, Stephanie, Storey, Claire, Ellis, Alison, Heazell, Alexander E. P., Downe, Soo, Cacciatore, Joanne, Siassakos, Dimitrios, Burden, Christy, Bradley, Stephanie, Storey, Claire, Ellis, Alison, Heazell, Alexander E. P., Downe, Soo, Cacciatore, Joanne, and Siassakos, Dimitrios
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Background Despite improvements in maternity healthcare services over the last few decades, more than 2.7 million babies worldwide are stillborn each year. The global health agenda is silent about stillbirth, perhaps, in part, because its wider impact has not been systematically analysed or understood before now across the world. Our study aimed to systematically review, evaluate and summarise the current evidence regarding the psychosocial impact of stillbirth to parents and their families, with the aim of improving guidance in bereavement care worldwide. Methods Systematic review and meta-summary (quantitative aggregation of qualitative findings) of quantitative, qualitative, and mixed-methods studies. All languages and countries were included. Results Two thousand, six hundred and nineteen abstracts were identified; 144 studies were included. Frequency effect sizes (FES %) were calculated for each theme, as a measure of their prevalence in the literature. Themes ranged from negative psychological symptoms post bereavement (77 · 1) and in subsequent pregnancies (27 · 1), to disenfranchised grief (31 · 2), and incongruent grief (28 · 5), There was also impact on siblings (23 · 6) and on the wider family (2 · 8). They included mixed-feelings about decisions made when the baby died (12 · 5), avoidance of memories (13 · 2), anxiety over other children (7 · 6), chronic pain and fatigue (6 · 9), and a different approach to the use of healthcare services (6 · 9). Some themes were particularly prominent in studies of fathers; grief suppression (avoidance)(18 · 1), employment difficulties, financial debt (5 · 6), and increased substance use (4 · 2). Others found in studies specific to mothers included altered body image (3 · 5) and impact on quality of life (2 · 1). Counter-intuitively, Some themes had mixed connotations. These included parental pride in the baby (5 · 6), motivation for engagement in healthcare improvement (4 · 2) and changed approaches to life and death
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- 2016
29. The feasibility and acceptability of using the Mother-Generated Index (MGI) as a Patient Reported Outcome Measure in a randomised controlled trial of maternity care
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Symon, Andrew, Downe, Soo, Finlayson, Kenneth William, Knapp, Rebecca, Diggle, Peter, Symon, Andrew, Downe, Soo, Finlayson, Kenneth William, Knapp, Rebecca, and Diggle, Peter
- Abstract
Background: Using patient-reported outcome measures (PROMs) to assess Quality of Life (QoL) is well established, but commonly-used PROM item-sets do not necessarily capture what all respondents consider important. Measuring complex constructs is particularly difficult in randomised controlled trials (RCTs). The Mother-Generated Index (MGI) is a validated antenatal and postnatal QoL instrument in which the variables and scores are completely respondent-driven. This paper reports on the feasibility and acceptability of the MGI in an RCT, and compares the resulting variables and QoL scores with more commonly used instruments. Methods: The single-page MGI was included at the end of a ten page questionnaire pack and posted to the RCT participants at baseline (28–32 weeks’ gestation) and follow-up (six weeks postnatal). Feasibility and acceptability were assessed by ease of administration, data entry and completion rates. Variables cited by women were analysed thematically. MGI QoL scores were compared with outcomes from the EQ-5D-3 L; Edinburgh Postnatal Depression Scale; Satisfaction With Life Scale; and State Trait Anxiety Inventory. Results: Six hundred and seventy eight pregnant women returned the pack at baseline; 668 completed the MGI (98.5 %); 383/400 returns at follow up included a completed MGI (95.7 %). Quantitative data were scanned into SPSS using a standard data scanning system, and were largely error-free; qualitative data were entered manually. The variables recorded by participants on the MGI forms incorporated many of those in the comparison instruments, and other outcomes commonly used in intrapartum trials, but they also revealed a wider range of issues affecting their quality of life. These included financial and work-related worries; moving house; and concerns over family illness and pets. The MGI scores demonstrated low-to-moderate correlation with other tools (all r values p < .01). Conclusions: Without face-to-face explanation and at the
