Search

Objective: To explore quality of maternal and newborn care (QMNC) in healthcare facilities during the COVID-19 pandemic in Switzerland. Methods: Women giving birth in Switzerland answered a validated online questionnaire including 40 WHO standards-based quality measures. QMNC score was calculated according to linguistic region and mode of birth. Differences were assessed using logistic regression analysis adjusting for relevant variables. Results: A total of 1175 women were included in the analysis. Limitations in QMNC during the pandemic were reported by 328 (27.9%) women. Several quality measures, such as deficient communication (18.0%, n = 212), insufficient number of healthcare professionals (19.7%, n= 231), no information on the newborn after cesarean (26.5%, n = 91) or maternal and newborn danger signs (34.1%, n = 401 and 41.4% n = 4 87, respectively) suggested preventable gaps in QMNC. Quality measures significantly differed by linguistic region and mode of birth. Multivariate analysis established a significantly lower QMNC for women in French- and Italian-speaking regions compared with the German-speaking region. Moreover, in several quality indicators reflecting communication with healthcare providers, women who did not answer the questionnaire in one of the Swiss national languages had significantly worse scores than others. A significant lower QMNC was also found for young and primiparous women and for those who experienced cesarean or instrumental vaginal birth. Conclusion: Women giving birth in Switzerland during the pandemic reported notable gaps in QMNC. Providers should be attuned to women who are younger, primiparous, and those who had an emergency cesarean or instrumental vaginal birth given the lower QMNC reported by these groups. Women who did not respond in a Swiss national language may need improved communication strategies.

BackgroundIn maternity services, as in other areas of healthcare, increasing emphasis is placed on improving “efficiency” or “productivity”. The first step in any efficiency and productivity analysis is the selection of relevant input and output measures. Within healthcare quantifying what is produced (outputs) can be difficult.The aim of this paper is to identify a potential output measure, that can be used in an assessment of the efficiency and productivity of labour and birth in-hospital care in Australia and to assess the extent to which it reflects the principles of woman-centred care.MethodsThis paper will survey available perinatal and maternal datasets in Australia to identify potential output measures; map identified output variables against the principles of woman-centred care outlined in Australia’s national maternity strategy; and based on this, create a preliminary composite outcome measure for use in assessing the efficiency and productivity of Australian maternity services.ResultsThere are significant gaps in Australia’s maternity data collections with regard to measuring how well a maternity service is performing against the values of respect, choice and access; however safety is well measured. Our proposed composite measure identified that of the 63,215 births in Queensland in 2014, 67% met the criteria of quality outlined in our composite measure.ConclusionsAdoption in Australia of the collection of woman-reported maternity outcomes would substantially strengthen Australia’s national maternity data collections and provide a more holistic view of pregnancy and childbirth in Australia beyond traditional measure of maternal and neonate morbidity and mortality. Such measures to capture respect, choice and access could complement existing safety measures to inform the assessment of productivity and efficiency in maternity care.

There have been gradual and continual improvements in maternity care in the UK. This has been paradoxically accompanied by increasing censure by authorities for adverse outcomes and public expression of dissatisfaction. Serious maternal and perinatal adverse outcomes have a devastating effect. Grieving families need an honest explanation, continued support and reassurance that lessons are being sought and learnt. Additionally, the public would welcome the acknowledgement of limitations of healthcare and the science itself; and that the adverse outcomes can be minimised but not eradicated. Blame culture is harmful to the clinicians, healthcare system and, ultimately, patients. The controversial issue of intrapartum fetal monitoring best illustrates the urgent need to reform mistaken science in addition to organisational and cultural improvements. Most enquiries do not critique bad science or guidelines but only birth attendants. The healthcare outcomes must continue to improve through investigations, reviews, openness, medical progress and by helping the clinicians to mitigate the limitations of scientific knowledge, resources and human factors.

