WorldWideScience

Sample records for maternity care methods

  1. Rural maternity care.

    Science.gov (United States)

    Miller, Katherine J; Couchie, Carol; Ehman, William; Graves, Lisa; Grzybowski, Stefan; Medves, Jennifer

    2012-10-01

    To provide an overview of current information on issues in maternity care relevant to rural populations. Medline was searched for articles published in English from 1995 to 2012 about rural maternity care. Relevant publications and position papers from appropriate organizations were also reviewed. This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities. Recommendations 1. Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible. 2. The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful. 3. Rural maternity care services should be supported through active policies aligned with these recommendations. 4. While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women. 5. The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally. 6. Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women. 7. Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills. 8. Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in

  2. Reconfiguring Maternity Care?

    DEFF Research Database (Denmark)

    Johannsen, Nis

    This dissertation constitutes a reflection on two initiatives seeking to reconfigure maternity care. One initiative sought to digitalise maternity records and included a pilot run of an electronic maternity record in a Danish county. The other consisted of a collaboration between a maternity ward...... at a hospital and a group of researchers which included me. Both initiatives involved numerous seemingly different interests that were held together and related to reconfiguring maternity care. None of the initiatives can unequivocally be labelled a success, as neither managed to change maternity care, at least...... experimental designs are constructed. The consequences and the politics of the proposed changes are engaged with in laboratory manner through collaborative development of the designs and through exposing them to members of field of maternity care...

  3. Opinions of maternity care professionals and other stakeholders about integration of maternity care: a qualitative study in the Netherlands.

    NARCIS (Netherlands)

    Perdok, H.; Jans, S.; Verhoeven, C.; Henneman, L.; Wiegers, T.; Mol, B.W.; Schellevis, F.; Jonge, A. de

    2016-01-01

    Background: This study aims to give insight into the opinions of maternity care professionals and other stakeholders on the integration of midwife-led care and obstetrician-led care and on the facilitating and inhibiting factors for integrating maternity care. Methods: Qualitative study using

  4. Women's access needs in maternity care in rural Tasmania, Australia: a mixed methods study.

    Science.gov (United States)

    Hoang, Ha; Le, Quynh; Terry, Daniel

    2014-03-01

    This study investigates (i) maternity care access issues in rural Tasmania, (ii) rural women's challenges in accessing maternity services and (iii) rural women's access needs in maternity services. A mixed-method approach using a survey and semi-structured interviews was conducted. The survey explored women's views of rural maternity services from antenatal to postnatal care, while interviews reinforced the survey results and provided insights into the access issues and needs of women in maternity care. The survey was completed by n=210 women, with a response rate of 35%, with n=22 follow-up interviews being conducted. The survey indicated the majority of rural women believed antenatal education and check-ups and postnatal check-ups should be provided locally. The majority of women surveyed also believed in the importance of having a maternity unit in the local hospital, which was further iterated and clarified within the interviews. Three main themes emerged from the interview data, namely (i) lack of access to maternity services, (ii) difficulties in accessing maternity services, and (iii) rural women's access needs. The study suggested that women's access needs are not fully met in some rural areas of Tasmania. Rural women face many challenges when accessing maternity services, including financial burden and risk of labouring en route. The study supports the claim that the closure of rural maternity units shifts cost and risk from the health care system to rural women and their families. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  5. Maternity-care: measuring women's perceptions.

    Science.gov (United States)

    Clark, Kim; Beatty, Shelley; Reibel, Tracy

    2016-01-01

    Achieving maternity-care outcomes that align with women's needs, preferences and expectations is important but theoretically driven measures of women's satisfaction with their entire maternity-care experience do not appear to exist. The purpose of this paper is to outline the development of an instrument to assess women's perception of their entire maternity-care experience. A questionnaire was developed on the basis of previous research and informed by a framework of standard service quality categories covering the spectrum of typical consumer concerns. A pilot survey with a sample of 195 women who had recent experience of birth was undertaken to establish valid and reliable scales pertaining to different stages of maternity care. Exploratory factor analysis was used to interpret scales and convergent validity was assessed using a modified version of the Client Satisfaction Questionnaire. Nine theoretically informed, reliable and valid stand-alone scales measuring the achievement of different dimensions of women's expectancies of public maternity care were developed. The study scales are intended for use in identifying some potential areas of focus for quality improvement in the delivery of maternity care. Reliable and valid tools for monitoring the extent to which services respond to women's expectations of their entire maternity care form part of the broader toolkit required to adequately manage health-care quality. This study offers guidance on the make-up of such tools. The scales produced from this research offer a means to assess maternity care across the full continuum of care and are brief and easy to use.

  6. Weight stigma in maternity care: women’s experiences and care providers’ attitudes

    Directory of Open Access Journals (Sweden)

    Mulherin Kate

    2013-01-01

    Full Text Available Abstract Background Weight stigma is pervasive in Western society and in healthcare settings, and has a negative impact on victims’ psychological and physical health. In the context of an increasing focus on the management of overweight and obese women during and after pregnancy in research and clinical practice, the current studies aimed to examine the presence of weight stigma in maternity care. Addressing previous limitations in the weight stigma literature, this paper quantitatively explores the presence of weight stigma from both patient and care provider perspectives. Methods Study One investigated associations between pre-pregnancy body mass index (BMI and experiences of maternity care from a state-wide, self-reported survey of 627 Australian women who gave birth in 2009. Study Two involved administration of an online survey to 248 Australian pre-service medical and maternity care providers, to investigate their perceptions of, and attitudes towards, providing care for pregnant patients of differing body sizes. Both studies used linear regression analyses. Results Women with a higher BMI were more likely to report negative experiences of care during pregnancy and after birth, compared to lower weight women. Pre-service maternity care providers perceived overweight and obese women as having poorer self-management behaviours, and reported less positive attitudes towards caring for overweight or obese pregnant women, than normal-weight pregnant women. Even care providers who reported few weight stigmatising attitudes responded less positively to overweight and obese pregnant women. Conclusions Overall, these results provide preliminary evidence that weight stigma is present in maternity care settings in Australia. They suggest a need for further research into the nature and consequences of weight stigma in maternity care, and for the inclusion of strategies to recognise and combat weight stigma in maternity care professionals’ training.

  7. Does prenatal care benefit maternal health? A study of post-partum maternal care use.

    Science.gov (United States)

    Liu, Tsai-Ching; Chen, Bradley; Chan, Yun-Shan; Chen, Chin-Shyan

    2015-10-01

    Most studies on prenatal care focus on its effects on infant health, while studying less about the effects on maternal health. Using the Longitudinal Health Insurance claims data in Taiwan in a recursive bivariate probit model, this study examines the impact of adequate prenatal care on the probability of post-partum maternal hospitalization during the first 6 months after birth. The results show that adequate prenatal care significantly reduces the probability of post-partum maternal hospitalization among women who have had vaginal delivery by 43.8%. This finding suggests that the benefits of prenatal care may have been underestimated among women with vaginal delivery. Timely and adequate prenatal care not only creates a positive impact on infant health, but also yields significant benefits for post-partum maternal health. However, we do not find similar benefits of prenatal care for women undergoing a cesarean section. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Labouring Together: collaborative alliances in maternity care in Victoria, Australia—protocol of a mixed-methods study

    Science.gov (United States)

    Nagle, Cate; Kent, Bridie; Hutchinson, Alison M

    2017-01-01

    Introduction For over a decade, enquiries into adverse perinatal outcomes have led to reports that poor collaboration has been detrimental to the safety and experience of maternity care. Despite efforts to improve collaboration, investigations into maternity care at Morecambe Bay (UK) and Djerriwarrh Health Services (Australia) have revealed that poor collaboration and decision-making remain a threat to perinatal safety. The Labouring Together study will investigate how elements hypothesised to influence the effectiveness of collaboration are reflected in perceptions and experiences of clinicians and childbearing women in Victoria, Australia. The study will explore conditions that assist clinicians and women to work collaboratively to support positive maternity outcomes. Results of the study will provide a platform for consumers, clinician groups, organisations and policymakers to work together to improve the quality, safety and experience of maternity care. Methods and analysis 4 case study sites have been selected to represent a range of models of maternity care in metropolitan and regional Victoria, Australia. A mixed-methods approach including cross-sectional surveys and interviews will be used in each case study site, involving both clinicians and consumers. Quantitative data analysis will include descriptive statistics, 2-way multivariate analysis of variance for the dependent and independent variables, and χ2 analysis to identify the degree of congruence between consumer preferences and experiences. Interview data will be analysed for emerging themes and concepts. Data will then be analysed for convergent lines of enquiry supported by triangulation of data to draw conclusions. Ethics and dissemination Organisational ethics approval has been received from the case study sites and Deakin University Human Research Ethics Committee (2014–238). Dissemination of the results of the Labouring Together study will be via peer-reviewed publications and conference

  9. What influences success in family medicine maternity care education programs?

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    Biringer, Anne; Forte, Milena; Tobin, Anastasia; Shaw, Elizabeth; Tannenbaum, David

    2018-01-01

    Abstract Objective To ascertain how program leaders in family medicine characterize success in family medicine maternity care education and determine which factors influence the success of training programs. Design Qualitative research using semistructured telephone interviews. Setting Purposive sample of 6 family medicine programs from 5 Canadian provinces. Participants Eighteen departmental leaders and program directors. METHODS Semistructured telephone interviews were conducted with program leaders in family medicine maternity care. Departmental leaders identified maternity care programs deemed to be “successful.” Interviews were audiorecorded and transcribed verbatim. Team members conducted thematic analysis. Main findings Participants considered their education programs to be successful in family medicine maternity care if residents achieved competency in intrapartum care, if graduates planned to include intrapartum care in their practices, and if their education programs were able to recruit and retain family medicine maternity care faculty. Five key factors were deemed to be critical to a program’s success in family medicine maternity care: adequate clinical exposure, the presence of strong family medicine role models, a family medicine–friendly hospital environment, support for the education program from multiple sources, and a dedicated and supportive community of family medicine maternity care providers. Conclusion Training programs wishing to achieve greater success in family medicine maternity care education should employ a multifaceted strategy that considers all 5 of the interdependent factors uncovered in our research. By paying particular attention to the informal processes that connect these factors, program leaders can preserve the possibility that family medicine residents will graduate with the competence and confidence to practise full-scope maternity care. PMID:29760273

  10. Leader of the Maternity care: Doctors or midwives

    DEFF Research Database (Denmark)

    Wagle, Rajendra R.

    2004-01-01

    Technology of delivery of health care for developing countries is not a resolved issue. Moreover, maternity care differs from other areas of health care in many ways. Developing countries have to carefully adapt to what has been done in developed countries. Recent debate and data on maternity...... health care organisation have been in favour of midwifery-led maternity care. Midwifery-led maternity care is described as the best and necessary part of the sufficiently and thus inevitably health producing maternity health care organisation....

  11. Interventions to support effective communication between maternity care staff and women in labour: A mixed-methods systematic review.

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    Chang, Yan-Shing; Coxon, Kirstie; Portela, Anayda Gerarda; Furuta, Marie; Bick, Debra

    2018-04-01

    the objectives of this review were (1) to assess whether interventions to support effective communication between maternity care staff and healthy women in labour with a term pregnancy could improve birth outcomes and experiences of care; and (2) to synthesize information related to the feasibility of implementation and resources required. a mixed-methods systematic review. studies which reported on interventions aimed at improving communication between maternity care staff and healthy women during normal labour and birth, with no apparent medical or obstetric complications, and their family members were included. 'Maternity care staff' included medical doctors (e.g. obstetricians, anaesthetists, physicians, family doctors, paediatricians), midwives, nurses and other skilled birth attendants providing labour, birth and immediate postnatal care. Studies from all birth settings (any country, any facility including home birth, any resource level) were included. two papers met the inclusion criteria. One was a step wedge randomised controlled trial conducted in Syria, and the other a sub-analysis of a randomised controlled trial from the United Kingdom. Both studies aimed to assess effects of communication training for maternity care staff on women's experiences of labour care. The study from Syria reported that a communication skills training intervention for resident doctors was not associated with higher satisfaction reported by women. In the UK study, patient-actors' (experienced midwives) perceptions of safety and communication significantly improved for postpartum haemorrhage scenarios after training with patient-actors in local hospitals, compared with training using manikins in simulation centres, but no differences were identified for other scenarios. Both studies had methodological limitations. the review identified a lack of evidence on impact of interventions to support effective communication between maternity care staff and healthy women during labour and

  12. 'What women want': Using image theory to develop expectations of maternity care framework.

    Science.gov (United States)

    Clark, Kim; Beatty, Shelley; Reibel, Tracy

    2015-05-01

    to develop, in consultation with women, a theoretically-grounded framework to guide the assessment of women's maternity-care experiences. qualitative research was undertaken with women to examine the appropriateness of Image Theory as a heuristic for understanding how women plan and evaluate their maternity-care experiences. maternity-care services in metropolitan and regional communities in Western Australia. an Episodes of Maternity Care Framework grounded in Image Theory was established that addressed various domains of women's perceptions and expectations of their maternity-care experience. previously-identified weaknesses of methods used to measure patient satisfaction were addressed and a valid framework for investigating women's perception of their maternity-services experiences was developed. This framework has the potential to contribute to the ongoing development and improvement of maternity-care service. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Association of Group Prenatal Care in US Family Medicine Residencies With Maternity Care Practice: A CERA Secondary Data Analysis.

    Science.gov (United States)

    Barr, Wendy B; Tong, Sebastian T; LeFevre, Nicholas M

    2017-03-01

    Group prenatal care has been shown to improve both maternal and neonatal outcomes. With increasing adaption of group prenatal care by family medicine residencies, this model may serve as a potential method to increase exposure to and interest in maternity care among trainees. This study aims to describe the penetration, regional and program variations, and potential impacts on future maternity care practice of group prenatal care in US family medicine residencies. The CAFM Educational Research Alliance (CERA) conducted a survey of all US family medicine residency program directors in 2013 containing questions about maternity care training. A secondary data analysis was completed to examine relevant data on group prenatal care in US family medicine residencies and maternity care practice patterns. 23.1% of family medicine residency programs report provision of group prenatal care. Programs with group prenatal care reported increased number of vaginal deliveries per resident. Controlling for average number of vaginal deliveries per resident, programs with group prenatal care had a 2.35 higher odds of having more than 10% of graduates practice obstetrics and a 2.93 higher odds of having at least one graduate in the past 5 years enter an obstetrics fellowship. Residency programs with group prenatal care models report more graduates entering OB fellowships and practicing maternity care. Implementing group prenatal care in residency training can be one method in a multifaceted approach to increasing maternity care practice among US family physicians.

  14. Are species differences in maternal effects arising from maternal care adaptive?

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    Benowitz, K M; Moody, K J; Moore, A J

    2015-02-01

    Parental care benefits offspring through maternal effects influencing their development, growth and survival. However, although parental care in general is likely the result of adaptive evolution, it does not follow that specific differences in the maternal effects that arise from care are also adaptive. Here, we used an interspecific cross-fostering design in the burying beetle species Nicrophorus orbicollis and N. vespilloides, both of which have elaborate parental care involving direct feeding of regurgitated food to offspring, to test whether maternal effects are optimized within a species and therefore adaptive. Using a full-factorial design, we first demonstrated that N. orbicollis care for offspring longer regardless of recipient species. We then examined offspring development and mass in offspring reared by hetero- or conspecific parents. As expected, there were species-specific direct effects independent of the maternal effects, as N. orbicollis larvae were larger and took longer to develop than N. vespilloides regardless of caregiver. We also found significant differences in maternal effects: N. vespilloides maternal care caused more rapid development of offspring of either species. Contrary to expectations if maternal effects were species-specific, there were no significant interactions between caretaker and recipient species for either development time or mass, suggesting that these maternal effects are general rather than optimized within species. We suggest that rather than coadaptation between parents and offspring performance, the species differences in maternal effects may be correlated with direct effects, and that their evolution is driven by selection on those direct effects. © 2014 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2014 European Society For Evolutionary Biology.

  15. Opinions of maternity care professionals and other stakeholders about integration of maternity care: a qualitative study in the Netherlands.

    Science.gov (United States)

    Perdok, Hilde; Jans, Suze; Verhoeven, Corine; Henneman, Lidewij; Wiegers, Therese; Mol, Ben Willem; Schellevis, François; de Jonge, Ank

    2016-07-26

    This study aims to give insight into the opinions of maternity care professionals and other stakeholders on the integration of midwife-led care and obstetrician-led care and on the facilitating and inhibiting factors for integrating maternity care. Qualitative study using interviews and focus groups from November 2012 to February 2013 in the Netherlands. Seventeen purposively selected stakeholder representatives participated in individual semi-structured interviews and 21 in focus groups. One face-to-face focus group included a combined group of midwives, obstetricians and a paediatrician involved in maternity care. Two online focus groups included a group of primary care midwives and a group of clinical midwives respectively. Thematic analysis was performed using Atlas.ti. Two researchers independently coded the interview and focus group transcripts by means of a mind map and themes and relations between them were described. Three main themes were identified with regard to integrating maternity care: client-centred care, continuity of care and task shifting between professionals. Opinions differed regarding the optimal maternity care organisation model. Participants considered the current payment structure an inhibiting factor, whereas a new modified payment structure based on the actual amount of work performed was seen as a facilitating factor. Both midwives and obstetricians indicated that they were afraid to loose autonomy. An integrated maternity care system may improve client-centred care, provide continuity of care for women during labour and birth and include a shift of responsibilities between health care providers. However, differences of opinion among professionals and other stakeholders with regard to the optimal maternity care organisation model may complicate the implementation of integrated care. Important factors for a successful implementation of integrated maternity care are an appropriate payment structure and maintenance of the autonomy of

  16. Student midwives' perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study.

    Science.gov (United States)

    Warmelink, J Catja; de Cock, T Paul; Combee, Yvonne; Rongen, Marloes; Wiegers, Therese A; Hutton, Eileen K

    2017-01-11

    A major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system involving midwives and obstetricians at all care levels. Student midwives are the future maternity care providers and they may be entering into a changing maternity care system, so inclusion of their views in the discussion is relevant. This study aimed to explore student midwives' perceptions on the current organisation of maternity care and alternative maternity care models, including integrated care. This qualitative study was based on the interpretivist/constructivist paradigm, using a grounded theory design. Interviews and focus groups with 18 female final year student midwives of the Midwifery Academy Amsterdam Groningen (AVAG) were held on the basis of a topic list, then later transcribed, coded and analysed. Students felt that inevitably there will be a change in the organisation of maternity care, and they were open to change. Participants indicated that good collaboration between professions, including a shared system of maternity notes and guidelines, and mutual trust and respect were important aspects of any alternative model. The students indicated that client-centered care and the safeguarding of the physiological, normalcy approach to pregnancy and birth should be maintained in any alternative model. Students expressed worries that the role of midwives in intrapartum care could become redundant, and thus they are motivated to take on new roles and competencies, so they can ensure their own role in intrapartum care. Final year student midwives recognise that change in the organisation of maternity care is inevitable and have an open attitude towards changes if they include good collaboration, client-centred care and safeguards for normal physiological birth. The graduating

  17. Effects of maternal confidence and competence on maternal parenting stress in newborn care.

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    Liu, Chien-Chi; Chen, Yueh-Chih; Yeh, Yen-Po; Hsieh, Yeu-Sheng

    2012-04-01

    This paper is a report of a correlational study of the relations of maternal confidence and maternal competence to maternal parenting stress during newborn care. Maternal role development is a cognitive and social process influenced by cultural and family contexts and mother and child characteristics. Most knowledge about maternal role development comes from western society. However, perceptions of the maternal role in contemporary Taiwanese society may be affected by contextual and environmental factors. A prospective correlational design was used to recruit 372 postpartum Taiwanese women and their infants from well-child clinics at 16 health centres in central Taiwan. Inclusion criteria for mothers were gestational age >37 weeks, ≥18 years old, and healthy, with infants maternal confidence, maternal competence and self-perceived maternal parenting stress. After controlling for maternal parity and infant temperament, high maternal confidence and competence were associated with low maternal parenting stress. Maternal confidence influenced maternal parenting stress both directly and indirectly via maternal competence. To assist postpartum women in infant care programmes achieve positive outcomes, nurses should evaluate and bolster mothers' belief in their own abilities. Likewise, nurses should not only consider mothers' infant care skills, but also mothers' parity and infant temperament. Finally, it is crucial for nurses and researchers to recognize that infant care programmes should be tailored to mothers' specific maternal characteristics. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

  18. Maternity care: a narrative overview of what women expect across their care continuum.

    Science.gov (United States)

    Clark, Kim; Beatty, Shelley; Reibel, Tracy

    2015-04-01

    to provide a narrative overview of the values schema underpinning women׳s expectations of public maternity-care services using an episodes-of-care framework. focus-group discussions and in-depth interviews were undertaken with Western Australian women who had opted for public maternity care to determine the values schema apparent in their expectations of their care. public maternity-care services in metropolitan (i.e. Armadale, Osborne Park and Rockingham) and regional (i.e. Broome, Geraldton, Bunbury) Western Australia. women interviewed were found to have consistent values schema underpinning their maternity-care expectations and evaluations. the current study suggests that while women׳s choices and experiences of maternity care may differ on a range of dimensions, the values schema underlying their care expectations and subsequent evaluations are similar. The study findings resonate with past Australian research regarding women׳s expectations of public maternity care, but complement it by providing a coherent narrative of core underpinning stage-specific values schema. These may assist maternity-care policy makers, practitioners and researchers seeking to better understand and comprehensively respond to women׳s maternity-care expectations. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Socioeconomic disparities in maternity care among Indian adolescents, 1990-2006.

    Directory of Open Access Journals (Sweden)

    Chandan Kumar

    Full Text Available BACKGROUND: India, with a population of more than 1.21 billion, has the highest maternal mortality in the world (estimated to be 56000 in 2010; and adolescent (aged 15-19 mortality shares 9% of total maternal deaths. Addressing the maternity care needs of adolescents may have considerable ramifications for achieving the Millennium Development Goal (MDG-5. This paper assesses the socioeconomic differentials in accessing full antenatal care and professional attendance at delivery by adolescent mothers (aged 15-19 in India during 1990-2006. METHODS AND FINDINGS: Data from three rounds of the National Family Health Survey of India conducted during 1992-93, 1998-99, and 2005-06 were analyzed. The Cochran-Armitage and Chi-squared test for linear and non-linear time trends were applied, respectively, to understand the trend in the proportion of adolescent mothers utilizing select maternity care services during 1990-2006. Using pooled multivariate logistic regression models, the probability of select maternal healthcare utilization among women by key socioeconomic characteristics was appraised. After adjusting for potential socio-demographic and economic characteristics, the likelihood of adolescents accessing full antenatal care increased by only 4% from 1990 to 2006. However, the probability of adolescent women availing themselves of professional attendance at delivery increased by 79% during the same period. The study also highlights the desolate disparities in maternity care services among adolescents across the most and the least favoured groups. CONCLUSION: Maternal care interventions in India need focused programs for rural, uneducated, poor adolescent women so that they can avail themselves of measures to delay child bearing, and for better antenatal consultation and delivery care in case of pregnancy. This study strongly advocates the promotion of a comprehensive 'adolescent scheme' along the lines of 'Continuum of Maternal, Newborn and Child

  20. Effectiveness of interventions to provide culturally appropriate maternity care in increasing uptake of skilled maternity care: a systematic review.

    Science.gov (United States)

    Coast, Ernestina; Jones, Eleri; Lattof, Samantha R; Portela, Anayda

    2016-12-01

    Addressing cultural factors that affect uptake of skilled maternity care is recognized as an important step in improving maternal and newborn health. This article describes a systematic review to examine the evidence available on the effects of interventions to provide culturally appropriate maternity care on the use of skilled maternity care during pregnancy, for birth or in the postpartum period. Items published in English, French and/or Spanish between 1 January 1990 and 31 March 2014 were considered. Fifteen studies describing a range of interventions met the inclusion criteria. Data were extracted on population and intervention characteristics; study design; definitions and data for relevant outcomes; and the contexts and conditions in which interventions occurred. Because most of the included studies focus on antenatal care outcomes, evidence of impact is particularly limited for care seeking for birth and after birth. Evidence in this review is clustered within a small number of countries, and evidence from low- and middle-income countries is notably lacking. Interventions largely had positive effects on uptake of skilled maternity care. Cultural factors are often not the sole factor affecting populations' use of maternity care services. Broader social, economic, geographical and political factors interacted with cultural factors to affect targeted populations' access to services in included studies. Programmes and policies should seek to establish an enabling environment and support respectful dialogue with communities to improve use of skilled maternity care. Whilst issues of culture are being recognized by programmes and researchers as being important, interventions that explicitly incorporate issues of culture are rarely evaluated. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

  1. [Costs of maternal-infant care in an institutionalized health care system].

    Science.gov (United States)

    Villarreal Ríos, E; Salinas Martínez, A M; Guzmán Padilla, J E; Garza Elizondo, M E; Tovar Castillo, N H; García Cornejo, M L

    1998-01-01

    Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities.