- Published
- 2015
30. Unexpected Consequences: Women’s experiences of a self-hypnosis intervention to help with pain relief during labour.
- Author
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Finlayson, Kenneth William, Downe, Soo, Hinder, Susan, Carr, Helen, Spiby, Helen, Whorwell, Peter, Finlayson, Kenneth William, Downe, Soo, Hinder, Susan, Carr, Helen, Spiby, Helen, and Whorwell, Peter
- Abstract
Background Self-hypnosis is becoming increasingly popular as a means of labour pain management. Previous studies have produced mixed results. There are very few data on women’s views and experiences of using hypnosis in this context. As part of a randomized controlled trial of self-hypnosis for intra-partum pain relief (the SHIP Trial) we conducted qualitative interviews with women randomized to the intervention arm to explore their views and experiences of using self-hypnosis during labour and birth. Methods Participants were randomly selected from the intervention arm of the study, which consisted of two antenatal self-hypnosis training sessions and a supporting CD that women were encouraged to listen to daily from 32 weeks gestation until the birth of their baby. Those who consented were interviewed in their own homes 8-12 weeks after birth. Following transcription, the interviews were analysed iteratively and emerging concepts were discussed amongst the authors to generate organizing themes. These were then used to develop a principal organizing metaphor or global theme, in a process known as thematic networks analysis. Results Of the 343 women in the intervention group, 48 were invited to interview, and 16 were interviewed over a 12 month period from February 2012 to January 2013. Coding of the data and subsequent analysis revealed a global theme of ‘unexpected consequences’, supported by 5 organising themes, ‘calmness in a climate of fear’, ‘from sceptic to believer’, ‘finding my space’, ‘delays and disappointments’ and ‘personal preferences’. Most respondents reported positive experiences of self-hypnosis and highlighted feelings of calmness, confidence and empowerment. They found the intervention to be beneficial and used a range of novel strategies to personalize their self-hypnosis practice. Occasionally women reported feeling frustrated or disappointed when their relaxed state was misinterpreted by midwives on admission or when their labour and birth expe
- Published
- 2015
31. "Engaging with birth stories in pregnancy: a hermeneutic phenomenological study of women's experiences across two generations".
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Kay, Lesley, Downe, Soo, Finlayson, Kenny, and Thomson, Gill
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- *
PREGNANCY & psychology , *PREGNANCY , *PARTURITION , *CHILDBIRTH , *MIDWIFERY , *PHYSIOLOGY , *DELIVERY (Obstetrics) , *LABOR (Obstetrics) , *INTERGENERATIONAL relations , *PHENOMENOLOGY , *NARRATIVES , *PSYCHOLOGY - Abstract
Background: The birth story has been widely understood as a crucial source of knowledge about childbirth. What has not been reported is the effect that birth stories may have on primigravid women's understandings of birth. Findings are presented from a qualitative study exploring how two generations of women came to understand birth in the milieu of other's stories. The prior assumption was that birth stories must surely have a positive or negative influence on listeners, steering them towards either medical or midwifery-led models of care.Methods: A Heideggerian hermeneutic phenomenological approach was used. Twenty UK participants were purposively selected and interviewed. Findings from the initial sample of 10 women who were pregnant in 2012 indicated that virtual media was a primary source of birth stories. This led to recruitment of a second sample of 10 women who gave birth in the 1970s-1980s, to determine whether they were more able to translate information into knowledge via stories told through personal contact and not through virtual technologies.Results: Findings revealed the experience of 'being-in-the-world' of birth and of stories in that world. From a Heideggerian perspective, the birth story was constructed through 'idle talk' (the taken for granted assumptions of things, which come into being through language). Both oral stories and those told through technology were described as the 'modern birth story'. The first theme 'Stories are difficult like that', examines the birth story as problematic and considers how stories shape meaning. The second 'It's a generational thing', considers how women from two generations came to understand what their experience might be. The third 'Birth in the twilight of certainty,' examines women's experience of Being in a system of birth as constructed, portrayed and sustained in the stories being shared.Conclusions: The women pregnant in 2012 framed their expectations in the language of choice, whilst the women who birthed in the 1970s-1980s framed their experience in the language of safety. For both, however, the world of birth was the same; saturated with, and only legitimised by the birth of a healthy baby. Rather than creating meaningful understanding, the 'idle talk' of birth made both cohorts fearful of leaving the relative comfort of the 'system', and of claiming an alternative birth. [ABSTRACT FROM AUTHOR]- Published