application/pdf

Introduction: Variation in outcomes reported in maternity-related clinical trials and practice stifles data synthesis and contributes to ineffective or harmful treatments and interventions. Variation can be addressed using core outcome sets (COSs), minimum agreed sets of outcomes that should be measured and reported in all clinical trials in a specific area of health or health care. This scoping review identified studies that developed maternity-related COSs; evaluated the extent, scope, quality, and consistency of outcomes across similar COSs; and identified current gaps in evidence. Methods: A multifaceted search of 2 COS registers (Core Outcome Measures in Effectiveness Trials, Core Outcomes in Women's and Newborn Health), the International Consortium for Health Outcomes Measurement website, electronic databases (MEDLINE, Embase, CINAHL), and hand search was conducted. Published, English-language studies describing maternal and neonatal COSs for any health condition and published from inception to January 2020 were included. COS development process was evaluated against recently published COS Standards for Development: scope, stakeholder involvement, and consensus process. Results: Thirty-two articles relating to 26 COSs were included (maternal: 18 articles that addressed 17 COSs; neonatal: 14 articles that addressed 9 COSs) and covered a range of obstetric and neonatal conditions. COSs were published between 2006 and 2020, 58% since 2017. Maternal COSs included more outcomes (median, 17; range, 50) than neonatal COSs (median, 8; range, 20). Overlap in COSs was seen for maternity care and gestational diabetes. Overlap in outcomes was seen across similar COSs, which were mostly inconsistent or poorly defined. No included COS met all minimum standards for development. Two COSs extended recommendations for how and when to measure outcomes. Discussion: Growth in COS development in the last 3 years signifies increasing commitment to address variation and improve data synthesis. Although the quality of the development process has improved in the last 3 years, there is a need for improvement. This article presents an urgent need to minimize overlap in outcomes and standardize outcome measurement, case definitions, and timing of measurement between COSs.

Highlights • The performance of maternity departments varies and is a policy concern. • Inspection and ratings is a possible means to increase performance. • Routinely collected data may help measure the performance of maternity departments. • Using routine data, post-inspection performance was not associated with inspection scores. • Inspection and rating do not stimulate improvement on the performance measures studied., Objectives To determine whether the prior performance of maternity services, as measured by Royal College of Obstetricians and Gynaecologists performance indicators, is associated with ratings by the Care Quality Commission at subsequent inspection, and whether performance changes occur after inspection. Methods We used hospital activity data from 176 maternity sites inspected between October 2013 and March 2016 to generate a set of performance indicators developed by the Royal College of Obstetricians and Gynaecologists. We linked these data to Care Quality Commission data on inspection dates and rating scores and used regression models, controlling for site level effects, to estimate the relationships between inspection ratings and performance indicators before and after inspections. Results Coefficients measuring the relationship between indicator performance and subsequent inspection rating score had wide confidence intervals which crossed zero suggesting no statistically significant relationship prior to inspection. The same absence of statistical significance was observed for changes in indicator performance after inspection. Conclusions The use of routine data for performance monitoring is becoming increasingly important as regular inspection is costly and regulators require accurate and timely intelligence. However, we found no statistically significant relationships between inspection ratings and performance indicators before or after inspections in maternity services. This calls into question the validity and reliability of the performance indicators, the inspection process and ratings, or both, as measures of performance.

Background Meeting the complex needs of pregnant migrants requires an innovative approach. Migrant women's experiences and opinions should directly guide service development if these needs are to be met effectively. Aims To evaluate the specialist migrant maternity service provided by Kings College Hospital London based upon users' experience and satisfaction. Methods A qualitative service evaluation via semi-structured, multi-lingual, in-depth interviews with 10 service users. Data was analysed using a general inductive approach for thematic analysis. Findings Positive aspects: access to midwife and referrals, provision of essentials and transport, respect and kindness of caregivers. Negative aspects: poor maternal nutrition, lack of access to hygienic infant-feeding equipment, lack of social support building and lack of service signposting. Conclusion Women conveyed a high level of satisfaction with the service. The negative aspects that persist are, arguably, not within the immediate remit of the maternity team, yet they negatively affect the health of these women, and therefore merit awareness raising if holistic care is to be achieved. Seven service recommendations have been made.

Background: Labor is an event and experience in a woman's life. After giving birth, a mother experiences a postpartum period or puerperal period that is a recovery period. Uncomfortable feeling can cause anxiety, especially in primiparous mothers. Therefore, not to have an impact rise in stress, even untill postpartum depression, a midwife as a spearhead of provider maternal health care must be able to reduce the anxiety which experiences of postpartum mothers, especially primiparous through assistance ‘OSOC’ methods. Objective: To determine the effect of the application of the OSOC assistance maternity service model toward anxiety among primiparous mothers in the postpartum period at Kendal District Health Center. Research Methods: Quantitative data analysis was used to assess the anxiety of postpartum primiparous mothers with the intervention group and the control group, a type of Quasi Experiment research with a non-equivalent control group design. The subjects of this research was divided into two groups, they were intervention groups and control groups. In the intervention group, it was given in the form of providing OSOC assistance in the postpartum period, while the control group was given conventional puerperal care. The research at Kendal District Health Center in May-October 2019. Results: There was a significant difference between anxiety in primiparous postpartum mothers with OSOC conventional assistance, and the magnitude of the effect of mentoring pregnant women with OSOC on anxiety by 7.804. Conclusions: There was a significant difference between anxiety in primiparous postpartum mothers with OSOC and conventional assistance.

