This animation was developed, based on interviews with women who had experienced their birth as t... more This animation was developed, based on interviews with women who had experienced their birth as traumatic, giving voice to these lived experiences.
Based on the findings of the following studies:
Koster D, Romeijn C, Sakko E, Stam C, Steenhuis N, de Vries D, van Willigen I, Fontein-Kuipers Y. Traumatic childbirth experiences: practice-based implications for maternity care professionals from the woman’s perspective. Scandinavian Journal of Caring Sciences. 2019. doi: 10.1111/scs.12786
Fontein-Kuipers Y, Koster D, Romeijn C, Sakko E, Stam C, Steenhuis N, de Vries D, van Willigen I. I-Poems – Listening to the voices of women with a traumatic birth experience. Journal of Psychology and Cognition. 2018; 3(2): 29-36. 10.35841/psychology-cognition.3.2.29-36
Background: Virtual reality has been shown to reduce pain during labour. We aimed to determine wh... more Background: Virtual reality has been shown to reduce pain during labour. We aimed to determine whether virtual reality reduces analgesia use and shortens labour duration.
Methods: A non-randomised pilot study was conducted, using a matched casecontrol design (1:2 ratio). Cases were women who voluntarily used virtual reality alongside standard intrapartum pain management, including non-pharmacological methods and/or epidural analgesia. Controls received standard intrapartum pain management.
Results: A total of 108 women were included for analysis (36 cases vs. 72 controls). Perceived pain scores before and after virtual reality use did not differ significantly (p = 0.43, p = 0.73), suggesting a limited immediate analgesic effect under current conditions. Epidural analgesia rates and cervical dilation at initiation of analgesia did not show significant differences between cases and controls (p = 0.13, p = 0.42). After adjusting for induction of labour and cervical dilation at admission, there were no significant differences for duration of epidural analgesia (p = 0.86, p = 0.56), duration of labour (p = 0.64, p = 0.55), or vaginal birth (p = 0.23). Adjusted models indicated a non-significant trend toward shorter durations of labour, birth, and epidural exposure for cases.
Conclusions: Our pilot study did not reveal a decrease in perceived pain or epidural analgesia use or an effect on duration of labour and vaginal birth.
Scandinavian journal of caring sciences, Mar 7, 2024
Objective: To reach consensus between care providers and childbearing women about the midwife&... more Objective: To reach consensus between care providers and childbearing women about the midwife's relevant and appropriate domains and elements to support transition to motherhood.
Methods: A modified web-based Delphi study was conducted in Flanders (Belgium). After performing a systematic literature review, searching the grey literature and an online poll, a set of 79 items was generated. In two rounds, the items were presented to an expert panel of (1) care providers from various disciplines providing services to childbearing women and (2) to pregnant women and postpartum women up to 1year postpartum. Consensus was defined when 70% or more of the experts scored ≥6, 5% or less scored ≤3, and a standard deviation of ≤1.1.
Findings: In the first Delphi round, 91 experts reached consensus on 24 items. Seventeen round one items that met one or two consensus objectives were included in round two and were scored by 64 panel experts, reaching consensus on three additional items. The final 27 items covered seven domains: attributes, liaison, management of care from a woman-centred perspective, management of care from the midwife's focus, informational support, relational support, and the midwife''s competencies.
Conclusions: The shared understanding between childbearing women and care providers shows that the midwife's transitional support is multifaceted. Our findings offer midwives a standard of care, criteria, guidance, and advice on how they can support childbearing women during transition to motherhood, beyond the existing recommendations and current provision of transitional care.
Background: The newest Belgian clinical practice guideline on intrapartum care for low-risk birth... more Background: The newest Belgian clinical practice guideline on intrapartum care for low-risk births requires support to facilitate its implementation, as merely presenting guidelines does not guarantee adoption by endusers. Aim: To systematically identify and prioritise clinical questions that need greater implementation support, understand the context of barriers and facilitators to implementation, and define a set of healthcare behavioural implementation activities for Belgian maternity services.
Methods: We employed an integrated knowledge translation approach, combining the Knowledge-To-Action and Intervention Mapping frameworks. This approach involves identifying clinical questions that require enhanced implementation support, analysing barriers within the context, and defining change and performance objectives. Feedback from a Belgian multi-stakeholder consulting group and Advisory Board informed the process.
Findings: Two clinical questions require greater support for implementation: (1) initial clinical investigations during labour and (2) ongoing investigations and interventions during a low-risk birth. Barriers to applying the recommendations include individual healthcare professional factors and professional interactions. Implementation demands healthcare professionals recognise the physiological aspects of labour and birth, stay updated on the evidence, accept the evidence supporting the management of low-risk births, and involve shared decision-making while seeking the woman's consent. Achieving behavioural change consists of shifting attitudes, intentions, knowledge, social norms, and skills.