- 2017
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32. The development and application of a new tool to assess the adequacy of the content and timing of antenatal care
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Beeckman, Katrien, Louckx, Fred, Masuy-Stroobant, Godelieve, Downe, Soo, Putman, Koen, Beeckman, Katrien, Louckx, Fred, Masuy-Stroobant, Godelieve, Downe, Soo, and Putman, Koen
- Abstract
Background: Current measures of antenatal care use are limited to initiation of care and number of visits. This study aimed to describe the development and application of a tool to assess the adequacy of the content and timing of antenatal care. Methods: The Content and Timing of care in Pregnancy (CTP) tool was developed based on clinical relevance for ongoing antenatal care and recommendations in national and international guidelines. The tool reflects minimal care recommended in every pregnancy, regardless of parity or risk status. CTP measures timing of initiation of care, content of care (number of blood pressure readings, blood tests and ultrasound scans) and whether the interventions were received at an appropriate time. Antenatal care trajectories for 333 pregnant women were then described using a standard tool (the APNCU index), that measures the quantity of care only, and the new CTP tool. Both tools categorise care into 4 categories, from ‘Inadequate’ (both tools) to ‘Adequate plus’ (APNCU) or ‘Appropriate’ (CTP). Participants recorded the timing and content of their antenatal care prospectively using diaries. Analysis included an examination of similarities and differences in categorisation of care episodes between the tools. Results: According to the CTP tool, the care trajectory of 10,2% of the women was classified as inadequate, 8,4% as intermediate, 36% as sufficient and 45,3% as appropriate. The assessment of quality of care differed significantly between the two tools. Seventeen care trajectories classified as ‘Adequate’ or ‘Adequate plus’ by the APNCU were deemed ‘Inadequate’ by the CTP. This suggests that, despite a high number of visits, these women did not receive the minimal recommended content and timing of care. Conclusions: The CTP tool provides a more detailed assessment of the adequacy of antenatal care than the current standard index. However, guidelines for the content of antenatal care vary, and the tool does not at the moment
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- 2011
33. Midwifery-led antenatal care models: mapping a systematic review to an evidence-based quality framework to identify key components and characteristics of care.
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Symon, Andrew, Pringle, Jan, Cheyne, Helen, Downe, Soo, Hundley, Vanora, Lee, Elaine, Lynn, Fiona, McFadden, Alison, McNeill, Jenny, Renfrew, Mary J., Ross-Davie, Mary, van Teijlingen, Edwin, Whitford, Heather, and Alderdice, Fiona
- Subjects
MIDWIFERY ,PRENATAL care ,NEWBORN infant care ,MEDICAL quality control ,RANDOMIZED controlled trials ,CLINICAL trials ,MATHEMATICAL models ,QUALITY assurance ,SYSTEMATIC reviews ,THEORY - Abstract
Background: Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportunity to identify systematically the characteristics of care delivery that may be generalizable across contexts, thereby enhancing implementation. Our objective was to map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to a new evidence-based framework for quality maternal and newborn care; thus facilitating the identification of characteristics of effective care.Methods: A systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of these models' characteristics to the QMNC framework using data extraction and scoring forms derived from the five framework components. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria.Results: From 13,050 citations initially retrieved we identified 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each). QMNC framework scores ranged from 9 to 25 (possible range 0-32), with most models reporting fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was lacking in many studies, but was better reported for the intervention arms. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported.Conclusions: The QMNC framework facilitates assessment of the characteristics of antenatal care models. It is vital to understand all the characteristics of multi-faceted interventions such as care models; not only what is done but why it is done, by whom, and how this differed from the standard care package. By applying the QMNC framework we have established a foundation for future reports of intervention studies so that the characteristics of individual models can be evaluated, and the impact of any differences appraised. [ABSTRACT FROM AUTHOR]- Published
- 2016
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34. Unexpected consequences: women's experiences of a self-hypnosis intervention to help with pain relief during labour.