Background Prenatal pertussis vaccination was introduced in 2012 in England and is primarily delivered through general practice. Since 2017 some maternity services are commissioned to offer it too. We aimed to describe the maternity service delivery of prenatal pertussis vaccination and its impact on vaccine uptake. Methods We described the proportion of maternity services in England commissioned to offer pertussis vaccination to pregnant women in 2017/18 and the proportion of women vaccinated in this setting using a self-administered survey of NHS commissioners. We categorised clinical commissioning groups (CCGs) in England into “implementing” and “non-implementing” pertussis vaccination in maternity services. We identified CCGs where vaccination data was reliably transferred from maternity services to primary care records (source of routine data on vaccine uptake) and among those compared changes in vaccine uptake in implementing vs non-implementing CCGs between March 2016 (before implementation) and March 2018 (after). Findings Of 141 maternity service units in England, 61% delivered prenatal pertussis vaccine in 2017/18. Of those 57.0% of maternity services immunized less than 10% of pregnant women and only 7.1% of maternity services immunized more than 40% of pregnant women. Between March 2016 and March 2018, coverage increased by 19.6% among non-implementing CCGs compared with 17.8% among all implementing CCGs (difference −2.2, p = 0.48) and 28.2% among implementing CCGs with reliable methods of data transfer (difference 8.6, p = 0.04). This difference translated to a difference of 1.6 percentage points in absolute terms. Interpretation Delivering pertussis vaccine through maternity services has a moderate but important impact on vaccine uptake. There is a need to improve data transfer on vaccines administered in maternity service units to primary care. Maternity services should offer the vaccine to improve coverage and thus optimise protection for young infants. Barriers to effective programme implementation should be investigated and addressed.

Background Pregnant women in prisons are recognised as a marginalised group. However, there is a limited understanding of the women’s unique maternity needs and how correctional institutions and maternity service providers respond to these needs. Aim The aims of the review are threefold. 1. Identify pregnant women’s needs during the antenatal, birthing and postnatal periods in prison. 2. Examine how the pregnant incarcerated women’s needs are met by the correctional institutions. 3. Explore what maternity services are available and how these services are provided. Method An integrative literature review was undertaken. A comprehensive search strategy using seven electronic databases resulted in the retrieval of 363 articles. Of them, 32 peer-reviewed studies met the final selection criteria and were included in this review which utilised the Critical Appraisal Skills Program tools and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart. Thematic analysis identified universal themes. Findings Three dominant themes emerged related to the experience of pregnant women in prison: (1) risks and vulnerability factors; (2) prison enablers and supports; and (3) prison barriers. Extant research on risks and vulnerability factors is disproportionate to research examining how prisons can enable or obstruct responding to the women’s perinatal needs. Limited research on the midwifery support available to the women in prison is available. Significantly, only two out of 32 reviewed papers include research directly conducted with the pregnant women in prison. Conclusion Pregnant women in prisons have complex needs. More research is required to understand how prisons can enhance the pregnancy experience by engaging pregnant women in prisons as research participants.

A number of studies show that acupuncture may help with labour and delivery. An NHS maternity acupuncture service providing birth preparation acupuncture has assessed its routine hospital maternity annual data from 2014 to 2016 to see what effect it had on labour and delivery outcomes. The data from this service was analysed and women who had birth preparation acupuncture were compared with those who did not receive it. Maternal age, parity and socio-economic status were considered confounders and were adjusted for in the analysis. Women who received acupuncture had more normal births (less surgical births) [OR 0.76 (0.64, 0.91)], required less intrapartum analgesia [OR 0.74 (0.63, 0.86)], fewer components of an induction of labour [OR 0.74 (0.61, 0.91)] and a reduced length of a hospital stay [OR 0.91 (0.87, 0.95)]. The patients highly valued the availability of acupuncture within the maternity service as it enhanced their patient journey.Impact statementWhat is already known on this subject? Numerous studies provide evidence for the effects of acupuncture in normalising pregnancy and birth. These effects include musculoskeletal preparation of the pelvis, cervical ripening, enhancing endogenous oxytocin release, and analgesic properties.What do the results of this study add? Our analysis shows that women who received birth preparation acupuncture had fewer surgical births, required less intrapartum analgesia, less components of induction of labour and had a reduced length of hospital stay, supporting the use of maternity acupuncture in normalising birth outcomes.What are the implications of these findings for clinical practice and/or further research? The findings show that acupuncture, by potentially normalising birth, may lead to reductions in costs of service. Further, additional research is required to see whether acupuncture is cost effective and could have an adjunctive role as a complementary therapy for improving birth outcomes and a woman's experience of childbirth.