Discussion: The identified barriers to implementing recommendations emphasise the crucial role of interpersonal dynamics in successful guideline implementation. Therefore, policies should tackle structural challenges within Belgian maternity care.
Conclusion: To enhance maternity care services, communication, collaboration, and mutual understanding across professional boundaries are needed.
Perspectives on Sexual and Reproductive Health, 2025
Background: Emotional touchpoints are moments during perinatal care that evoke an emotional respo... more Background: Emotional touchpoints are moments during perinatal care that evoke an emotional response in a woman. There is a lack of knowledge regarding the centrality of how touchpoints and emotions are framed in the real-life experiences of childbearing women. Aim: To explore how birth-related emotional touchpoints interact and how the emotions in the context of these healthcare experiences interact. Methods: We performed a systematic mixed studies review to capture childbearing women's prospective and retrospective reports of birth expectations and experiences. We conducted a literature search in CINAHL (EBSCO), Medline (EBSCO), PubMed, Web of Science, and Ovid, followed by hand searching and forward and backward citation searching from the included articles. We performed a quality appraisal using the Critical Appraisal Skills Program. We used Epistemic Network Analysis to model and visualize the connections and structure of the emotional touchpoints and the emotions. Results: We included 28 articles, showing overall moderate quality. We constructed two models, one of emotional touchpoints and one of emotions. The emotional touchpoints model showed a strong connection between Coping and the Process of Labor & Birth and between the Process of Labor & Birth and Beliefs (belief systems) about Labor & Birth. The primary emotions model showed strong connections between Joy and Fear, between Fear and Sadness and between Sadness and Joy. Conclusions: This paper illustrates how the multidimensionality of birth-related emotional touchpoints and the positive and negative emotions prospectively and retrospectively reported by pregnant and postpartum women were distilled-informing the conversation between care providers and childbearing women. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Aim: To investigate the underlying constructs of the 29 digital adaptability competencies to iden... more Aim: To investigate the underlying constructs of the 29 digital adaptability competencies to identify the phenomenon's key or conceptual properties.
Background: A shift towards a strong and increasing presence of eHealth in future practice requires the competencies of nurses and midwives. This ability to adapt to technological evolutions is called digital adaptability. A set of 29 items representing the competencies of digital adaptability for nurses and midwives provides the first comprehensive description of this relatively new concept.
Design: Cross-sectional survey with a total sample size of 557 Flemish midwives and nurses.
Methods: Internal consistency and construct validity were established using Cronbach's alpha, exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA).
Results: EFA revealed two factors: 'me and the digital world' (17 items) and 'me, the digital world, and my patient' (12 items). CFA tested the model and showed a good model-fit. Strong internal consistency was observed.
Conclusions: Two factors were identified. The first, 'me & the digital world,' is task-oriented and focuses on nurses/midwives' personal use of technology. The second, 'me, the digital world, and my patient,' is patientcentered and focuses on nurses' and midwives' use of technology while interacting with their patients during care provision.
Background: The social space of birth-the birth environment, its occupants, and the human activit... more Background: The social space of birth-the birth environment, its occupants, and the human activities taking place-is interconnected with birth experiences.
Aim: To investigate how the reality of the social space of birth affects women's positive birth experiences.
Methods: We combined open-text responses to the Babies Born Better survey from 3633 postpartum women in Austria, Belgium, the Czech Republic, Germany, Spain, the Netherlands, and the United Kingdom and 39 interview transcripts from Czech and Dutch postpartum women. We conducted a textual and thematic analysis.
Findings: Three themes and 11 categories were generated: (1) Exercising fundamental human agency in the birth space consists of the categories: 'exercising rights', 'the protection of human vulnerability', and 'the freedom to be authentic', which women regard as prerequisite components of the birth space. (2) Regulatory frameworks & care philosophies in maternity services, including the categories '(financial) regulations', 'values of the care provider and the institution', and 'model of care', are regarded as attributes of the birth space. Theme (3) Building a nest for comfort and connection comprises the categories 'relational and affective atmosphere during labour & birth', 'performative atmosphere during labour & birth', 'shelter', 'implicit and explicit tacit doing & being' and 'symbol of deeper meaning'.
Discussion/Conclusion: The reality of the birth space of women with positive birth experiences consists of human rights and birth rights, the quality of interactions with care providers during labour and birth in a relationshipcentred and relation-continuity model of care, and a place to retreat from the world.