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Finlayson, Kenneth, Soo Downe, Hinder, Susan, Carr, Helen, Spiby, Helen, Whorwell, Peter, and Downe, Soo
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PAIN management ,LABOR (Obstetrics) ,COMPARATIVE studies ,HYPNOTISM ,RESEARCH methodology ,MEDICAL cooperation ,PATIENT satisfaction ,POWER (Social sciences) ,RESEARCH ,RESEARCH funding ,STATISTICAL sampling ,QUALITATIVE research ,EVALUATION research ,RANDOMIZED controlled trials ,LABOR pain (Obstetrics) ,OBSTETRICAL analgesia ,PSYCHOLOGY - Abstract
Background: Self-hypnosis is becoming increasingly popular as a means of labour pain management. Previous studies have produced mixed results. There are very few data on women's views and experiences of using hypnosis in this context. As part of a randomized controlled trial of self-hypnosis for intra-partum pain relief (the SHIP Trial) we conducted qualitative interviews with women randomized to the intervention arm to explore their views and experiences of using self-hypnosis during labour and birth.Methods: Participants were randomly selected from the intervention arm of the study, which consisted of two antenatal self-hypnosis training sessions and a supporting CD that women were encouraged to listen to daily from 32 weeks gestation until the birth of their baby. Those who consented were interviewed in their own homes 8-12 weeks after birth. Following transcription, the interviews were analysed iteratively and emerging concepts were discussed amongst the authors to generate organizing themes. These were then used to develop a principal organizing metaphor or global theme, in a process known as thematic networks analysis.Results: Of the 343 women in the intervention group, 48 were invited to interview, and 16 were interviewed over a 12 month period from February 2012 to January 2013. Coding of the data and subsequent analysis revealed a global theme of 'unexpected consequences', supported by 5 organising themes, 'calmness in a climate of fear', 'from sceptic to believer', 'finding my space', 'delays and disappointments' and 'personal preferences'. Most respondents reported positive experiences of self-hypnosis and highlighted feelings of calmness, confidence and empowerment. They found the intervention to be beneficial and used a range of novel strategies to personalize their self-hypnosis practice. Occasionally women reported feeling frustrated or disappointed when their relaxed state was misinterpreted by midwives on admission or when their labour and birth experiences did not match their expectations.Conclusion: The women in this study generally appreciated antenatal self-hypnosis training and found it to be beneficial during labour and birth. The state of focused relaxation experienced by women using the technique needs to be recognized by providers if the intervention is to be implemented into the maternity service. [ABSTRACT FROM AUTHOR]- Published
- 2015
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35. Value based maternal and newborn care requires alignment of adequate resources with high value activities.
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De Jonge, Ank, Downe, Soo, Page, Lesley, Devane, Declan, Lindgren, Helena, Klinkert, Joke, Gray, Muir, and Jani, Anant
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- *
INFANT care , *MEDICAL quality control , *MEDICAL care , *INFANT mortality , *RESOURCE allocation - Abstract
Background: Evidence based practice has been associated with better quality of care in many situations, but it has not been able to address increasing need and demand in healthcare globally and stagnant or decreasing healthcare resources. Implementation of value-based healthcare could address many important challenges in health care systems worldwide. Scaling up exemplary high value care practices offers the potential to ensure values-driven maternal and newborn care for all women and babies.Discussion: Increased use of healthcare interventions over the last century have been associated with reductions in maternal and newborn mortality and morbidity. However, over an optimum threshold, these are associated with increases in adverse effects and inappropriate use of scarce resources. The Quality Maternal and Newborn Care framework provides an example of what value based maternity care might look like. To deliver value based maternal and newborn care, a system-level shift is needed, 'from fragmented care focused on identification and treatment of pathology for the minority to skilled care for all'. Ideally, resources would be allocated at population and individual level to ensure care is woman-centred instead of institution/ profession centred but oftentimes, the drivers for spending resources are 'the demands and beliefs of the acute sector'. We argue that decisions to allocate resources to high value activities, such as continuity of carer, need to be made at the macro level in the knowledge that these investments will relieve pressure on acute services while also ensuring the delivery of appropriate and high value care in the long run. To ensure that high value preventive and supportive care can be delivered, it is important that separate staff and money are allocated to, for example, models of continuity of carer to prevent shortages of resources due to rising demands of the acute services. To achieve value based maternal and newborn care, mechanisms are needed to ensure adequate resource allocation to high value maternity care activities that should be separate from the resource demands of acute maternity services. Funding arrangements should support, where wanted and needed, seamless movement of women and neonates between systems of care. [ABSTRACT FROM AUTHOR]- Published
- 2019
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36. Preference for cesarean section in young nulligravid women in eight OECD countries and implications for reproductive health education
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Stoll, Kathrin H, Hauck, Yvonne L, Downe, Soo, Payne, Deborah, and Hall, Wendy A
- Subjects
3. Good health - Abstract
Background: Efforts to reduce unnecessary Cesarean sections (CS) in high and middle income countries have focused on changing hospital cultures and policies, care provider attitudes and behaviors, and increasing women’s knowledge about the benefits of vaginal birth. These strategies have been largely ineffective. Despite evidence that women have well-developed preferences for mode of delivery prior to conceiving their first child, few studies and no interventions have targeted the next generation of maternity care consumers. The objectives of the study were to identify how many women prefer Cesarean section in a hypothetical healthy pregnancy, why they prefer CS and whether women report knowledge gaps about pregnancy and childbirth that can inform educational interventions. Methods: Data was collected via an online survey at colleges and universities in 8 OECD countries (Australia, Canada, Chile, England, Germany, Iceland, New Zealand, United States) in 2014/2015. Childless young men and women between 18 and 40 years of age who planned to have at least one child in the future were eligible to participate. The current analysis is focused on the attitudes of women (n = 3616); rates of CS preference across countries are compared, using a standardized cohort of women aged 18–25 years, who were born in the survey country and did not study health sciences (n = 1390). Results: One in ten young women in our study preferred CS, ranging from 7.6% in Iceland to 18.4% in Australia. Fear of uncontrollable labor pain and fear of physical damage were primary reasons for preferring a CS. Both fear of childbirth and preferences for CS declined as the level of confidence in women’s knowledge of pregnancy and birth increased. Conclusion: Education sessions delivered online, through social media, and face-to-face using drama and stories told by peers (young women who have recently had babies) or celebrities could be designed to maximize young women’s capacity to understand the physiology of labor and birth, and the range of methods available to support them in coping with labor pain and to minimize invasive procedures, therefore reducing fear of pain, bodily damage, and loss of control. The most efficacious designs and content for such education for young women and girls remains to be tested in future studies.
