{"id":7919,"date":"2018-05-18T09:56:44","date_gmt":"2018-05-18T08:56:44","guid":{"rendered":"https:\/\/mojababica.si\/continuity-of-midwifery-care\/"},"modified":"2018-05-18T09:56:44","modified_gmt":"2018-05-18T08:56:44","slug":"continuity-of-midwifery-care","status":"publish","type":"post","link":"https:\/\/mojababica.si\/en\/continuity-of-midwifery-care\/","title":{"rendered":"Continuity of midwifery care"},"content":{"rendered":"
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Midwives are the primary care providers and experts for low-risk women of childbearing age worldwide (Fraser, Cooper, 2009; Sandall et al., 2013). However, depending on midwife-led models and other models of care for women, there are differences in morbidity and mortality, effectiveness, and psychosocial outcomes (Sandall et al., 2013). Continuous contact is essential for establishing trust between the woman and the midwife and is a prerequisite for a positive experience on the journey of motherhood<\/strong><\/em> (Lundgren, Berg, 2007). <\/p>\n

The Cochrane systematic review of midwifery care describes how continuity of midwifery care affects the safety and quality of women’s healthcare. Midwifery care contributes significantly to the re-demedicalization of childbirth and to the quality and safety of healthcare.<\/strong> <\/em>Policy makers who want safer and higher quality care for children and newborns must consider the midwifery model of care and its funding, especially regarding the normalization and humanization of birth. Compared to other models of care, midwifery care affects different levels of continuity, different degrees of obstetric risk, and the determination of obstetric practice (in the community or hospital). A cost comparison of the models is also presented. The models were divided into the prenatal and labor periods, as certain decisions and measures during pregnancy affect the birth. They were defined in the following ways: <\/p>\n

A) Midwifery care, where the midwife is the lead professional, but other healthcare professionals (one or more) are also routinely involved.
\nB) Gynecological care, which is common in North America, where obstetricians are the lead professionals. They are present at the birth, but not necessarily the same ones who guided the woman through pregnancy. Nurses are also present. <\/p>\n

C) Family doctor care with referral to an obstetrician if necessary. Labor nurses or midwives are present during pregnancy and birth but have no decision-making power. An obstetrician is present at the birth.
\nD) Shared model of care, where the responsibility for organization and birth care is shared among different healthcare professionals (Sandall et al., 2010). <\/p>\n

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Sutcliffe et al. (2012) also compared midwifery care with physician-led care. Three meta-analytic reviews were included. Although cost-effectiveness could not be established, given the positive effects of midwifery care on meeting women’s needs, their satisfaction, and the satisfaction of their children, practitioners and policy makers considered the possibility of continuous midwifery care for low-risk women. <\/p>\n

You can read about the professionalization process in Slovenia and the autonomy of midwifery activity in Europe in the doctoral dissertation of Asst. Prof. Dr. Miv\u0161ek (2012) titled: “The Process of Professionalization of Midwifery in Slovenia” –  link<\/a><\/p>\n

To summarize the table “Autonomy of midwifery activity \u2013 a view across European countries (Miv\u0161ek, 2012)”: In normal pregnancy, birth, and the postpartum period, midwives have a leading role in Belgium, Denmark, France, Ireland, Spain, Sweden, and England. In Austria, both the midwife and\/or doctor are responsible for normal pregnancy, birth, and the postpartum period. In other countries, despite the WHO definition and competencies, midwives are not primarily responsible for physiological pregnancy, birth, and the postpartum period; sometimes it is only a combination of a general practitioner and a pediatrician or a midwife. What we need to change in Slovenia is for midwives to be practically involved in the five preventive systematic check-ups during pregnancy (at the 16th, 32nd, 37th, 38th, and 39th weeks of pregnancy)<\/strong><\/em>, which are listed in the “Rules for the implementation of preventive healthcare at the primary level<\/a>“. As we will see later, contact with a midwife already during pregnancy has extremely positive results. <\/p>\n<\/div>\n<\/div>\n

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To address the economic crisis and the lack of healthcare funding, midwifery care for women is a good way to reduce costs. The lower costs of midwifery care and the effectiveness of adopting such approaches are crucial in the UK. Of course, more research is needed in this area, especially regarding non-physical outcomes such as satisfaction and early breastfeeding. The International Confederation of Midwives (ICM) (2011) states that midwife-led care for women is an effective and sustainable solution given the current economic conditions. The development of midwife-led care models would be positively influenced by the experiences of women who received, for example, only medical care. Research is needed on different midwifery approaches in midwifery care, as models can differ from one another. Thus, research in this area would allow for the investigation of the theoretical foundations of these complex interventions and their integration with processes and outcomes. This would provide a precise understanding of what the effective mechanisms in continuous midwifery care are. A rigorous and complex review and comparison of midwifery care and medical care would thus yield results that show more accurately the benefits midwifery care has for mother and child. As already mentioned, evidence shows that low-risk women under the care of midwives do not have more complications and problems compared to those treated by doctors. These women have fewer medical procedures and are more satisfied with their care. Women who received continuous midwifery care report higher satisfaction in terms of emotional support, being better informed, more frequent involvement in the care process, and a greater possibility of shared decision-making compared to standard care. No harmful consequences were found in women who were in the care of midwives<\/strong> <\/em>(Bir\u00f3 et al., 2003; Hodnett et al., 2011; Sutcliffe et al., 2012). <\/p>\n

