Woman-centred maternity care

In de gezondheidszorg en ethiek rondom zwangerschap en geboorte is de aandacht vaak gefocust op het kind: het kind dat gewenst wordt, het kind dat in de baarmoeder groeit en zo gezond mogelijk ter wereld dient te komen, het kind dat mogelijk een beperking heeft, of dat een erfelijk risico loopt. Deze kwesties krijgen terecht aandacht in de zorg; de inspanningen van de meeste wens- of aanstaande ouders en de zorgprofessionals zijn gericht op een gezond kind met een goede start. Minder aandacht krijgen echter de ethische en existentiële kwesties die te maken hebben met de moeder, haar beleving, haar transitie naar moederschap.

Objective: To examine how student midwives in higher education learn to become competent and confident woman-centred practitioners.
Design: Participant observation study using a ‘buddy’ approach.
Setting: Bachelor of Midwifery students in one higher education institution in the Netherlands
Methods: First-year student midwives followed one woman throughout the continuum of childbirth. The students attended a minimum of five of the woman’s antenatal care encounters and a minimum of one postnatal care encounter. In addition, students explored the woman’s professional care network. Student midwives used participant observation, structured interview techniques and reflective practice to focus on (1) the woman and to gain insight into her wishes and experiences of care throughout the continuum of pregnancy, birth and postpartum period; (2) the impact of the caregiver on the woman; and (3) the woman’s experience of the partnership. Lectures, peer-debriefing, competency assessments, research activities and a logbook supported students’ learning.
Results: Learning was achieved through the student’s relational continuity and active engagement with the individual woman. Students gained insight into the experiences of individual pregnant and postpartum women, the individual practice of healthcare practitioners and the interaction between the woman and the healthcare practitioner. Students’ development of critical thinking and reflective practice was enhanced to begin to form a vision of woman-centred care.
Conclusion: The project was successful in equipping Bachelor of Midwifery students with competencies to support them in their learning of providing woman-centred care and offered them unique and in-depth experiences supporting and augmenting their personal, professional and academic development.

Background: Placing the woman at the centre of midwifery care is a key recommendation for optimising Dutch midwifery care, although not fully utilised.
Methods: Semi-structured interviews with ten Dutch midwives. The interviews were analysed using the Attitude, Social influence & self-Efficacy (ASE) model.
Results: The research identified the following themes: Woman-centered care manifested in providing information, assessing needs, taking time, articulating a vision about woman-centered care and adhering to a physiological approach of pregnancy and birth and to care standards. Woman-centered care was perceived as care that is adapted to women’s needs but it was not regarded as infinite. Midwives’ overall intention and attitude about woman-centered care was positive, although midwives often could not fulfil these intentions as a result of perceived barriers. Midwives’ personal boundaries, women’s unrealistic wishes and logistic factors, such as time were barriers to provide woman-centered care. Personal factors, such as midwives’ personal outlook on life, influenced woman-centered care. Woman-centeredness was also influenced by the woman’s expression of her individual wishes or by the woman-centered care norm of colleague midwives. Not all midwives perceived that they had the abilities to provide woman-centered care. Being familiar with one’s population and with woman-centered care were perceived as helpful. Midwives associated vocational characteristics with woman-centered care.
Discussion/Conclusion: Woman-centered care behaviour is determined by various factors, predominantly showing a paradox between behaviour and attitude and intention. Woman-centered care therefore needs a philosophical underpinning to provide guidance for midwives.

IBD is an overarching term that defines severe digestive disorders such as Crohn's disease and ulcerative colitis Comment on this article Women with inflammatory bowel disease (IBD) need more advice about pregnancy in order to make informed choices about their pregnancy. A research project that documented the experiences of 22 women and found that some had decided not to have children, or restrict their family size, and many women feared the consequences of pregnancy. 'It is desperately sad that women are opting to remain childless because they are unable to get an accurate picture of the risks they face,' said Anna Madill, a supervisor of the research. 'If they have access to that information, they may make an entirely different choice. The healthcare system needs to make sure that women living with IBD have access to all the facts necessary to make a fully informed decision.' Participants were concerned that they would pass down the condition to their children as well as worried that they would be unable to cope with a small child during periods when their condition would flare-up. IBD is an overarching term that defines severe digestive disorders such as Crohn's disease and ulcerative colitis, both of which can cause severe stomach pains, weight loss, and recurring diarrhoea. There is no cure for IBD and people living with the condition will experience periods of stability, with no symptoms, and then periods of flare-ups which be debilitating and affect quality of life. In the UK, 1 in 250 people have the condition and its incidence is increasing. The researchers, from the University of Leeds, made three films featuring participants describing their experiences of living with, being pregnant with, and being a mother with IBD. 'One of the main points to emerge from the study is that learning to live with a chronic illness has helped the women prepare for motherhood,' added Ms Madill. 'These women coped well with becoming parents.'