37. Unexpected consequences: women’s experiences of a self-hypnosis intervention to help with pain relief during labour
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Finlayson, Kenneth, Downe, Soo, Hinder, Susan, Carr, Helen, Spiby, Helen, Whorwell, Peter, Finlayson, Kenneth, Downe, Soo, Hinder, Susan, Carr, Helen, Spiby, Helen, and Whorwell, Peter
- Abstract
Background: Self-hypnosis is becoming increasingly popular as a means of labour pain management. Previous studies have produced mixed results. There are very few data on women’s views and experiences of using hypnosis in this context. As part of a randomized controlled trial of self-hypnosis for intra-partum pain relief (the SHIP Trial) we conducted qualitative interviews with women randomized to the intervention arm to explore their views and experiences of using self-hypnosis during labour and birth. Methods: Participants were randomly selected from the intervention arm of the study, which consisted of two antenatal self-hypnosis training sessions and a supporting CD that women were encouraged to listen to daily from 32 weeks gestation until the birth of their baby. Those who consented were interviewed in their own homes 8–12 weeks after birth. Following transcription, the interviews were analysed iteratively and emerging concepts were discussed amongst the authors to generate organizing themes. These were then used to develop a principal organizing metaphor or global theme, in a process known as thematic networks analysis. Results: Of the 343 women in the intervention group, 48 were invited to interview, and 16 were interviewed over a 12 month period from February 2012 to January 2013. Coding of the data and subsequent analysis revealed a global theme of ‘unexpected consequences’, supported by 5 organising themes, ‘calmness in a climate of fear’, ‘from sceptic to believer’, ‘finding my space’, ‘delays and disappointments’ and ‘personal preferences’. Most respondents reported positive experiences of self hypnosis and highlighted feelings of calmness, confidence and empowerment. They found the intervention to be beneficial and used a range of novel strategies to personalize their self-hypnosis practice. Occasionally women reported feeling frustrated or disappointed when their relaxed state was misinterpreted by midwives on admission or when their labour and birth e
- Full Text
- View/download PDF
38. Unexpected consequences: women’s experiences of a self-hypnosis intervention to help with pain relief during labour
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Finlayson, Kenneth, Downe, Soo, Hinder, Susan, Carr, Helen, Spiby, Helen, Whorwell, Peter, Finlayson, Kenneth, Downe, Soo, Hinder, Susan, Carr, Helen, Spiby, Helen, and Whorwell, Peter
- Abstract
Background: Self-hypnosis is becoming increasingly popular as a means of labour pain management. Previous studies have produced mixed results. There are very few data on women’s views and experiences of using hypnosis in this context. As part of a randomized controlled trial of self-hypnosis for intra-partum pain relief (the SHIP Trial) we conducted qualitative interviews with women randomized to the intervention arm to explore their views and experiences of using self-hypnosis during labour and birth. Methods: Participants were randomly selected from the intervention arm of the study, which consisted of two antenatal self-hypnosis training sessions and a supporting CD that women were encouraged to listen to daily from 32 weeks gestation until the birth of their baby. Those who consented were interviewed in their own homes 8–12 weeks after birth. Following transcription, the interviews were analysed iteratively and emerging concepts were discussed amongst the authors to generate organizing themes. These were then used to develop a principal organizing metaphor or global theme, in a process known as thematic networks analysis. Results: Of the 343 women in the intervention group, 48 were invited to interview, and 16 were interviewed over a 12 month period from February 2012 to January 2013. Coding of the data and subsequent analysis revealed a global theme of ‘unexpected consequences’, supported by 5 organising themes, ‘calmness in a climate of fear’, ‘from sceptic to believer’, ‘finding my space’, ‘delays and disappointments’ and ‘personal preferences’. Most respondents reported positive experiences of self hypnosis and highlighted feelings of calmness, confidence and empowerment. They found the intervention to be beneficial and used a range of novel strategies to personalize their self-hypnosis practice. Occasionally women reported feeling frustrated or disappointed when their relaxed state was misinterpreted by midwives on admission or when their labour and birth e
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39. Global research priorities related to the World Health Organization Labour Care Guide: results of a global consultation