  2. Student midwives' perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study.

    NARCIS (Netherlands)

    Warmelink, J.C.; Cock, T.P. de; Combee, Y.; Rongen, M.; Wiegers, T.A.; Hutton, E.K.

    2017-01-01

    BACKGROUND: A major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system

  3. Inequalities in maternal care in Italy: the role of socioeconomic and migrant status

    Directory of Open Access Journals (Sweden)

    Laura Lauria

    2013-06-01

    Full Text Available INTRODUCTION: Maternal care is affected by socioeconomic factors. This study analyses the effect of maternal education, employment and citizenship on some antenatal and postnatal care indicators in Italy. METHODS: Data are from two population-based follow-up surveys conducted to evaluate the quality of maternal care in 25 Italian Local Health Units in 2008/9 and 2010/1 (6942 women. Logistic models were applied and interactions among independent variables were explored. RESULTS: Education and employment status affect antenatal and postnatal care indicators and migrant women are less likely to make use of health opportunities. Low education status exacerbates the initial social disadvantage of migrants. Migrant women are also more affected by socioeconomic pressure to restart working early, with negative impact on postnatal care. CONCLUSIONS: Interventions focusing on women's empowerment may tackle inequalities in maternal care for those women, Italians or migrants, who have a worse initial maternal health literacy due to their lower socioeconomic conditions.

  4. Measuring maternal satisfaction with maternity care: A systematic integrative review: What is the most appropriate, reliable and valid tool that can be used to measure maternal satisfaction with continuity of maternity care?

    Science.gov (United States)

    Perriman, Noelyn; Davis, Deborah

    2016-06-01

    The objective of this systematic integrative review is to identify, summarise and communicate the findings of research relating to tools that measure maternal satisfaction with continuity of maternity care models. In so doing the most appropriate, reliable and valid tool that can be used to measure maternal satisfaction with continuity of maternity care will be determined. A systematic integrative review of published and unpublished literature was undertaken using selected databases. Research papers were included if they measured maternal satisfaction in a continuity model of maternity care, were published in English after 1999 and if they included (or made available) the instrument used to measure satisfaction. Six hundred and thirty two unique papers were identified and after applying the selection criteria, four papers were included in the review. Three of these originated in Australia and one in Canada. The primary focus of all papers was not on the development of a tool to measure maternal satisfaction but on the comparison of outcomes in different models of care. The instruments developed varied in terms of the degree to which they were tested for validity and reliability. Women's satisfaction with maternity services is an important measure of quality. Most satisfaction surveys in maternity appear to reflect fragmented models of care though continuity of care models are increasing in line with the evidence demonstrating their effectiveness. It is important that robust tools are developed for this context and that there is some consistency in the way this is measured and reported for the purposes of benchmarking and quality improvement. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  5. Collaboration of midwives in primary care midwifery practices with other maternity care providers.

    Science.gov (United States)

    Warmelink, J Catja; Wiegers, Therese A; de Cock, T Paul; Klomp, Trudy; Hutton, Eileen K

    2017-12-01

    Inter-professional collaboration is considered essential in effective maternity care. National projects are being undertaken to enhance inter-professional relationships and improve communication between all maternity care providers in order to improve the quality of maternity care in the Netherlands. However, little is known about primary care midwives' satisfaction with collaboration with other maternity care providers, such as general practitioners, maternity care assistance organisations (MCAO), maternity care assistants (MCA), obstetricians, clinical midwives and paediatricians. More insight is needed into the professional working relations of primary care midwives in the Netherlands before major changes are made OBJECTIVE: To assess how satisfied primary care midwives are with collaboration with other maternity care providers and to assess the relationship between their 'satisfaction with collaboration' and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics (accessibility). The aim of this study was to provide insight into the professional working relations of primary care midwives in the Netherlands. Our descriptive cross-sectional study is part of the DELIVER study. Ninety nine midwives completed a written questionnaire in May 2010. A Friedman ANOVA test assessed differences in satisfaction with collaboration with six groups of maternity care providers. Bivariate analyses were carried out to assess the relationship between satisfaction with collaboration and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics. Satisfaction experienced by primary care midwives when collaborating with the different maternity care providers varies within and between primary and secondary/tertiary care. Interactions with non-physicians (clinical midwives and MCA(O)) are ranked consistently higher on satisfaction compared with

  6. An Approach to measuring Integrated Care within a Maternity Care System: Experiences from the Maternity Care Network Study and the Dutch Birth Centre Study

    Science.gov (United States)

    Valentijn, Pim P.; Hitzert, Marit; Hermus, Marieke A.A.; Franx, Arie; de Vries, Raymond G.; Wiegers, Therese A.; Bruijnzeels, Marc A.

    2017-01-01

    Introduction: Integrated care is considered to be a means to reduce costs, improve the quality of care and generate better patient outcomes. At present, little is known about integrated care in maternity care systems. We developed questionnaires to examine integrated care in two different settings, using the taxonomy of the Rainbow Model of Integrated Care. The aim of this study was to explore the validity of these questionnaires. Methods: We used data collected between 2013 and 2015 from two studies: the Maternity Care Network Study (634 respondents) and the Dutch Birth Centre Study (56 respondents). We assessed the feasibility, discriminative validity, and reliability of the questionnaires. Results: Both questionnaires showed good feasibility (overall missing rate 0.70). Between-subgroups post-hoc comparisons showed statistically significant differences on integration profiles between regional networks (on all items, dimensions of integration and total integration score) and birth centres (on 50% of the items and dimensions of integration). Discussion: Both questionnaires are feasible and can discriminate between sites with different integration profiles in The Netherlands. They offer an opportunity to better understand integrated care as one step in understanding the complexity of the concept. PMID:28970747

  7. More than a name: Heterogeneity in characteristics of models of maternity care reported from the Australian Maternity Care Classification System validation study.

    Science.gov (United States)

    Donnolley, Natasha R; Chambers, Georgina M; Butler-Henderson, Kerryn A; Chapman, Michael G; Sullivan, Elizabeth A

    2017-08-01

    Without a standard terminology to classify models of maternity care, it is problematic to compare and evaluate clinical outcomes across different models. The Maternity Care Classification System is a novel system developed in Australia to classify models of maternity care based on their characteristics and an overarching broad model descriptor (Major Model Category). This study aimed to assess the extent of variability in the defining characteristics of models of care grouped to the same Major Model Category, using the Maternity Care Classification System. All public hospital maternity services in New South Wales, Australia, were invited to complete a web-based survey classifying two local models of care using the Maternity Care Classification System. A descriptive analysis of the variation in 15 attributes of models of care was conducted to evaluate the level of heterogeneity within and across Major Model Categories. Sixty-nine out of seventy hospitals responded, classifying 129 models of care. There was wide variation in a number of important attributes of models classified to the same Major Model Category. The category of 'Public hospital maternity care' contained the most variation across all characteristics. This study demonstrated that although models of care can be grouped into a distinct set of Major Model Categories, there are significant variations in models of the same type. This could result in seemingly 'like' models of care being incorrectly compared if grouped only by the Major Model Category. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  8. Evidence from Maternity Leave Expansions of the Impact of Maternal Care on Early Child Development

    Science.gov (United States)

    Baker, Michael; Milligan, Kevin

    2010-01-01

    We study the impact of maternal care on early child development using an expansion in Canadian maternity leave entitlements. Following the leave expansion, mothers who took leave spent 48-58 percent more time not working in their children's first year of life. This extra maternal care primarily crowded out home-based care by unlicensed…

  9. Huge poor-rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries

    NARCIS (Netherlands)

    Houweling, Tanja A. J.; Ronsmans, Carine; Campbell, Oona M. R.; Kunst, Anton E.

    2007-01-01

    OBJECTIVE: Progress towards the Millennium Development Goals for maternal health has been slow, and accelerated progress in scaling up professional delivery care is needed. This paper describes poor-rich inequalities in the use of maternity care and seeks to understand these inequalities through

  10. Maternity Care Services Provided by Family Physicians in Rural Hospitals.

    Science.gov (United States)

    Young, Richard A

    The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.

  11. Suboptimal care and maternal mortality among foreign-born women in Sweden

    DEFF Research Database (Denmark)

    Esscher, Annika; Binder-Finnema, Pauline; Bødker, Birgit

    2014-01-01

    that occurred in Sweden from 1988-2010. METHODS: A subset of maternal death records (n = 75) among foreign-born women from low- and middle-income countries and Swedish-born women were audited using structured implicit review. One case of foreign-born maternal death was matched with two native born Swedish cases...... language and suboptimal interpreter system or usage. Inadequate care occurred more often among the foreign-born (p = 0.04), whereas delays in consultation/referral and miscommunication between health care providers where equally common between the two groups. CONCLUSIONS: Suboptimal care factors, major...

  12. [A Maternal Health Care System Based on Mobile Health Care].

    Science.gov (United States)

    Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

    2016-02-01

    Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.

  13. Addressing disparities in maternal health care in Pakistan: gender, class and exclusion

    Directory of Open Access Journals (Sweden)

    Mumtaz Zubia

    2012-08-01

    Full Text Available Abstract Background After more than two decades of the Safe Motherhood Initiative and Millennium Development Goals aimed at reducing maternal mortality, women continue to die in childbirth at unacceptably high rates in Pakistan. While an extensive literature describes various programmatic strategies, it neglects the rigorous analysis of the reasons these strategies have been unsuccessful, especially for women living at the economic and social margins of society. A critical gap in current knowledge is a detailed understanding of the root causes of disparities in maternal health care, and in particular, how gender and class influence policy formulation and the design and delivery of maternal health care services. Taking Pakistan as a case study, this research builds upon two distinct yet interlinked conceptual approaches to understanding the phenomenon of inequity in access to maternal health care: social exclusion and health systems as social institutions. Methods/Design This four year project consists of two interrelated modules that focus on two distinct groups of participants: (1 poor, disadvantaged women and men and (2 policy makers, program managers and health service providers. Module one will employ critical ethnography to understand the key axes of social exclusion as related to gender, class and zaat and how they affect women’s experiences of using maternal health care. Through health care setting observations, interviews and document review, Module two will assess policy design and delivery of maternal health services. Discussion This research will provide theoretical advances to enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems in Pakistan. It will also provide empirical evidence to support formulation of maternal health care policies and health care system practices aimed at reducing disparities in maternal health care in Pakistan. Lastly, it

  14. Maternal ability to take care of children exposed to HIV

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    Julyana Gomes Freitas

    2013-07-01

    Full Text Available OBJECTIVE: to assess the ability of mothers to take care of children exposed to HIV, using the Assessment Scale of Care Skills for Children Exposed to HIV at Birth and to check the association between the scale dimensions and maternal characteristics. METHOD: this cross-sectional study involved 62 HIV+ mothers whose children of up to one year old had been exposed to the virus at birth. The Assessment Scale of Care Skills for Children Exposed to HIV at Birth consists of 52 items and five dimensions, indicating high, moderate or low care ability. RESULTS: 72.7% of the mothers appropriately offered zidovudine syrup; 86.0% were highly skilled to prepare and administer milk formula; 44.4% were moderately able to prepare and administer complementary feeding; 76.5% revealed high ability to administer prophylactic treatment against pneumonia and 95.3% demonstrated high abilities for clinical monitoring and immunization. Significant associations were found between some maternal variables and the scale dimensions. CONCLUSION: the scale permits the assessment of maternal care delivery to these children and the accomplishment of specific child health interventions.

  15. Developing evidence-based maternity care in Iran: a quality improvement study

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    Mohammad Kazem

    2008-06-01

    Full Text Available Abstract Background Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. Methods The major steps of the study were to (1 identify women's needs, values and preferences via interviews, (2 select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3 redesign care based on the selected evidence-based recommendations and women's views, and (4 implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model. Results Twenty women's needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p Conclusion The introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in women's satisfaction levels and a reduction in rates of caesarean birth.

  16. Utilization of maternal health care services in post-conflict Nepal

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    Bhandari TR

    2015-08-01

    Full Text Available Tulsi Ram Bhandari, Prabhakaran Sankara Sarma, Vellappillil Raman Kutty Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India Background: Despite a decade-long armed conflict in Nepal, the country made progress in reducing maternal mortality and is on its way to achieve the Millennium Development Goal Five. This study aimed to assess the degree of the utilization of maternal health care services during and after the armed conflict in Nepal.Methods: This study is based on Nepal Demographic and Health Survey data 2006 and 2011. The units of analysis were women who had given birth to at least one child in the past 5 years preceding the survey. First, we compared the utilization of maternal health care services of 2006 with that of 2011. Second, we merged the two data sets and applied logistic regression to distinguish whether the utilization of maternal health care services had improved after the peace process 2006 was underway.Results: In 2011, 85% of the women sought antenatal care at least once. Skilled health workers for delivery care assisted 36.1% of the women, and 46% of the women attended postnatal care visit at least once. These figures were 70%, 18.7%, and 16%, respectively, in 2006. Similarly, women were more likely to utilize antenatal care at least once (odds ratio [OR] =2.18, confidence interval [CI] =1.95–2.43, skilled care at birth (OR =2.58, CI =2.36–2.81, and postnatal care at least once (OR =4.13, CI =3.75–4.50 in 2011.Conclusion: The utilization of maternal health care services tended to increase continuously during both the armed conflict and the post-conflict period in Nepal. However, the increasing proportion of the utilization was higher after the Comprehensive Peace Process Agreement 2006. Keywords: antenatal care, armed conflict, Nepal, post-conflict, postnatal care, skilled care at birth

  17. Barriers to providing maternity care to women with physical disabilities: Perspectives from health care practitioners.

    Science.gov (United States)

    Mitra, Monika; Smith, Lauren D; Smeltzer, Suzanne C; Long-Bellil, Linda M; Sammet Moring, Nechama; Iezzoni, Lisa I

    2017-07-01

    Women with physical disabilities are known to experience disparities in maternity care access and quality, and communication gaps with maternity care providers, however there is little research exploring the maternity care experiences of women with physical disabilities from the perspective of their health care practitioners. This study explored health care practitioners' experiences and needs around providing perinatal care to women with physical disabilities in order to identify potential drivers of these disparities. We conducted semi-structured telephone interviews with 14 health care practitioners in the United States who provide maternity care to women with physical disabilities, as identified by affiliation with disability-related organizations, publications and snowball sampling. Descriptive coding and content analysis techniques were used to develop an iterative code book related to barriers to caring for this population. Public health theory regarding levels of barriers was applied to generate broad barrier categories, which were then analyzed using content analysis. Participant-reported barriers to providing optimal maternity care to women with physical disabilities were grouped into four levels: practitioner level (e.g., unwillingness to provide care), clinical practice level (e.g., accessible office equipment like adjustable exam tables), system level (e.g., time limits, reimbursement policies), and barriers relating to lack of scientific evidence (e.g., lack of disability-specific clinical data). Participants endorsed barriers to providing optimal maternity care to women with physical disabilities. Our findings highlight the needs for maternity care practice guidelines for women with physical disabilities, and for training and education regarding the maternity care needs of this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Development of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) for migrants to Western societies

    DEFF Research Database (Denmark)

    Gagnon, Anita J; DeBruyn, Rebecca; Essén, Birgitta

    2014-01-01

    was undertaken to identify priority themes and questions as well as to clarify wording and format. Third, the draft questionnaire was translated from English to French and Spanish and back-translated and subsequently culturally validated (assessed for cultural appropriateness) by migrant women. Fourth...... Initiative; adaptations of these recommendations specific to maternity care have yet to be elucidated and validated. We aimed to develop a questionnaire measuring migrant-friendly maternity care (MFMC) which could be used in a range of maternity care settings and countries. METHODS: This study was conducted......, and perceptions of care, has been created--the Migrant Friendly Maternity Care Questionnaire (MFMCQ)--in three languages (English, French and Spanish). It is completed in 45 minutes via interview administration several months post-birth. CONCLUSIONS: A 4-stage process of questionnaire development...

  19. Impact of Potential Accreditation and Certification in Family Medicine Maternity Care.

    Science.gov (United States)

    Eden, Aimee R; Peterson, Lars E

    2017-01-01

    Advanced maternity care training in family medicine is highly variable at both the residency and fellowship levels. Declining numbers of family physicians providing maternity care services may exacerbate disparities in access to maternal and child care, especially in rural and other underserved communities. Accreditation of maternity care fellowships and board certification may be one potential avenue to address this trend. This study sought to understand the perceptions and beliefs of key family medicine stakeholders in advanced maternity care regarding the formalization of maternity care training through fellowship accreditation and the creation of a certificate of added qualification (CAQ). In 2014 and 2015, the authors conducted semi-structured interviews with 51 key stakeholders in family medicine maternity care. Transcribed interviews were coded using an iterative process to identify themes and patterns until saturation was reached. Participants generally supported both maternity care fellowship accreditation and a CAQ and recognized multiple advantages such as legitimization of training. Many had concerns about potential negative unintended consequences such as a loss of curricular flexibility; however, most felt that these could be mediated. Only a few did not support one or both aspects of formalization. Most participants interviewed support formalizing maternity care fellowship training in family medicine through accreditation and a subsequent CAQ, if implemented with attention to minimizing the potential negative consequences. Such formalization would recognize the advanced skill and training of family physicians practicing advanced maternity care and could address some access issues to essential maternity care services for rural and other underserved populations.

  20. Wealth and antenatal care use: implications for maternal health care utilisation in Ghana.

    Science.gov (United States)

    Arthur, Eric

    2012-08-06

    The study investigates the effect of wealth on maternal health care utilization in Ghana via its effect on Antenatal care use. Antenatal care serves as the initial point of contact of expectant mothers to maternal health care providers before delivery. The study is pivoted on the introduction of the free maternal health care policy in April 2005 in Ghana with the aim of reducing the financial barrier to the use of maternal health care services, to help reduce the high rate of maternal deaths. Prior to the introduction of the policy, studies found wealth to have a positive and significant influence on the use of Antenatal care. It is thus expected that with the policy, wealth should not influence the use of maternal health care significantly. Using secondary data from the 2008 Ghana Demographic and Health survey, the results have revealed that wealth still has a significant influence on adequate use of Antenatal care. Education, age, number of living children, transportation and health insurance are other factors that were found to influence the use of Antenatal care in Ghana. There also exist considerable variations in the use of Antenatal care in the geographical regions and between the rural and urban dwellers. It is recommended that to improve the use of Antenatal care and hence maternal health care utilization, some means of support is provided especially to women within the lowest wealth quintiles, like the provision and availability of recommended medication at the health center; secondly, women should be encouraged to pursue education to at least the secondary level since this improves their use of maternal health services. Policy should also target mothers who have had the experience of child birth on the need to use adequate Antenatal care for each pregnancy, since these mothers tend to use less antenatal care for subsequent pregnancies. The regional disparities found may be due to inaccessibility and unavailability of health facilities and services in the

  1. Defining Remoteness from Health Care: Integrated Research on Accessing Emergency Maternal Care in Indonesia

    Directory of Open Access Journals (Sweden)

    Bronwyn A Myers

    2015-07-01

    Full Text Available The causes of maternal death are well known, and are largely preventable if skilled health care is received promptly. Complex interactions between geographic and socio-cultural factors affect access to, and remoteness from, health care but research on this topic rarely integrates spatial and social sciences. In this study, modeling of travel time was integrated with social science research to refine our understanding of remoteness from health care. Travel time to health facilities offering emergency obstetric care (EmOC and population distribution were modelled for a district in eastern Indonesia. As an index of remoteness, the proportion of the population more than two hours estimated travel time from EmOC was calculated. For the best case scenario (transport by ambulance in the dry season, modelling estimated more than 10,000 fertile aged women were more than two hours from EmOC. Maternal mortality ratios were positively correlated with the remoteness index, however there was considerable variation around this relationship. In a companion study, ethnographic research in a subdistrict with relatively good access to health care and high maternal mortality identified factors influencing access to EmOC, including some that had not been incorporated into the travel time model. Ethnographic research provided information about actual travel involved in requesting and reaching EmOC. Modeled travel time could be improved by incorporating time to deliver request for care. Further integration of social and spatial methods and the development of more dynamic travel time models are needed to develop programs and policies to address these multiple factors to improve maternal health outcomes.

  2. Infant feeding-related maternity care practices and maternal report of breastfeeding outcomes.

    Science.gov (United States)

    Nelson, Jennifer M; Perrine, Cria G; Freedman, David S; Williams, Letitia; Morrow, Brian; Smith, Ruben A; Dee, Deborah L

    2018-02-07

    Evidence-based maternity practices and policies can improve breastfeeding duration and exclusivity. Maternity facilities report practices through the Maternity Practices in Infant Nutrition and Care (mPINC) survey, but individual outcomes, such as breastfeeding duration and exclusivity, are not collected. mPINC data on maternity care practices for 2009 were linked to data from the 2009 Pregnancy Risk Assessment Monitoring System (PRAMS), which collects information on mothers' behaviors and experiences around pregnancy. We calculated total mPINC scores (range 0-100). PRAMS data on any and exclusive breastfeeding at 8 weeks were examined by total mPINC score quartile. Of 15 715 women in our sample, 53.7% were breastfeeding any at 8 weeks, and 29.3% were breastfeeding exclusively. They gave birth at 1016 facilities that had a mean total mPINC score of 65/100 (range 19-99). Care dimension subscores ranged from 41 for facility discharge care to 81 for breastfeeding assistance. In multivariable analysis adjusting for covariates, a positive relationship was found between total mPINC score quartile and both any breastfeeding (quartile 2: odds ratio [OR] 1.40 [95% confidence interval {CI} 1.08-1.83], quartile 3: OR 1.50 [95% CI 1.15-1.96], quartile 4: OR 2.12 [95% CI 1.61-2.78] vs quartile 1) and exclusive breastfeeding (quartile 3: OR 1.41 [95% CI 1.04-1.90], quartile 4: OR 1.89 [95% CI 1.41-2.55] vs quartile 1) at 8 weeks. These data demonstrate that evidence-based maternity care practices and policies are associated with better breastfeeding outcomes. Maternity facilities may evaluate their practices and policies to ensure they are helping mothers achieve their breastfeeding goals. © 2018 Wiley Periodicals, Inc.

  3. The Maternity Care Nurse Workforce in Rural U.S. Hospitals.

    Science.gov (United States)

    Henning-Smith, Carrie; Almanza, Jennifer; Kozhimannil, Katy B

    To describe the maternity care nurse staffing in rural U.S. hospitals and identify key challenges and opportunities in maintaining an adequate nursing workforce. Cross-sectional survey study. Maternity care units within rural hospitals in nine U.S. states. Maternity care unit managers. We calculated descriptive statistics to characterize the rural maternity care nursing workforce by hospital birth volume and nursing staff model. We used simple content analysis to analyze responses to open-ended questions and identified themes related to challenges and opportunities for maternity care nursing in rural hospitals. Of the 263 hospitals, 51% were low volume (maternity care nurses. They did, however, identify significant challenges related to recruiting nurses, maintaining adequate staffing during times of census variability, orienting and training nurses, and retaining experienced nurses. Rural maternity care unit managers recognize the importance of nursing and have varied staffing needs. Policy implementation and programmatic support to ameliorate challenges may help ensure that an adequate nursing staff can be maintained, even in small-volume rural hospitals. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  4. Experienced job autonomy among maternity care professionals in The Netherlands.

    Science.gov (United States)

    Perdok, Hilde; Cronie, Doug; van der Speld, Cecile; van Dillen, Jeroen; de Jonge, Ank; Rijnders, Marlies; de Graaf, Irene; Schellevis, François G; Verhoeven, Corine J

    2017-11-01

    High levels of experienced job autonomy are found to be beneficial for healthcare professionals and for the relationship with their patients. The aim of this study was to assess how maternity care professionals in the Netherlands perceive their job autonomy in the Dutch maternity care system and whether they expect a new system of integrated maternity care to affect their experienced job autonomy. A cross-sectional survey. The Leiden Quality of Work Life Questionnaire was used to assess experienced job autonomy among maternity care professionals. Data were collected in the Netherlands in 2015. 799 professionals participated of whom 362 were primary care midwives, 240 obstetricians, 93 clinical midwives and 104 obstetric nurses. The mean score for experienced job autonomy was highest for primary care midwives, followed by obstetricians, clinical midwives and obstetric nurses. Primary care midwives scored highest in expecting to lose their job autonomy in an integrated care system. There are significant differences in experienced job autonomy between maternity care professionals. When changing the maternity care system it will be a challenge to maintain a high level of experienced job autonomy for professionals. A decrease in job autonomy could lead to a reduction in job related wellbeing and in satisfaction with care among pregnant women. Copyright © 2017. Published by Elsevier Ltd.

