Supporting midwifery is the answer to the wicked problems in maternity care

Dahlen, Hannah; Drandić, Daniela; Shah, Neel; Cadée, Franka; Malata, Address

doi:10.1016/s2214-109x(22)00183-8

Cited by 10 publications

(9 citation statements)

References 8 publications

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“…Tensions between professions have been reported in the joint model of care 14,31 . where the process of shared decision‐making needs to be negotiated and hierarchies and power structures exist, which can make the care in such organizations dysfunctional 14,34 …”

Section: Resultsmentioning

confidence: 99%

“…14,31 where the process of shared decision-making needs to be negotiated and hierarchies and power structures exist, which can make the care in such organizations dysfunctional. 14,34 We chose to include nurse assistants in our study as they are a part of the team providing care to the birthing woman. The greatest differences in attitudes between the nurse assistants and the other two professions were for the scales Organizational oversight and Best practices.…”

Section: Discussionmentioning

confidence: 99%

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Labor unit culture and attitudes toward supporting vaginal birth—The Swedish version of the labor culture survey (S‐LCS)—Psychometric properties

Ängeby,

VanGompel,

Johansson

et al. 2023

Birth

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BackgroundIn order to evaluate interventions aimed at reducing cesarean births, care practitioners’ attitudes are important to measure. The Labor Culture Survey (LCS) is a scale that measures individual and unit attitudes towards supporting vaginal birth. As no equivalent scale exists in Sweden, the aim was to translate, adapt, and validate the LCS and to investigate whether there were differences in attitudes toward supporting vaginal birth between maternity care practitioners.MethodsA cross‐sectional study including midwives, physicians, and nurse assistants working with intrapartum care in five labor wards in Sweden. The original LCS was translated into Swedish, and six context‐specific items were developed for the Swedish setting (SLCS). The translation was tested for face validity. Psychometric analysis was conducted using exploratory factor analysis with principal component analysis, parallel analysis, and principal axis factoring. Reliability was estimated using Cronbach's alpha. One‐way ANOVA and Tukey HSD were calculated to analyze differences in attitudes between professions on the subscales of the S‐LCS.ResultsA total of 539 midwives, physicians, and nurse assistants participated. The final S‐LCS showed a five‐factor solution with the following subscales: Best Practices to reduce cesarean overuse, Unpredictability of vaginal birth, Unit Microculture, Maternal Agency, and Organizational Oversight. Chronbach alpha values varied from 0.60 to 0.83. Midwives were more supportive towards vaginal birth and less fearful of potential consequences of vaginal birth compared with physicians.ConclusionsThe S‐LCS demonstrated satisfactory psychometric properties for use in Swedish maternity care. Further work to improve the scale should include additional items reflecting the subscale Maternal Agency.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Labor unit culture and attitudes toward supporting vaginal birth—The Swedish version of the labor culture survey (S‐LCS)—Psychometric properties

Ängeby,

VanGompel,

Johansson

et al. 2023

Birth

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“…However, these guidelines were highly detailed, and risk oriented which created barriers for many women who desired waterbirths. It is well known that midwives play a crucial role in facilitating physiological births, yet their actions and practices are influenced by the ward culture and local guidelines 4 , 19 . Restrictive guidelines may hinder midwives’ ability to assist waterbirths and limit women’s autonomy and decision-making 20 , 21 .…”

Section: Introductionmentioning

confidence: 99%

Introducing waterbirth in a university hospital setting in Sweden: A qualitative study of midwives’ experiences

Larsson,

Bogren,

Ulfsdottir

2024

Eur J Midwifery

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INTRODUCTION Waterbirth is a popular and increasing care option in several countries but is still debated. In Sweden, there are challenges in the process of reintroducing waterbirth after decades of interruption invoked by a dissuasion. The aim of this study was to explore factors affecting midwives’ provision of waterbirth at a university birthing clinic in Sweden. METHODS A qualitative research design was used with three focus group interviews with 18 midwives at three birthing units. The data were analyzed using the principles of inductive content analysis. RESULTS The midwives in the study expressed positive attitudes and potentiality about waterbirth, contributing to their desire to support physiological birth. However, obstacles were also disclosed, maiming waterbirth evolvement. Hence, two categories emerged, promoting factors and obstructing factors. The subcategories were: Provides a good experience whilst promoting physiological birth; Increased knowledge and information about waterbirth; Support from management; Updated guidelines; Ergonomic challenges; Lacking practical conditions; Lack of knowledge; Paradigm conflicts; and Limiting guidelines. CONCLUSIONS The study concluded that midwives recognized both promoting and obstructing factors affecting the provision of waterbirth. The predominant factor highlighted was the care-culture, with a clear distinction between a risk-focused, medicalized approach that inhibits waterbirth and a salutogenic perspective advocating for it. This dichotomy underscores the importance of providing opportunities that support women’s choices to facilitate an empowering birth experience.

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Section: Introductionmentioning

confidence: 99%

“…The ICI is concerned with maternal safety which is grounded in human rights and kindness and compassion as well as supportive working environments for staff (The WHO Reproductive Health Library 2018 ). However, it is also important to contextualise the concept of RMC as a reflection of societal attitudes, as in Dahlen et al’s 2022 Lancet commentary (Dahlen et al 2022 ), where they say. “The way we treat women during pregnancy, childbirth, and postpartum, and the institutional options of care we provide them within health systems, directly reflect the way we value women in our societies.…”

Section: Introductionmentioning

confidence: 99%

Respectful maternity care in the UK using a decolonial lens

Lokugamage

Robinson

Pathberiya³

et al. 2022

SN Soc Sci

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Respectful maternity care (RMC) is part of a global movement addressing the previous absence of human rights in global safe maternal care guidance. RMC is grounded in kindness, compassion, dignity and respectful working conditions. The decolonisation movement in healthcare seeks to dismantle structural biases set up from a historically white, male, heteronormative Eurocentric medical system. This article applies a decolonising lens to the RMC agenda and examines barriers to its implementation in UK healthcare systems. Searches of peer-reviewed journals about decolonising maternity care in the UK revealed little. Drawing from wider information bases, we examine power imbalances constructed throughout a history of various colonial biases yet lingering in maternity care. The overarching findings of our analysis revealed 3 areas of focus: professional structures and institutional biases; power imbalances between types of staff and stakeholders of care; and person-centred care through a decolonial lens. To uproot inequity and create fairer and more respectful maternity care for women, birthing people and staff, it is vital that contemporary maternity institutions understand the decolonial perspective. This novel enquiry offers a scaffolding to undertake this process. Due to significant differences in colonial history between Western colonising powers, it is important to decolonise with respect to these different territories, histories and challenges.

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Supporting midwifery is the answer to the wicked problems in maternity care

Cited by 10 publications

References 8 publications

Labor unit culture and attitudes toward supporting vaginal birth—The Swedish version of the labor culture survey (S‐LCS)—Psychometric properties

Labor unit culture and attitudes toward supporting vaginal birth—The Swedish version of the labor culture survey (S‐LCS)—Psychometric properties

Introducing waterbirth in a university hospital setting in Sweden: A qualitative study of midwives’ experiences

Respectful maternity care in the UK using a decolonial lens

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