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Abalos, Edgardo, Adanu, Richard, Bernitz, Stine, Binfa, Lorena, Dao, Blami, Downe, Soo, Galadanci, Hadiza, Gogoi, Aparajita, Hofmeyr, Justus G., Homer, Caroline S.E., Hundley, Vanora, Lavender, Tina, Lissauer, David, Lumbiganon, Pisake, Pattinson, Robert, Pujar, Yeshita V., Qureshi, Zahida, Stringer, Jeffrey S.A., Vogel, Joshua P., Yunis, Khalid, Abalos, Edgardo, Adanu, Richard, Bernitz, Stine, Binfa, Lorena, Dao, Blami, Downe, Soo, Galadanci, Hadiza, Gogoi, Aparajita, Hofmeyr, Justus G., Homer, Caroline S.E., Hundley, Vanora, Lavender, Tina, Lissauer, David, Lumbiganon, Pisake, Pattinson, Robert, Pujar, Yeshita V., Qureshi, Zahida, Stringer, Jeffrey S.A., Vogel, Joshua P., and Yunis, Khalid
- Abstract
Background The World Health Organization (WHO) published the WHO Labour Care Guide (LCG) in 2020 to support the implementation of its 2018 recommendations on intrapartum care. The WHO LCG promotes evidence-based labour monitoring and stimulates shared decision-making between maternity care providers and labouring women. There is a need to identify critical questions that will contribute to defining the research agenda relating to implementation of the WHO LCG. Methods This mixed-methods prioritization exercise, adapted from the Child Health and Nutrition Research Initiative (CHNRI) and James Lind Alliance (JLA) methods, combined a metrics-based design with a qualitative, consensusbuilding consultation in three phases. The exercise followed the reporting guideline for priority setting of health research (REPRISE). First, 30 stakeholders were invited to submit online ideas or questions (generation of research ideas). Then, 220 stakeholders were invited to score "research avenues" (i.e., broad research ideas that could be answered through a set of research questions) against six independent and equally weighted criteria (scoring of research avenues). Finally, a technical working group (TWG) of 20 purposively selected stakeholders reviewed the scoring, and refined and ranked the research avenues (consensus-building meeting). Results Initially, 24 stakeholders submitted 89 research ideas or questions. A list of 10 consolidated research avenues was scored by 75/220 stakeholders. During the virtual consensus-building meeting, research avenues were refined, and the top three priorities agreed upon were: (1) optimize implementation strategies of WHO LCG, (2) improve understanding of the effect of WHO LCG on maternal and perinatal outcomes, and the process and experience of labour and childbirth care, and (3) assess the effect of the WHO LCG in special situations or settings. Research avenues related to the organization of care and resource utilization ranked lowest during bo
40. Unexpected consequences: women’s experiences of a self-hypnosis intervention to help with pain relief during labour
- Author
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Finlayson, Kenneth, Downe, Soo, Hinder, Susan, Carr, Helen, Spiby, Helen, Whorwell, Peter, Finlayson, Kenneth, Downe, Soo, Hinder, Susan, Carr, Helen, Spiby, Helen, and Whorwell, Peter
- Abstract
Background: Self-hypnosis is becoming increasingly popular as a means of labour pain management. Previous studies have produced mixed results. There are very few data on women’s views and experiences of using hypnosis in this context. As part of a randomized controlled trial of self-hypnosis for intra-partum pain relief (the SHIP Trial) we conducted qualitative interviews with women randomized to the intervention arm to explore their views and experiences of using self-hypnosis during labour and birth. Methods: Participants were randomly selected from the intervention arm of the study, which consisted of two antenatal self-hypnosis training sessions and a supporting CD that women were encouraged to listen to daily from 32 weeks gestation until the birth of their baby. Those who consented were interviewed in their own homes 8–12 weeks after birth. Following transcription, the interviews were analysed iteratively and emerging concepts were discussed amongst the authors to generate organizing themes. These were then used to develop a principal organizing metaphor or global theme, in a process known as thematic networks analysis. Results: Of the 343 women in the intervention group, 48 were invited to interview, and 16 were interviewed over a 12 month period from February 2012 to January 2013. Coding of the data and subsequent analysis revealed a global theme of ‘unexpected consequences’, supported by 5 organising themes, ‘calmness in a climate of fear’, ‘from sceptic to believer’, ‘finding my space’, ‘delays and disappointments’ and ‘personal preferences’. Most respondents reported positive experiences of self hypnosis and highlighted feelings of calmness, confidence and empowerment. They found the intervention to be beneficial and used a range of novel strategies to personalize their self-hypnosis practice. Occasionally women reported feeling frustrated or disappointed when their relaxed state was misinterpreted by midwives on admission or when their labour and birth e