In 2017, the continuity of midwifery care model was introduced as the way forward in Scottish mat... more In 2017, the continuity of midwifery care model was introduced as the way forward in Scottish maternity and neonatal services. There is no shared research strategy aligning research needs with an agenda, setting goals and revising plans. In this paper, we outline the systematic multi-actor and integrated knowledge translation process that frames and informs our initiative to develop a continuity of midwifery care research strategy, focusing on establishing a comprehensive mission, vision, and research topics. Guided by the pre-implementation process as part of the implementation science methodology, we engaged with a Scottish group of stakeholders, including service providers, academics, managers/policymakers, service users' advocates and midwifery students during targeted activities to contribute to a widely held perspective. We collected data using an online poll, subgroup brainstorming sessions, plenary group discussions, evaluation and video recording to frame and inform the research mission, vision and study topics. Data collection tools included word clouds, brainstorming sheets, observation notes, ranking, evaluation forms and recording transcripts. The outcomes of a stepwise analytic approach of mapping, synthesising, and using the data to develop a continuity of midwifery care research direction and focus will inform future funding applications, studies and projects. The pre-implementation process and actions described in this paper can serve as an example of structuring comprehensive research strategies in other settings, cultures, domains or contexts.
Writing for publication can be a challenging experience. Whilst midwives develop writing skills t... more Writing for publication can be a challenging experience. Whilst midwives develop writing skills through their university education, writing a journal article can be quite different.
Purpose: To explain some basic skills of scientific writing when preparing a paper for publication to support midwives in engaging in scientific writing.
Overview: Four basic elements of scientific writing will be presented: the importance of careful word choices, the use of active and passive voice, sentence and paragraph structures, and review and editing. Examples of poor and better writing are given to illustrate these basic elements of good academic writing. We hope potential midwifery authors will read and refer to this article when writing. As editors, the elements addressed here are common problems found when reviewing submitted manuscripts that, with guidance, can be easily overcome.
Writing for publication can be a challenging experience. Whilst midwives develop writing skills t... more Writing for publication can be a challenging experience. Whilst midwives develop writing skills through their university education, writing a journal article can be quite different. Purpose: To explain some basic skills of scientific writing when preparing a paper for publication to support midwives in engaging in scientific writing. Overview: Four basic elements of scientific writing will be presented: the importance of careful word choices, the use of active and passive voice, sentence and paragraph structures, and review and editing. Examples of poor and better writing are given to illustrate these basic elements of good academic writing. We hope potential midwifery authors will read and refer to this article when writing. As editors, the elements addressed here are common problems found when reviewing submitted manuscripts that, with guidance, can be easily overcome.
Background: The Continuity of Midwife Care (CMC) model is an evidence-based care model that posit... more Background: The Continuity of Midwife Care (CMC) model is an evidence-based care model that positively influences the health and well-being of women, their families, and midwives. Although effective communication strategies have not been determined, online resources are known to reach a wider audience and make CMC research more visible. The All-you-need-to-know-about-continuity- of-carer newsletter, distributed by the authors, is a strategy to communicate valuable and credible CMC content from knowledge producers to users.
Purpose: To explore the newsletter’s functional elements and the connection between it as a communication strategy and the individuals interacting with it and to present a case demonstration of a newsletter example.
Methods: A descriptive case report with a theory-driven approach using 10 elements of human communication theories.
Conclusions: The following elements of human communication contribute to understanding the functioning of the newsletter: Grounded Theoretical Theory, the Practical-Action Theory and goal-oriented communication (communication theory), the Syntactic Theory of Visual Communication and the rhetorical tradition of communication (tradition of communication), Elaboration Likelihood and the socio-cultural model of communication (communicator), implied compliance-gaining, parole, semiosis, narrative paradigm and rhetoric logic (message), social organisation communication, co-cultural communication and invitational rhetoric (conversation), the orientation and exploratory affective exchange stages of social exchange (relationship), Structuration Theory (group), the Theory of Bureaucracy (organisation), the Cultivation Theory (media), and the Diffusion of Innovation and Ethnography of Communication (culture and society). Implications: The newsletter succeeds in managing CMC information and reaching an interested audience. Further evaluation is required to explore if or how the newsletter affects information use.
Background/Problem: To integrate midwife-led care in Belgian maternity services, understanding wh... more Background/Problem: To integrate midwife-led care in Belgian maternity services, understanding whether midwives are primed of executing the change is needed.
Aim: To explore Belgian midwives’ readiness for midwife-led care and understand the underlying processes.
Methods: A mixed-methods sequential study: 1) A survey including 414 practising midwives and 2) individual interviews with 12 (student) midwives. General linear model analysis was used to examine the trend between knowledge, self-efficacy and performance mean scores - indicators of midwife-led care readiness - proposed in a 27-item questionnaire. The Readiness Assessment Framework served as a template for qualitative thematic analysis.