  5. Paperbark and pinard: A historical account of maternity care in one remote Australian Aboriginal town.

    Science.gov (United States)

    Ireland, Sarah; Belton, Suzanne; McGrath, Ann; Saggers, Sherry; Narjic, Concepta Wulili

    2015-12-01

    Maternity care in remote areas of the Australian Northern Territory is restricted to antenatal and postnatal care only, with women routinely evacuated to give birth in hospital. Using one remote Aboriginal community as a case study, our aim with this research was to document and explore the major changes to the provision of remote maternity care over the period spanning pre-European colonisation to 1996. Our research methods included historical ethnographic fieldwork (2007-2013); interviews with Aboriginal women, Aboriginal health workers, religious and non-religious non-Aboriginal health workers and past residents; and archival review of historical documents. We identified four distinct eras of maternity care. Maternity care staffed by nuns who were trained in nursing and midwifery serviced childbirth in the local community. Support for community childbirth was incrementally withdrawn over a period, until the government eventually assumed responsibility for all health care. The introduction of Western maternity care colonised Aboriginal birth practices and midwifery practice. Historical population statistics suggest that access to local Western maternity care may have contributed to a significant population increase. Despite population growth and higher demand for maternity services, local maternity services declined significantly. The rationale for removing childbirth services from the community was never explicitly addressed in any known written policy directive. Declining maternity services led to the de-skilling of many Aboriginal health workers and the significant community loss of future career pathways for Aboriginal midwives. This has contributed to the current status quo, with very few female Aboriginal health workers actively providing remote maternity care. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  6. Respectful maternity care in Ethiopian public health facilities

    NARCIS (Netherlands)

    Sheferaw, Ephrem D.; Bazant, Eva; Gibson, Hannah; Fenta, Hone B.; Ayalew, Firew; Belay, Tsigereda B.; Worku, Maria M.; Kebebu, Aelaf E.; Woldie, Sintayehu A.; Kim, Young-Mi; van den Akker, T.; Stekelenburg, Jelle

    2017-01-01

    Background: Disrespect and abuse of women during institutional childbirth services is one of the deterrents to utilization of maternity care services in Ethiopia and other low- and middle-income countries. This paper describes the prevalence of respectful maternity care (RMC) and mistreatment of

  7. Wired for motherhood: induction of maternal care but not maternal aggression in virgin female CD1 mice.

    Science.gov (United States)

    Martín-Sánchez, Ana; Valera-Marín, Guillermo; Hernández-Martínez, Adoración; Lanuza, Enrique; Martínez-García, Fernando; Agustín-Pavón, Carmen

    2015-01-01

    Virgin adult female mice display nearly spontaneous maternal care towards foster pups after a short period of sensitization. This indicates that maternal care is triggered by sensory stimulation provided by the pups and that its onset is largely independent on the physiological events related to gestation, parturition and lactation. Conversely, the factors influencing maternal aggression are poorly understood. In this study, we sought to characterize two models of maternal sensitization in the outbred CD1 strain. To do so, a group of virgin females (godmothers) were exposed to continuous cohabitation with a lactating dam and their pups from the moment of parturition, whereas a second group (pup-sensitized females), were exposed 2 h daily to foster pups. Both groups were tested for maternal behavior on postnatal days 2-4. Godmothers expressed full maternal care from the first test. Also, they expressed higher levels of crouching than dams. Pup-sensitized females differed from dams in all measures of pup-directed behavior in the first test, and expressed full maternal care after two sessions of contact with pups. However, both protocols failed to induce maternal aggression toward a male intruder after full onset of pup-directed maternal behavior, even in the presence of pups. Our study confirms that adult female mice need a short sensitization period before the onset of maternal care. Further, it shows that pup-oriented and non-pup-oriented components of maternal behavior are under different physiological control. We conclude that the godmother model might be useful to study the physiological and neural bases of the maternal behavior repertoire.

  8. Maternal health care professionals' perspectives on the provision and use of antenatal and delivery care: a qualitative descriptive study in rural Vietnam

    Directory of Open Access Journals (Sweden)

    Krantz Gunilla

    2010-10-01

    Full Text Available Abstract Background High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam. Method The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis. Result Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment. Conclusion Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and

  9. Experience with and amount of postpartum maternity care: Comparing women who rated the care they received from the maternity care assistant as 'good' or 'less than good care'.

    Science.gov (United States)

    Baas, C I; Wiegers, T A; de Cock, T P; Erwich, J J H M; Spelten, E R; Hutton, E K

    2017-12-01

    The postpartum period is an important time in the lives of new mothers, their children and their families. The aim of postpartum care is 'to detect health problems of mother and/or baby at an early stage, to encourage breastfeeding and to give families a good start' (Wiegers, 2006). The Netherlands maternity care system aims to enable every new family to receive postpartum care in their home by a maternity care assistant (MCA). In order to better understand this approach, in this study we focus on women who experienced the postpartum care by the MCA as 'less than good' care. Our research questions are; among postpartum women in the Netherlands, what is the uptake of MCA care and what factors are significantly associated with women's rating of care provided by the MCA. Design and setting This study uses data from the 'DELIVER study', a dynamic cohort study, which was set up to investigate the organization, accessibility and quality of primary midwifery care in the Netherlands. Participants In the DELIVER population 95.6% of the women indicated that they had received postpartum maternity care by an MCA in their home. We included the responses of 3170 women. To assess the factors that were significantly associated with reporting 'less than good (postpartum) care' by the MCA, a full cases backward logistic regression model was built using the multilevel approach in Generalized Linear Mixed Models. The mean rating of the postpartum care by the MCA was 8.8 (on a scale from 1-10), and 444 women (14%) rated the postpartum maternity care by the MCA as 'less than good care'. In the full cases multivariable analysis model, odds of reporting 'less than good care' by the MCA were significantly higher for women who were younger (women 25-35 years had an OR 1.32, CI 0.96-1.81 and women 35 years), multiparous (OR 1.27, CI 1.01-1.60) and had a higher level of education (women with a middle level had an OR 1.84,CI 1.22-2.79, and women with a high level of education had an OR 2

  10. Maternal knowledge and care.seeking behaviors for newborn ...

    African Journals Online (AJOL)

    Background: Delay in the presentation of infants with jaundice at the hospital is a reason for the persistence of the severe forms of jaundice. Objective: The aim was to determine the influence of maternal knowledge on newborn jaundice on their care-seeking practices. Methods: In a cross-sectional survey, mothers whose ...

  11. Burden of maternal bipolar disorder on at-risk offspring: a controlled study on family planning and maternal care.

    Science.gov (United States)

    Moreno, Doris Hupfeld; Bio, Danielle Soares; Petresco, Sandra; Petresco, Denise; Gutt, Elisa Kijner; Soeiro-de-Souza, Márcio Gerhardt; Moreno, Ricardo Alberto

    2012-12-20

    Bipolar disorder (BD) is a highly incapacitating disease typically associated with high rates of familial dysfunction. Despite recent literature suggesting that maternal care is an important environmental factor in the development of behavioral disorders, it is unclear how much maternal care is dysfunctional in BD subjects. The objective of this study was to characterize maternal care in DSM-IV/SCID diagnosed BD type I subjects compared to healthy controls with (PD) and without (NPD) other psychiatric diagnoses. Thirty-four BD mothers and 106 controls underwent an interview about family planning and maternal care, obstetrical complications, and mother-child interactions. K-SADS-PL questions about violence exposure were used to ascertain domestic violence and physical/sexual abuse. BD mothers were less likely to have stable unions (45.5%; pmothers. Due to BD mothers' symptoms, 33.3% of offspring suffered physical and/or psychological abuse. Post hoc analysis, and the use of questions as a surrogate of symptoms as opposed to validated instruments. This is one of few reports confirming that maternal care given by BD women is dysfunctional. BD psychopathology can lead to poor maternal care and both should be considered important environmental risk factors in BD, suggesting that BD psychoeducation should include maternal care orientation. Copyright © 2012 Elsevier B.V. All rights reserved.

  12. Impact of maternal and neonatal health initiatives on inequity in maternal health care utilization in Bangladesh.

    Science.gov (United States)

    Haider, Mohammad Rifat; Rahman, Mohammad Masudur; Moinuddin, Md; Rahman, Ahmed Ehsanur; Ahmed, Shakil; Khan, M Mahmud

    2017-01-01

    Despite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children's Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization. Two surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index. Mean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370). Overall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups

  13. GP obstetricians' views of the model of maternity care in New Zealand.

    Science.gov (United States)

    Miller, Dawn L; Mason, Zara; Jaye, Chrystal

    2013-02-01

    The Lead Maternity Carer (LMC) model of maternity care, and independent midwifery practice, was introduced to New Zealand in the 1990s. The LMC midwife or general practitioner obstetrician (GPO) has clinical and budgetary responsibility for women's primary maternity care. To determine views of practising GPOs and former GPOs about the LMC model of care, its impact on maternity care in general practice, and future of maternity care in general practice. 10 GPOs and 13 former GPOs were interviewed: one focus group (n = 3), 20 semi-structured interviews. The qualitative data analysis program ATLAS.ti assisted thematic analysis. Participants thought the LMC model isolates the LMC - particularly concerning during intrapartum care, in rural practice, and covering 24-hour call; Is not compatible with or adequately funded for GP participation; Excludes the GP from caring for their pregnant patients. Participants would like a flexible, locally adaptable, adequately funded maternity model, supporting shared care. Some thought work-life balance and low GPO numbers could deter future GPs from maternity practice. Others felt with political will, support of universities, and Royal New Zealand College of General Practice and Royal Australian and New Zealand College of Obstetrics and Gynaecology, GPs could become more involved in maternity care again. Participants thought the LMC model isolates maternity practitioners, is incompatible with general practice and causes loss of continuity of general practice care. They support provision of maternity care in general practice; however, for more GPs to become involved, the LMC model needs review. © 2013 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  14. Maternity high-dependency care and the Australian midwife: A review of the literature.

    Science.gov (United States)

    Kingwell, Emma L; Butt, Janice; Leslie, Gavin

    2017-04-01

    Maternity high-dependency care has emerged throughout the 21st century in Australian maternity hospitals as a distinct sub-speciality of maternity care. However, what the care involves, how and why it should be provided, and the role of midwives in the provision of such care remains highly variable. Rising levels of maternal morbidity from non-obstetric causes have led midwives to work with women who require highly complex care, beyond the standard customary midwifery role. Whilst the nursing profession has developed and refined its expertise as a specialty in the field of high-dependency care, the midwifery profession has been less likely to pursue this as a specific area of practice. This paper explores the literature surrounding maternity high-dependency care. From the articles reviewed, four key themes emerge which include; the need for maternity high-dependency care, maternal morbidity and maternity high-dependency care, the role of the midwife and maternity high-dependency care and midwifery education and preparation for practice. It highlights the challenges that health services are faced with in order to provide maternity high-dependency care to women. Some of these challenges include resourcing and budgeting limitations, availability of educators with the expertise to train staff, and the availability of suitably trained staff to care for the women when required. In order to provide maternity high-dependency care, midwives need to be suitably equipped with the knowledge and skills required to do so. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  15. What influences success in family medicine maternity care education programs? Qualitative exploration.

    Science.gov (United States)

    Biringer, Anne; Forte, Milena; Tobin, Anastasia; Shaw, Elizabeth; Tannenbaum, David

    2018-05-01

    To ascertain how program leaders in family medicine characterize success in family medicine maternity care education and determine which factors influence the success of training programs. Qualitative research using semistructured telephone interviews. Purposive sample of 6 family medicine programs from 5 Canadian provinces. Eighteen departmental leaders and program directors. Semistructured telephone interviews were conducted with program leaders in family medicine maternity care. Departmental leaders identified maternity care programs deemed to be "successful." Interviews were audiorecorded and transcribed verbatim. Team members conducted thematic analysis. Participants considered their education programs to be successful in family medicine maternity care if residents achieved competency in intrapartum care, if graduates planned to include intrapartum care in their practices, and if their education programs were able to recruit and retain family medicine maternity care faculty. Five key factors were deemed to be critical to a program's success in family medicine maternity care: adequate clinical exposure, the presence of strong family medicine role models, a family medicine-friendly hospital environment, support for the education program from multiple sources, and a dedicated and supportive community of family medicine maternity care providers. Training programs wishing to achieve greater success in family medicine maternity care education should employ a multifaceted strategy that considers all 5 of the interdependent factors uncovered in our research. By paying particular attention to the informal processes that connect these factors, program leaders can preserve the possibility that family medicine residents will graduate with the competence and confidence to practise full-scope maternity care. Copyright© the College of Family Physicians of Canada.

  16. General practice registrars' views on maternity care in general practice in New Zealand.

    Science.gov (United States)

    Preston, Hanna; Jaye, Chrystal; Miller, Dawn L

    2015-12-01

    The number of general practitioners (GPs) providing maternity care in New Zealand has declined dramatically since legislative changes of the 1990s. The Ministry of Health wants GPs to provide maternity care again. To investigate New Zealand general practice registrars' perspectives on GPs' role in maternity care; specifically, whether maternity services should be provided by GPs, registrars' preparedness to provide such services, and training opportunities available or required to achieve this. An anonymous online questionnaire was distributed to all registrars enrolled in The Royal New Zealand College of General Practitioners' (RNZCGP's) General Practice Education Programme (GPEP) in 2012, via their online learning platform OWL. 165 of the 643 general practice registrars responded (25.7% response rate). Most (95%) believe that GPs interested and trained in maternity care should consider providing antenatal, postnatal or shared care with midwives, and 95% believe women should be able to access maternity care from their general practice. When practising as a GP, 90% would consider providing antenatal and postnatal care, 47.3% shared care, and 4.3% full pregnancy care. Professional factors including training and adequate funding were most important when considering providing maternity care as a GP. Ninety-five percent of general practice registrars who responded to our survey believe that GPs should provide some maternity services, and about 90% would consider providing maternity care in their future practice. Addressing professional issues of training, support and funding are essential if more GPs are to participate in maternity care in New Zealand.

  17. Refusal of recommended maternity care: Time to make a pact with women?

    Science.gov (United States)

    Jenkinson, Bec; Kruske, Sue; Kildea, Sue

    2018-03-28

    The right to refuse medical treatment can be contentious in maternity care. Professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy, but there is little guidance available to clinicians about the appropriate clinical responses when women decline recommended care. We propose a comprehensive, woman-centred, systems-level framework for documentation and communication with the goal of supporting women, clinicians and health services in situations of maternal refusal. We term this the Personalised Alternative Care and Treatment framework. The Personalised Alternative Care and Treatment framework addresses Australian policy, practice, education and professional issues to underpin woman-centred care in the context of maternal refusal. It embeds Respectful Maternity Care in system-level maternity care policy; highlights the woman's role as decision maker about her maternity care; documents information exchanged with women; creates a 'living' plan that respects the woman's birth intentions and can be reviewed as circumstances change; enables communication between clinicians; permits flexible initiation pathways; provides for professional education for clinicians, and incorporates a mediation role to act as a failsafe. The Personalised Alternative Care and Treatment framework has the potential to meet the needs of women, clinicians and health services when pregnant women decline recommended maternity care. Copyright © 2018. Published by Elsevier Ltd.

  18. Stakeholders' views on the strengths and weaknesses of maternal care financing and its reform in Georgia.

    Science.gov (United States)

    Shengelia, Lela; Pavlova, Milena; Groot, Wim

    2017-08-08

    The improvement of maternal health has been one of the aims of the health financing reforms in Georgia. Public-private relationships are the most notable part of the reform. This study aimed to assess the strengths and weakness of the maternal care financing in Georgia in terms of adequacy and effects. A qualitative design was used to explore the opinions of key stakeholders about the adequacy of maternal care financing and financial protection of pregnant women in Georgia. Women who had used maternal care during the past 4 years along with health care providers, policy makers, and representatives of international partner organizations and national professional body were the respondents in this study. Six focus group discussions to collect data from women and 15 face-to-face in-depth interviews to collect data from the other stakeholders were conducted. Each focus group discussion consisted of 7-8 women. Two focus group discussions were carried out at each of the target settings (i.e. Tbilisi, Imereti and Adjara). Women were selected in each location through the hospital registry and snowballing method. The evidence shows that there is a consensus among maternal care stakeholder groups on the influence of the healthcare financing reforms on maternal health. Specifically, the privatization of the maternal care services has had positive effects because it significantly improved the environment and technical capacity of the maternity houses. Also, in contrast to other former-soviet republics, there are no informal payments anymore for maternal care in Georgia. However the privatization, which was done without strict regulation, negatively influenced the reform process and provided the possibility to private providers to manipulate the formal user fees in maternal care. Stakeholders also indicated that the UHC programs implemented at the last stage of the healthcare financing reform as well as other state maternal health programs protect women from catastrophic health

  19. 32 CFR 728.71 - Ex-service maternity care.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 5 2010-07-01 2010-07-01 false Ex-service maternity care. 728.71 Section 728.71... FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Other Persons § 728.71 Ex-service maternity... certified by medical authorities that the pregnancy existed prior to entry into service (EPTE), maternity...

  20. Differential in Utilization of Maternal Care Services in Empowered Action Group States, India (1990-2006

    Directory of Open Access Journals (Sweden)

    Jeetendra Yadav

    2016-03-01

    Full Text Available Background: Low use of maternal care services is one of the reasons why child mortality and maternal mortality is still considerably high in India. Most maternal deaths are preventable if mothers receive essential health care before, during, and after childbirth. In India, the eight socioeconomically backward states referred to as the Empowered Action Group (EAG states; lag behind in the demographic transition and low utilization of maternal health care services. Addressing the maternity care needs of women may have considerable ramifications for achieving the Millennium Development Goal (MDG – 5.Aims & Objectives:  To explore the prevalence, trends and factors associated with the utilization of maternal care services in Empowered Action Group States, India (1990-2006.Material Methods: Data from three rounds of the round of the Demographic and Health Survey (DHS, known as the National Family Health Survey (NFHS of India were analyzed. Bivariate and multivariate-pooled logistic regression model were applied to examine the utilization of the maternal and child health care trends over time.Result: The results from analysis indicate that the full ANC and skilled birth attendant (SBA has increased from 17% and 20% to 25% and35% respectively during the last one and half decade (1990-2006.Conclusion: Various socioeconomic and demographic factors are associated with the utilization of maternal care services in EAG states, India. Promoting the use of family planning, female education, targeting vulnerable groups such as poor, illiterate, high parity women, involving media and grass root level workers and collaboration between community leaders and health care system could be some important policy level interventions to address the unmet need of maternal and child health care services among women. The study concludes that much of these differentials are social constructs that can be reduced by prioritizing the needs of the disadvantaged and adopting

  1. Differential in Utilization of Maternal Care Services in Empowered Action Group States, India (1990-2006

    Directory of Open Access Journals (Sweden)

    Jeetendra Yadav

    2016-03-01

    Full Text Available Background: Low use of maternal care services is one of the reasons why child mortality and maternal mortality is still considerably high in India. Most maternal deaths are preventable if mothers receive essential health care before, during, and after childbirth. In India, the eight socioeconomically backward states referred to as the Empowered Action Group (EAG states; lag behind in the demographic transition and low utilization of maternal health care services. Addressing the maternity care needs of women may have considerable ramifications for achieving the Millennium Development Goal (MDG – 5. Aims & Objectives:  To explore the prevalence, trends and factors associated with the utilization of maternal care services in Empowered Action Group States, India (1990-2006. Material Methods: Data from three rounds of the round of the Demographic and Health Survey (DHS, known as the National Family Health Survey (NFHS of India were analyzed. Bivariate and multivariate-pooled logistic regression model were applied to examine the utilization of the maternal and child health care trends over time. Result: The results from analysis indicate that the full ANC and skilled birth attendant (SBA has increased from 17% and 20% to 25% and35% respectively during the last one and half decade (1990-2006. Conclusion: Various socioeconomic and demographic factors are associated with the utilization of maternal care services in EAG states, India. Promoting the use of family planning, female education, targeting vulnerable groups such as poor, illiterate, high parity women, involving media and grass root level workers and collaboration between community leaders and health care system could be some important policy level interventions to address the unmet need of maternal and child health care services among women. The study concludes that much of these differentials are social constructs that can be reduced by prioritizing the needs of the disadvantaged and

  2. The Effects of Kangaroo Care in the Neonatal Intensive Care Unit on the Physiological Functions of Preterm Infants, Maternal-Infant Attachment, and Maternal Stress.

    Science.gov (United States)

    Cho, Eun-Sook; Kim, Shin-Jeong; Kwon, Myung Soon; Cho, Haeryun; Kim, Eun Hye; Jun, Eun Mi; Lee, Sunhee

    2016-01-01

    This study was conducted to identify the effects of kangaroo care on the physiological functions of preterm infants, maternal-infant attachment, and maternal stress. For this study, a quasi-experiment design was used with a nonequivalent control group, and a pre- and post-test. Data were collected from preterm infants with corrected gestational ages of ≥33weeks who were hospitalized between May and October 2011. Twenty infants were assigned to the experimental group and 20 to the control group. As an intervention, kangaroo care was provided in 30-min sessions conducted thrice a week for a total of 10 times. The collected data were analyzed by using the t test, repeated-measures ANOVA, and the ANCOVA test. After kangaroo care, the respiration rate significantly differed between the two groups (F=5.701, p=.020). The experimental group had higher maternal-infant attachment scores (F=25.881, pinfant physiological functions such as respiration rate, increasing maternal-infant attachment, and reducing maternal stress. This study suggests that kangaroo care can be used to promote emotional bonding and support between mothers and their babies, and to stabilize the physiological functions of premature babies. Kangaroo care may be one of the most effective nursing interventions in the neonatal intensive care unit for the care of preterm infants and their mothers. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Oxytocin in the medial prefrontal cortex regulates maternal care, maternal aggression and anxiety during the postpartum period

    Science.gov (United States)

    Sabihi, Sara; Dong, Shirley M.; Durosko, Nicole E.; Leuner, Benedetta

    2014-01-01

    The neuropeptide oxytocin (OT) acts on a widespread network of brain regions to regulate numerous behavioral adaptations during the postpartum period including maternal care, maternal aggression, and anxiety. In the present study, we examined whether this network also includes the medial prefrontal cortex (mPFC). We found that bilateral infusion of a highly specific oxytocin receptor antagonist (OTR-A) into the prelimbic (PL) region of the mPFC increased anxiety-like behavior in postpartum, but not virgin, females. In addition, OTR blockade in the postpartum mPFC impaired maternal care behaviors and enhanced maternal aggression. Overall, these results suggest that OT in the mPFC modulates maternal care and aggression, as well as anxiety-like behavior, during the postpartum period. Although the relationship among these behaviors is complicated and further investigation is required to refine our understanding of OT actions in the maternal mPFC, these data nonetheless provide new insights into neural circuitry of OT-mediated postpartum behaviors. PMID:25147513

  4. Maternal experiences with premature children in a neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Raphael Colares de Sá

    2012-06-01

    Full Text Available Objective: Understand the maternal experience with premature children in neonatal intensive care unit. Methods: This is a qualitative and descriptive study. A questionnaire was used with semi-structured interview type, analyzed by the technique of content analysis and discussed, using the theoretical framework. The sample consisted of 11 mothers who accompanied their babies every day in the Neonatal Intensive Care Unit. Results: After discourse analysis emerged the following categories: experiencing maternal feelings in relation to the baby at risk; the meaning of the neonatal unit for mothers of premature infants, maternal perceptions about prematurity and experiencing the formation of the maternal-filial bond. Conclusions:The mother of premature experiences difficult times in the face of risk and instability of the baby, causing ambivalent feelings in relation to prematurity. Nevertheless, it was found thatfeelings of happiness, love and desire to see your baby being discharged form hospital and live with his family, were significant in relation to feelings of sadness and fear of losing her child.

  5. Rural maternity care: can we learn from Wal-Mart?

    Science.gov (United States)

    van Teijlingen, E R; Pitchforth, E

    2010-03-01

    In many countries rural maternity care is under threat. Consequently rural pregnant women will have to travel further to attend larger maternity units to receive care and deliver their babies. This trend is not dissimilar from the disappearance of other rural services, such as village shops, banks, post offices and bus services. We use a comparative approach to draw an analogy with large-scale supermarkets, such as the Wal-Mart and Tesco and their effect on the viability of smaller rural shops, depersonalisation of service and the wider community. The closure of a community-maternity unit leads to women attending a different type of hospital with a different approach to maternity care. Thus small community-midwifery units are being replaced, not by a very similar unit that happens to be further away, but by a larger obstetric unit that operates on different models, philosophy and notions of risk. Comparative analysis allows a fresh perspective on the provision of rural maternity services. We argue that previous discussions focusing on medicalisation and change in maternity services can be enhanced by drawing on experience in other sectors and taking a wider societal lens. Copyright 2009 Elsevier Ltd. All rights reserved.

  6. Unauthorised pregnancies and use of maternity care in rural China.

    Science.gov (United States)

    Klemetti, Reija; Regushevskaya, Elena; Zhang, Wei-Hong; Wu, Zhuochun; Yan, Hong; Wang, Yang; Hemminki, Elina

    2011-10-01

    To describe the use of maternity care in rural China by the legal status of the pregnancy. Cross-sectional survey wherein information was obtained about 2576 women who gave birth in 2006. Logistic regression was used to compare women having an unauthorised pregnancy with those having an authorised second birth, adjusting for confounding factors. Almost all respondents had antenatal care and most deliveries occurred in hospitals. Women with unauthorised pregnancies were significantly less likely to have had maternity care, particularly prenatal care, postnatal care, to have been hospitalised during pregnancy, and to have been reimbursed for hospital delivery costs than women with an authorised second birth. They were also more likely to have been hospitalised for seven or more days after delivery. Primiparous women used maternity care services and received financial support more often than women with an authorised second birth. Among the women with an unauthorised pregnancy an important reason for not using hospital care during pregnancy or delivery was financial constraint. Women with unauthorised pregnancies use less maternity care, although pregnancy in such circumstances may adversely impact their health. Primiparous women benefit from more financial support than multiparous women.

