Woman-centred or women-centred care: does it matter?

Objective. To investigate agreement with the National Health and Medical Research Council (NHMRC) definition of collaboration in maternity care by care providers, and to examine their preferences for models of care in order to shed light on the lack of success in implementing collaborative practice.Methods. Maternity care providers completed a survey in Queensland. The final sample consisted of 337 participants, including 281 midwives (83.38%), 35 obstetricians (10.39%), and 21 general practitioners (6.23%).Results. Ninety-one percent of the participants agreed with the NHMRC definition of collaboration: Midwives (M = 5.97, s.d. = 1.2) and doctors (obstetricians and general practitioners: M = 5.7, s.d. = 1.35) did not differ significantly in their level of agreement with definition (t (332) = -1.8, P = .068). However, 72% of doctors endorsed a doctor-led model of care, whereas only 6.8% of midwives indicated agreement with it. Fewer (56%) doctors agreed with the midwife-led model of care, whereas 99.3% of midwives endorsed it.Conclusion. The concept of collaboration does not recognise the different interpretations by midwives and doctors of its impact on their roles and behaviours. Successful collaborative practice requires the development of guidelines that recognise these differences and specify the communication behaviour that would assist midwives and doctors to practice collaboratively.What is known about the topic? Across all healthcare contexts effective communication is a critical part of good patient care. Effective communication refers to communication between care providers and patients but also between different interprofessional care providers. In the area of maternity care one aspect of effective communication between maternity care providers is collaborative care. This paper highlights why collaborative care and effective communication between maternity care providers is lacking. We demonstrate that the NHMRC guidelines are interpreted differently according to the different professional role of the maternity care provider. What does this paper add? This paper empirically investigates the perceptions of maternity care providers. It shows that each maternity care profession has a different understanding about what collaboration means in practice. This paper acknowledges these different perceptions, which are usually not noted, and builds on this fact to improve effective communication and bring about collaborative care. What are the implications for practitioners? In this paper, we highlight that while maternity care practitioners all aspire to collaborative care, their perceptions of what collaborative care actually means differs according to professional role. For practitioners to move forward they must develop guidelines that take account of the respective philosophies and levels of different expertise each maternity care profession brings to a woman's care. The guidelines will assist obstetricians and midwives to recognise their unique and specific areas of expertise, each of which may b...

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“…This work is particularly important if women are to have choice and a voice about maternity care decisions affecting them. 23 …”

Section: Discussionmentioning

confidence: 99%

An empirical investigation into beliefs about collaborative practice among maternity care providers

Watson

Heatley²,

Kruske³

et al. 2012

Aust. Health Review

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“…The UK and Australian Departments of Health and the Australian College of Midwives also recommend this model of care for maternity services [31][32][33]. Leap described the wider concept of WCC as a concept that includes the need to address women's emotional, physical, psychological and cultural need and expectations with continuity and control over the care delivered by a single or a group of HCP [34]. This addresses that relationship between the woman and the woman is the key component of the 'women-centred care' which incorporated respectfulness and sensitivity of the midwife [35].…”

Section: Women-centred Carementioning

confidence: 99%

“…Leap [34] already addressed the tension that WCC is seen as exclusively linked to normal birth and midwifery-led care [24]. In most circumstances, a midwife would take the role of lead professional for all healthy women with straightforward pregnancies.…”

Section: Women-centred Carementioning

confidence: 99%

Patient-Centred Care in Maternity Services

Labrusse¹,

Ramelet²,

Humphrey³

et al. 2017

Patient Centered Medicine

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Providing patient-centred care (PCC) is one of the goals described by the Institute of Medicine (IOM) to deliver quality of care. Across several interventions described in the literature, there is no clear consensus of one that will best fit the diversity of women coming to seek care in maternity services and across the variety of healthcare providers (HCPs) who provide that care. A reason for that may be the lack of consensus about the model of care to adopt for maternity services reveals a neglected area of research. Managing quality of care should also mean considering the best model of care in practice for all women, incorporating the core and legitimate attributes of maternity care.

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“…They should be given choice in place of birth, caregiver and care, and be given control over their own care and experience (Page 2003: 33). This philosophical 3 approach to care has emerged in the context of a broader agenda in health towards power-sharing with patients and families (Hogg 1999).However, woman-centred care is a contested concept which is enacted in everyday practice in organisations which may constrain such aspirations towards woman-centred practices (Leap 2009). It is also the case that midwives, although experts in normal childbirth, work in contexts that are framed by discourses of risk, with fear of litigation dominating (Mackenzie Bryers & van Teijlingen 2010).…”

mentioning

confidence: 99%

Gatekeeping access to the midwifery unit: Managing complaints by bending the rules

et al. 2015

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While poor communication between service users and front line staff causes many service user complaints in the British National Health Service (NHS), staff rarely reflect on the causes of these complaints. We discuss findings from an action research project with midwives which suggest that the midwives struggled to fully understand complaints from women, their partners and families particularly about restricted visiting and the locked door to the midwifery unit. They responded to individual requests to visit out of hours while maintaining the general policy of restricted visiting. In this way the door was a gatekeeping device which allowed access to the unit within certain rules. The locked door remained a barrier to women and their families and as a result was a common source of informal complaints. We argue that the locked door and restricted visiting to the midwifery unit were forms of gate-keeping and boundary making by midwives which reveals a tension between their espoused woman-centred care and contemporary midwifery practice which is increasingly constrained by institutional values. 2 IntroductionEvidence suggests that poor communication is a key factor which contributes to service user dissatisfaction and complaints in the UK (The Information Centre for Health and Social Care, 2011, 2012, 2013, and internationally (Montini et al., 2008) means that women and their families should be at the heart of everything midwives do in practice. They should be given choice in place of birth, caregiver and care, and be given control over their own care and experience (Page 2003: 33). This philosophical 3 approach to care has emerged in the context of a broader agenda in health towards power-sharing with patients and families (Hogg 1999).However, woman-centred care is a contested concept which is enacted in everyday practice in organisations which may constrain such aspirations towards woman-centred practices (Leap 2009). It is also the case that midwives, although experts in normal childbirth, work in contexts that are framed by discourses of risk, with fear of litigation dominating (Mackenzie Bryers & van Teijlingen 2010). This may add to tensions between practice ideals and reality and lead to ambiguity and defensive practice women's reproductive care. In this paper we develop these ideas on boundary work and routines to discuss what meaning complaints have for midwives and how they respond to informal complaints in a midwifery unit. We draw on findings from an action research (AR) study 1 into informal complaints management in a midwifery unit in one NationalHealth Service (NHS) hospital trust in the UK. The aim of the project was to work with staff to explore their responses to informal complaints which they had identified as a challenging and stressful part of their work. Using findings from the (AR) project, we suggest that midwives struggled to understand women and their families' complaints 1 Responding Effectively to Service users' and Practitioners' perspectives ON care concerns: challenging Susta...

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Woman-centred or women-centred care: does it matter?

Cited by 132 publications

References 7 publications

An empirical investigation into beliefs about collaborative practice among maternity care providers

An empirical investigation into beliefs about collaborative practice among maternity care providers

Patient-Centred Care in Maternity Services

Gatekeeping access to the midwifery unit: Managing complaints by bending the rules

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