Findings: Template analysis illustrated the underlying mechanisms of midwifery-led care readiness: Governmental and institutional steering and rule-making functions, regulation and reimbursement, awareness of midwife-led care among stakeholders, capacity to extend primary care postpartum services to antenatal and intrapartum care and healthcare professionals’ lack of awareness of available data of women’s experiences and midwife-led care efficacy in Belgium. These qualitative findings contribute to the understanding of the significant trend with decreasing function for knowledge, self-efficacy and performance mean scores of 25 midwife-led care readiness indicators, and the two non-significant indicators referring to a physiological postpartum period.
Discussion/Conclusion: In determining midwife readiness for midwife-led care, we observed adequate knowledge mean scores, associated with low self-efficacy and even lower midwife-led care performance mean scores. Our findings suggest limited readiness for MLC in antenatal and intrapartum care. Belgian midwives are the domain experts of postpartum
Methods: A 1:3 nested case-control study was performed. A data set including 676 participants (169 cases/507 controls) was composed based on core characteristics. Using independent t-test and chi-square, the two groups were compared for mean depression, self and perceived stigma, depression literacy scores, and for positive Whooley items and heightened depression scores. The primary analysis was adjusted for covariates.
Results: The number of positive Whooley items, the above cut-off depression scores, mean depression, perceived stigma, and depression literacy scores showed statistically significant differences between cases and controls, in favor of the intervention group. When adjusting for the covariates, the statistically significant differences between cases and controls remained for depression, perceived stigma, and depression literacy, for the positive Whooley items and for above cut-off depression scores.
Background In Belgium most women receive epidural analgesia during labour. Although, it offers sa... more Background In Belgium most women receive epidural analgesia during labour. Although, it offers satisfactory pain relief during labour, the risk on a series of adverse advents has been reported. The objective of this study was to determine factors associated with the intention of pregnant women, anticipating a vaginal birth, of requesting epidural analgesia during labour. Methods A cross-sectional study, using an online self-report questionnaire was performed, including socio-demographic and personal details. Associated factors were examined with the HEXACO-60 questionnaire, the Mental Health Inventory-5, the Tilburg Pregnancy Distress Scale and the Labour Pain Relief Attitude Questionnaire for pregnant women. The level of intention to request epidural analgesia was based on two questions: Do you intend to ask for epidural analgesia (1) at the start of your labour; (2) at some point during labour? Data were collected predominantly during the second and third trimester of pregnancy. D...
Methods: A 1:3 nested case-control study was performed. A data set including 676 participants (169 cases/507 controls) was composed based on core characteristics. Using independent t-test and chi-square, the two groups were compared for mean depression, self and perceived stigma, depression literacy scores, and for positive Whooley items and heightened depression scores. The primary analysis was adjusted for covariates.
Results: The number of positive Whooley items, the above cutoff depression scores, mean depression, perceived stigma, and depression literacy scores showed statistically significant differences between cases and controls, in favor of the intervention group. When adjusting for the covariates, the statistically significant differences between cases and controls remained for depression, perceived stigma, and depression literacy, for the positive Whooley items and for above cutoff depression scores.
Humanised midwifery care is a fundamental human right and need. This exploratory online survey pr... more Humanised midwifery care is a fundamental human right and need. This exploratory online survey presents a collective perception of meaningful standards of humanised midwifery care for excellent daily practice obtained from an international multi-actor group of maternity service users and providers. After performing a literature review, 137 key elements of humanised midwifery were extracted, listed, and rephrased into criteria. The criteria were distributed, and participants added 38 criteria. The perceived level of humanised midwifery performance was scored from 1 (low/substandard) to 10 (excellent). The 9-10 scores benchmarked humanised midwifery care excellence. 312 care professionals benchmarked 42 criteria, and 277 pregnant and postpartum women benchmarked 23 criteria showing a 30 % overlap. A total set of 50 criteria emerged, promoting humanised midwifery excellence. The benchmarking criteria suggest a shared conceptual thinking of person-centeredness and meaningfulness and provide a practical paradigm for the provision and receipt of humanised midwifery care.
Purpose: This study aims to describe the phenomenon of unperceived pregnancy followed by neonatic... more Purpose: This study aims to describe the phenomenon of unperceived pregnancy followed by neonaticide with a focus on the lack of awareness of reproductive potential in an Austrian sample.
Methods: An explorative comparative study of neonaticide cases with single and repeat perpetrators was conducted using nationwide register-based data from 1995 to 2017. A total number of 55 cases out of 66 were included in the analysis. A standardized coding sheet was used and calculations were performed.
