Labouring Together: Women's experiences of “Getting the care that I want and need” in maternity care

Watkins, Vanessa; Nagle, Cate; Kent, Bridie; Street, Maryann; Hutchinson, Professor Alison M

doi:10.1016/j.midw.2022.103420

Cited by 18 publications

(5 citation statements)

References 44 publications

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“…Handheld paper-based records were seen to facilitate SDM in maternity services in Australia. 53 In this study, respondents felt that the use of EMRs could better support clear communication between clinicians and patients. Previous studies suggest that not embedding SDM in EMRs workflows may inhibit implementation.…”

Section: Discussionmentioning

confidence: 84%

“The Terminology Might Be Ahead of Practice”: Embedding Shared Decision Making in Practice—Barriers and Facilitators to Implementation of SDM in the Context of Maternity Care

Waddell,

Goodwin,

Spassova

et al. 2023

MDM Policy & Practice

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Background. It is a patient’s right to be included in decisions about their health care. Implementing shared decision making (SDM) is important to enable active communication between clinicians and patients. Although health policy makers are increasingly mandating SDM implementation, SDM adoption has been slow. This study explored stakeholders’ organizational- and system-level barriers and facilitators to implementing policy mandated SDM in maternity care in Victoria, Australia. Method. Twenty-four semi-structured interviews were conducted with participants including clinicians, health service administrators and decision makers, and government policy makers. Data were mapped to the Theoretical Domains Framework to identify barriers and facilitators to SDM implementation. Results. Factors identified as facilitating SDM implementation included using a whole-of-system approach, providing additional implementation resources, correct documentation facilitated by electronic medical records, and including patient outcomes in measurement. Barriers included health service lack of capacity, unclear policy definitions of SDM, and policy makers’ lack of resources to track implementation. Conclusion. This is the first study to our knowledge to explore barriers and facilitators to SDM implementation from the perspective of multiple actors following policy mandating SDM in tertiary health services in Australia. The primary finding was that there are concerns that SDM implementation policy is outpacing practice. Nonclinical staff play a crucial role translating policy to practice. Addressing organizational- and system-level barriers and facilitators to SDM implementation should be a key concern of health policy makers, health services, and staff. Highlights New government policies require shared decision making (SDM) implementation in hospitals. There is limited evidence for how to implement SDM in hospital settings. There are concerns SDM implementation policy is outpacing practice. Understanding and capacity for SDM varies considerably among stakeholders. Whole of system approaches and electronic medical records are seen to facilitate SDM.

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Section: Discussionmentioning

confidence: 84%

“The Terminology Might Be Ahead of Practice”: Embedding Shared Decision Making in Practice—Barriers and Facilitators to Implementation of SDM in the Context of Maternity Care

Waddell,

Goodwin,

Spassova

et al. 2023

MDM Policy & Practice

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“…Many maternity models of care such as woman-centred and midwifery-led care places the woman at the centre of care and her experience, focusing on woman’s health needs, expectations and aspirations [ 108 , 109 ]. These models have proven to return high levels of satisfaction and are beneficial to the psychological and physiological recovery of the woman [ 110 , 111 ]. The COVID-19 pandemic has disrupted these models of care for women who were pregnant and gave birth during the pandemic.…”

Section: Discussionmentioning

confidence: 99%

Pregnant and postpartum women’s experiences of the indirect impacts of the COVID-19 pandemic in high-income countries: a qualitative evidence synthesis