- Full Text
- View/download PDF
41. Unexpected consequences: women’s experiences of a self-hypnosis intervention to help with pain relief during labour
- Author
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Finlayson, Kenneth, Downe, Soo, Hinder, Susan, Carr, Helen, Spiby, Helen, Whorwell, Peter, Finlayson, Kenneth, Downe, Soo, Hinder, Susan, Carr, Helen, Spiby, Helen, and Whorwell, Peter
- Abstract
Background: Self-hypnosis is becoming increasingly popular as a means of labour pain management. Previous studies have produced mixed results. There are very few data on women’s views and experiences of using hypnosis in this context. As part of a randomized controlled trial of self-hypnosis for intra-partum pain relief (the SHIP Trial) we conducted qualitative interviews with women randomized to the intervention arm to explore their views and experiences of using self-hypnosis during labour and birth. Methods: Participants were randomly selected from the intervention arm of the study, which consisted of two antenatal self-hypnosis training sessions and a supporting CD that women were encouraged to listen to daily from 32 weeks gestation until the birth of their baby. Those who consented were interviewed in their own homes 8–12 weeks after birth. Following transcription, the interviews were analysed iteratively and emerging concepts were discussed amongst the authors to generate organizing themes. These were then used to develop a principal organizing metaphor or global theme, in a process known as thematic networks analysis. Results: Of the 343 women in the intervention group, 48 were invited to interview, and 16 were interviewed over a 12 month period from February 2012 to January 2013. Coding of the data and subsequent analysis revealed a global theme of ‘unexpected consequences’, supported by 5 organising themes, ‘calmness in a climate of fear’, ‘from sceptic to believer’, ‘finding my space’, ‘delays and disappointments’ and ‘personal preferences’. Most respondents reported positive experiences of self hypnosis and highlighted feelings of calmness, confidence and empowerment. They found the intervention to be beneficial and used a range of novel strategies to personalize their self-hypnosis practice. Occasionally women reported feeling frustrated or disappointed when their relaxed state was misinterpreted by midwives on admission or when their labour and birth e
- Full Text
- View/download PDF
42. Unexpected consequences: women’s experiences of a self-hypnosis intervention to help with pain relief during labour
- Author
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Finlayson, Kenneth, Downe, Soo, Hinder, Susan, Carr, Helen, Spiby, Helen, Whorwell, Peter, Finlayson, Kenneth, Downe, Soo, Hinder, Susan, Carr, Helen, Spiby, Helen, and Whorwell, Peter
- Abstract
Background: Self-hypnosis is becoming increasingly popular as a means of labour pain management. Previous studies have produced mixed results. There are very few data on women’s views and experiences of using hypnosis in this context. As part of a randomized controlled trial of self-hypnosis for intra-partum pain relief (the SHIP Trial) we conducted qualitative interviews with women randomized to the intervention arm to explore their views and experiences of using self-hypnosis during labour and birth. Methods: Participants were randomly selected from the intervention arm of the study, which consisted of two antenatal self-hypnosis training sessions and a supporting CD that women were encouraged to listen to daily from 32 weeks gestation until the birth of their baby. Those who consented were interviewed in their own homes 8–12 weeks after birth. Following transcription, the interviews were analysed iteratively and emerging concepts were discussed amongst the authors to generate organizing themes. These were then used to develop a principal organizing metaphor or global theme, in a process known as thematic networks analysis. Results: Of the 343 women in the intervention group, 48 were invited to interview, and 16 were interviewed over a 12 month period from February 2012 to January 2013. Coding of the data and subsequent analysis revealed a global theme of ‘unexpected consequences’, supported by 5 organising themes, ‘calmness in a climate of fear’, ‘from sceptic to believer’, ‘finding my space’, ‘delays and disappointments’ and ‘personal preferences’. Most respondents reported positive experiences of self hypnosis and highlighted feelings of calmness, confidence and empowerment. They found the intervention to be beneficial and used a range of novel strategies to personalize their self-hypnosis practice. Occasionally women reported feeling frustrated or disappointed when their relaxed state was misinterpreted by midwives on admission or when their labour and birth e
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43. Discrimination against childbearing Romani women in maternity care in Europe: a mixed-methods systematic review.