Results: 48 women gave birth to 101 children, of which 55 were killed, 23 children lived out of home care and 23 lived with the perpetrator We found a higher fertility rate in both neonaticide perpetrators in the single (1,9) and the repeat group (4,25) in comparison to the general population (1,4). The use of contraception was only 31% among neonaticide perpetrators, deviating substantially from the general Austrian population age group (16-29yrs) which used contraception in 91%. The neonaticide perpetrators used an effective contraception method (pearl-index < 4) in only 2%, whereas 20% of the general population did so. The number of unperceived pregnancies was high in both groups (50/55) 91%.
Conclusion: Future case reports and forensic evaluations should take reproductive behavior into account, as it may offer valuable insights into the events leading up to neonaticide. Our findings suggest that denial of reproductive potential often precedes unperceived pregnancies. In the Austrian cohort, women who experienced unperceived pregnancies resulting in unassisted births and subsequent neonaticide showed a low prevalence of contraceptive use. This is particularly noteworthy given that the primary motive for neonaticide is unwanted pregnancy.
Aim: To examine the current literature on educational strategies and interventions developed with... more Aim: To examine the current literature on educational strategies and interventions developed with the objective of teaching or enhancing communication skills of student midwives during their pre-registration education programmes.
Design: A scoping review based on the Joanna Briggs Institute framework was conducted using predefined criteria and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.
Methods: A comprehensive search was conducted using various databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, PsycINFO, Maternity and Infant Care Database (MIDIRS), Web of Science and Education Resources Information Centre (ERIC)) in October 2023.
Results: A total of 120 titles and abstracts were screened. A final number of eight articles were subjected to quality appraisal and included in the scoping review. Five themes were identified which describe educational strategies and interventions including: simulation-based training, the use of role-play, pedagogical approaches, theory-based information workshops and debrief and reflection.
Conclusions: This review highlights a gap in research focusing on the importance of communication skills training for student midwives throughout midwifery education. Despite the limited numbers of studies, different interventions and educational strategies have been recognized for enhancing these skills. To equip midwives with strong communication skills, a combination of interventions is recommended, including communication-focused workshops tailored for midwifery education and debriefing and student reflection sessions specifically designed to enhanced communication skills.
This study aimed to determine what childbearing women want when using virtual reality as an intra... more This study aimed to determine what childbearing women want when using virtual reality as an intrapartum pain management method. Researchers performed a qualitative exploratory study using content analysis. Two focus groups were organized including pregnant women anticipating a vaginal birth and women who recently had given birth, no longer than 6 months ago. The focus groups included a 30-minute virtual reality demo. In total, 10 women participated. Five themes emerged: (1) “try, test and explore”: the need to receive information and to get acquainted with virtual reality during the antenatal period; (2) “variety and diversity in physical and digital options”: the preference for a variety in virtual content and view virtual reality as a complementary method to methods for intrapartum pain management; (3) “distraction versus focus”: virtual reality as a method to distract from pain, from the clinical context or to help them focus; (4) “comfort both physical and digital”: measures to ensure a comfortable physical and virtual experience; and (5)“birthing partner”: the potential need to include partners. This study is an essential step informing the development, implementation, and research of labor-specific virtual reality and informing antenatal healthcare providers when offering women virtual reality as intrapartum pain management.
Objective: To reach consensus between care providers and childbearing women about the midwife's r... more Objective: To reach consensus between care providers and childbearing women about the midwife's relevant and appropriate domains and elements to support transition to motherhood.
Methods: A modified web-based Delphi study was conducted in Flanders (Belgium). After performing a systematic literature review, searching the grey literature and an online poll, a set of 79 items was generated. In two rounds, the items were presented to an expert panel of (1) care providers from various disciplines providing services to childbearing women and (2) to pregnant women and postpartum women up to 1year postpartum. Consensus was defined when 70% or more of the experts scored ≥6, 5% or less scored ≤3, and a standard deviation of ≤1.1.
Findings: In the first Delphi round, 91 experts reached consensus on 24 items. Seventeen round one items that met one or two consensus objectives were included in round two and were scored by 64 panel experts, reaching consensus on three additional items. The final 27 items covered seven domains: attributes, liaison, management of care from a woman-centred perspective, management of care from the midwife's focus, informational support, relational support, and the midwife's competencies.
ConclusionS: The shared understanding between childbearing women and care providers shows that the midwife's transitional support is multifaceted. Our findings offer midwives a standard of care, criteria, guidance, and advice on how they can support childbearing women during transition to motherhood, beyond the existing recommendations and current provision of transitional care.