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Barimani and Hylander (2012) state that better support and continuous midwifery care for women after midwifery care reduces the duration of postpartum hospital stays. They define a trend in Western countries. Their aim is to examine strategies to improve continuous care for pregnant women and new mothers. The strategies that enable continuity are based on the main category, i.e., joint action by midwives and community nurses. The positive effects of cooperation were also cited by women who received such healthcare treatment. The main task of the interviewed midwives and nurses was to ensure continuous care, which is what the mothers also expected. The difference was that some only had theoretically developed strategies, while others were already using them in practice; for example, employees at the family center reported how strategies are used in practice, while employees at the medical center described strategies without actually using them. When the strategies were put into practice, midwives and community nurses participated in several different joint practices guided by continuity strategies: transfer, adaptation, establishment, and maintenance of mutual relationships. By having healthcare professionals collaborate and have the possibility of constant communication, the care system becomes safer. They began to collaborate when they realized they were caring for the same mother, thus supporting the idea that parenthood begins with pregnancy and continues with the birth of the child. Midwives stated that with a good transfer of information, nurses can continue where they left off. Through such work, they gain more trust from the mothers. In family centers, midwives and nurses collaborated on joint measures to establish continuous care for pregnant women and mothers. Joint measures were seen as joint activities (socializing, meetings, and interactions) for joint support for mothers.<\/strong><\/em> Clear strategies for joint measures were also mentioned, such as making decisions in informal ways and active assistance during work hours. Staff met at formal meetings where they planned visits to pregnant women and newborns. Informal meetings (e.g., coffee breaks) are also important as an opportunity to plan new things. Likewise, midwives and nurses performed home visits together. Visits usually involve the midwife talking to the mother about the birth experience, then introducing the nurse and handing over the work. This again builds more trust, as the woman doesn’t feel like she has a complete stranger in front of her. The nurse can get involved in the care as early as the last month before the end of pregnancy. Midwives and nurses try to coordinate their policies and learn together. Care providers benefit greatly from this way of working. They save time, learn from each other, and are more satisfied. These benefits were listed by both midwives and nurses. Women also cited the benefits of such work (work schedule, joint visits, involvement of nurses already during pregnancy, and more). Unfortunately, in the study, such treatment was only experienced by women who attended family centers. In medical centers, this cooperation did not exist. Also, mothers who visited the family center had more support. <\/p>\n

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To develop and implement midwife-led care, ICM members work in countries where women do not have the option of midwife-led care by encouraging the government to develop such care models together with women and other stakeholders. They emphasize that the midwife-led care model ensures safe and high-quality care. In countries where the midwife-led care model already exists, ICM members are encouraged to work with women and other stakeholders to maintain and improve this model of care (ICM, 2011). In 2010, a pilot program for continuous midwifery care was carried out in Slovenia in cooperation between the City of Ljubljana and the Department of Midwifery (Faculty of Health Sciences, University of Ljubljana). The project title was “Healthy Woman \u2013 Healthy Families of the Future”<\/strong><\/em><\/a> and the purpose was to determine the benefits of continuous midwifery care with a chosen midwife for women and whether continuous support affects a woman’s satisfaction (Miv\u0161ek et al., 2011). <\/p>\n

From the research, we can see that the midwife-led model of care is the best choice for (low-risk) women during pregnancy, birth, and the postpartum period.<\/strong><\/em> Hospitalizations during pregnancy are reduced, there are fewer sudden fetal deaths in early pregnancy, fewer women resort to pharmacological pain relief, there are more spontaneous vaginal births, and there are fewer problems in the postpartum period. Studies are conducted in countries with a higher gross domestic product, such as Australia, Canada, New Zealand, and the UK. If we wanted to apply the results obtained in economically less developed countries, it would be necessary to consider the availability of midwives, the community’s opinion on midwife-led care, accessibility to other models of care and their costs, and maternal and perinatal mortality and morbidity when assessing applicability. <\/p>\n

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Midwife-led care has the potential to reduce inequalities in access and treatment, and the healthcare system must enable this with educated staff.<\/strong> <\/em>Midwives need to be supported and supervised in their work. In the case of continuous midwifery care, there is a lack of rigorous research on this topic in economically less developed countries. In these cases, randomized controlled trials are used to assess the effects of this way of working. As we can see, it is not just about blindly introducing a new way of working. It is about the mindset of healthcare professionals \u2013 midwives \u2013 and the wider population \u2013 women. Women must want such care.<\/strong> <\/em>Our task is to present the research results to the general public and to those responsible for introducing changes at the national level.<\/p>\n<\/div>\n

In the end, we want a healthy and happy mother, child, and family. And with continuous midwifery care, this can be achieved to a greater extent. <\/p>\n

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Pavel N, 2016. Six reports in the delivery room for better birth practice. Master’s thesis. University of Maribor, Faculty of Health Sciences.  <\/em><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Midwives are the primary care providers and experts for low-risk women of childbearing age worldwide (Fraser, Cooper, 2009; Sandall et al., 2013). 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