Tan,

Blair,

Homer

et al. 2024

BMC Pregnancy Childbirth

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Background Pregnant and postpartum women’s experiences of the COVID-19 pandemic, as well as the emotional and psychosocial impact of COVID-19 on perinatal health, has been well-documented across high-income countries. Increased anxiety and fear, isolation, as well as a disrupted pregnancy and postnatal period are widely described in many studies. The aim of this study was to explore, describe and synthesise studies that addressed the experiences of pregnant and postpartum women in high-income countries during the first two years of the pandemic. Methods A qualitative evidence synthesis of studies relating to women’s experiences in high-income countries during the pandemic were included. Two reviewers extracted the data using a thematic synthesis approach and NVivo 20 software. The GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) was used to assess confidence in review findings. Results Sixty-eight studies were eligible and subjected to a sampling framework to ensure data richness. In total, 36 sampled studies contributed to the development of themes, sub-themes and review findings. There were six over-arching themes: (1) dealing with public health restrictions; (2) navigating changing health policies; (3) adapting to alternative ways of receiving social support; (4) dealing with impacts on their own mental health; (5) managing the new and changing information; and (6) being resilient and optimistic. Seventeen review findings were developed under these themes with high to moderate confidence according to the GRADE-CERQual assessment. Conclusions The findings from this synthesis offer different strategies for practice and policy makers to better support women, babies and their families in future emergency responses. These strategies include optimising care delivery, enhancing communication, and supporting social and mental wellbeing.

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“…Interestingly, there was no difference in the number of antenatal appointments attended in that trial, but this may be attributable to the restricted sample (low risk pregnancies and not especially disadvantaged women). Unfortunately, there is evidence that high demand for models such as caseload midwifery is coupled with limited access (Watkins et al, 2022 ) that disproportionately affects women experiencing disadvantage (Sutherland et al, 2012 ).…”

Section: Discussionmentioning

confidence: 99%

Barriers to accessing and receiving antenatal care: Findings from interviews with Australian women experiencing disadvantage

Penman

Beatson

Walker

et al. 2023

Journal of Advanced Nursing

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AimTo identify the barriers associated with inadequate antenatal attendance by disadvantaged women in Australia and to further explore how these barriers are experienced by this population group.DesignA qualitative descriptive study utilizing semi‐structured interviews and thematic analysis.MethodsInterviews were conducted with 11 pregnant women who self‐identified as experiencing disadvantage, purposively sampled from a local government area of Victoria, Australia, characterized by socio‐economic disadvantage. Data were collected from February to July 2019.ResultsStudy participants reported a range of barriers to receiving timely and adequate antenatal care (ANC). For several women, a combination of personal (e.g., emotions, knowledge), health service provision (e.g., limited access to continuity of care provider and continuity of information, inflexible scheduling, difficulty travelling, staff attitudes), and broader social‐contextual factors (e.g., financial situation, language, cultural norms) were ultimately insurmountable. Whereas some barriers were experienced as hassles or annoyances, others were unacceptable, overwhelming, or humiliating.ConclusionWomen experiencing disadvantage in Australia value ANC but face multiple and complex barriers that undermine timely and regular access.Implications for the Profession and/Patient CareA wide range of strategies targeting barriers across multiple levels of the social‐ecological environment are required if ANC attendance rates are to improve and ultimately redress existing health disparities. Various continuity of care models are well‐placed to address many of the identified barriers and should be made more accessible to women, and particularly those women experiencing disadvantage.ImpactAntenatal care appointments promote the health of women and their babies during pregnancy, but for many women, particularly those experiencing disadvantage, access is delayed or inadequate. ANC providers play a critical role in facilitating timely and adequate care. Health service practitioners and management, and health services policymakers need to understand the complexity of the barriers women encounter. These stakeholders can utilize the findings reported herein to develop more effective strategies for overcoming multiple and multi‐level barriers.Reporting MethodThe study is reported in accordance with the relevant EQUATOR guidelines: the standards for reporting qualitative research (SRQR) and consolidated criteria for reporting qualitative research (COREQ).Patient or Public ContributionNo patient or public contribution.

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Labouring Together: Women's experiences of “Getting the care that I want and need” in maternity care

Cited by 18 publications

References 44 publications

“The Terminology Might Be Ahead of Practice”: Embedding Shared Decision Making in Practice—Barriers and Facilitators to Implementation of SDM in the Context of Maternity Care

“The Terminology Might Be Ahead of Practice”: Embedding Shared Decision Making in Practice—Barriers and Facilitators to Implementation of SDM in the Context of Maternity Care

Pregnant and postpartum women’s experiences of the indirect impacts of the COVID-19 pandemic in high-income countries: a qualitative evidence synthesis

Barriers to accessing and receiving antenatal care: Findings from interviews with Australian women experiencing disadvantage

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