A positive experience of the perinatal period is significant for women in midwifery care. The literature on women’s experiences of the care in this period is extensive. However, a clear overview of the dimensions important for women’s experiences is lacking. Consequently, care providers and researchers may ignore aspects significant to women’s experience. In this short communication, we present a framework identifying the dimensions relevant for women’s experiences of the perinatal period.
Introduction This study aims to explore maternal and perinatal outcomes of migrant women in Iceland. Material and methods This prospective population-based cohort study included women who gave birth to a singleton in Iceland between 1997 and 2018, comprising a total of 92 403 births. Migrant women were defined as women with citizenship other than Icelandic, including refugees and asylum seekers, and categorized into three groups, based on their country of citizenship Human Development Index score. The effect of country of citizenship was estimated. The main outcome measures were onset of labor, augmentation, epidural, perineum support, episiotomy, mode of birth, obstetric anal sphincter injury, postpartum hemorrhage, preterm birth, a 5-minute Apgar <7, neonatal intensive care unit admission and perinatal mortality. Odds ratios (ORs) and 95% confidence intervals (CIs) for maternal and perinatal outcomes were calculated using logistic regression models. Results A total of 8158 migrant women gave birth during the study period: 4401 primiparous and 3757 multiparous. Overall, migrant women had higher adjusted ORs (aORs) for episiotomy (primiparas: aOR 1.43, 95% CI 1.26–1.61; multiparas: 1.39, 95% CI 1.21–1.60) and instrumental births (primiparas: 1.14, 95% CI 1.02–1.27, multiparas: 1.41, 95% CI 1.16–1.72) and lower aORs of induction of labor (primiparas: 0.88, 95% CI 0.79–0.98; multiparas: 0.74, 95% CI 0.66–0.83), compared with Icelandic women. Migrant women from countries with a high Human Development Index score (≥0.900) had similar or better outcomes compared with Icelandic women, whereas migrant women from countries with a lower Human Development Index score than that of Iceland (<0.900) had additionally increased odds of maternal and perinatal complications and interventions, such as emergency cesarean and postpartum hemorrhage. Conclusions Women’s citizenship and country of citizenship Human Development Index scores are significantly associated with a range of maternal and perinatal complications and interventions, such as episiotomy and instrumental birth. The results indicate the need for further exploration of whether Icelandic perinatal healthcare services meet the care needs of migrant women.
Introduction: Shared decision-making is considered to be a key aspect of woman-centered care and a strategy to improve communication, respect, and satisfaction. This scoping review identified studies that used a shared decision-making support strategy as the primary intervention in the context of perinatal care. Methods: A literature search of PubMed, CINAHL, Cochrane Library, PsycINFO, and SCOPUS databases was completed for English-language studies conducted from January 2000 through November 2019 that examined the impact of a shared decision-making support strategy on a perinatal decision (such as choice of mode of birth after prior cesarean birth). Studies that only examined the use of a decision aid were excluded. Nine studies met inclusion criteria and were examined for the nature of the shared decision-making intervention as well as outcome measures such as decisional evaluation, including decisional conflict, decisional regret, and certainty. Results: The 9 included studies were heterogeneous with regard to shared decision-making interventions and measured outcomes and were performed in different countries and in a variety of perinatal situations, such as women facing the choice of mode of birth after prior cesarean birth. The impact of a shared decision-making intervention on women’s perception of shared decision-making and on their experiences of the decision-making process were mixed. There may be a decrease in decisional conflict and regret related to feeling informed, but no change in decisional certainty. Discussion: Despite the call to increase the use of shared decision-making in perinatal care, there are few studies that have examined the effects of a shared decision-making support strategy. Further studies that include antepartum and intrapartum settings, which include common perinatal decisions such as induction of labor, are needed. In addition, clear guidance and strategies for successfully integrating shared decision-making and practice recommendations would help women and health care providers navigate these complex decisions.
Adequate gezondheidsvaardigheden van ouders zijn onontbeerlijk voor gezonde groei en ontwikkeling van hun kind en de basis voor stevig ouderschap. Bijna een derde (29%) van de Nederlandse bevolking heeft echter beperkte gezondheidsvaardigheden. Zij hebben moeite met begrijpen en toepassen van informatie van zorgverleners en regie voeren over hun gezondheid. Dit heeft negatieve invloed op gezondheidsgedrag van ouders in de zorg voor de gezondheid van henzelf en hun kinderen. Beperkte gezondheidsvaardigheden zijn complex en lastig te veranderen. Afstemmen van zorgverleners op beperkte gezondheidsvaardigheden is hierin een eerste stap. Verloskundigen en kraamverzorgenden willen beperkte gezondheidsvaardigheden beter herkennen. Tegelijk willen ze aansluitend op elkaar, optimaal afstemmen op beperkte gezondheidsvaardigheden van ouders. Onderzoeksvraag Hoe kunnen geboortezorgverleners effectief worden toegerust met bruikbare werkwijzen voor optimale afstemming op ouders met beperkte gezondheidsvaardigheden? Doelen 1. Breed gedragen en bruikbare gesprekstool om beperkte gezondheidsvaardigheden bij ouders te herkennen: de CHAT-geboortezorg. 2. Ontwerp van werkwijzen voor 3 domeinen die relevant zijn voor afstemmen van geboortezorg op beperkte gezondheidsvaardigheden van ouders: ondersteunende zorgrelaties, bevorderen van ondersteunende persoonlijke relaties van ouders en afstemmen door communicatie-op-maat. 3. Op bruikbaarheid en draagvlak getoetste en doorontwikkelde werkwijzen voor afstemming op beperkte gezondheidsvaardigheden. 4. Duurzame doorwerking en disseminatie van project- en onderzoeksresultaten in de beroepspraktijk, onderwijs en onderzoek. Met extra aandacht voor verbinding met jeugdgezondheidszorg en huisartsgeneeskunde om continuïteit van zorg na de perinatale periode te bevorderen. Methoden • Participatief Actie Onderzoek om werkwijzen te ontwikkelen in co-creatie met ouders en zorgverleners. • Most Significant Change, QQ-10 en MIDI-vragenlijsten voor kwalitatieve en kwantitatieve evaluatie- en effectmetingen. Resultaat Een interprofessioneel pakket werkwijzen voor geboortezorgverleners dat bestaat uit een breed geëvalueerde gesprekstool om beperkte gezondheidsvaardigheden bij ouders te herkennen en uit werkwijzen om de zorgverlening op hen af te stemmen binnen de domeinen (1) ondersteunende relatie met zorgverleners, (2) ondersteunende persoonlijke relaties en (3) informatievoorziening.