  7. Maternity Care in Russia: Issues, Achievements, and Potential.

    Science.gov (United States)

    Shuvalova, Marina P; Yarotskaya, Ekaterina L; Pismenskaya, Tatiana V; Dolgushina, Nataliya V; Baibarina, Elena N; Sukhikh, Gennady T

    2015-10-01

    In this review, we provide basic facts about maternity care services within the health care system in Russia. We give a short overview of such key aspects as the demographic situation, reproductive behaviour, regulatory framework for providing health care for women and children, maternal and perinatal mortality, and the availability of medical personnel. In 2012, Russia began registration of births in accordance with the WHO recommendations (births with weight ≥ 500 g at ≥ 22 weeks' gestation). Introduction of this new registration system increased the completeness and quality of the collected information and expanded possibilities for future international comparative assessments. A three-level system of specialized medical care has been introduced in Russia for women and newborns during pregnancy, childbirth, and the postpartum period. In 2014, the system included 1942 state (public) maternity hospitals providing 20 obstetric beds per 10 000 women aged 15 to 49 years. More than 100 perinatal centres (level III) are currently functioning in the country, with 32 new perinatal centres planned to open by 2016. The total number of obstetrician-gynaecologists in Russia is approximately 44 000, providing a ratio of 5.7 specialists per 10 000 women. The total number of midwives is 62 000, providing a ratio of 8.1 midwives per 10 000 women. In recent years we have succeeded in optimizing the maternity care system by increasing its accessibility and quality. This was achieved through qualitative and quantitative progress in the training of neonatologists, the development of intensive care technologies and neonatal critical care, capacity building of medical-genetic services and counselling, prenatal diagnosis, and the standardization of health care with data collection.

  8. Examining inequalities in uptake of maternal health care and choice of provider in underserved urban areas of Mumbai, India: a mixed methods study.

    Science.gov (United States)

    Alcock, Glyn; Das, Sushmita; Shah More, Neena; Hate, Ketaki; More, Sharda; Pantvaidya, Shanti; Osrin, David; Houweling, Tanja A J

    2015-09-28

    Discussions of maternity care in developing countries tend to emphasise service uptake and overlook choice of provider. Understanding how families choose among health providers is essential to addressing inequitable access to care. Our objectives were to quantify the determinants and choice of maternity care provider in Mumbai's informal urban settlements, and to explore the reasons underlying their choices. The study was conducted in informal urban communities in eastern Mumbai. We developed regression models using data from a census of married women aged 15-49 to test for associations between maternal characteristics and uptake of care and choice of provider. We then conducted seven focus group discussions and 16 in-depth interviews with purposively selected participants, and used grounded theory methods to examine the reasons for their choices. Three thousand eight hundred forty-eight women who had given birth in the preceding 2 years were interviewed in the census. The odds of institutional prenatal and delivery care increased with education, economic status, and duration of residence in Mumbai, and decreased with parity. Tertiary public hospitals were the commonest site of care, but there was a preference for private hospitals with increasing socio-economic status. Women were more likely to use tertiary public hospitals for delivery if they had fewer children and were Hindu. The odds of delivery in the private sector increased with maternal education, wealth, age, recent arrival in Mumbai, and Muslim faith. Four processes were identified in choosing a health care provider: exploring the options, defining a sphere of access, negotiating autonomy, and protective reasoning. Women seeking a positive health experience and outcome adopted strategies to select the best or most suitable, accessible provider. In Mumbai's informal settlements, institutional maternity care is the norm, except among recent migrants. Poor perceptions of primary public health facilities

  9. Testing cost-benefit models of parental care evolution using lizard populations differing in the expression of maternal care.

    Directory of Open Access Journals (Sweden)

    Wen-San Huang

    Full Text Available Parents are expected to evolve tactics to care for eggs or offspring when providing such care increases fitness above the costs incurred by this behavior. Costs to the parent include the energetic demands of protecting offspring, delaying future fecundity, and increased risk of predation. We used cost-benefit models to test the ecological conditions favoring the evolution of parental care, using lizard populations that differ in whether or not they express maternal care. We found that predators play an important role in the evolution of maternal care because: (1 evolving maternal care is unlikely when care increases predation pressure on the parents; (2 maternal care cannot evolve under low levels of predation pressure on both parents and offspring; and (3 maternal care evolves only when parents are able to successfully defend offspring from predators without increasing predation risk to themselves. Our studies of one of the only known vertebrate species to exhibit interpopulation differences in the expression of maternal care provide clear support for some of the hypothesized circumstances under which maternal care should evolve (e.g., when nests are in exposed locations, parents are able to defend the eggs from predators, and egg incubation periods are brief, but do not support others (e.g., when nest-sites are scarce, life history strategies are "risky", reproductive frequency is low, and environmental conditions are harsh. We conclude that multiple pathways can lead to the evolution of parental care from a non-caring state, even in a single population of a widespread species.

  10. Planning Nurses in Maternity Care: a Stochastic Assignment Problem

    International Nuclear Information System (INIS)

    Phillipson, Frank

    2015-01-01

    With 23 percent of all births taking place at home, The Netherlands have the highest rate of home births in the world. Also if the birth did not take place at home, it is not unusual for the mother and child to be out of hospital in a few hours after the baby was born. The explanation for both is the very well organised maternity care system. However, getting the right maternity care nurse available on time introduces a complex planning issue that can be recognized as a Stochastic Assignment Problem. In this paper an expert rule based approach is combined with scenario analysis to support the planner of the maternity care agency in his work. (paper)

  11. Planning Nurses in Maternity Care: a Stochastic Assignment Problem

    Science.gov (United States)

    Phillipson, Frank

    2015-05-01

    With 23 percent of all births taking place at home, The Netherlands have the highest rate of home births in the world. Also if the birth did not take place at home, it is not unusual for the mother and child to be out of hospital in a few hours after the baby was born. The explanation for both is the very well organised maternity care system. However, getting the right maternity care nurse available on time introduces a complex planning issue that can be recognized as a Stochastic Assignment Problem. In this paper an expert rule based approach is combined with scenario analysis to support the planner of the maternity care agency in his work.

  12. Seeking maternal care at times of conflict: the case of Lebanon.

    Science.gov (United States)

    Kabakian-Khasholian, Tamar; Shayboub, Rawan; El-Kak, Faysal

    2013-01-01

    Providing quality maternity care within the emergency care packages for internally displaced populations in war-affected areas is somewhat challenging, although very essential. In this retrospective study, we describe the experiences and health care seeking behaviors of 1,015 pregnant and postpartum women during the 2006 war in Lebanon. Women reported interruptions in regular maternity care and experienced more complications during this period. Availability of health services and experiences of complications were the most important determinants of health care seeking behaviors. Maternal health services should be a part of any comprehensive emergency responsiveness plan, catering to women's needs in war-affected areas.

  13. Perceived early-life maternal care and the cortisol response to repeated psychosocial stress.

    Science.gov (United States)

    Engert, Veronika; Efanov, Simona I; Dedovic, Katarina; Duchesne, Annie; Dagher, Alain; Pruessner, Jens C

    2010-11-01

    In the past decade, a body of animal and human research has revealed a profound influence of early-life experiences, ranging from variations in parenting behaviour to severe adversity, on hypothalamic-pituitary-adrenal axis regulation in adulthood. In our own previous studies, we have shown how variations in early-life parental care influence the development of the hippocampus and modify the cortisol awakening response. In the present study, we investigated the influence of early-life maternal care on cortisol, heart rate and subjective psychological responses to the repeated administration of a psychosocial laboratory stressor in a population of 63 healthy young adults. Low, medium and high early-life maternal care groups were identified using the Parental Bonding Instrument. Controlling for the effect of sex, we found an inverted u-shaped relation between increasing levels of maternal care and cortisol stress responsivity. Specifically, overall and stress-induced cortisol levels went from below normal in the low maternal care, to normal in the medium care, back to below normal in the high maternal care groups. We found no group differences with respect to heart rate and subjective psychological stress measures. Whereas low and high maternal care groups exhibited similarly low endocrine stress responses, their psychological profiles were opposed with increased levels of depression and anxiety and decreased self-esteem in the low care group. Sex was unequally distributed among maternal care groups, whereby the number of men with low maternal care was too small to allow introducing sex as a second between-group variable. We discuss the potential significance of this dissociation between endocrine and psychological parameters with respect to stress vulnerability and resistance for each maternal care group.

  14. A hermeneutic phenomenological study of Belgian midwives' views on ideal and actual maternity care.

    Science.gov (United States)

    Van Kelst, Liesbeth; Spitz, Bernard; Sermeus, Walter; Thomson, Ann M

    2013-01-01

    to explore midwives' views on ideal and actual maternity care. a qualitative hermeneutic phenomenological study based on the method of van Manen (1997) using individual in-depth interviews to gather data. Flanders, Belgium. 12 purposively sampled midwives, of whom nine from three different non-university hospitals and three independent midwives conducting home births. five major themes were identified: 'woman-centred care', 'cultural change', 'support', 'midwife and obstetrician as equal partners' and 'inter-collegial harmony'. In this paper 'woman-centred care', 'cultural change' and 'support' are discussed along with their subthemes. Midwives thought ideal maternity care should be woman-centred in which there were no unnecessary interventions, women were able to make an informed choice and there was continuity of care. Furthermore, ideal maternity care should be supported by midwifery education and an adequate staffing level. Also, a cultural change was wanted as actual maternity care was perceived to be highly medicalised. Barriers to achieving woman-centred care and possible strategies to overcome these were described. findings from this study were consistent with those of other studies on midwives' experience with obstetric-led care. Despite the medicalised care, midwives still held a woman-centred ideology. In order to be able to work according to their ideology, different barriers need to be addressed. Although midwives suggested strategies to overcome these barriers, some were considered to be very difficult to overcome. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care

    Directory of Open Access Journals (Sweden)

    Sundby Johanne

    2005-05-01

    Full Text Available Abstract Background Maternal mortality is the vital indicator with the greatest disparity between developed and developing countries. The challenging nature of measuring maternal mortality has made it necessary to perform an action-oriented means of gathering information on where, how and why deaths are occurring; what kinds of action are needed and have been taken. A maternal death review is an in-depth investigation of the causes and circumstances surrounding maternal deaths. The objectives of the present study were to describe the socio-cultural and health service factors associated with maternal deaths in rural Gambia. Methods We reviewed the cases of 42 maternal deaths of women who actually tried to reach or have reached health care services. A verbal autopsy technique was applied for 32 of the cases. Key people who had witnessed any stage during the process leading to death were interviewed. Health care staff who participated in the provision of care to the deceased was also interviewed. All interviews were tape recorded and analyzed by using a grounded theory approach. The standard WHO definition of maternal deaths was used. Results The length of time in delay within each phase of the model was estimated from the moment the woman, her family or health care providers realized that there was a complication until the decision to seeking or implementing care was made. The following items evolved as important: underestimation of the severity of the complication, bad experience with the health care system, delay in reaching an appropriate medical facility, lack of transportation, prolonged transportation, seeking care at more than one medical facility and delay in receiving prompt and appropriate care after reaching the hospital. Conclusion Women do seek access to care for obstetric emergencies, but because of a variety of problems encountered, appropriate care is often delayed. Disorganized health care with lack of prompt response to

  16. Wealth index and maternal health care: Revisiting NFHS-3.

    Science.gov (United States)

    Goel, Manish Kr; Roy, Pritam; Rasania, Sanjeev Kumar; Roy, Sakhi; Kumar, Yogesh; Kumar, Arun

    2015-01-01

    The third National Family Health Survey (NFHS-3) is a large dataset on indicators of family welfare, maternal and child health, and nutrition in India. This article using NFHS-3 data is an attempt to bring out the impact of economic status, i.e., the wealth index on maternal health. The study was based on an analysis of the NFHS-3 data. Independent variables taken were the wealth index, literacy, and age at first child birth. Effects of these variables on the maternal health care services were investigated. Out of the total 124,385 women aged 15-49 years included in the NFHS-3 dataset, 36,850 (29.6%) had one or more childbirth during the past 5 years. The number of antenatal care (ANC) visits increased as the wealth index increased and there was a pattern for choice of place of delivery (for all deliveries during the last 5 years) according to the wealth index. Logistic regression analysis of the abovementioned variables were sought to find out the independent role of key determinants of the different aspects of maternal health care. It showed that the wealth index is the leading key independent determinant for three or more ANC received: Tetanus toxoid (TT) received before delivery, iron tablet/syrup taken for more than 100 days, and institutional delivery. Mother's literacy was the leading independent key determinant for early antenatal registration. The study suggested that along with the mother's literacy, the wealth index that is an important predictor of maternal health care can be added for categorization of the districts for providing differential approach for maternal health care services.

  17. Patient decision aids in routine maternity care: Benefits, barriers, and new opportunities.

    Science.gov (United States)

    Stevens, Gabrielle; Thompson, Rachel; Watson, Bernadette; Miller, Yvette D

    2016-02-01

    Participation in decision-making, supported by comprehensive and quality information provision, is increasingly emphasised as a priority for women in maternity care. Patient decision aids are tools that can offer women greater access to information and guidance to participate in maternity care decision-making. Relative to their evaluation in controlled settings, the implementation of patient decision aids in routine maternity care has received little attention and our understanding of which approaches may be effective is limited. This paper critically discusses the application of patient decision aids in routine maternity care and explores viable solutions for promoting their successful uptake. A range of patient decision aids have been developed for use within maternity care, and controlled trials have highlighted their positive impact on the decision-making process for women. Nevertheless, evidence of successful patient decision aid implementation in real world health care settings is lacking due to practical and ideological barriers that exist. Patient-directed social marketing campaigns are a relatively novel approach to patient decision aid delivery that may facilitate their adoption in maternity care, at least in the short-term, by overcoming common implementation barriers. Social marketing may also be particularly well suited to maternity care, given the unique characteristics of this health context. The potential of social marketing campaigns to facilitate patient decision aid adoption in maternity care highlights the need for pragmatic trials to evaluate their effectiveness. Identifying which sub-groups of women are more or less likely to respond to these strategies will further direct implementation. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  18. Incorporating immunizations into routine obstetric care to facilitate Health Care Practitioners in implementing maternal immunization recommendations.

    Science.gov (United States)

    Webb, Heather; Street, Jackie; Marshall, Helen

    2014-01-01

    Immunization against pertussis, influenza, and rubella reduces morbidity and mortality in pregnant women and their offspring. Health care professionals (HCPs) caring for women perinatally are uniquely placed to reduce maternal vaccine preventable diseases (VPDs). Despite guidelines recommending immunization during the perinatal period, maternal vaccine uptake remains low. This qualitative study explored the role of obstetricians, general practitioners, and midwives in maternal vaccine uptake. Semi-structured interviews (n = 15) were conducted with perinatal HCPs at a tertiary maternity hospital in South Australia. HCPs were asked to reflect on their knowledge, beliefs, and practice relating to immunization advice and vaccine provision. Interviews were transcribed and coded using thematic analysis. Data collection and analysis was an iterative process, with collection ceasing with theoretical saturation. Participants unanimously supported maternal vaccination as an effective way of reducing risk of disease in this vulnerable population, however only rubella immunity detection and immunization is embedded in routine care. Among these professionals, delegation of responsibility for maternal immunization was unclear and knowledge about maternal immunization was variable. Influenza and pertussis vaccine prevention measures were not included in standard pregnancy record documentation, information provision to patients was "ad hoc" and vaccinations not offered on-site. The key finding was that the incorporation of maternal vaccinations into standard care through a structured process is an important facilitator for immunization uptake. Incorporating vaccine preventable disease management measures into routine obstetric care including incorporation into the Pregnancy Record would facilitate HCPs in implementing recommendations. Rubella prevention provides a useful 'template' for other vaccines.

  19. Umbilical Cord Management and Stump Care in Normal Childbirth in Slovenian and Croatian Maternity Hospitals.

    Science.gov (United States)

    Mivšek, Ana Polona; Petročnik, Petra; Skubic, Metka; Škodič Zakšek, Teja; Jug Došler, Anita

    2017-12-01

    The aim was to investigate first-care procedures for the newborn's umbilical cord at maternity hospitals in Slovenia and Croatia. The study was based on an empirical survey research approach and quantitative research paradigms and included all Slovenian (n=14) and all Croatian (n=35) maternity hospitals. Leaders of midwifery team of 14 Slovenian and 35 Croatian labor wards were invited to participate. The study was conducted in 2013, with 67% of Slovenian and 66% of Croatian maternity hospitals having responded. A causal and non-experimental method of empirical research was used. The research instrument was a questionnaire. Descriptive statistics was used on data analysis. The independence hypothesis was tested with the χ2-test or Kullback 2Î-test. A vast ma-jority of study wards employed delayed umbilical cord clamping, i.e. clamping the cord after pulsa-tion had ceased. Only 10% of Slovenian in comparison with 36.4% of Croatian maternity hospitals practiced dry cord care. Others applied disinfectant on the cord, in Slovenia most frequently 6% po-tassium permanganate, and in Croatia a combination of octenidine and phenoxyethanol. Most Croa-tian -maternity wards (95.7%) still covered the stump, while it was not regular practice in Slovenia. The authors estimate that the prevailing Slovenian and Croatian practices in regard to cord clamping are in accordance with the evidence, while improvements could be made regarding stump care, since dry cord care is the recommended method.

  20. Factors Affecting The Adoption Of Mhealth In Maternal Health Care In Nakuru Provincial General Hospital

    Directory of Open Access Journals (Sweden)

    Simon Munyua

    2015-08-01

    Full Text Available Abstract Access to timely and quality maternal health care remains to be a major development challenge in many developing economies particularly in Kenya. The countrys system of providing maternal health care also continue to be anchored on conventional methods of physical presence of the patient and the doctor in a hospital setup. The countrys ICT and health policies also place very little emphasis on the use of these platforms. This study therefore sought to establish the factors affecting the adoption of mHealth by focusing on maternal health in Nakuru Provincial General Hospital. Objectives of the study were to determine the extent to knowledge and awareness affects the adoption of mHealth in maternal health care at Nakuru PGH to identify the government policies affecting the adoption of mHealth in maternal health care at Nakuru PGH to assess how access to technology affects the adoption of mHealth in maternal healthcare to establish the effects of ICT infrastructure on the adoption of mHealth in maternal health care and to identify the cost aspects affecting the adoption of mHealth in maternal health care at Nakuru Provincial General Hospital. It is envisaged that the study could provide useful information on the adoption of mHealth in managing maternal health care in Nakuru Provincial General Hospital. Descriptive survey research design will be used where all the medical staff and patients of Nakuru Provincial General Hospital was surveyed. The study population therefore was made up of 24 medical staff and 3460 mothers visiting the antenatal clinic selected using clustered random sampling technique. The main instrument for primary data collection was the questionnaire. Data analysis was then done using both descriptive and inferential statistics. Descriptive statistics to be used include frequency counts percentages and measures of central tendency. Inferential statistics on the other hand include t-test analysis and spearman correlation

  1. Experienced job autonomy among maternity care professionals in The Netherlands

    NARCIS (Netherlands)

    Perdok, H.; Cronie, D.; Speld, C. van der; Dillen, J. van; Jonge, A . de; Rijnders, M.; Graaf, I. de; Schellevis, F.G.; Verhoeven, C.J.

    2017-01-01

    OBJECTIVE: High levels of experienced job autonomy are found to be beneficial for healthcare professionals and for the relationship with their patients. The aim of this study was to assess how maternity care professionals in the Netherlands perceive their job autonomy in the Dutch maternity care

  2. Experienced job autonomy among maternity care professionals in The Netherlands

    NARCIS (Netherlands)

    Perdok, Hilde; Cronie, Doug; van der Speld, Cecile; van Dillen, Jeroen; de Jonge, Ank; Rijnders, Marlies; de Graaf, Irene; Schellevis, François G.; Verhoeven, Corine J.

    2017-01-01

    Objective: High levels of experienced job autonomy are found to be beneficial for healthcare professionals and for the relationship with their patients. The aim of this study was to assess how maternity care professionals in the Netherlands perceive their job autonomy in the Dutch maternity care

  3. Experienced job autonomy among maternity care professionals in The Netherlands

    NARCIS (Netherlands)

    Perdok, H.; Cronie, D.; Speld, C. van der; Dillen, J. van; Jonge, A. de; Rijnders, M.; Graaf, I. de; Schellevis, F.G.; Verhoeven, G.

    2017-01-01

    Objective High levels of experienced job autonomy are found to be beneficial for healthcare professionals and for the relationship with their patients. The aim of this study was to assess how maternity care professionals in the Netherlands perceive their job autonomy in the Dutch maternity care

  4. Experienced job autonomy among maternity care professionals in The Netherlands.

    NARCIS (Netherlands)

    Perdok, H.; Cronie, D.; Speld, C. van der; Dillen, J. van; Jonge, A. de; Rijnders, M.; Graaf, J. de; Schellevis, F.; Verhoeven, C.

    2017-01-01

    Objective: High levels of experienced job autonomy are found to be beneficial for healthcare professionals and for the relationship with their patients. The aim of this study was to assess how maternity care professionals in the Netherlands perceive their job autonomy in the Dutch maternity care

  5. Maternity care and maternal serum screening. Do male and female family physicians care for women differently?

    Science.gov (United States)

    Woodward, C A; Carroll, J C; Ryan, G; Reid, A J; Permaul-Woods, J A; Arbitman, S; Domb, S B; Fallis, B; Kilthei, J

    1997-06-01

    To examine whether male and female family physicians practise maternity care differently, particularly regarding the maternal serum screening (MSS) program. Mailed survey fielded between October 1994 and March 1995. Ontario family practices. Random sample of 2000 members of the College of Family Physicians of Canada who care for pregnant women. More than 90% of eligible physicians responded. Attitudes toward, knowledge about, and behaviour toward MSS. Women physicians were more likely than men to practise part time, in groups, and in larger communities. Men physicians were more likely to perform deliveries; women were more likely to do shared care. Despite a shorter work week, on average, female physicians cared for more pregnant women than male physicians did. Among those providing intrapartum care, women performed more deliveries, on average, than men. Women physicians were more likely than men to offer MSS to all pregnant patients. Although average time spent discussing MSS before the test was similar, women physicians had better knowledge of when best to do the test and its true-positive rate. All differences reported were statistically significant (P women, women physicians cared for more pregnant women than men did. Both spent similar time discussing MSS with their patients before offering screening, but more women physicians offered MSS to all their patients and were more knowledgeable about MSS than men physicians.

  6. Quality maternity care for every woman, everywhere: a call to action.

    Science.gov (United States)

    Koblinsky, Marjorie; Moyer, Cheryl A; Calvert, Clara; Campbell, James; Campbell, Oona M R; Feigl, Andrea B; Graham, Wendy J; Hatt, Laurel; Hodgins, Steve; Matthews, Zoe; McDougall, Lori; Moran, Allisyn C; Nandakumar, Allyala K; Langer, Ana

    2016-11-05

    To improve maternal health requires action to ensure quality maternal health care for all women and girls, and to guarantee access to care for those outside the system. In this paper, we highlight some of the most pressing issues in maternal health and ask: what steps can be taken in the next 5 years to catalyse action toward achieving the Sustainable Development Goal target of less than 70 maternal deaths per 100 000 livebirths by 2030, with no single country exceeding 140? What steps can be taken to ensure that high-quality maternal health care is prioritised for every woman and girl everywhere? We call on all stakeholders to work together in securing a healthy, prosperous future for all women. National and local governments must be supported by development partners, civil society, and the private sector in leading efforts to improve maternal-perinatal health. This effort means dedicating needed policies and resources, and sustaining implementation to address the many factors influencing maternal health-care provision and use. Five priority actions emerge for all partners: prioritise quality maternal health services that respond to the local specificities of need, and meet emerging challenges; promote equity through universal coverage of quality maternal health services, including for the most vulnerable women; increase the resilience and strength of health systems by optimising the health workforce, and improve facility capability; guarantee sustainable finances for maternal-perinatal health; and accelerate progress through evidence, advocacy, and accountability. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Quality of Care: A Review Of Maternal Deaths In A Regional ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    emergency obstetric care services to prevent further maternal deaths. (Afr J Reprod Health 2015; 19[3]: 68-76). Keywords: Maternal death, Review, Quality of care, Sub-saharan Africa, Ghana .... technology, adequate human resource, health.