Aim To determine the institutional delivery service use and identify factors associated among women who delivered during the last two years in Dallocha town. Design A community‐based cross‐sectional study. Methods The study was conducted from 10 March–10 April 2016. A total of 411 study participants were selected by using systematic sampling method. The source population was all reproductive age group mothers. Bivariate and multiple logistic regression was conducted. Results Institutional delivery was 304 (74%). Factors associated with increased likelihood of institutional delivery were owning a radio or television, making more than four antenatal care visits, knowing at least one maternity service advantage. Not knowing about at least one benefit institutional delivery decreased the likelihood of institutional delivery. Conclusion Three‐quarters of the mothers delivered at the health institution. Accordingly, promotion of antenatal care follow‐up, in‐service training of health professionals and health education is recommended.

Objective: To explore women’s experiences of maternity service reconfiguration during the first wave of the SARS-CoV-2 (COVID-19) pandemic.Design: Qualitative interview study.Setting: South London, United Kingdom.Participants: Women (N=23) who gave birth between March and August 2020 in one of the ten South London maternity hospitals.Methods: Semi-structured interviews were conducted (N=23), via video-conferencing software. Transcribed interviews were analysed ‘by hand’ using Microsoft Word. Template analysis was selected to code, analyse, and interpret data, according to the findings of a recently-published national survey of maternity service reconfiguration across the UK in response to COVID-19.Findings: Three main themes emerged through analysis: (i) Disruption to In-Person Care and Increased Virtual Care Provision, (ii) Changes to Labour and Birth Preferences and Plans, (iii) Advice for Navigating Maternity Services During a Pandemic. Key Conclusions: Women reported mixed views on the reduction in scheduled in-person appointments. The increase in remote care, especially via telephone, was not well endorsed by women. Furthermore, women reported an under-reliance on healthcare professionals for support, rather turning to family.Implications for Practice: We provide insight into the experiences of women who received antenatal, intrapartum, and postnatal care during the first wave of the COVID-19 pandemic. Our findings should inform healthcare policy to build back better maternity care services after the pandemic.

BackgroundThe Healthcare Complaints Analysis Tool (HCAT) is a coding taxonomy developed to interrogate patient complaints for quality and safety improvement lessons. The reliability of the tool has...

Doug Cronie,1,2 Marlies Rijnders,3 Suze Jans,3,4 Corine J Verhoeven,5,6 Raymond de Vries7–9 1Department of Midwifery, OLVG (West) Hospital, Amsterdam, The Netherlands; 2Department of Midwifery Science, Faculty of Public Health and Primary Care, University of Maastricht, Maastricht, The Netherlands; 3Department of Child Health, TNO, Leiden, The Netherlands; 4Editorial Department, Dutch Journal for Midwives (KNOV), Utrecht, The Netherlands; 5Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands; 6Department of Obstetrics and Gynecology, Maxima Medical Centre, Veldhoven, The Netherlands; 7Faculty of Midwifery Education & Studies, Zuyd University, Maastricht, The Netherlands; 8CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; 9Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA Aims: To examine the experiences of inter-professional collaboration of maternity service providers in the Netherlands and to identify potential enhancing and inhibiting factors for inter-professional collaboration within maternity care in the Netherlands. Background: Good collaboration between health care professionals is a key element of safe, effective care, but creating a collaborative culture can be challenging. Good collaboration requires, among other things, negotiating different professional orientations and the organizational constraints of hierarchies and scheduling. Good collaboration is especially important in maternity care. In the Netherlands, suboptimal collaboration has been cited as a significant factor in maternal deaths and in adverse incidents occurring in hospitals during evenings, nights, and weekends. In spite of its importance for effective maternity care, little is known about the nature and quality of collaboration between maternity care professionals. In order to fill this gap, we examined the inter-professional collaboration within multi-disciplinary teams (MDTs) providing maternity services in the Netherlands. Methods: Online survey of MDTs (consisting of hospital and PCMs, doctors, and carers) involved in the provision of maternity services in the Netherlands. We used a validated measure of collaboration (the Leiden Quality of Work Questionnaire) to analyze the attitudes of those involved in the provision of maternity services about multi-disciplinary collaboration in their work. We used descriptive and inferential statistics to assess differences between the groups. Results: 40% of all respondents were not satisfied with collaboration within their MDT. Overall, mean collaboration scores (MCS) were low. We found significant differences in MCS between professional groups. Midwives – community and hospital based – were pessimistic about collaboration in future models of maternity care. Discussion: In the Netherlands, collaboration in maternity care is less than optimal. Poor collaboration is associated with negative consequences for patient safety and quality of care. Strategies to address suboptimal collaboration exist; however, no one-size-fits-all approach is identified in the literature. Conclusion: Suboptimal collaboration exists within the midwifery model of care in the Netherlands and the relationship between care providers is under pressure. This could affect patient safety and quality of care, according to the literature. Précis: This paper presents an in-depth examination of the nature of, and attitudes about, collaboration between members of the MDT involved in the provision of maternity services in the Netherlands. Keywords: interprofessional communication, communication, multi-disciplinary team, interprofessional teamwork, interprofessional collaboration survey, questionnaire hospital midwife, primary care midwife, midwifery, carer, doctor, nurse, maternity care assistant, integrated-care