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Watson HL and Downe S
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- Female, Health Promotion, Human Rights, Humans, Pregnancy, Romania, Maternal Health Services standards, Obstetrics standards, Social Discrimination prevention & control
- Abstract
Background: Freedom from discrimination is one of the key principles in a human rights-based approach to maternal and newborn health., Objective: To review the published evidence on discrimination against Romani women in maternity care in Europe, and on interventions to address this., Search Strategy: A systematic search of eight electronic databases was undertaken in 2015 using the terms "Roma" and "maternity care". A broad search for grey literature included the websites of relevant agencies., Data Extraction and Synthesis: Standardised data extraction tables were utilised, quality was formally assessed and a line of argument synthesis was developed and tested against the data from the grey literature., Results: Nine hundred papers were identified; three qualitative studies and seven sources of grey literature met the review criteria. These revealed that many Romani women encounter barriers to accessing maternity care. Even when they are able to access care, they can experience discriminatory mistreatment on the basis of their ethnicity, economic status, place of residence or language. The grey literature revealed some health professionals held underlying negative beliefs about Romani women. There were no published research studies examining the effectiveness of interventions to address discrimination against Romani women and their infants in Europe. The Roma Health Mediation Programme is a promising intervention identified in the grey literature., Conclusions: There is evidence of discrimination against Romani women in maternity care in Europe. Interventions to address discrimination against childbearing Romani women and underlying health provider prejudice are urgently needed, alongside analysis of factors predicting the success or failure of such initiatives.
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- 2017
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44. The development and application of a new tool to assess the adequacy of the content and timing of antenatal care.
- Author
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Beeckman K, Louckx F, Masuy-Stroobant G, Downe S, and Putman K
- Subjects
- Adolescent, Adult, Belgium, Female, Gestational Age, Health Care Surveys, Humans, Monitoring, Physiologic methods, Patient Satisfaction, Pregnancy, Prenatal Care trends, Time Factors, Young Adult, Maternal Welfare, Pregnancy Complications prevention & control, Pregnancy Outcome, Prenatal Care standards
- Abstract
Background: Current measures of antenatal care use are limited to initiation of care and number of visits. This study aimed to describe the development and application of a tool to assess the adequacy of the content and timing of antenatal care., Methods: The Content and Timing of care in Pregnancy (CTP) tool was developed based on clinical relevance for ongoing antenatal care and recommendations in national and international guidelines. The tool reflects minimal care recommended in every pregnancy, regardless of parity or risk status. CTP measures timing of initiation of care, content of care (number of blood pressure readings, blood tests and ultrasound scans) and whether the interventions were received at an appropriate time. Antenatal care trajectories for 333 pregnant women were then described using a standard tool (the APNCU index), that measures the quantity of care only, and the new CTP tool. Both tools categorise care into 4 categories, from 'Inadequate' (both tools) to 'Adequate plus' (APNCU) or 'Appropriate' (CTP). Participants recorded the timing and content of their antenatal care prospectively using diaries. Analysis included an examination of similarities and differences in categorisation of care episodes between the tools., Results: According to the CTP tool, the care trajectory of 10,2% of the women was classified as inadequate, 8,4% as intermediate, 36% as sufficient and 45,3% as appropriate. The assessment of quality of care differed significantly between the two tools. Seventeen care trajectories classified as 'Adequate' or 'Adequate plus' by the APNCU were deemed 'Inadequate' by the CTP. This suggests that, despite a high number of visits, these women did not receive the minimal recommended content and timing of care., Conclusions: The CTP tool provides a more detailed assessment of the adequacy of antenatal care than the current standard index. However, guidelines for the content of antenatal care vary, and the tool does not at the moment grade over-use of interventions as 'Inappropriate'. Further work needs to be done to refine the content items prior to larger scale testing of the impact of the new measure.
- Published
- 2011
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