  8. Spousal violence and receipt of skilled maternity care during and after pregnancy in Nepal.

    Science.gov (United States)

    Furuta, Marie; Bick, Debra; Matsufuji, Hiromi; Coxon, Kirstie

    2016-12-01

    a substantial number of Nepali women experience spousal violence, which affects their health in many ways, including during and after pregnancy. This study aimed to examine associations between women's experiences of spousal violence and their receipt of skilled maternity care, using two indicators: (1) receiving skilled maternity care across a continuum from pregnancy to the early postnatal period and (2) receiving any skilled maternity care in pregnancy, childbirth, or postpartum. data were analysed for married women aged 15-49 from the 2011 Nepal Demographic and Health Survey. Data were included on women who completed an interview on spousal violence as part of the survey and had given birth within the five years preceding the survey (weighted n=1375). Logistic regression models were developed for analyses. the proportion of women who received skilled maternity care across the pregnancy continuum and those who received any skilled maternity care was 24.1% and 53.7%, respectively. Logistic regression analyses showed that spousal violence was statistically significantly associated with receiving low levels of skilled maternity care, after adjusting for accessibility of health care. However, after controlling for women's sociodemographic backgrounds (age, number of children born, educational level, husband's education level, husband's occupation, region of residence, urban/rural residence, wealth index), these significant associations disappeared. Better-educated women, women whose husbands were professionals or skilled workers and women from well-off households were more likely to receive skilled maternity care either across the pregnancy continuum or at recommended points during or after pregnancy. spousal violence and low uptake of skilled maternity care are deeply embedded in a society in which gender inequality prevails. Factors affecting the receipt of skilled maternity care are multidimensional; simply expanding geographical access to maternity services may

  9. Sampling maternal care behaviour in domestic dogs: What's the best approach?

    Science.gov (United States)

    Czerwinski, Veronika H; Smith, Bradley P; Hynd, Philip I; Hazel, Susan J

    2017-07-01

    Our understanding of the frequency and duration of maternal care behaviours in the domestic dog during the first two postnatal weeks is limited, largely due to the inconsistencies in the sampling methodologies that have been employed. In order to develop a more concise picture of maternal care behaviour during this period, and to help establish the sampling method that represents these behaviours best, we compared a variety of time sampling methods Six litters were continuously observed for a total of 96h over postnatal days 3, 6, 9 and 12 (24h per day). Frequent (dam presence, nursing duration, contact duration) and infrequent maternal behaviours (anogenital licking duration and frequency) were coded using five different time sampling methods that included: 12-h night (1800-0600h), 12-h day (0600-1800h), one hour period during the night (1800-0600h), one hour period during the day (0600-1800h) and a one hour period anytime. Each of the one hour time sampling method consisted of four randomly chosen 15-min periods. Two random sets of four 15-min period were also analysed to ensure reliability. We then determined which of the time sampling methods averaged over the three 24-h periods best represented the frequency and duration of behaviours. As might be expected, frequently occurring behaviours were adequately represented by short (oneh) sampling periods, however this was not the case with the infrequent behaviour. Thus, we argue that the time sampling methodology employed must match the behaviour of interest. This caution applies to maternal behaviour in altricial species, such as canids, as well as all systematic behavioural observations utilising time sampling methodology. Copyright © 2017. Published by Elsevier B.V.

  10. High Spending on Maternity Care in India: What Are the Factors Explaining It?

    Science.gov (United States)

    Goli, Srinivas; Moradhvaj; Rammohan, Anu; Shruti; Pradhan, Jalandhar

    2016-01-01

    High maternity-related health care spending is often cited as an important barrier in utilizing quality health care during pregnancy and childbirth. This study has two objectives: (i) to measure the levels of expenditure on total maternity care in disaggregated components such as ANCs, PNCs, and Natal care expenditure; (ii) to quantify the extent of catastrophic maternity expenditure (CME) incurred by households and identify the factors responsible for it. Data from the 71st round of the National Sample Survey (2014) was used to estimate maternity expenditure and its predictors. CME was measured as a share of consumption expenditure by different cut-offs. The two-part model was used to identify the factors associated with maternity spending and CME. The findings show that household spending on maternity care (US$ 149 in constant price) is much higher than previous estimates (US$ 50 in constant price). A significant proportion of households in India (51%) are incurring CME. Along with economic and educational status, type of health care and place of residence emerged as significant factors in explaining CME. Findings from this study assume importance in the context of an emerging demand for higher maternity entitlements and government spending on public health care in India. To reduce CME, India needs to improve the availability and accessibility of better-quality public health services and increase maternity entitlements in line with maternity expenditure identified in this study.

  11. Factors Affecting The Adoption Of Mhealth In Maternal Health Care In Nakuru Provincial General Hospital

    OpenAIRE

    Simon Munyua; Dr. Gladys Rotich; Dr. Michael Kimwele

    2015-01-01

    Abstract Access to timely and quality maternal health care remains to be a major development challenge in many developing economies particularly in Kenya. The countrys system of providing maternal health care also continue to be anchored on conventional methods of physical presence of the patient and the doctor in a hospital setup. The countrys ICT and health policies also place very little emphasis on the use of these platforms. This study therefore sought to establish the factors affecting...

  12. Maternal mortality and maternity care from 1990 to 2005: uneven but important gains.

    Science.gov (United States)

    Shah, Iqbal H; Say, Lale

    2007-11-01

    Maternal mortality continues to be the major cause of death among women of reproductive age in many countries. Data from published studies and Demographic and Health Surveys show that gains in reducing maternal mortality between 1990 and 2005 have been modest overall. In 2005, there were about 536,000 maternal deaths, and the maternal mortality ratio was estimated at 400 per 100,000 live births, compared to 430 in 1990. Noteworthy declines took place in east Asia (4% per year) and north Africa (3% per year). Maternal deaths and mortality ratios were highest in sub-Saharan Africa and southeast Asia and low in east Asia and Latin America/Caribbean. In 11 of 53 countries with data, fewer than 25% of women had had at least four antenatal visits. About 63% of births were attended by a skilled attendant: from 47% in Africa to 88% in Latin America/Caribbean. In 16 of 23 countries with data, less than 50% of the recommended levels of emergency obstetric care had been fulfilled. Only 61% of women who delivered in a health facility in 30 developing countries received post-partum care, and far fewer who gave birth at home. Countries with maternal mortality ratios of 750+ per 100,000 live births shared problems of high fertility and unplanned pregnancies, poor health infrastructure with limited resources and low availability of health personnel. The task ahead is enormous.

  13. Overview, methods and results of multi-country community-based maternal and newborn care economic analysis.

    Science.gov (United States)

    Daviaud, Emmanuelle; Owen, Helen; Pitt, Catherine; Kerber, Kate; Bianchi Jassir, Fiorella; Barger, Diana; Manzi, Fatuma; Ekipara-Kiracho, Elizabeth; Greco, Giulia; Waiswa, Peter; Lawn, Joy E

    2017-10-01

    Home visits for pregnancy and postnatal care were endorsed by the WHO and partners as a complementary strategy to facility-based care to reduce newborn and maternal mortality. This article aims to synthesise findings and implications from the economic analyses of community-based maternal and newborn care (CBMNC) evaluations in seven countries. The evaluations included five cluster randomized trials (Ethiopia, Ghana, South Africa, Tanzania, Uganda) and programmatic before/after assessments (Bolivia, Malawi). The economic analyses were undertaken using a standardized, comparable methodology the 'Cost of Integrated Newborn Care' Tool, developed by the South African Medical Research Council, with Saving Newborn Lives and a network of African economists. The main driver of costs is the number of community health workers (CHWs), determined by their time availability, as fixed costs per CHW (equipment, training, salary/stipend, supervision and management), independent from the level of activity (number of mothers visited) represented over 96% of economic and financial costs in five of the countries. Unpaid volunteers are not necessarily a cheap option. An integrated programme with multi-purpose paid workers usually has lower costs per visit but requires innovative management, including supervision to ensure that coverage, or quality of care are not compromised since these workers have many other responsibilities apart from maternal and newborn health. If CHWs reach 95% of pregnant women in a standardized 100 000 population, the additional financial cost in all cases would be under USD1 per capita. In five of the six countries, the programme would be highly cost-effective (cost per DALY averted < GDP/capita) by WHO threshold even if they only achieved a reduction of 1 neonatal death per 1000 live births. These results contribute useful information for implementation planning and sustainability of CBMNC programmes. © The Author 2017. Published by Oxford University

  14. Blueprint for action: steps toward a high-quality, high-value maternity care system.

    Science.gov (United States)

    Angood, Peter B; Armstrong, Elizabeth Mitchell; Ashton, Diane; Burstin, Helen; Corry, Maureen P; Delbanco, Suzanne F; Fildes, Barbara; Fox, Daniel M; Gluck, Paul A; Gullo, Sue Leavitt; Howes, Joanne; Jolivet, R Rima; Laube, Douglas W; Lynne, Donna; Main, Elliott; Markus, Anne Rossier; Mayberry, Linda; Mitchell, Lynn V; Ness, Debra L; Nuzum, Rachel; Quinlan, Jeffrey D; Sakala, Carol; Salganicoff, Alina

    2010-01-01

    Childbirth Connection hosted a 90th Anniversary national policy symposium, Transforming Maternity Care: A High Value Proposition, on April 3, 2009, in Washington, DC. Over 100 leaders from across the range of stakeholder perspectives were actively engaged in the symposium work to improve the quality and value of U.S. maternity care through broad system improvement. A multi-disciplinary symposium steering committee guided the strategy from its inception and contributed to every phase of the project. The "Blueprint for Action: Steps Toward a High Quality, High Value Maternity Care System", issued by the Transforming Maternity Care Symposium Steering Committee, answers the fundamental question, "Who needs to do what, to, for, and with whom to improve the quality of maternity care over the next five years?" Five stakeholder workgroups collaborated to propose actionable strategies in 11 critical focus areas for moving expeditiously toward the realization of the long term "2020 Vision for a High Quality, High Value Maternity Care System", also published in this issue. Following the symposium these workgroup reports and recommendations were synthesized into the current blueprint. For each critical focus area, the "Blueprint for Action" presents a brief problem statement, a set of system goals for improvement in that area, and major recommendations with proposed action steps to achieve them. This process created a clear sightline to action that if enacted could improve the structure, process, experiences of care, and outcomes of the maternity care system in ways that when anchored in the culture can indeed transform maternity care. Copyright 2010 Jacobs Institute of Women

  15. Fostering maternal and newborn care in India the Yashoda way: does this improve maternal and newborn care practices during institutional delivery?

    Directory of Open Access Journals (Sweden)

    Beena Varghese

    Full Text Available BACKGROUND: The Yashoda program, named after a legendary foster-mother in Indian mythology, under the Norway-India Partnership Initiative was launched as a pilot program in 2008 to improve the quality of maternal and neonatal care at facilities in select districts of India. Yashodas were placed mainly at district hospitals, which are high delivery load facilities, to provide support and care to mothers and newborns during their stay at these facilities. This study presents the results from the evaluation of this intervention in two states in India. METHODS: Data collection methods included in-depth interviews with healthcare providers and mothers and a survey of mothers who had recently delivered within a quasi-experimental design. Fifty IDIs were done and 1,652 mothers who had delivered in the past three months were surveyed during 2010 and 2011. RESULTS: A significantly higher proportion of mothers at facilities with Yashodas (55 percent to 97 percent received counseling on immunization, breastfeeding, family planning, danger signs, and nutrition compared to those in control districts (34 percent to 66 percent. Mothers in intervention facilities were four to five times more likely to receive postnatal checks than mothers in control facilities. Among mothers who underwent cesarean sections, initiation of breastfeeding within five hours was 50 percent higher in intervention facilities. Mothers and families also reported increased support, care and respect at intervention facilities. CONCLUSION: Yashoda as mothers' aide thus seems to be an effective intervention to improve quality of maternal and newborn care in India. Scaling up of this intervention is recommended in district hospitals and other facilities with high volume of deliveries.

  16. Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis.

    Science.gov (United States)

    Worku, Abebaw Gebeyehu; Yalew, Alemayehu Worku; Afework, Mesganaw Fantahun

    2013-04-15

    The evaluation of all potential sources of low skilled maternal care utilization is crucial for Ethiopia. Previous studies have largely disregarded the contribution of different levels. This study was planned to assess the effect of individual, communal, and health facility characteristics in the utilization of antenatal, delivery, and postnatal care by a skilled provider. A linked facility and population-based survey was conducted over three months (January - March 2012) in twelve "kebeles" of North Gondar Zone, Amhara Region. A total of 1668 women who had births in the year preceding the survey were selected for analysis. Using a multilevel modelling, we examined the effect of cluster variation and a number of individual, communal (kebele), and facility-related variables for skilled maternal care utilization. About 32.3%, 13.8% and 6.3% of the women had the chance to get skilled providers for their antenatal, delivery and postnatal care, respectively. A significant heterogeneity was observed among clusters for each indicator of skilled maternal care utilization. At the individual level, variables related to awareness and perceptions were found to be much more relevant for skilled maternal service utilization. Preference for skilled providers and previous experience of antenatal care were consistently strong predictors of all indicators of skilled maternal health care utilizations. Birth order, maternal education, and awareness about health facilities to get skilled professionals were consistently strong predictors of skilled antenatal and delivery care use. Communal factors were relevant for both delivery and postnatal care, whereas the characteristics of a health facility were more relevant for use of skilled delivery care than other maternity services. Factors operating at individual and "kebele" levels play a significant role in determining utilization of skilled maternal health services. Interventions to create better community awareness and perception about

  17. Severe maternal morbidity in Zanzibar's referral hospital: Measuring the impact of in-hospital care

    NARCIS (Netherlands)

    Herklots, T.; Acht, L. van; Meguid, T.; Franx, A.; Jacod, B.C.

    2017-01-01

    OBJECTIVE: to analyse the impact of in-hospital care on severe maternal morbidity using WHO's near-miss approach in the low-resource, high mortality setting of Zanzibar's referral hospital. SETTING: Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania. METHODS: We identified all

  18. Suboptimal care and maternal mortality among foreign-born women in Sweden: maternal death audit with application of the 'migration three delays' model.

    Science.gov (United States)

    Esscher, Annika; Binder-Finnema, Pauline; Bødker, Birgit; Högberg, Ulf; Mulic-Lutvica, Ajlana; Essén, Birgitta

    2014-04-12

    Several European countries report differences in risk of maternal mortality between immigrants from low- and middle-income countries and host country women. The present study identified suboptimal factors related to care-seeking, accessibility, and quality of care for maternal deaths that occurred in Sweden from 1988-2010. A subset of maternal death records (n = 75) among foreign-born women from low- and middle-income countries and Swedish-born women were audited using structured implicit review. One case of foreign-born maternal death was matched with two native born Swedish cases of maternal death. An assessment protocol was developed that applied both the 'migration three delays' framework and a modified version of the Confidential Enquiry from the United Kingdom. The main outcomes were major and minor suboptimal factors associated with maternal death in this high-income, low-maternal mortality context. Major and minor suboptimal factors were associated with a majority of maternal deaths and significantly more often to foreign-born women (p = 0.01). The main delays to care-seeking were non-compliance among foreign-born women and communication barriers, such as incongruent language and suboptimal interpreter system or usage. Inadequate care occurred more often among the foreign-born (p = 0.04), whereas delays in consultation/referral and miscommunication between health care providers where equally common between the two groups. Suboptimal care factors, major and minor, were present in more than 2/3 of maternal deaths in this high-income setting. Those related to migration were associated to miscommunication, lack of professional interpreters, and limited knowledge about rare diseases and pregnancy complications. Increased insight into a migration perspective is advocated for maternity clinicians who provide care to foreign-born women.

  19. Experiencing maternity care: the care received and perceptions of women from different ethnic groups

    Science.gov (United States)

    2013-01-01

    Background According to the Office for National Statistics, approximately a quarter of women giving birth in England and Wales are from minority ethnic groups. Previous work has indicated that these women have poorer pregnancy outcomes than White women and poorer experience of maternity care, sometimes encountering stereotyping and racism. The aims of this study were to examine service use and perceptions of care in ethnic minority women from different groups compared to White women. Methods Secondary analysis of data from a survey of women in 2010 was undertaken. The questionnaire asked about women’s experience of care during pregnancy, labour and birth, and the postnatal period, as well as demographic factors. Ethnicity was grouped into eight categories: White, Mixed, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African, and Other ethnicity. Results A total of 24,319 women completed the survey. Compared to White women, women from minority ethnic groups were more likely to be younger, multiparous and without a partner. They tended to access antenatal care later in pregnancy, have fewer antenatal checks, fewer ultrasound scans and less screening. They were less likely to receive pain relief in labour and, Black African women in particular, were more likely to deliver by emergency caesarean section. Postnatally, women from minority ethnic groups had longer lengths of hospital stay and were more likely to breastfeed but they had fewer home visits from midwives. Throughout their maternity care, women from minority ethnic groups were less likely to feel spoken to so they could understand, to be treated with kindness, to be sufficiently involved in decisions and to have confidence and trust in the staff. Conclusion Women in all minority ethnic groups had a poorer experience of maternity services than White women. That this was still the case following publication of a number of national policy documents and local initiatives is a cause for concern. PMID

  20. The relationship between maternal education and mortality among women giving birth in health care institutions: Analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health

    Directory of Open Access Journals (Sweden)

    Gülmezoglu A Metin

    2011-07-01

    Full Text Available Abstract Background Approximately one-third of a million women die each year from pregnancy-related conditions. Three-quarters of these deaths are considered avoidable. Millennium Development Goal five calls for a reduction in maternal mortality and the establishment of universal access to high quality reproductive health care. There is evidence of a relationship between lower levels of maternal education and higher maternal mortality. This study examines the relationship between maternal education and maternal mortality among women giving birth in health care institutions and investigates the association of maternal age, marital status, parity, institutional capacity and state-level investment in health care with these relationships. Methods Cross-sectional information was collected on 287,035 inpatients giving birth in 373 health care institutions in 24 countries in Africa, Asia and Latin America, between 2004-2005 (in Africa and Latin America and 2007-2008 (in Asia as part of the WHO Global Survey on Maternal and Perinatal Health. Analyses investigated associations between indicators measured at the individual, institutional and country level and maternal mortality during the intrapartum period: from admission to, until discharge from, the institution where women gave birth. There were 363 maternal deaths. Results In the adjusted models, women with no education had 2.7 times and those with between one and six years of education had twice the risk of maternal mortality of women with more than 12 years of education. Institutional capacity was not associated with maternal mortality in the adjusted model. Those not married or cohabiting had almost twice the risk of death of those who were. There was a significantly higher risk of death among those aged over 35 (compared with those aged between 20 and 25 years, those with higher numbers of previous births and lower levels of state investment in health care. There were also additional effects

  1. Prehospital maternity care in Norway.

    Science.gov (United States)

    Egenberg, Signe; Puntervoll, Stein Atle; Øian, Pål

    2011-11-29

    Out-of-hospital maternity care in Norway is randomly organised and not properly formalized. We wished to examine the extent, organisation and quality of this service. We obtained information from the Norwegian Medical Birth Registry on all unplanned out-of-hospital births in 2008. A questionnaire was sent to all maternity institutions, municipalities and emergency dispatch centres, with questions regarding the practical and formal organisation of the service using figures from 2008. 430 children, all above 22 weeks gestation, were born unplanned outside of hospitals in Norway in 2008. Of these, 194 were born unplanned at home, 189 while being transported and 47 in other locations (doctor's offices, infirmaries, unknown). Five out of 53 maternity institutions (9 %) confirmed they had a formal midwife service agreement for out-of-hospital births. 247 municipalities (79 %) claimed to have no such assistance. Of these, 33 are located at least 90 minutes away from the nearest maternity ward. Half of the emergency dispatch centres had no registration identifying formal agreements on assistance by midwives for out-of-hospital births. There is an urgent need to put in place formal agreements between the regional health authorities and the municipalities on out-of-hospital midwife services. A distance of 90 minutes' journey time to a maternity ward to fulfil the right to qualified assistance is not well-founded.

  2. Quality of Care: A Review of Maternal Deaths in a Regional Hospital in Ghana.

    Science.gov (United States)

    Adusi-Poku, Yaw; Antwil, Edward; Osei-Kwakye, Kingsley; Tetteh, Chris; Detoh, Eric Kwame; Antwi, Phyllis

    2015-09-01

    The government of Ghana and key stakeholders have put into place several interventions aimed at reducing maternal deaths. At the institutional level, the conduct of maternal deaths audit has been instituted. This also contributes to reducing maternal deaths as shortcomings that may have contributed to such deaths could be identified to inform best practice and forestall such occurrences in the future. The objective of this study was to review the quality of maternal care in a regional hospital. A review of maternal deaths using Quality of Care Evaluation Form adapted from the Komfo Anokye Teaching Hospital (KATH) Maternal Death Audit Evaluation Committee was used. About fifty-five percent, 18 (55%) of cases were deemed to have received adequate documentation, senior clinicians were involved in 26(85%) of cases. Poor documentation, non-involvement of senior clinicians in the management of cases, laboratory related issues particularly in relation to blood and blood products as well as promptness of care and adequacy of intensive care facilities and specialists in the hospital were contributory factors to maternal deaths . These are common themes contributing to maternal deaths in developing countries which need to be urgently tackled. Maternal death review with emphasis on quality of care, coupled with facility gap assessment, is a useful tool to address the adequacy of emergency obstetric care services to prevent further maternal deaths.

  3. Measuring quality in maternal-newborn care: developing a clinical dashboard.

    Science.gov (United States)

    Sprague, Ann E; Dunn, Sandra I; Fell, Deshayne B; Harrold, Joann; Walker, Mark C; Kelly, Sherrie; Smith, Graeme N

    2013-01-01

    Pregnancy, birth, and the early newborn period are times of high use of health care services. As well as opportunities for providing quality care, there are potential missed opportunities for health promotion, safety issues, and increased costs for the individual and the system when quality is not well defined or measured. There has been a need to identify key performance indicators (KPIs) to measure quality care within the provincial maternal-newborn system. We also wanted to provide automated audit and feedback about these KPIs to support quality improvement initiatives in a large Canadian province with approximately 140 000 births per year. We therefore worked to develop a maternal-newborn dashboard to increase awareness about selected KPIs and to inform and support hospitals and care providers about areas for quality improvement. We mapped maternal-newborn data elements to a quality domain framework, sought feedback via survey for the relevance and feasibility of change, and examined current data and the literature to assist in setting provincial benchmarks. Six clinical performance indicators of maternal-newborn quality care were identified and evidence-informed benchmarks were set. A maternal-newborn dashboard with "drill down" capacity for detailed analysis to enhance audit and feedback is now available for implementation. While audit and feedback does not guarantee individuals or institutions will make practice changes and move towards quality improvement, it is an important first step. Practice change and quality improvement will not occur without an awareness of the issues.

  4. Postpartum depression: Etiology, treatment and consequences for maternal care.

    Science.gov (United States)

    Brummelte, Susanne; Galea, Liisa A M

    2016-01-01

    This article is part of a Special Issue "Parental Care". Pregnancy and postpartum are associated with dramatic alterations in steroid and peptide hormones which alter the mothers' hypothalamic pituitary adrenal (HPA) and hypothalamic pituitary gonadal (HPG) axes. Dysregulations in these endocrine axes are related to mood disorders and as such it should not come as a major surprise that pregnancy and the postpartum period can have profound effects on maternal mood. Indeed, pregnancy and postpartum are associated with an increased risk for developing depressive symptoms in women. Postpartum depression affects approximately 10-15% of women and impairs mother-infant interactions that in turn are important for child development. Maternal attachment, sensitivity and parenting style are essential for a healthy maturation of an infant's social, cognitive and behavioral skills and depressed mothers often display less attachment, sensitivity and more harsh or disrupted parenting behaviors, which may contribute to reports of adverse child outcomes in children of depressed mothers. Here we review, in honor of the "father of motherhood", Jay Rosenblatt, the literature on postnatal depression in the mother and its effect on mother-infant interactions. We will cover clinical and pre-clinical findings highlighting putative neurobiological mechanisms underlying postpartum depression and how they relate to maternal behaviors and infant outcome. We also review animal models that investigate the neurobiology of maternal mood and disrupted maternal care. In particular, we discuss the implications of endogenous and exogenous manipulations of glucocorticoids on maternal care and mood. Lastly we discuss interventions during gestation and postpartum that may improve maternal symptoms and behavior and thus may alter developmental outcome of the offspring. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Inequity in maternal health care service utilization in Gujarat: analyses of district-level health survey data

    Directory of Open Access Journals (Sweden)

    Dileep V. Mavalankar

    2013-03-01

    Full Text Available Background: Two decades after the launch of the Safe Motherhood campaign, India still accounts for at least a quarter of maternal death globally. Gujarat is one of the most economically developed states of India, but progress in the social sector has not been commensurate with economic growth. The purpose of this study was to use district-level data to gain a better understanding of equity in access to maternal health care and to draw the attention of the policy planers to monitor equity in maternal care. Methods: Secondary data analyses were performed among 7,534 ever-married women who delivered since January 2004 in the District Level Household and Facility Survey (DLHS-3 carried out during 2007–2008 in Gujarat, India. Based on the conceptual framework designed by the Commission on the Social Determinants of Health, associations were assessed between three outcomes – Institutional delivery, antenatal care (ANC, and use of modern contraception – and selected intermediary and structural determinants of health using multiple logistic regression. Results: Inequities in maternal health care utilization persist in Gujarat. Structural determinants like caste group, wealth, and education were all significantly associated with access to the minimum three antenatal care visits, institutional deliveries, and use of any modern method of contraceptive. There is a significant relationship between being poor and access to less utilization of ANC services independent of caste category or residence. Discussion and conclusions: Poverty is the most important determinant of non-use of maternal health services in Gujarat. In addition, social position (i.e. caste has a strong independent effect on maternal health service use. More focused and targeted efforts towards these disadvantaged groups needs to be taken at policy level in order to achieve targets and goals laid out as per the MDGs. In particular, the Government of Gujarat should invest more in basic

  6. Maternal near miss and mortality in a tertiary care hospital in Rwanda

    NARCIS (Netherlands)

    Rulisa, S.; Umuziranenge, I.; Small, M; van Roosmalen, J.