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Videos by Yvonne Kuipers
Based on the findings of the following studies:
Koster D, Romeijn C, Sakko E, Stam C, Steenhuis N, de Vries D, van Willigen I, Fontein-Kuipers Y. Traumatic childbirth experiences: practice-based implications for maternity care professionals from the woman’s perspective. Scandinavian Journal of Caring Sciences. 2019. doi: 10.1111/scs.12786
Fontein-Kuipers Y, Koster D, Romeijn C, Sakko E, Stam C, Steenhuis N, de Vries D, van Willigen I. I-Poems – Listening to the voices of women with a traumatic birth experience. Journal of Psychology and Cognition. 2018; 3(2): 29-36. 10.35841/psychology-cognition.3.2.29-36
Papers by Yvonne Kuipers
Methods: A non-randomised pilot study was conducted, using a matched casecontrol design (1:2 ratio). Cases were women who voluntarily used virtual reality alongside standard intrapartum pain management, including non-pharmacological methods and/or epidural analgesia. Controls received standard intrapartum pain management.
Results: A total of 108 women were included for analysis (36 cases vs. 72 controls). Perceived pain scores before and after virtual reality use did not differ significantly (p = 0.43, p = 0.73), suggesting a limited immediate analgesic effect under current conditions. Epidural analgesia rates and cervical dilation at initiation of analgesia did not show significant differences between cases and controls (p = 0.13, p = 0.42). After adjusting for induction of labour and cervical dilation at admission, there were no significant differences for duration of epidural analgesia (p = 0.86, p = 0.56), duration of labour (p = 0.64, p = 0.55), or vaginal birth (p = 0.23). Adjusted models indicated a non-significant trend toward shorter durations of labour, birth, and epidural exposure for cases.
Conclusions: Our pilot study did not reveal a decrease in perceived pain or epidural analgesia use or an effect on duration of labour and vaginal birth.
Methods: A modified web-based Delphi study was conducted in Flanders (Belgium). After performing a systematic literature review, searching the grey literature and an online poll, a set of 79 items was generated. In two rounds, the items were presented to an expert panel of (1) care providers from various disciplines providing services to childbearing women and (2) to pregnant women and postpartum women up to 1year postpartum. Consensus was defined when 70% or more of the experts scored ≥6, 5% or less scored ≤3, and a standard deviation of ≤1.1.
Findings: In the first Delphi round, 91 experts reached consensus on 24 items. Seventeen round one items that met one or two consensus objectives were included in round two and were scored by 64 panel experts, reaching consensus on three additional items. The final 27 items covered seven domains: attributes, liaison, management of care from a woman-centred perspective, management of care from the midwife's focus, informational support, relational support, and the midwife''s competencies.
Conclusions: The shared understanding between childbearing women and care providers shows that the midwife's transitional support is multifaceted. Our findings offer midwives a standard of care, criteria, guidance, and advice on how they can support childbearing women during transition to motherhood, beyond the existing recommendations and current provision of transitional care.
Methods: We employed an integrated knowledge translation approach, combining the Knowledge-To-Action and Intervention Mapping frameworks. This approach involves identifying clinical questions that require enhanced implementation support, analysing barriers within the context, and defining change and performance objectives. Feedback from a Belgian multi-stakeholder consulting group and Advisory Board informed the process.
Findings: Two clinical questions require greater support for implementation: (1) initial clinical investigations during labour and (2) ongoing investigations and interventions during a low-risk birth. Barriers to applying the recommendations include individual healthcare professional factors and professional interactions. Implementation demands healthcare professionals recognise the physiological aspects of labour and birth, stay updated on the evidence, accept the evidence supporting the management of low-risk births, and involve shared decision-making while seeking the woman's consent. Achieving behavioural change consists of shifting attitudes, intentions, knowledge, social norms, and skills.
Discussion: The identified barriers to implementing recommendations emphasise the crucial role of interpersonal dynamics in successful guideline implementation. Therefore, policies should tackle structural challenges within Belgian maternity care.
Conclusion: To enhance maternity care services, communication, collaboration, and mutual understanding across professional boundaries are needed.
Background: A shift towards a strong and increasing presence of eHealth in future practice requires the competencies of nurses and midwives. This ability to adapt to technological evolutions is called digital adaptability. A set of 29 items representing the competencies of digital adaptability for nurses and midwives provides the first comprehensive description of this relatively new concept.
Design: Cross-sectional survey with a total sample size of 557 Flemish midwives and nurses.
Methods: Internal consistency and construct validity were established using Cronbach's alpha, exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA).
Results: EFA revealed two factors: 'me and the digital world' (17 items) and 'me, the digital world, and my patient' (12 items). CFA tested the model and showed a good model-fit. Strong internal consistency was observed.
Conclusions: Two factors were identified. The first, 'me & the digital world,' is task-oriented and focuses on nurses/midwives' personal use of technology. The second, 'me, the digital world, and my patient,' is patientcentered and focuses on nurses' and midwives' use of technology while interacting with their patients during care provision.
