Asking different questions: research priorities to improve the quality of care for every woman, every child

Abstract

Asking diff erent questions: research priorities to improve the quality of care for every woman, every child Unacceptably high rates of adverse outcomes persist for childbearing women and infants, including maternal and newborn mortality, stillbirth, and short-term and long-term morbidity. 1 In light of the challenges to achieve the UN Sustainable Development Goals, it is timely to reconsider priorities for research in maternal and newborn health. Are we asking the right questions? 2 Recent evidence indicates the importance of seeking knowledge beyond the treatment of complications, to inform better ways of providing sustainable, high quality care, including preventing problems before they occur. 3 The 2014 publication of The Lancet's Series on Midwifery presented a unique opportunity to generate future areas of inquiry by drawing on the most extensive examination to date of evidence on the care that all women and newborn infants need across the continuum from pre-pregnancy, birth, post partum, and the early weeks of life. [4][5][6] The Series summarised the evidence base for quality maternal and newborn care in a new framework that focuses on the needs of women, infants, and families and diff erentiates between what care is provided, how it is provided, and Research prioritiesResearch priority score

Women's Perceptions of Prenatal Influences on Maternal Confidence for Physiologic Birth

“…Information about maternity care providers’ perspectives regarding prenatal preparation for physiologic birth, similar to women's views, is available; additional research examining maternity care provider and system experiences implementing practice changes to increase confidence prior to labor and birth in all settings is needed. These research recommendations are consistent with multistakeholder research priorities identified after a series in The Lancet on midwifery; they include identifying and describing aspects of care that optimize physiologic processes for healthy childbearing women and newborns and assessing women's views and preferences across settings about maternal and newborn care . Development of a prenatal care model intentionally focused on supporting the normalcy of pregnancy and birth, helping women feel confident for physiologic birth, and reducing unnecessary interventions, and examining the effect of such a model on care outcomes, women's satisfaction, and cost of care is necessary.…”

“…These research recommendations are consistent with multistakeholder research priorities identified after a series in The Lancet on midwifery; they include identifying and describing aspects of care that optimize physiologic processes for healthy childbearing women and newborns and assessing women's views and preferences across settings about maternal and newborn care. 33 Development of a prenatal care model intentionally focused on supporting the normalcy of pregnancy and birth, helping women feel confident for physiologic birth, and reducing unnecessary interventions, and examining the effect of such a model on care outcomes, women's satisfaction, and cost of care is necessary. In addition, development of a clinically useful tool to measure women's confidence for physiologic birth prenatally may help maternity care providers guide and individualize care.…”

United States Model Midwifery Legislation and Regulation: Development of a Consensus Document

“…The Lancet Global Health published a global identification of future research priorities to improve maternal and newborn health outcomes. 5 It demands that we ask different questions to address complex and systemic challenges in pregnancy and childbirth care; access to midwifery care in the United States is one of those challenges. The Patient Protection and Affordable Care Act increased financial access to health care for all US citizens, including requiring maternity care as an essential health benefit.…”

“…A follow‐up study identified top research priorities to improve maternal and newborn health. The second top priority was to “evaluate the effectiveness of midwife‐led care when compared to other models of care across various settings, particularly on rates of fetal and infant death, preterm birth, and low birthweight.” (p e777)…”

Midwifery is a vital solution—What is holding back global progress?

“…1,12 Much less research exists on enhancing the respectful, supportive, women-and newborn-centered, high-quality care for all that prevents complications and enables timely response when they arise. Most research has focused on obstetric areas of interest: the clinical and emergency interventions needed when complications arise.…”