    2015-01-01

    Background: To determine the prevalence and factors associated with severe ('near miss') maternal morbidity and mortality in the University Teaching Hospital of Kigali - Rwanda. Methods: We performed a cross sectional study of all women admitted to the tertiary care University Hospital in Kigali

  7. The role of maternal care in borderline personality disorder and dependent life stress.

    Science.gov (United States)

    Ball Cooper, Ericka; Venta, Amanda; Sharp, Carla

    2018-01-01

    Borderline Personality Disorder (BPD) affects 0.9%-3.2% of adolescents, and more than 20% of inpatient adolescents. Life stress has been linked to BPD across the lifespan, and previous research in adults has linked BPD to dependent stress (i.e., stress induced by the individual). However, prior research has not examined dependent stress alongside BPD in adolescents. Additionally, the potential protective effect of maternal care has not been considered in this relation. This study tested a moderation model expecting that (1) BPD would be positively associated with dependent life stress, (2) maternal care would be negatively associated with BPD, and (3) maternal care would moderate the relation between BPD and dependent life stress. The sample consisted of 184 adolescents recruited from an inpatient psychiatric facility serving a diverse population in the Southwestern United States. Dependent life stress, BPD, and maternal care were measured using the UCLA Life Stress Interview, DSM-IV Childhood Interview for BPD, and Kerns Security Scale, respectively. Results supported the first two hypotheses; BPD diagnosis was significantly, positively associated with dependent life stress, and negatively associated with maternal availability and dependability. Contrary to the third hypothesis, no significant evidence that maternal care acts as a buffer in the relation between BPD and dependent life stress was found. Although maternal care was not found to moderate the association between BPD and dependent life stress, results supported previously found relations between BPD, dependent life stress, and maternal care, and did so within a diverse inpatient adolescent sample.

  8. What models of maternity care do pregnant women in Ireland want?

    LENUS (Irish Health Repository)

    Byrne, C

    2012-02-01

    The introduction of new models of care in the Irish maternity services has been recommended by both advocacy groups and strategic reports. Yet there is a dearth of information about what models of care pregnant women want. We surveyed women in early pregnancy who were attending a large Dublin maternity hospital. Demographic and clinical details were recorded from the hospital chart. Of the 501 women, 351 (70%) (352 (70.3%) of women wanted shared antenatal care between their family doctor and either a hospital doctor or midwife. 228 (45.5%) preferred to have their baby delivered in a doctor-led unit, while 215 (42.9%) preferred a midwifery-led unit. Of those 215 (42.9%), 118 (55%) met criteria for suitability. There was minimal demand (1.6%) for home births. Choice was influenced by whether the woman was attending for private care or not. Safety is the most important factor for women when choosing the type of maternity care they want. Pregnant women want a wide range of choices when it comes to models of maternity care. Their choice is strongly influenced by safety considerations, and will be determined in part by risk assessment.

  9. Teaching respectful maternity care using an intellectual partnership model in Tanzania.

    Science.gov (United States)

    Wilson-Mitchell, Karline; Robinson, Jamie; Sharpe, Mary

    2018-05-01

    to develop and deliver a two-day Respectful Maternity Care workshop for midwives using Intellectual Partnership Model principles SETTING: rural Tanzania BACKGROUND: respectful Maternity Care is an objective, measurable indicator of quality maternal newborn care INTERVENTIONS: using the Intellectual Partnership Model, educators facilitated cocreation of solutions alongside learners for complex ethical and logistic problems in the workplace FINDINGS: the mean scores on a 10-item multiple choice test increased by 20% on average following completion of the interventions; however 2-year certificate learners were less prepared for critical thinking work and social innovations than those midwives who had 3 or 4 year formal training KEY CONCLUSIONS: the implementation of the Intellectual Partnership Model revealed that midwife learners were creative, innovative, context specific in their social innovation creations related to Respectful Maternity Care when supported by respectful facilitators. the Intellectual Partnership Model should be considered along with problem-based learning in the Global South, for pre and post-service education. Copyright © 2018 Elsevier Ltd. All rights reserved.

  10. Is poor maternal mortality index in Nigeria a problem of care ...

    African Journals Online (AJOL)

    Maternal mortality in Nigeria is unacceptably high. Some of the reasons may include poor socioeconomic development, weak health care system, low socioeconomic status of women and socio-cultural barriers to care utilization. A cross sectional study was carried out to assess the use of maternal services in Anambra State.

  11. Perceptions of health care providers and patients on quality of care in maternal and neonatal health in fourteen Bangladesh government healthcare facilities: a mixed-method study.

    Science.gov (United States)

    Islam, Farzana; Rahman, Aminur; Halim, Abdul; Eriksson, Charli; Rahman, Fazlur; Dalal, Koustuv

    2015-06-19

    Bangladesh has achieved remarkable progress in healthcare with a steady decline in maternal and under-5 child mortality rates in efforts to achieve Millennium Development Goals 4 and 5. However, the mortality rates are still very high compared with high-income countries. The quality of healthcare needs improve to reduce mortality rates further. It is essential to investigate the current quality of healthcare before implementing any interventions. The study was conducted to explore the perception of healthcare providers about the quality of maternal and neonatal health (MNH) care. The study also investigated patient satisfaction with the MNH care received from district and sub-district hospitals. Both qualitative and quantitative methods were used in the study. Two district and 12 sub-district hospitals in Thakurgaon and Jamalpur in Bangladesh were the study settings. Fourteen group discussions and 56 in-depth interviews were conducted among the healthcare providers. Client exit interviews were conducted with 112 patients and their attendants from maternity, labor, and neonatal wards before being discharged from the hospitals. Eight physicians and four anthropologists collected data between November and December 2011 using pretested guidelines. The hospital staff identified several key factors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under use of patient-management protocols; a lack of training; and insufficient supervision. Doctors were unable to provide optimal care because of the high volume of patients. The exit interviews revealed that 85 % of respondents were satisfied with the hospital services received. Seven out of 14 respondents were satisfied with the cleanliness of the hospital facilities. More than half of the respondents were satisfied with the drugs they received. In half of the facilities, patients did not get an opportunity to ask the healthcare providers questions about their health

  12. An emerging model of maternity care: smartphone, midwife, doctor?

    Science.gov (United States)

    Tripp, Nadia; Hainey, Kirsten; Liu, Anthony; Poulton, Alison; Peek, Michael; Kim, Jinman; Nanan, Ralph

    2014-03-01

    Mobile technology in the form of the smartphone is widely used, particularly in pregnancy and they are an increasing and influential source of information. To describe the diverse nature of pregnancy related applications (apps) for the smartphone and to flag that these apps can potentially affect maternity care and should be considered in future planning of care provision. The 2 smartphone platforms, Apple and Android, were searched for pregnancy related apps and reviewed for their purpose and popularity. iTunes and Google Play returned 1059 and 497 pregnancy related apps respectively. Forty percent of the apps were informative, 13% interactive, 19% had features of a medical tool and 11% were social media apps. By far the most popular apps, calculated as the number of reviews multiplied by average reviewer rating, were those with interactive features. The popularity of pregnancy-related apps could indicate a shift towards patient empowerment within maternity care provision. The traditional model of 'shared maternity care' needs to accommodate electronic devices into its functioning. Reliance on healthcare professionals may be reduced by the availability of interactive and personalised information delivered via a smartphone. This combined with the fact that smartphones are widely used by many women of childbearing age, has the potential to modify maternity care and experiences of pregnancy. Therefore it is important that healthcare professionals and policy-makers are more aware of these new developments, which are likely to influence healthcare and alter health-seeking behaviour. In addition healthcare professionals need to consider whether to discuss the use of apps in pregnancy with the women in their care. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  13. Striving to promote male involvement in maternal health care in rural and urban settings in Malawi - a qualitative study

    Directory of Open Access Journals (Sweden)

    Kululanga Lucy I

    2011-12-01

    Full Text Available Abstract Background Understanding the strategies that health care providers employ in order to invite men to participate in maternal health care is very vital especially in today's dynamic cultural environment. Effective utilization of such strategies is dependent on uncovering the salient issues that facilitate male participation in maternal health care. This paper examines and describes the strategies that were used by different health care facilities to invite husbands to participate in maternal health care in rural and urban settings of southern Malawi. Methods The data was collected through in-depth interviews from sixteen of the twenty health care providers from five different health facilities in rural and urban settings of Malawi. The health facilities comprised two health centres, one district hospital, one mission hospital, one private hospital and one central hospital. A semi-structured interview guide was used to collect data from health care providers with the aim of understanding strategies they used to invite men to participate in maternal health care. Results Four main strategies were used to invite men to participate in maternal health care. The strategies were; health care provider initiative, partner notification, couple initiative and community mobilization. The health care provider initiative and partner notification were at health facility level, while the couple initiative was at family level and community mobilization was at village (community level. The community mobilization had three sub-themes namely; male peer initiative, use of incentives and community sensitization. The sustainability of each strategy to significantly influence behaviour change for male participation in maternal health care is discussed. Conclusion Strategies to invite men to participate in maternal health care were at health facility, family and community levels. The couple strategy was most appropriate but was mostly used by educated and city

  14. Out-of-pocket expenditure on maternity care for hospital births in Uttar Pradesh, India.

    Science.gov (United States)

    Goli, Srinivas; Rammohan, Anu; Moradhvaj

    2018-02-27

    The studies measured Out-of-Pocket Expenditure (OOPE) for hospital births previously suffer from serious data limitations. To overcome such limitations, we designed a hospital-based study for measuring the levels and factors of OOPE on maternity care for hospital births by its detailed components. Data were collected from women for non-complicated deliveries 24-h before the survey and complicated deliveries 48-h prior to the survey at the hospital settings in Uttar Pradesh, India during 2014. The simple random sampling design was used in the selection of respondents. Bivariate analyses were used to estimate mean expenditure on Antenatal care services (ANCs), Delivery care and Total Maternity Expenditure (TME). Multivariate linear regression was employed to examine the factor associated with the absolute and relative share of expenditure in couple's annual income on ANCs, delivery care, and TME. The findings show that average expenditure on maternal health care is high ($155) in the study population. Findings suggest that factors such as income, place, and number of ANCs, type, and place of institutional delivery are significantly associated with both absolute and relative expenditure on maternity care. The likelihood of incidence of catastrophic expenditure on maternity care is significantly higher for women delivered in private hospitals (β = 2.427, p maternity care for hospital births reported in this study is much higher as it was collected with a better methodology, although with smaller sample size. Therefore, ongoing maternity benefit scheme in India in general and Uttar Pradesh in particular need to consider the levels of OOPE on maternity care and demand-side and supply-side factors determining it for a more effective policy to reduce the catastrophic burden on households and help women to achieve better maternity health outcomes in poor regional settings like Uttar Pradesh in India.

  15. General practitioners and their role in maternity care.

    NARCIS (Netherlands)

    Wiegers, T.A.

    2003-01-01

    During the last century the perception of pregnancy and childbirth has changed from a normal, physiological life-event to a potentially dangerous condition. Maternity care has become more and more obstetrical care, focussed on pathology and complications. The involvement of general practitioners

  16. Maternal perception regarding child care and development

    Directory of Open Access Journals (Sweden)

    Mirna Albuquerque Frota

    2011-09-01

    Full Text Available Objective: To investigate the perception of mothers regarding the care and development of their children. Methods: This was a descriptive and qualitative study, conducted in a Basic Health Unit (UBS in Fortaleza-CE, Brazil, in the period from July to October, 2008. The subjects were twenty mothers who accompanied their children in childcare consultation and met with favorable clinical conditions. Data collection techniques used free observation and semistructured interview consisting of questions involving the perception of child development and care. Results: By means of data analysis the following categories emerged: “Smile and play: mother’s perception regarding the development of the child”; “Take care: emphasis on breastfeeding and body hygiene”. The main source of nonverbal communication that the child has to convey affection and love is the smile, being an essential activity to child development. We verified that the care with breastfeeding and body hygiene suggest behavioral indicators of maternal sensitivity. Final considerations: The childcare consultation held in UBS is essential, because it allows integration of ideas and actions shared with the professional-parent dyad, thus providing the arousal of new experiences in care and the influence on child development.

  17. An evaluation of the implementation of maternal obesity pathways of care: a mixed methods study with data integration.

    Directory of Open Access Journals (Sweden)

    Nicola Heslehurst

    Full Text Available Maternal obesity has multiple associated risks and requires substantial intervention. This research evaluated the implementation of maternal obesity care pathways from multiple stakeholder perspectives.A simultaneous mixed methods model with data integration was used. Three component studies were given equal priority. 1: Semi-structured qualitative interviews explored obese pregnant women's experiences of being on the pathways. 2: A quantitative and qualitative postal survey explored healthcare professionals' experiences of delivering the pathways. 3: A case note audit quantitatively assessed pathway compliance. Data were integrated using following a thread and convergence coding matrix methods to search for agreement and disagreement between studies.Study 1: Four themes were identified: women's overall (positive and negative views of the pathways; knowledge and understanding of the pathways; views on clinical and weight management advice and support; and views on the information leaflet. Key results included positive views of receiving additional clinical care, negative experiences of risk communication, and weight management support was considered a priority. Study 2: Healthcare professionals felt the pathways were worthwhile, facilitated good practice, and increased confidence. Training was consistently identified as being required. Healthcare professionals predominantly focussed on women's response to sensitive obesity communication. Study 3: There was good compliance with antenatal clinical interventions. However, there was poor compliance with public health and postnatal interventions. There were some strong areas of agreement between component studies which can inform future development of the pathways. However, disagreement between studies included a lack of shared priorities between healthcare professionals and women, different perspectives on communication issues, and different perspectives on women's prioritisation of weight

  18. An Evaluation of the Implementation of Maternal Obesity Pathways of Care: A Mixed Methods Study with Data Integration

    Science.gov (United States)

    Heslehurst, Nicola; Dinsdale, Sarah; Sedgewick, Gillian; Simpson, Helen; Sen, Seema; Summerbell, Carolyn Dawn; Rankin, Judith

    2015-01-01

    Objectives Maternal obesity has multiple associated risks and requires substantial intervention. This research evaluated the implementation of maternal obesity care pathways from multiple stakeholder perspectives. Study Design A simultaneous mixed methods model with data integration was used. Three component studies were given equal priority. 1: Semi-structured qualitative interviews explored obese pregnant women’s experiences of being on the pathways. 2: A quantitative and qualitative postal survey explored healthcare professionals’ experiences of delivering the pathways. 3: A case note audit quantitatively assessed pathway compliance. Data were integrated using following a thread and convergence coding matrix methods to search for agreement and disagreement between studies. Results Study 1: Four themes were identified: women’s overall (positive and negative) views of the pathways; knowledge and understanding of the pathways; views on clinical and weight management advice and support; and views on the information leaflet. Key results included positive views of receiving additional clinical care, negative experiences of risk communication, and weight management support was considered a priority. Study 2: Healthcare professionals felt the pathways were worthwhile, facilitated good practice, and increased confidence. Training was consistently identified as being required. Healthcare professionals predominantly focussed on women’s response to sensitive obesity communication. Study 3: There was good compliance with antenatal clinical interventions. However, there was poor compliance with public health and postnatal interventions. There were some strong areas of agreement between component studies which can inform future development of the pathways. However, disagreement between studies included a lack of shared priorities between healthcare professionals and women, different perspectives on communication issues, and different perspectives on women

  19. Assessment of provider competence and quality of maternal/newborn care in selected Latin American and Caribbean countries

    Directory of Open Access Journals (Sweden)

    Joyce E Thompson

    2015-05-01

    Full Text Available OBJECTIVE: To obtain a snapshot of the maternal and newborn care provided by different types of maternal and child health providers in Latin America and the Caribbean (LAC to 1 better inform advocacy and programmatic strategies and interventions to improve the quality of those services in the region, and 2 determine the need for more rigorous study of the issues. METHODS: A rapid assessment of 83 health workers providing antepartum, intrapartum, and immediate postpartum and newborn care (within two hours of birth in eight LAC countries was conducted in November and December of 2011. Health workers were observed by two-person expert maternal/newborn clinician teams using pretested forms based on international quality-of-care standards. A total of 105 care encounters were observed, primarily in urban, public, referral-level settings. Providers of care included obstetricians, midwives, generalist physicians, medical residents, registered nurses, auxiliary nurses, and students of medicine, midwifery, and nursing. RESULTS: Hand washing, as an indicator of quality of antepartum care, was observed in only 41% of the observed encounters. Labor management often lacked certain elements of respectful maternity care across all provider groups. Several clinical tasks of high importance in the identification and prevention of common complications of antepartum, intrapartum, and immediate postpartum/newborn care were not documented as performed during the observation periods. Providers self-reported limited competence (ability to perform to a defined level of proficiency in manual removal of the placenta, bimanual compression of the uterus, and newborn resuscitation. CONCLUSIONS: The findings suggest that 1 the quality of maternal and newborn care and 2 the competence of maternal and child health providers in the diverse selection of LAC countries that were studied require substantial attention.

  20. Severe maternal morbidity in Zanzibar’s referral hospital : Measuring the impact of in-hospital care

    NARCIS (Netherlands)

    Herklots, Tanneke; Van Acht, Lieke; Meguid, Tarek; Franx, Arie; Jacod, Benoit

    2017-01-01

    Objective: to analyse the impact of in-hospital care on severe maternal morbidity using WHO’s near-miss approach in the low-resource, high mortality setting of Zanzibar’s referral hospital. Setting: Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania. Methods: We identified all

  1. Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care.

    Science.gov (United States)

    Miller, Margaret; Hearn, Lydia; van der Pligt, Paige; Wilcox, Jane; Campbell, Karen J

    2014-01-01

    Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.

  2. Development of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) for migrants to Western societies: an international Delphi consensus process

    Science.gov (United States)

    2014-01-01

    Background Through the World Health Assembly Resolution, ‘Health of Migrants’, the international community has identified migrant health as a priority. Recommendations for general hospital care for international migrants in receiving-countries have been put forward by the Migrant Friendly Hospital Initiative; adaptations of these recommendations specific to maternity care have yet to be elucidated and validated. We aimed to develop a questionnaire measuring migrant-friendly maternity care (MFMC) which could be used in a range of maternity care settings and countries. Methods This study was conducted in four stages. First, questions related to migrant friendly maternity care were identified from existing questionnaires including the Migrant Friendliness Quality Questionnaire, developed in Europe to capture recommended general hospital care for migrants, and the Mothers In a New Country (MINC) Questionnaire, developed in Australia and revised for use in Canada to capture the maternity care experiences of migrant women, and combined to create an initial MFMC questionnaire. Second, a Delphi consensus process in three rounds with a panel of 89 experts in perinatal health and migration from 17 countries was undertaken to identify priority themes and questions as well as to clarify wording and format. Third, the draft questionnaire was translated from English to French and Spanish and back-translated and subsequently culturally validated (assessed for cultural appropriateness) by migrant women. Fourth, the questionnaire was piloted with migrant women who had recently given birth in Montreal, Canada. Results A 112-item questionnaire on maternity care from pregnancy, through labour and birth, to postpartum care, and including items on maternal socio-demographic, migration and obstetrical characteristics, and perceptions of care, has been created - the Migrant Friendly Maternity Care Questionnaire (MFMCQ) – in three languages (English, French and Spanish). It is

  3. Maternal health care professionals' perspectives on the provision and use of antenatal and delivery care: a qualitative descriptive study in rural Vietnam.

    Science.gov (United States)

    Graner, Sophie; Mogren, Ingrid; Duong, Le Q; Krantz, Gunilla; Klingberg-Allvin, Marie

    2010-10-14

    High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam. The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis. Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment. Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and reduce their possibility to make independent decisions about their

  4. Maternal care practices among the ultra poor households in rural Bangladesh: a qualitative exploratory study

    Directory of Open Access Journals (Sweden)

    Choudhury Nuzhat

    2011-03-01

    Full Text Available Abstract Background Although many studies have been carried out to learn about maternal care practices in rural areas and urban-slums of Bangladesh, none have focused on ultra poor women. Understanding the context in which women would be willing to accept new practices is essential for developing realistic and relevant behaviour change messages. This study sought to fill in this knowledge gap by exploring maternal care practices among women who participated in a grant-based livelihood programme for the ultra poor. This is expected to assist the designing of the health education messages programme in an effort to improve maternal morbidity and survival towards achieving the UN millennium Development Goal 5. Methods Qualitative method was used to collect data on maternal care practices during pregnancy, delivery, and post-partum period from women in ultra poor households. The sample included both currently pregnant women who have had a previous childbirth, and lactating women, participating in a grant-based livelihood development programme. Rangpur and Kurigram districts in northern Bangladesh were selected for data collection. Results Women usually considered pregnancy as a normal event unless complications arose, and most of them refrained from seeking antenatal care (ANC except for confirmation of pregnancy, and no prior preparation for childbirth was taken. Financial constraints, coupled with traditional beliefs and rituals, delayed care-seeking in cases where complications arose. Delivery usually took place on the floor in the squatting posture and the attendants did not always follow antiseptic measures such as washing hands before conducting delivery. Following the birth of the baby, attention was mainly focused on the expulsion of the placenta and various maneuvres were adapted to hasten the process, which were sometimes harmful. There were multiple food-related taboos and restrictions, which decreased the consumption of protein during

  5. Assessment of utilization of maternal health care provisions in ...

    African Journals Online (AJOL)

    Assessment of utilization of maternal health care provisions in Orumba North Local Government Area of Anambra State, Nigeria. ... care facilities (52%). This study therefore, recommends equipping modern health care facilities with both human and material resources to enhance their performance. Also, periodic training of ...

  6. Examining the Relationship Between Individual Characteristics, Community-Level Traits, Multidimensional Empowerment, and Maternal Health Care Utilization in the Islamic Republic of Pakistan.

    Science.gov (United States)

    Hearld, Kristine R; Anderson, Jami L; Budhwani, Henna

    2018-03-06

    Introduction The Islamic Republic of Pakistan's maternal mortality ratio is particularly high, and the nation ranks 126 out of 149 countries on the Human Development Report-Gender Inequality Index. This is because Pakistani women have low levels of empowerment, make limited economic contributions, and underutilization of maternal health care. The aim of this study is to create a multidimensional index of women's empowerment and assess the association between this index and maternal health care utilization in Pakistan, controlling for individual characteristics and community-level traits. Methods Data from the 2012-2013 Pakistan Demographic and Health Surveys were employed to investigate the relationship between this index and the latent construct of maternal health care utilization. Results Using exploratory factor analysis, four indicators of maternal health care utilization were loaded onto a single latent factor. Multivariate analyses found support for the association between empowerment and health care utilization, despite adjustments for individual and area level factors. Positive associations between education, wealth, and maternal health care utilization were found. Conclusions Although we find support for the association of educational attainment with maternal health care utilization, the multidimensional women's empowerment index was independently a consistent associate of maternal health care utilization. This illustrates a complex mechanism with both-education and empowerment, being necessary for improved maternal health care utilization. Policy makers seeking to improve outcomes should expand their focus beyond simply improving rates of education to examining effects of cultural norms which constrain the independence of women in making decisions about their own health care.