Aim: To investigate how the reality of the social space of birth affects women's positive birth experiences.
Methods: We combined open-text responses to the Babies Born Better survey from 3633 postpartum women in Austria, Belgium, the Czech Republic, Germany, Spain, the Netherlands, and the United Kingdom and 39 interview transcripts from Czech and Dutch postpartum women. We conducted a textual and thematic analysis.
Findings: Three themes and 11 categories were generated: (1) Exercising fundamental human agency in the birth space consists of the categories: 'exercising rights', 'the protection of human vulnerability', and 'the freedom to be authentic', which women regard as prerequisite components of the birth space. (2) Regulatory frameworks & care philosophies in maternity services, including the categories '(financial) regulations', 'values of the care provider and the institution', and 'model of care', are regarded as attributes of the birth space. Theme (3) Building a nest for comfort and connection comprises the categories 'relational and affective atmosphere during labour & birth', 'performative atmosphere during labour & birth', 'shelter', 'implicit and explicit tacit doing & being' and 'symbol of deeper meaning'.
Discussion/Conclusion: The reality of the birth space of women with positive birth experiences consists of human rights and birth rights, the quality of interactions with care providers during labour and birth in a relationshipcentred and relation-continuity model of care, and a place to retreat from the world.
Purpose: To explain some basic skills of scientific writing when preparing a paper for publication to support midwives in engaging in scientific writing.
Overview: Four basic elements of scientific writing will be presented: the importance of careful word choices, the use of active and passive voice, sentence and paragraph structures, and review and editing. Examples of poor and better writing are given to illustrate these basic elements of good academic writing. We hope potential midwifery authors will read and refer to this article when writing. As editors, the elements addressed here are common problems found when reviewing submitted manuscripts that, with guidance, can be easily overcome.
Purpose: To explore the newsletter’s functional elements and the connection between it as a communication strategy and the individuals interacting with it and to present a case demonstration of a newsletter example.
Methods: A descriptive case report with a theory-driven approach using 10 elements of human communication theories.
Conclusions: The following elements of human communication contribute to understanding the functioning of the newsletter: Grounded Theoretical Theory, the Practical-Action Theory and goal-oriented communication (communication theory), the Syntactic Theory of Visual Communication and the rhetorical tradition of communication (tradition of communication),
Elaboration Likelihood and the socio-cultural model of communication (communicator), implied compliance-gaining, parole, semiosis, narrative paradigm and rhetoric logic (message), social organisation communication, co-cultural communication and invitational rhetoric (conversation), the orientation and exploratory affective exchange stages of social exchange (relationship), Structuration Theory (group), the Theory of Bureaucracy (organisation), the Cultivation Theory (media), and the Diffusion of Innovation and Ethnography of Communication (culture and society). Implications: The newsletter succeeds in managing CMC information
and reaching an interested audience. Further evaluation is required to explore if or how the newsletter affects information use.
Aim: To explore Belgian midwives’ readiness for midwife-led care and understand the underlying processes.
Methods: A mixed-methods sequential study: 1) A survey including 414 practising midwives and 2) individual interviews with 12 (student) midwives. General linear model analysis was used to examine the trend between
knowledge, self-efficacy and performance mean scores - indicators of midwife-led care readiness - proposed in a 27-item questionnaire. The Readiness Assessment Framework served as a template for qualitative thematic analysis.
Findings: Template analysis illustrated the underlying mechanisms of midwifery-led care readiness: Governmental and institutional steering and rule-making functions, regulation and reimbursement, awareness of
midwife-led care among stakeholders, capacity to extend primary care postpartum services to antenatal and intrapartum care and healthcare professionals’ lack of awareness of available data of women’s experiences and midwife-led care efficacy in Belgium. These qualitative findings contribute to the understanding of the significant trend with decreasing function for knowledge, self-efficacy and performance mean scores of 25 midwife-led care readiness indicators, and the two non-significant indicators referring to a physiological postpartum period.
Discussion/Conclusion: In determining midwife readiness for midwife-led care, we observed adequate knowledge mean scores, associated with low self-efficacy and even lower midwife-led care performance mean scores. Our
findings suggest limited readiness for MLC in antenatal and intrapartum care. Belgian midwives are the domain experts of postpartum
Methods: A 1:3 nested case-control study was performed. A data set including 676 participants (169 cases/507 controls) was composed based on core characteristics. Using independent t-test and chi-square, the two groups were compared for mean depression, self and perceived stigma, depression literacy scores, and for positive Whooley items and heightened depression scores. The primary analysis was adjusted for covariates.