Background: The number of interventions is lower, and the level of satisfaction is higher among women who receive midwife-led primary care from one or two midwives, compared to more midwives. This suggests that midwives in small-sized practices practice more women-centred. This has yet to be explored.
Objective: To examine pregnant women’s perceptions, of the interpersonal action component of woman- centred care by primary care midwives, working in different sized practices.
Methods: A cross-sectional study using the Client Centred Care Questionnaire (CCCQ), administered during the third trimester of pregnancy among Dutch women receiving midwife-led primary care from midwives organised in small-sized practices (1
2 midwives), medium-sized (3
4 midwives) and large- sized practices (!5 midwives). A Welch ANOVA with post hoc Bonferroni correction was performed to examine the differences.
Results: 553 completed questionnaires were received from 91 small-sized practices/104 women, 98 medium-sized practices/258 women and 65 large-sized practices/191 women. The overall sum scores varied between 57–72 on a minimum/maximum scoring range of 15–75. Women reported significantly higher woman-centred care scores of midwives in small-sized practices (score 70.7) compared with midwives in medium-sized practices (score 63.6) (p<.001) and large-sized practices (score 57.9) (p < .001), showing a large effect (d .88; d 1.56). Women reported statistically significant higher woman- centred care scores of midwives in medium-sized practices compared with large-sized practices (p < .001), showing a medium effect (d .69).
Conclusion: There is a significant variance in woman-centred care based on women’s perceptions of woman-midwife interactions in primary care midwifery, with highest scores reported by women receiving care from a maximum of two midwives. Although the CCCQ scores of all practices are relatively high, the significant differences in favour of small-sized practices may contribute to moving woman- centred care practice from ‘good’ to ‘excellent’ practice.

Women with inflammatory bowel disease (IBD) should be given more advice about pregnancy so they can make informed choices about whether to have a family, say researchers. In their paper in the journal Qualitative Health Research, the scientists draw on evidence that women with the disease often decide not to have children, or to restrict the size of their family, because of fears the pregnancy would affect their health or that of their baby. Although inflammatory bowel disease can cause complications during pregnancy, research shows that one third of women with the condition will not get worse and another third will actually see an improvement in their health. The study, led by the University of Leeds, chronicled the experiences of 22 women who have had children, to plug an information gap about the realities of becoming a mother with IBD.

This video talks about how women with IBD cope with young children within the early years of motherhood. If you want to find out more about planning for a baby with IBD click here: https://www.youtube.com/watch?v=2iwLh6XCnq8&t=4s

For more information on pregnancy and IBD click here: https://www.youtube.com/watch?v=br0kciD8xJk&t=5s

Background music "Where I am From" by Topher Mohr and Alex Elena (taken from YouTube audio Library, free to use)

If you wish to know more about the study "IBD and Mums-to-Be" you can follow us on Facebook or Twitter @IBDandMumstoBe

This video talks about the challenges and considerations women with IBD face when planning for a baby. The stories end well for all the mums we interviewed as they all went on to have successful pregnancies and healthy babies.

For more information on planning for a child within the context of IBD check Crohn's and Colitis UK's website: https://www.youtube.com/watch?v=2iwLh6XCnq8&t=4s
To watch a video on pregnancy with IBD click here: https://www.youtube.com/watch?v=br0kciD8xJk&t=5s

To watch a video on the early years of motherhood with IBD click here: https://www.youtube.com/watch?v=TQjt8pnMv4I&t=10s

Background music "Where I am From" by Topher Mohr and Alex Elena (taken from YouTube audio Library, free to use)

If you wish to know more about the study "IBD and Mums-to-Be" you can follow us on Facebook or Twitter @IBDandMumstoBe

This study examines how the extension of the period of parental leave, from 60 days to 180 days that occurred in the Maldives in 2019, affected the family dynamics of mothers and their children. Purposive sampling technique was used to collect data from seven full-time working mothers, who had experienced both shorter and longer parental leave. The data was collected through semi-structured interviews. The most prominent finding was the higher level of involvement of father in taking care of the child with mothers reporting substantial strengthening in mother-child bond and the husbandwife relationship as parents during the longer parental leave. This research adds a new dimension to the discussion of the impact of longer parental leave legislation on family consolidation outcomes. It also has implications for the development of family policies that support the needs of both mothers and fathers during the first months of an infant's life.

AIMS: To examine the woman-centeredness of maternity care providers from the woman’s perspective. To investigate the validity and reliability of the Client Centered Care Questionnaire among a childbearing population.
DESIGN: A cross-sectional study.
METHODS: The self-report Client Centered Care Questionnaire was administered to evaluate women’s one-on-one antenatal and postnatal care appointments with various Dutch care providers: community and hospital-based midwives, General Practitioners, (registrar) obstetricians, sonographers, and maternity care nurses.
RESULTS: Eight-hundred and fifteen completed questionnaires were received. Exploratory and confirmatory factor analyses provided support for a two-factor model, with an acceptable model fit. Woman-centeredness of all maternity care providers showed scores above baseline for the neutral value. Welch ANOVA showed a statistical significant effect of the type of maternity care practitioner in providing woman-centered care during antenatal and postnatal visits (F(5.8) = 7.79). The Bonferroni post hoc test showed that women assigned significantly higher woman-centered care scores to community-based midwives compared with hospital-based midwives (p .011) and compared with registrars/obstetricians (p < .001).
CONCLUSION: Although overall scores of perceived woman-centeredness indicated a good to excellent performance of woman-centered care, with significantly higher scores for community-based midwives, it cannot be assumed that current woman-centered care completely meets the needs of Dutch childbearing women. The Client Centered Care Questionnaire (CCCQ) is an adequate instrument to measure woman-centered care in antenatal and postnatal maternity services. Further research regarding measuring woman-centered care is needed.

Researchers say that women with inflammatory bowel disease should be given more advice about pregnancy, so that they can make informed choices about their options and care. The study, led by the University of Leeds, chronicled the experiences of 22 women who have had children, to plug an information gap about the realities of becoming a mother with IBD. The research, published in the journal Qualitative Health Research, draws on the evidence that women with the disease often decide not to have children, or to restrict the size of their family, because of fears for their health during pregnancy and that of their baby too......