  7. Performance indicators for maternity care in a circumpolar context: a scoping review

    Science.gov (United States)

    Rich, Rebecca; D'Hont, Thomsen; Linton, Janice; Murphy, Kellie E.; Veillard, Jeremy; Chatwood, Susan

    2016-01-01

    Background In circumpolar regions, harsh climates and scattered populations have prompted the centralization of care and reduction of local maternity services. The resulting practice of routine evacuation for birth from smaller towns to larger urban centres points to a potential conflict between the necessity to ensure patient safety and the importance of delivering services that are responsive to the health needs and values of populations served. Objective To identify recommended performance/quality indicators for use in circumpolar maternity care systems. Methods We searched Scopus, Ebscohost databases (including Academic Search Complete and CINAHL), the Global Health Database, High North Research Documents, and online grey literature. Articles were included if they focused on maternal health indicators in the population of interest (Indigenous women, women receiving care in circumpolar or remote regions). Articles were excluded if they were not related to pregnancy, birth or the immediate post-partum or neonatal periods. Two reviewers independently reviewed articles for inclusion and extracted relevant data. Results Twenty-six documents were included. Twelve were government documents, seven were review articles or indicator compilations, four were indicator sets recommended by academics or non-governmental organizations and three were research papers. We extracted and categorized 81 unique health indicators. The majority of indicators reflected health systems processes and outcomes during the antenatal and intra-partum periods. Only two governmental indicator sets explicitly considered the needs of Indigenous peoples. Conclusions This review demonstrates that, although most circumpolar health systems engage in performance reporting for maternity care, efforts to capture local priorities and values are limited in most regions. Future work in this area should involve northern stakeholders in the process of indicator selection and development. PMID:27938636

  8. Performance indicators for maternity care in a circumpolar context: a scoping review

    Directory of Open Access Journals (Sweden)

    Rebecca Rich

    2016-12-01

    Full Text Available Background: In circumpolar regions, harsh climates and scattered populations have prompted the centralization of care and reduction of local maternity services. The resulting practice of routine evacuation for birth from smaller towns to larger urban centres points to a potential conflict between the necessity to ensure patient safety and the importance of delivering services that are responsive to the health needs and values of populations served. Objective: To identify recommended performance/quality indicators for use in circumpolar maternity care systems. Methods: We searched Scopus, Ebscohost databases (including Academic Search Complete and CINAHL, the Global Health Database, High North Research Documents, and online grey literature. Articles were included if they focused on maternal health indicators in the population of interest (Indigenous women, women receiving care in circumpolar or remote regions. Articles were excluded if they were not related to pregnancy, birth or the immediate post-partum or neonatal periods. Two reviewers independently reviewed articles for inclusion and extracted relevant data. Results: Twenty-six documents were included. Twelve were government documents, seven were review articles or indicator compilations, four were indicator sets recommended by academics or non-governmental organizations and three were research papers. We extracted and categorized 81 unique health indicators. The majority of indicators reflected health systems processes and outcomes during the antenatal and intra-partum periods. Only two governmental indicator sets explicitly considered the needs of Indigenous peoples. Conclusions: This review demonstrates that, although most circumpolar health systems engage in performance reporting for maternity care, efforts to capture local priorities and values are limited in most regions. Future work in this area should involve northern stakeholders in the process of indicator selection and development.

  9. Interventions to provide culturally-appropriate maternity care services: factors affecting implementation.

    Science.gov (United States)

    Jones, Eleri; Lattof, Samantha R; Coast, Ernestina

    2017-08-31

    The World Health Organization recently made a recommendation supporting 'culturally-appropriate' maternity care services to improve maternal and newborn health. This recommendation results, in part, from a systematic review we conducted, which showed that interventions to provide culturally-appropriate maternity care have largely improved women's use of skilled maternity care. Factors relating to the implementation of these interventions can have implications for their success. This paper examines stakeholders' perspectives and experiences of these interventions, and facilitators and barriers to implementation; and concludes with how they relate to the effects of the interventions on care-seeking outcomes. We based our analysis on 15 papers included in the systematic review. To extract, collate and organise data on the context and conditions from each paper, we adapted the SURE (Supporting the Use of Research Evidence) framework that lists categories of factors that could influence implementation. We considered information from the background and discussion sections of papers included in the systematic review, as well as cost data and qualitative data when included. Women's and other stakeholders' perspectives on the interventions were generally positive. Four key themes emerged in our analysis of facilitators and barriers to implementation. Firstly, interventions must consider broader economic, geographical and social factors that affect ethnic minority groups' access to services, alongside providing culturally-appropriate care. Secondly, community participation is important in understanding problems with existing services and potential solutions from the community perspective, and in the development and implementation of interventions. Thirdly, respectful, person-centred care should be at the core of these interventions. Finally, cohesiveness is essential between the culturally-appropriate service and other health care providers encountered by women and their

  10. Levels of maternal care in dogs affect adult offspring temperament.

    Science.gov (United States)

    Foyer, Pernilla; Wilsson, Erik; Jensen, Per

    2016-01-13

    Dog puppies are born in a state of large neural immaturity; therefore, the nervous system is sensitive to environmental influences early in life. In primates and rodents, early experiences, such as maternal care, have been shown to have profound and lasting effects on the later behaviour and physiology of offspring. We hypothesised that this would also be the case for dogs with important implications for the breeding of working dogs. In the present study, variation in the mother-offspring interactions of German Shepherd dogs within the Swedish breeding program for military working dogs was studied by video recording 22 mothers with their litters during the first three weeks postpartum. The aim was to classify mothers with respect to their level of maternal care and to investigate the effect of this care on pup behaviour in a standardised temperament test carried out at approximately 18 months of age. The results show that females differed consistently in their level of maternal care, which significantly affected the adult behaviour of the offspring, mainly with respect to behaviours classified as Physical and Social Engagement, as well as Aggression. Taking maternal quality into account in breeding programs may therefore improve the process of selecting working dogs.

  11. Maternal care in rural China: a case study from Anhui province

    Directory of Open Access Journals (Sweden)

    Li Xiaohong

    2008-03-01

    Full Text Available Abstract Background Studies on prenatal care in China have focused on the timing and frequency of prenatal care and relatively little information can be found on how maternal care has been organized and funded or on the actual content of the visits, especially in the less developed rural areas. This study explored maternal care in a rural county from Anhui province in terms of care organization, provision and utilization. Methods A total of 699 mothers of infants under one year of age were interviewed with structured questionnaires; the county health bureau officials and managers of township hospitals (n = 10 and county level hospitals (n = 2 were interviewed; the process of the maternal care services was observed by the researchers. In addition, statistics from the local government were used. Results The county level hospitals were well staffed and equipped and served as a referral centre for women with a high-risk pregnancy. Township hospitals had, on average, 1.7 midwives serving an average population of 15,000 people. Only 10–20% of the current costs in county level hospitals and township hospitals were funded by the local government, and women paid for delivery care. There was no systematic organized prenatal care and referrals were not mandatory. About half of the women had their first prenatal visit before the 13th gestational week, 36% had fewer than 5 prenatal visits, and about 9% had no prenatal visits. A major reason for not having prenatal care visits was that women considered it unnecessary. Most women (87% gave birth in public health facilities, and the rest in a private clinic or at home. A total of 8% of births were delivered by caesarean section. Very few women had any postnatal visits. About half of the women received the recommended number of prenatal blood pressure and haemoglobin measurements. Conclusion Delivery care was better provided than both prenatal and postnatal care in the study area. Reliance on user fees gave

  12. Factors affecting maternal health care services utilization in rural ...

    African Journals Online (AJOL)

    admin

    husband's level of ... countries, where women have access to basic health care, ... Democratic Republic of Congo, Ethiopia, India, ... existing information gap about maternal health care by providing empirical evidence-based on the data of the.

  13. Sex differences in life history drive evolutionary transitions among maternal, paternal, and bi-parental care.

    Science.gov (United States)

    Klug, Hope; Bonsall, Michael B; Alonzo, Suzanne H

    2013-04-01

    Evolutionary transitions among maternal, paternal, and bi-parental care have been common in many animal groups. We use a mathematical model to examine the effect of male and female life-history characteristics (stage-specific maturation and mortality) on evolutionary transitions among maternal, paternal, and bi-parental care. When males and females are relatively similar - that is, when females initially invest relatively little into eggs and both sexes have similar mortality and maturation - transitions among different patterns of care are unlikely to be strongly favored. As males and females become more different, transitions are more likely. If females initially invest heavily into eggs and this reduces their expected future reproductive success, transitions to increased maternal care (paternal → maternal, paternal → bi-parental, bi-parental → maternal) are favored. This effect of anisogamy (i.e., the fact that females initially invest more into each individual zygote than males) might help explain the predominance of maternal care in nature and differs from previous work that found no effect of anisogamy on the origin of different sex-specific patterns of care from an ancestral state of no care. When male mortality is high or male egg maturation rate is low, males have reduced future reproductive potential and transitions to increased paternal care (maternal → paternal, bi-parental → paternal, maternal → bi-parental) are favored. Offspring need (i.e., low offspring survival in the absence of care) also plays a role in transitions to paternal care. In general, basic life-history differences between the sexes can drive evolutionary transitions among different sex-specific patterns of care. The finding that simple life-history differences can alone lead to transitions among maternal and paternal care suggests that the effect of inter-sexual life-history differences should be considered as a baseline scenario when attempting to understand how other

  14. Use of performance metrics for the measurement of universal coverage for maternal care in Mexico.

    Science.gov (United States)

    Serván-Mori, Edson; Contreras-Loya, David; Gomez-Dantés, Octavio; Nigenda, Gustavo; Sosa-Rubí, Sandra G; Lozano, Rafael

    2017-06-01

    This study provides evidence for those working in the maternal health metrics and health system performance fields, as well as those interested in achieving universal and effective health care coverage. Based on the perspective of continuity of health care and applying quasi-experimental methods to analyse the cross-sectional 2009 National Demographic Dynamics Survey (n = 14 414 women), we estimated the middle-term effects of Mexico's new public health insurance scheme, Seguro Popular de Salud (SPS) (vs women without health insurance) on seven indicators related to maternal health care (according to official guidelines): (a) access to skilled antenatal care (ANC); (b) timely ANC; (c) frequent ANC; (d) adequate content of ANC; (e) institutional delivery; (f) postnatal consultation and (g) access to standardized comprehensive antenatal and postnatal care (or the intersection of the seven process indicators). Our results show that 94% of all pregnancies were attended by trained health personnel. However, comprehensive access to ANC declines steeply in both groups as we move along the maternal healthcare continuum. The percentage of institutional deliveries providing timely, frequent and adequate content of ANC reached 70% among SPS women (vs 64.7% in the uninsured), and only 57.4% of SPS-affiliated women received standardized comprehensive care (vs 53.7% in the uninsured group). In Mexico, access to comprehensive antenatal and postnatal care as defined by Mexican guidelines (in accordance to WHO recommendations) is far from optimal. Even though a positive influence of SPS on maternal care was documented, important challenges still remain. Our results identified key bottlenecks of the maternal healthcare continuum that should be addressed by policy makers through a combination of supply side interventions and interventions directed to social determinants of access to health care. © The Author 2017. Published by Oxford University Press in association with The

  15. The hidden cost of 'free' maternity care in Dhaka, Bangladesh.

    Science.gov (United States)

    Nahar, S; Costello, A

    1998-12-01

    We studied the cost and affordability of 'free' maternity services at government facilities in Dhaka, Bangladesh, to assess whether economic factors may contribute to low utilization. We conducted a questionnaire survey and in-depth interviews among 220 post-partum mothers and their husbands, selected from four government maternity facilities (three referral hospitals and one Mother and Child Health hospital) in Dhaka. Mothers with serious complications were excluded. Information was collected on the costs of maternity care, household income, the sources of finance used to cover the costs, and the family's willingness to pay for maternity services. The mean cost for normal delivery was 1275 taka (US$31.9) and for caesarean section 4703 taka (US$117.5). Average monthly household income was 4933 taka (US$123). Twenty-one per cent of families were spending 51-100% of monthly income, and 27% of families 2-8 times their monthly income for maternity care. Overall, 51% of the families (and 74% of those having a caesarean delivery) did not have enough money to pay; of these, 79% had to borrow from a money lender or relative. Surprisingly, 72% of the families said they were willing to pay a government-levied user charge, though this was less popular among low-income families (61%). 'Free' maternity care in Bangladesh involves considerable hidden costs which may be a major contributor to low utilization of maternity services, especially among low-income groups. To increase utilization of safer motherhood services, policy-makers might consider introducing fixed user charges with clear exemption guidelines, or greater subsidies for existing services, especially caesarean section.

  16. Women's expectations and experiences of maternity care in NSW--what women highlight as most important.

    Science.gov (United States)

    Jenkins, Mary G; Ford, Jane B; Morris, Jonathan M; Roberts, Christine L

    2014-09-01

    Although surveys have identified that women are generally highly satisfied with maternity care provision, those aspects of care that women highlight as most important for achieving satisfaction and a satisfactory maternity care experience have not been reported. The aim of this study was to investigate how women understand and experience their maternity care and to report which aspects of care women highlight as most important. This large qualitative study explored women's expectations and experiences of maternity care provision. In-depth semi-structured interviews were conducted with 53 women experiencing maternity care in a range of tertiary, regional, rural, remote hospitals and midwife-led practices in the state of New South Wales, Australia during 2011-2012. Included in the interview schedule was the question 'What 3 aspects would you see as most important for delivery of maternity care?' Descriptive analyses of entire transcripts and responses to the question on most important aspects of care were undertaken. Descriptive analyses of women's responses identified 5 important aspects of care: woman-focused care, staff qualities, systems and facilities, family-focused care and continuity of care/information. First-time mothers were more likely to identify woman-focused care, staff qualities and continuity of care/information as important aspects than multiparous mothers. Urban and regional mothers highlighted staff qualities as having greater importance for satisfaction with their care while rural and particularly remote women nominated systems and facilities as important. Our study showed that women from a range of settings are more concerned with staff and relational issues than facilities. Differences in perceptions among primiparous versus multiparous women, at different stages of pregnancy and among women from rural and remote compared to urban settings highlight the need to include women with a diversity of experience when trying to understand the aspects

  17. Maternal postnatal care utilization and associated factors: A community-based study among women of child-bearing age in Lagos, Nigeria

    Directory of Open Access Journals (Sweden)

    I P Okafor

    2013-01-01

    Full Text Available Background and Objective: Nigeria has one of the highest maternal and child death rates in the world. Postnatal care is one of the major interventions recommended to reduce maternal and newborn deaths globally. The aim of this study is to determine the utilization of postnatal health services and identify the factors which affect this utilization among mothers of under-fives in Lagos. Methods: This was a cross-sectional study among women of child bearing age in Lagos using structured, interviewer-administered questionnaire. Six hundred women selected by multi stage sampling method were interviewed and data analyzed with EPI-info Version 3.5.1. Results: Two thirds (66.2% of the respondents utilized postnatal health services. Factors which significantly influenced postnatal health services utilization were: number of children (p=0.031, maternal education (p=0.001, religion (Fisher′s exact p= 0.004, number of antenatal care visits (p<0.001 and skilled attendance at birth (p<0.001. Maternal occupation and time taken to the health facility were not significant determinants of utilization. Conclusion: Utilization of postnatal care services was high but not optimal. Interventions to increase family planning use and improve maternal educational status should be undertaken as well as increasing use of focused antenatal care and skilled delivery services.

  18. Enhancing early postnatal care: findings from a major reform of maternity care in three Australian hospitals.

    Science.gov (United States)

    Yelland, Jane; Krastev, Ann; Brown, Stephanie

    2009-08-01

    four hospitals comprising a health network in Melbourne, Australia, implemented a range of initiatives aimed at enhancing women's experiences of postnatal maternity care. to compare women's views and experiences of early postnatal care before and after implementation of maternity enhancement initiatives. 'before and after' study design incorporating two postal surveys of recent mothers (baseline and post-implementation). four hospitals in Melbourne, Australia. Analysis of postnatal outcomes was confined to three hospitals where the initiatives were fully operational. 1256 women participated in the baseline survey in 1999 (before implementing the initiative) and 1050 women responded to the post-implementation survey in 2001. the response to the 1999 baseline survey was 65.3% (1256/1922) and to the 2001 post-implementation survey 57.4% (1050/1829). Comparative analysis revealed a statistically significant improvement in overall ratings of hospital postnatal care; the level of advice and support received in relation to discharge and going home; the sensitivity of caregivers; and the proportion of women receiving domiciliary care after discharge. There was little change in the time women spent in hospital after birth between the two survey time-points. Over 90% of women reported one or more health problems in the first 3 months postpartum. The proportion of women reporting physical or emotional health problems between the two surveys did not change. mainstream maternity care can be restructured to improve women's experiences of early postnatal care. maternity service providers should consider a multi-faceted approach to reorienting postnatal services and improving women's experiences of care. Approaches worthy of consideration include attempts to ensure consistency and continuity of care through staffing arrangements, guidelines and protocols; an emphasis on planning for postnatal care during pregnancy; the use of evidence to inform both consumer information and advice

  19. Maternal Health Care Services Utilization in Tea Gardens of ...

    African Journals Online (AJOL)

    Mubeen

    Despite this, India is still struggling with a high maternal mortality and morbidity ..... care utilization and the mothers' age, religion and caste. However, women .... health care system and presents an opportunity to evaluate the mother's overall ...

  20. Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome.

    Science.gov (United States)

    Gadson, Alexis; Akpovi, Eloho; Mehta, Pooja K

    2017-08-01

    Rates of maternal morbidity and mortality are rising in the United States. Non-Hispanic Black women are at highest risk for these outcomes compared to those of other race/ethnicities. Black women are also more likely to be late to prenatal care or be inadequate users of prenatal care. Prenatal care can engage those at risk and potentially influence perinatal outcomes but further research on the link between prenatal care and maternal outcomes is needed. The objective of this article is to review literature illuminating the relationship between prenatal care utilization, social determinants of health, and racial disparities in maternal outcome. We present a theoretical framework connecting the complex factors that may link race, social context, prenatal care utilization, and maternal morbidity/mortality. Prenatal care innovations showing potential to engage with the social determinants of maternal health and address disparities and priorities for future research are reviewed. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. 'Shedding light' on the challenges faced by Palestinian maternal health-care providers.

    Science.gov (United States)

    Hassan-Bitar, Sahar; Narrainen, Sheila

    2011-04-01

    to explore the challenges and barriers faced by Palestinian maternal health-care providers (HCPs) to the provision of quality maternal health-care services through a case study of a Palestinian public referral hospital in the Occupied Palestinian Territory. descriptive qualitative study. The data are from a broader study, conducted in 2005 at the same hospital as part of a baseline assessment of maternal health services. 31 maternal HCPs; nine midwives and 14 nurses and eight doctors. the quality of care provided for women and infants at this Palestinian public hospital is substandard. The maternal HCPs work within a difficult and resource-constrained environment. ISSUES INCLUDE: high workload, poor compensation, humiliation in the workplace, suboptimal supervision and the absence of professional support and guidance. Midwives are perceived to be at the bottom of the health professional hierarchy. there is a need for managers and policy makers to enable maternal HCPs to provide better quality care for women and infants during childbirth, through facilitating the roles of midwives and nurses and creating a more positive and resourceful environment. Palestinian midwives need to increase their knowledge and use evidence-based practices during childbirth. They need to unite and create their own circle of professional support in the form of a Palestinian midwifery professional body. Copyright © 2009 Elsevier Ltd. All rights reserved.

  2. Low maternal care exacerbates adult stress susceptibility in the chronic mild stress rat model of depression

    DEFF Research Database (Denmark)

    Henningsen, Kim; Johannesen, Mads Dyrvig; Bouzinova, Elena

    2012-01-01

    In the present study we report the finding that the quality of maternal care, in early life, increased the susceptibility to stress exposure in adulthood, when rats were exposed to the chronic mild stress paradigm. Our results indicate that high, as opposed to low maternal care, predisposed rats...... to a differential stress-coping ability. Thus rats fostered by low maternal care dams became more prone to adopt a stress-susceptible phenotype developing an anhedonic-like condition. Moreover, low maternal care offspring had lower weight gain and lower locomotion, with no additive effect of stress. Subchronic...... exposure to chronic mild stress induced an increase in faecal corticosterone metabolites, which was only significant in rats from low maternal care dams. Examination of glucocorticoid receptor exon 17 promoter methylation in unchallenged adult, maternally characterized rats, showed an insignificant...

  3. Associated Factors and Quality of Care Received among Maternal ...

    African Journals Online (AJOL)

    USER

    discussions with health staff to assess care received and factors leading to death. A total of 43 maternal deaths ... department with bed capacity of 105, one ..... evidence for emergency obstetric care. ... Planning; 15(2): 170-176. 13. Ray S ...

  4. Maternal DRD2, SLC6A3, and OXTR genotypes as potential moderators of the relation between maternal history of care and maternal cortisol secretion in the context of mother-infant separation.

    Science.gov (United States)

    Ludmer, Jaclyn A; Jamieson, Brittany; Gonzalez, Andrea; Levitan, Robert; Kennedy, James; Villani, Vanessa; Masellis, Mario; Basile, Vincenzo S; Atkinson, Leslie

    2017-10-01

    A mother's cortisol secretion is importantly associated with her own mental health and her infant's cortisol secretion. This study investigated the influences of maternal history of care and maternal DRD2, SLC6A3, and OXTR genotypes on maternal cortisol in the context of infant stress. A community sample of 296 mother-infant dyads completed a maternal separation at infant age 17 months. Maternal salivary cortisol, buccal cells, and self-reported history of care were collected. Multilevel models revealed that history of care had a greater influence on maternal baseline cortisol (but not cortisol trajectory) for mothers with more plasticity alleles of SLC6A3 (10R) and OXTR (G), relative to mothers with fewer or no plasticity alleles. Findings indicate that a mother's history of care is related to her cortisol secretion in anticipation of infant stress, but that this relation depends on her genetic characteristics. Findings are discussed in relation to the maternal protective system and anticipatory cortisol secretion. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Getting behind Discourses of Love, Care and Maternalism in Early Childhood Education

    Science.gov (United States)

    Aslanian, Teresa K.

    2015-01-01

    Discourses of love, care and maternalism affect the everyday lives of children enrolled in early childhood education. These discourses bear witness to the ontological transformation that has occurred since the Romantic era that birthed the kindergarten movement to today. Reflecting on historical discourses of love, care and maternalism from the…

  6. Social capital and maternal health care use in rural Ethiopia

    NARCIS (Netherlands)

    Sheabo Dessalegn, S.

    2017-01-01

    This thesis analyzes the effect of social capital on maternal health care use in rural Ethiopia. Reports show that in Ethiopia, despite the huge investment in health infrastructure and the deployment of health professionals to provide maternal health services free of charge, utilization remains low.

  7. Predicting Maternal Health Care Use by Age at Marriage in Multiple Countries.

    Science.gov (United States)

    Godha, Deepali; Gage, Anastasia J; Hotchkiss, David R; Cappa, Claudia

    2016-05-01

    In light of the global pervasiveness of child marriage and given that improving maternal health care use is an effective strategy in reducing maternal and child morbidity and mortality, the available empirical evidence on the association of child marriage with maternal health care utilization seems woefully inadequate. Furthermore, existing studies have not considered the interaction of type of place of residence and parity with child marriage, which can give added insight to program managers. Demographic Health Survey data for seven countries are used to estimate logistic regression models including interactions of age at marriage with area of residence and birth order. Adjusted predicted probabilities at representative values and marginal effects are computed for each outcome. The results show a negative association between child marriage and maternal health care use in most study countries, and this association is more negative in rural areas and with higher orders of parity. However, the association between age at marriage and maternal health care use is not straightforward but depends on parity and area of residence and varies across countries. The marginal effects in use of delivery care services between women married at age 14 years or younger and those married at age 18 years or older are more than 10% and highly significant in Bangladesh, Burkina Faso, and Nepal. The study's findings call for the formulation of country-and age at marriage-specific recommendations to improve maternal and child health outcomes. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  8. "Very Good" Ratings in a Survey of Maternity Care: Kindness and Understanding Matter to Australian Women.

    Science.gov (United States)

    Todd, Angela L; Ampt, Amanda J; Roberts, Christine L

    2017-03-01

    Surveys have shown that women are highly satisfied with their maternity care. Their satisfaction has been associated with various demographic, personal, and care factors. Isolating the factors that most matter to women about their care can guide quality improvement efforts. This study aimed to identify the most significant factors associated with high ratings of care by women in the three maternity periods (antenatal, birth, and postnatal). A survey was sent to 2,048 women who gave birth at seven public hospitals in New South Wales, Australia, exploring their expectations of, and experiences with maternity care. Women's overall ratings of care for the antenatal, birth, and postnatal periods were analyzed, and a number of maternal characteristics and care factors examined as potential predictors of "Very good" ratings of care. Among 886 women with a completed survey, 65 percent assigned a "Very good" rating for antenatal care, 74 percent for birth care, 58 percent for postnatal care, and 44 percent for all three periods. One factor was strongly associated with care ratings in all three maternity periods: women who were "always or almost always" treated with kindness and understanding were 1.8-2.8 times more likely to rate their antenatal, birth, and postnatal care as "Very good." A limited number of other factors were significantly associated with high care ratings for one or two of the maternity periods. Women's perceptions about the quality of their interpersonal interactions with health caregivers have a significant bearing on women's views about their maternity care journey. © 2016 Wiley Periodicals, Inc.

  9. The experiences of women with maternal near miss and their perception of quality of care in Kelantan, Malaysia: a qualitative study.