Results: The number of positive Whooley items, the above cut-off depression scores, mean depression, perceived stigma, and depression literacy scores showed statistically significant differences between cases and controls, in
favor of the intervention group. When adjusting for the covariates, the statistically significant differences between cases and controls remained for depression, perceived stigma, and depression literacy, for the positive
Whooley items and for above cut-off depression scores.
Conclusion: WazzUp Mama© indicates to have a moderate to large positive effect on optimizing perinatal emotional wellbeing, to positively change perceived stigma and to increase depression literacy.
Methods: A 1:3 nested case-control study was performed. A data set including 676 participants (169 cases/507 controls) was composed based on core characteristics. Using independent t-test and chi-square, the two groups were compared for mean depression, self and perceived stigma, depression literacy scores, and for positive Whooley items and heightened depression scores. The primary analysis was adjusted for covariates.
Results: The number of positive Whooley items, the above cutoff depression scores, mean depression, perceived stigma, and depression literacy scores showed statistically significant differences between cases and controls, in favor of the intervention group. When adjusting for the covariates, the statistically significant differences between cases and controls remained for depression, perceived stigma, and depression literacy, for the positive Whooley items and for above cutoff depression scores.
Conclusion: WazzUp Mama© indicates to have a moderate to large positive effect on optimizing perinatal emotional wellbeing, to positively change perceived stigma and to increase depression literacy.
Methods: An explorative comparative study of neonaticide cases with single and repeat perpetrators was conducted using nationwide register-based data from 1995 to 2017. A total number of 55 cases out of 66 were included in the analysis. A standardized coding sheet was used and calculations were performed.
Results: 48 women gave birth to 101 children, of which 55 were killed, 23 children lived out of home care and 23 lived with the perpetrator We found a higher fertility rate in both neonaticide perpetrators in the single (1,9) and the repeat group (4,25) in comparison to the general population (1,4). The use of contraception was only 31% among neonaticide perpetrators, deviating substantially from the general Austrian population age group (16-29yrs) which used contraception in 91%. The neonaticide perpetrators used an effective contraception method (pearl-index < 4) in only 2%, whereas 20% of the general population did so. The number of unperceived pregnancies was high in both groups (50/55) 91%.
Conclusion: Future case reports and forensic evaluations should take reproductive behavior into account, as it may offer valuable insights into the events leading up to neonaticide. Our findings suggest that denial of reproductive potential often precedes unperceived pregnancies. In the Austrian cohort, women who experienced unperceived pregnancies resulting in unassisted births and subsequent neonaticide showed a low prevalence of contraceptive use. This is particularly noteworthy given that the primary motive for neonaticide is unwanted pregnancy.
Design: A scoping review based on the Joanna Briggs Institute framework was conducted using predefined criteria and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.
Methods: A comprehensive search was conducted using various databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, PsycINFO, Maternity and Infant Care Database (MIDIRS), Web of Science and Education Resources Information Centre (ERIC)) in October 2023.
Results: A total of 120 titles and abstracts were screened. A final number of eight articles were subjected to quality appraisal and included in the scoping review. Five themes were identified which describe educational strategies and interventions including: simulation-based training, the use of role-play, pedagogical approaches, theory-based information workshops and debrief and reflection.
Conclusions: This review highlights a gap in research focusing on the importance of communication skills training for student midwives throughout midwifery education. Despite the limited numbers of studies, different interventions and educational strategies have been recognized for enhancing these skills. To equip midwives with strong communication skills, a combination of interventions is recommended, including communication-focused workshops tailored for midwifery education and debriefing and student reflection sessions specifically designed to enhanced communication skills.
Methods: A modified web-based Delphi study was conducted in Flanders (Belgium). After performing a systematic literature review, searching the grey literature and an online poll, a set of 79 items was generated. In two rounds, the items were presented to an expert panel of (1) care providers from various disciplines providing services to childbearing women and (2) to pregnant women and postpartum women up to 1year postpartum. Consensus was defined when 70% or more of the experts scored ≥6, 5% or less scored ≤3, and a standard deviation of ≤1.1.
Findings: In the first Delphi round, 91 experts reached consensus on 24 items. Seventeen round one items that met one or two consensus objectives were included in round two and were scored by 64 panel experts, reaching consensus on three additional items. The final 27 items covered seven domains: attributes, liaison, management of care from a woman-centred perspective, management of care from the midwife's focus, informational support, relational support, and the midwife's competencies.
ConclusionS: The shared understanding between childbearing women and care providers shows that the midwife's transitional support is multifaceted. Our findings offer midwives a standard of care, criteria, guidance, and advice on how they can support childbearing women during transition to motherhood, beyond the existing recommendations and current provision of transitional care.