Introducción: La policitemia afecta del 1 a 5% de los recién nacidos, se asocia a complicaciones por afectación orgánica y sistémica en el neonato que puede ser prevenible. El objetivo de la presente investigación fue determinar la prevalencia de Policitemia neonatal y sus factores asociados en recién nacidos en el servicio de maternidad del Hospital ¨Vicente Corral Moscoso de la ciudad de Cuenca-Ecuador en el período mayo 2018 a mayo 2019. Métodos: Se realizó un estudio transversal analítico, el universo estuvo conformado por todos los recién nacidos en el servicio de maternidad del Hospital ¨Vicente Corral Moscoso¨. La muestra fue probabilística de 470 neonatos y sus madres. Para identificar asociación se realizó mediante X2 y para medir intensidad de asociación se utilizó OR (IC 95%) y valor de P < 0.05. Resultados: Ingresaron al estudio en forma aleatoria 470 casos. Se obtuvo una prevalencia del 12.8%. La residencia materna del 93% fue por sobre los 2000 metros sobre el nivel del mar. Los factores asociados fueron: bajo peso al nacer (OR 3.8; IC95%: 1.9 – 7.5) P < 0.001), patología materna incluida la diabetes (OR 2.6, IC95%: 1.3 – 5.2) P = 0.013), toxemia del embarazo (OR 2.3; IC95%: 0.7 – 7.6) P = 0.134 y asociación negativa con prematuridad (OR 0.3; IC 95%: 0.07 – 1.2) P = 0.099. Conclusiones: la prevalencia de policitemia neonatal es alta y se asocia significativamente con bajo peso al nacer, patología materna.

Background Emergency cesarean section is a commonly performed surgical procedure in pregnant women with life-threatening conditions of the mother and/or fetus. According to the Royal College of Obstetricians and Gynecologists and the American College of Obstetricians and Gynecologists, decision to delivery interval for emergency cesarean sections should be within 30 min. It is an indicator of quality of care in maternity service, and if prolonged, it constitutes a third-degree delay. This study aimed to assess the decision to delivery interval and associated factors for emergency cesarean section in Bahir Dar City Public Hospitals, Ethiopia. Method An institution-based cross-sectional study was conducted at Bahir Dar City Public Hospitals from February to May 2020. Study participants were selected using a systematic random sampling technique. A combination of observations and interviews was used to collect the data. Data entry and analysis were performed using Epi-data version 3.1 and SPSS version 25, respectively. Statistical significance was set at p Result Decision-to-delivery interval below 30 min was observed in 20.3% [95% CI = 15.90–24.70%] of emergency cesarean section. The results showed that referral status [AOR = 2.5, 95% CI = 1.26–5.00], time of day of emergency cesarean section [AOR = 2.5, 95%CI = 1.26–4.92], status of surgeons [AOR = 2.95, 95%CI = 1.30–6.70], type of anesthesia [AOR = 4, 95% CI = 1.60–10.00] and transfer time [AOR = 5.26, 95% CI = 2.65–10.46] were factors significantly associated with the decision to delivery interval. Conclusion Decision-to-delivery intervals were not achieved within the recommended time interval. Therefore, to address institutional delays in emergency cesarean section, providers and facilities should be better prepared in advance and ready for rapid emergency action.