    Science.gov (United States)

    Norhayati, Mohd Noor; Nik Hazlina, Nik Hussain; Asrenee, Ab Razak; Sulaiman, Zaharah

    2017-06-15

    Maternal mortality has been the main way of ascertaining the outcome of maternal and obstetric care. However, maternal morbidities occur more frequently than maternal deaths; therefore, maternal near miss was suggested as a more useful indicator for the evaluation and improvement of maternal health services. Our study aimed to explore the experiences of women with maternal near miss and their perception of the quality of care in Kelantan, Malaysia. A qualitative phenomenological approach with in-depth interview method was conducted in two tertiary hospitals in Kelantan, Malaysia. All women admitted to labour room, obstetrics and gynaecology wards and intensive care units in 2014 were screened for the presence of any vital organ dysfunction or failure based on the World Health Organization criteria for maternal near miss. Pregnancy irrespective of the gestational age was included. Women younger than 18 years old, with psychiatric disorder and beyond 42 days of childbirth were excluded. Thirty women who had experienced maternal near miss events were included in the analysis. All were Malays between the ages of 22 and 45. Almost all women (93.3%) had secondary and tertiary education and 63.3% were employed. The women's perceptions of the quality of their care were influenced by the competency and promptness in the provision of care, interpersonal communication, information-sharing and the quality of physical resources. The predisposition to seek healthcare was influenced by costs, self-attitude and beliefs. Self-appraisal of maternal near miss, their perception of the quality of care, their predisposition to seek healthcare and the social support received were the four major themes that emerged from the experiences and perceptions of women with maternal near miss. The women with maternal near miss viewed their experiences as frightening and that they experienced other negative emotions and a sense of imminent death. The factors influencing women's perceptions of

  10. Effects of Day Care and Maternal Employment: Views from Introductory Psychology Textbooks.

    Science.gov (United States)

    Etaugh, Claire; Cohen, Joseph; Cummings-Hill, Myra; Massey, Michelle; Detweiler, Kelly Selchow

    1999-01-01

    Examines the treatment of day care and maternal employment in introductory psychology textbooks between 1970 and 1997. Finds that the coverage of day care and maternal employment increased over the 28 year span, while 95% of the later textbooks presented views ranging from positive to balanced in the mid-1990s. (CMK)

  11. Women's autonomy and husbands' involvement in maternal health care in Nepal.

    Science.gov (United States)

    Thapa, Deependra Kaji; Niehof, Anke

    2013-09-01

    Both increasing women's autonomy and increasing husbands' involvement in maternal health care are promising strategies to enhance maternal health care utilization. However, these two may be at odds with each other insofar as autonomous women may not seek their husband's involvement, and involved husbands may limit women's autonomy. This study assessed the relationship between women's autonomy and husbands' involvement in maternal health care. Field work for this study was carried out during September-November 2011 in the Kailali district of Nepal. In-depth interviews and focus group discussions were used to investigate the extent of husbands' involvement in maternal health care. A survey was carried out among 341 randomly selected women who delivered a live baby within one year prior to the survey. The results show that husbands were involved in giving advice, supporting to reduce the household work burden, and making financial and transportation arrangements for the delivery. After adjustment for other covariates, economic autonomy was associated with lower likelihood of discussion with husband during pregnancy, while domestic decision-making autonomy was associated with both lower likelihood of discussion with husband during pregnancy and the husband's presence at antenatal care (ANC) visits. Movement autonomy was associated with lower likelihood of the husband's presence at ANC visits. Intra-spousal communication was associated with higher likelihood of discussing health with the husband during pregnancy, birth preparedness, and the husbands' presence at the health facility delivery. The magnitude and direction of association varied per autonomy dimension. These findings suggest that programs to improve the women's autonomy and at the same time increase the husband's involvement should be carefully planned. Despite the traditional cultural beliefs that go against the involvement of husbands, Nepalese husbands are increasingly entering into the area of maternal

  12. Improving the quality of maternal and neonatal care: the role of standard based participatory assessments.

    Directory of Open Access Journals (Sweden)

    Giorgio Tamburlini

    Full Text Available BACKGROUND: Gaps in quality of care are seriously affecting maternal and neonatal health globally but reports of successful quality improvement cycles implemented at large scale are scanty. We report the results of a nation-wide program to improve quality of maternal and neonatal hospital care in a lower-middle income country focusing on the role played by standard-based participatory assessments. METHODS: Improvements in the quality of maternal and neonatal care following an action-oriented participatory assessment of 19 areas covering the whole continuum from admission to discharge were measured after an average period of 10 months in four busy referral maternity hospitals in Uzbekistan. Information was collected by a multidisciplinary national team with international supervision through visit to hospital services, examination of medical records, direct observation of cases and interviews with staff and mothers. Scores (range 0 to 3 attributed to over 400 items and combined in average scores for each area were compared with the baseline assessment. RESULTS: Between the first and the second assessment, all four hospitals improved their overall score by an average 0.7 points out of 3 (range 0.4 to 1, i.e. by 22%. The improvements occurred in all main areas of care and were greater in the care of normal labor and delivery (+0.9, monitoring, infection control and mother and baby friendly care (+0.8 the role of the participatory action-oriented approach in determining the observed changes was estimated crucial in 6 out of 19 areas and contributory in other 8. Ongoing implementation of referral system and new classification of neonatal deaths impede the improved process of care to be reflected in current statistics. CONCLUSIONS: Important improvements in the quality of hospital care provided to mothers and newborn babies can be achieved through a standard-based action-oriented and participatory assessment and reassessment process.

  13. Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis

    OpenAIRE

    Worku, Abebaw Gebeyehu; Yalew, Alemayehu Worku; Afework, Mesganaw Fantahun

    2013-01-01

    Background The evaluation of all potential sources of low skilled maternal care utilization is crucial for Ethiopia. Previous studies have largely disregarded the contribution of different levels. This study was planned to assess the effect of individual, communal, and health facility characteristics in the utilization of antenatal, delivery, and postnatal care by a skilled provider. Methods A linked facility and population-based survey was conducted over three months (January - March 2012) i...

  14. The Role of Quality Obstetric Care Services on Reducing Maternal ...

    African Journals Online (AJOL)

    The study recommends that, special initiative should be done to bring changes on reducing maternal mortality, such as ensure essential equipments and ... Enforcement in providing quality of obstetric care services in maternal health services especially in rural areas where majority of people in Tanzania reside is not an ...

  15. Student midwives' views on maternity care just before their graduation.

    Science.gov (United States)

    Van Kelst, Liesbeth; Spitz, Bernard; Sermeus, Walter; Thomson, Ann M

    2013-03-01

    To report a hermeneutic study of student midwives' views on maternity care just before their graduation. background: Woman-centred care, which is the hallmark of midwifery, is taught to midwifery students around the globe. Woman-centred care is advantageous for women at low obstetric risk. However, adopting this ideology might be a problem for student midwives whose clinical placements are mainly in a medicalized obstetric-led hospital setting. A hermeneutic phenomenological study was conducted. In 2010, three focus groups were held where 19 student midwives participated. Data were transcribed verbatim and analysed using van Manen's approach. The choice for midwifery was a 'positive' choice and not the result of an elimination process. Students' description of a midwife as a coach was in line with the international definition of a midwife. With regard to maternity care, midwifery students identified two types of care, factory-style care and tailored care, both of which were ascribed to caregivers and hospital culture. Furthermore, student midwives made the distinction between hierarchy and teamwork, referring to the professional relations in maternity care. Hierarchy was driven by tradition, it implied that decisions were made top-down, and it resulted in impersonal relations. Midwifery students felt it was unjust that midwives were not allowed to perform deliveries while having the legal autonomy to do so. In spite of the medicalized context, midwifery education succeeded in educating midwives who hold a woman-centred ideology. Midwifery students linked style of care to a person rather than to a profession. © 2012 Blackwell Publishing Ltd.

  16. Early transfer of mated females into the maternity unit reduces stress and increases maternal care in farm mink

    DEFF Research Database (Denmark)

    Malmkvist, Jens; Palme, Rupert

    2015-01-01

    Mated mammals on farms are typically transferred to another housing environment prior to delivery. We investigated whether the timing of this transfer – EARLY (Day −36), INTERMEDIATE (Day −18), or LATE (Day −3) relative to the expected day of birth (Day 0) – affects maternal stress, maternal care...... sized groups (n = 60): (i) ‘EARLY’, transfer to maternity unit immediately after the end of the mating period, March 23; (ii) ‘INTERMEDIATE’, transfer in the middle of the period, April 10; (iii) ‘LATE’, transfer late in the pregnancy period, April 25. Data collection included weekly determination...... of faecal cortisol metabolites (FCM) and evaluation of maternal care: nest building, in-nest temperature, plus kit-retrieval behaviour, kit mortality and growth day 0–7 postpartum. We document that mated mink females build and maintain a nest at least 1 month prior to delivery when transferred...

  17. Inequity in maternal health care service utilization in Gujarat: analyses of district-level health survey data.

    Science.gov (United States)

    Saxena, Deepak; Vangani, Ruchi; Mavalankar, Dileep V; Thomsen, Sarah

    2013-03-06

    Two decades after the launch of the Safe Motherhood campaign, India still accounts for at least a quarter of maternal death globally. Gujarat is one of the most economically developed states of India, but progress in the social sector has not been commensurate with economic growth. The purpose of this study was to use district-level data to gain a better understanding of equity in access to maternal health care and to draw the attention of the policy planers to monitor equity in maternal care. Secondary data analyses were performed among 7,534 ever-married women who delivered since January 2004 in the District Level Household and Facility Survey (DLHS-3) carried out during 2007-2008 in Gujarat, India. Based on the conceptual framework designed by the Commission on the Social Determinants of Health, associations were assessed between three outcomes - Institutional delivery, antenatal care (ANC), and use of modern contraception - and selected intermediary and structural determinants of health using multiple logistic regression. Inequities in maternal health care utilization persist in Gujarat. Structural determinants like caste group, wealth, and education were all significantly associated with access to the minimum three antenatal care visits, institutional deliveries, and use of any modern method of contraceptive. There is a significant relationship between being poor and access to less utilization of ANC services independent of caste category or residence. Poverty is the most important determinant of non-use of maternal health services in Gujarat. In addition, social position (i.e. caste) has a strong independent effect on maternal health service use. More focused and targeted efforts towards these disadvantaged groups needs to be taken at policy level in order to achieve targets and goals laid out as per the MDGs. In particular, the Government of Gujarat should invest more in basic education and infrastructural development to begin to remove the structural causes

  18. Maternal Employment, Nonparental Care, Mother-Child Interactions, and Child Outcomes during Preschool Years

    Science.gov (United States)

    Nomaguchi, Kei M.

    2006-01-01

    This study examines the relationships between maternal employment, nonparental care, mother-child interactions, and preschoolers' outcomes. Data from the Canadian National Longitudinal Survey of Children and Youth (N = 1,248) show that maternal employment during the previous year, especially full-time employment, was related to care by…

  19. Family Medicine Maternity Care Call to Action: Moving Toward National Standards for Training and Competency Assessment.

    Science.gov (United States)

    Magee, Susanna R; Eidson-Ton, W Suzanne; Leeman, Larry; Tuggy, Michael; Kim, Thomas O; Nothnagle, Melissa; Breuner, Joseph; Loafman, Mark

    2017-03-01

    Maternity care is an integral part of family medicine, and the quality and cost-effectiveness of maternity care provided by family physicians is well documented. Considering the population health perspective, increasing the number of family physicians competent to provide maternity care is imperative, as is working to overcome the barriers discouraging maternity care practice. A standard that clearly defines maternity care competency and a systematic set of tools to assess competency levels could help overcome these barriers. National discussions between 2012 and 2014 revealed that tools for competency assessment varied widely. These discussions resulted in the formation of a workgroup, culminating in a Family Medicine Maternity Care Summit in October 2014. This summit allowed for expert consensus to describe three scopes of maternity practice, draft procedural and competency assessment tools for each scope, and then revise the tools, guided by the Family Medicine and OB/GYN Milestones documents from the respective residency review committees. The summit group proposed that achievement of a specified number of procedures completed should not determine competency; instead, a standardized competency assessment should take place after a minimum number is performed. The traditionally held required numbers for core procedures were reassessed at the summit, and the resulting consensus opinion is proposed here. Several ways in which these evaluation tools can be disseminated and refined through the creation of a learning collaborative across residency programs is described. The summit group believed that standardization in training will more clearly define the competencies of family medicine maternity care providers and begin to reduce one of the barriers that may discourage family physicians from providing maternity care.

  20. DECOMPOSING THE SOCIOECONOMIC INEQUALITY IN UTILIZATION OF MATERNAL HEALTH CARE SERVICES IN SELECTED COUNTRIES OF SOUTH ASIA AND SUB-SAHARAN AFRICA.

    Science.gov (United States)

    Goli, Srinivas; Nawal, Dipty; Rammohan, Anu; Sekher, T V; Singh, Deepshikha

    2017-10-30

    The gap in access to maternal health care services is a challenge of an unequal world. In 2015, each day about 830 women died due to complications of pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. This study quantified the contributions of the socioeconomic determinants of inequality to the utilization of maternal health care services in four countries in diverse geographical and cultural settings: Bangladesh, Ethiopia, Nepal and Zimbabwe. Data from the 2010-11 Demographic and Health Surveys of the four countries were used, and methods developed by Wagstaff and colleagues for decomposing socioeconomic inequalities in health were applied. The results showed that although the Concentration Index (CI) was negative for the selected indicators, meaning maternal health care was poorer among lower socioeconomic status groups, the level of CI varied across the different countries for the same outcome indicator: CI of -0.1147, -0.1146, -0.2859 and -0.0638 for inequalities in maternal health care varied across the selected countries. The findings are significant for a global understanding of the various determinants of maternal health care use in high-maternal-mortality settings in different geographical and socio-cultural contexts.

  1. Mobile Health in Maternal and Newborn Care: Fuzzy Logic

    Directory of Open Access Journals (Sweden)

    Shahirose Premji

    2014-06-01

    Full Text Available Whether mHealth improves maternal and newborn health outcomes remains uncertain as the response is perhaps not true or false but lies somewhere in between when considering unintended harmful consequences. Fuzzy logic, a mathematical approach to computing, extends the traditional binary “true or false” (one or zero to exemplify this notion of partial truths that lies between completely true and false. The commentary explores health, socio-ecological and environmental consequences–positive, neutral or negative. Of particular significance is the negative influence of mHealth on maternal care-behaviors, which can increase stress reactivity and vulnerability to stress-induced illness across the lifespan of the child and establish pathways for intergenerational transmission of behaviors. A mHealth “fingerprinting” approach is essential to monitor psychosocial, economic, cultural, environmental and physical impact of mHealth intervention and make evidence-informed decision(s about use of mHealth in maternal and newborn care.

  2. A link between thrifty phenotype and maternal care across two generations of intercrossed mice.

    Directory of Open Access Journals (Sweden)

    Bruno Sauce

    Full Text Available Maternal effects are causal influences from mother to offspring beyond genetic information, and have lifelong consequences for multiple traits. Previously, we reported that mice whose mothers did not nurse properly had low birth weight followed by rapid fat accumulation and disturbed development of some organs. That pattern resembles metabolic syndromes known collectively as the thrifty phenotype, which is believed to be an adaptation to a stressful environment which prepares offspring for reduced nutrient supply. The potential link between maternal care, stress reactivity, and the thrifty phenotype, however, has been poorly explored in the human and animal literature: only a couple of studies even mention (much less, test these concepts under a cohesive framework. Here, we explored this link using mice of the parental inbred strains SM/J and LG/J-who differ dramatically in their maternal care-and the intercrossed generations F1 and F2. We measured individual differences in 15 phenotypes and used structural equation modeling to test our hypotheses. We found a remarkable relationship between thrifty phenotype and lower quality of maternal behaviors, including nest building, pup retrieval, grooming/licking, and nursing. To our knowledge, this is the first study to show, in any mammal, a clear connection between the natural variation in thrifty phenotype and maternal care. Both traits in the mother also had a substantial effect on survival rate in the F3 offspring. To our surprise, however, stress reactivity seemed to play no role in our models. Furthermore, the strain of maternal grandmother, but not of paternal grandmother, affected the variation of maternal care in F2 mice, and this effect was mediated by thrifty phenotype in F2. Since F1 animals were all genetically identical, this finding suggests that maternal effects pass down both maternal care and thrifty phenotype in these mice across generations via epigenetic transmission.

  3. Determinants of marginalization and inequitable maternal health care in North–Central Vietnam: a framework analysis

    Directory of Open Access Journals (Sweden)

    Pauline Binder-Finnema

    2015-07-01

    Full Text Available Background: Vietnam has achieved great improvements in maternal healthcare outcomes, but there is evidence of increasing inequity. Disadvantaged groups, predominantly ethnic minorities and people living in remote mountainous areas, do not gain access to maternal health improvements despite targeted efforts from policymakers. Objective: This study identifies underlying structural barriers to equitable maternal health care in Nghe An province, Vietnam. Experiences of social inequity and limited access among child-bearing ethnic and minority women are explored in relation to barriers of care provision experienced by maternal health professionals to gain deeper understanding on health outcomes. Design: In 2012, 11 focus group discussions with women and medical care professionals at local community health centers and district hospitals were conducted using a hermeneutic–dialectic method and analyzed for interpretation using framework analysis. Results: The social determinants ‘limited negotiation power’ and ‘limited autonomy’ orchestrate cyclical effects of shared marginalization for both women and care professionals within the provincial health system’s infrastructure. Under-staffed and poorly equipped community health facilities refer women and create overload at receiving health centers. Limited resources appear diverted away from local community centers as compensation to the district for overloaded facilities. Poor reputation for low care quality exists, and professionals are held in low repute for causing overload and resulting adverse outcomes. Country-wide reforms force women to bear responsibility for limited treatment adherence and health insight, but overlook providers’ limited professional development. Ethnic minority women are hindered by relatives from accessing care choices and costs, despite having advanced insight about government reforms to alleviate poverty. Communication challenges are worsened by non

  4. Determinants of marginalization and inequitable maternal health care in North–Central Vietnam: a framework analysis

    Science.gov (United States)

    Binder-Finnema, Pauline; Lien, Pham T. L.; Hoa, Dinh T. P.; Målqvist, Mats

    2015-01-01

    Background Vietnam has achieved great improvements in maternal healthcare outcomes, but there is evidence of increasing inequity. Disadvantaged groups, predominantly ethnic minorities and people living in remote mountainous areas, do not gain access to maternal health improvements despite targeted efforts from policymakers. Objective This study identifies underlying structural barriers to equitable maternal health care in Nghe An province, Vietnam. Experiences of social inequity and limited access among child-bearing ethnic and minority women are explored in relation to barriers of care provision experienced by maternal health professionals to gain deeper understanding on health outcomes. Design In 2012, 11 focus group discussions with women and medical care professionals at local community health centers and district hospitals were conducted using a hermeneutic–dialectic method and analyzed for interpretation using framework analysis. Results The social determinants ‘limited negotiation power’ and ‘limited autonomy’ orchestrate cyclical effects of shared marginalization for both women and care professionals within the provincial health system’s infrastructure. Under-staffed and poorly equipped community health facilities refer women and create overload at receiving health centers. Limited resources appear diverted away from local community centers as compensation to the district for overloaded facilities. Poor reputation for low care quality exists, and professionals are held in low repute for causing overload and resulting adverse outcomes. Country-wide reforms force women to bear responsibility for limited treatment adherence and health insight, but overlook providers’ limited professional development. Ethnic minority women are hindered by relatives from accessing care choices and costs, despite having advanced insight about government reforms to alleviate poverty. Communication challenges are worsened by non-existent interpretation systems

  5. Determinants of marginalization and inequitable maternal health care in North-Central Vietnam: a framework analysis.

    Science.gov (United States)

    Binder-Finnema, Pauline; Lien, Pham T L; Hoa, Dinh T P; Målqvist, Mats

    2015-01-01

    Vietnam has achieved great improvements in maternal healthcare outcomes, but there is evidence of increasing inequity. Disadvantaged groups, predominantly ethnic minorities and people living in remote mountainous areas, do not gain access to maternal health improvements despite targeted efforts from policymakers. This study identifies underlying structural barriers to equitable maternal health care in Nghe An province, Vietnam. Experiences of social inequity and limited access among child-bearing ethnic and minority women are explored in relation to barriers of care provision experienced by maternal health professionals to gain deeper understanding on health outcomes. In 2012, 11 focus group discussions with women and medical care professionals at local community health centers and district hospitals were conducted using a hermeneutic-dialectic method and analyzed for interpretation using framework analysis. The social determinants 'limited negotiation power' and 'limited autonomy' orchestrate cyclical effects of shared marginalization for both women and care professionals within the provincial health system's infrastructure. Under-staffed and poorly equipped community health facilities refer women and create overload at receiving health centers. Limited resources appear diverted away from local community centers as compensation to the district for overloaded facilities. Poor reputation for low care quality exists, and professionals are held in low repute for causing overload and resulting adverse outcomes. Country-wide reforms force women to bear responsibility for limited treatment adherence and health insight, but overlook providers' limited professional development. Ethnic minority women are hindered by relatives from accessing care choices and costs, despite having advanced insight about government reforms to alleviate poverty. Communication challenges are worsened by non-existent interpretation systems. For maternal health policy outcomes to become effective

  6. Mother and offspring fitness in an insect with maternal care: phenotypic trade-offs between egg number, egg mass and egg care

    Science.gov (United States)

    2014-01-01

    Background Oviparous females have three main options to increase their reproductive success: investing into egg number, egg mass and/or egg care. Although allocating resources to either of these three components is known to shape offspring number and size, potential trade-offs among them may have key impacts on maternal and offspring fitness. Here, we tested the occurrence of phenotypic trade-offs between egg number, egg mass and maternal expenditure on egg care in the European earwig, Forficula auricularia, an insect with pre- and post-hatching forms of maternal care. In particular, we used a series of laboratory observations and experiments to investigate whether these three components non-additively influenced offspring weight and number at hatching, and whether they were associated with potential costs to females in terms of future reproduction. Results We found negative associations between egg number and mass as well as between egg number and maternal expenditure on egg care. However, these trade-offs could only be detected after statistically correcting for female weight at egg laying. Hatchling number was not determined by single or additive effects among the three life-history traits, but instead by pairwise interactions among them. In particular, offspring number was positively associated with the number of eggs only in clutches receiving high maternal care or consisting of heavy eggs, and negatively associated with mean egg mass in clutches receiving low care. In contrast, offspring weight was positively associated with egg mass only. Finally, maternal expenditure on egg care reduced their future reproduction, but this effect was only detected when mothers were experimentally isolated from their offspring at egg hatching. Conclusions Overall, our study reveals simultaneous trade-offs between the number, mass and care of eggs. It also demonstrates that these factors interact in their impact on offspring production, and that maternal expenditure on egg

  7. Making time for well-baby care: the role of maternal employment.

    Science.gov (United States)

    Hamman, Mary Kathryn

    2011-10-01

    The American Academy of Pediatrics recommends children receive six well-baby visits between ages 1 month and 1 year, yet by age 14 months less than 10% of infants have received all six visits. Cost sharing under public and private insurance is very low. Low compliance rates despite the low cost of care suggest other factors, such as time costs, may be important. This paper examines the relationship between maternal employment and receipt of well-baby care. The Medical Expenditure Panel Survey contains rich information on use of preventive care, maternal employment, and other economic and non-economic factors that may influence care decisions. Several approaches, including a proxy variable strategy and instrumental variables analysis, are used to attempt to address the potential endogeneity of maternal employment and examine the sensitivity of findings. Findings indicate mothers who work full-time take their children to 0.18 fewer visits (or 9% fewer at the mean) than those who have quit their jobs. Mothers with employer provided paid vacation leave take their children to 0.20 more visits (or 9% more at the mean) than other working mothers. Time appears to be an important factor in determining well-baby care receipt. Policies that extend paid leave to more employed women may improve compliance with preventive care recommendations.

  8. Comparing two survey methods for estimating maternal and perinatal mortality in rural Cambodia.

    Science.gov (United States)

    Chandy, Hoeuy; Heng, Yang Van; Samol, Ha; Husum, Hans

    2008-03-01

    We need solid estimates of maternal mortality rates (MMR) to monitor the impact of maternal care programs. Cambodian health authorities and WHO report the MMR in Cambodia at 450 per 100,000 live births. The figure is drawn from surveys where information is obtained by interviewing respondents about the survival of all their adult sisters (sisterhood method). The estimate is statistically imprecise, 95% confidence intervals ranging from 260 to 620/100,000. The MMR estimate is also uncertain due to under-reporting; where 80-90% of women deliver at home maternal fatalities may go undetected especially where mortality is highest, in remote rural areas. The aim of this study was to attain more reliable MMR estimates by using survey methods other than the sisterhood method prior to an intervention targeting obstetric rural emergencies. The study was carried out in rural Northwestern Cambodia where access to health services is poor and poverty, endemic diseases, and land mines are endemic. Two survey methods were applied in two separate sectors: a community-based survey gathering data from public sources and a household survey gathering data direct from primary sources. There was no statistically significant difference between the two survey results for maternal deaths, both types of survey reported mortality rates around the public figure. The household survey reported a significantly higher perinatal mortality rate as compared to the community-based survey, 8.6% versus 5.0%. Also the household survey gave qualitative data important for a better understanding of the many problems faced by mothers giving birth in the remote villages. There are detection failures in both surveys; the failure rate may be as high as 30-40%. PRINCIPLE CONCLUSION: Both survey methods are inaccurate, therefore inappropriate for evaluation of short-term changes of mortality rates. Surveys based on primary informants yield qualitative information about mothers' hardships important for the design

  9. National female literacy, individual socio-economic status, and maternal health care use in sub-Saharan Africa.

    Science.gov (United States)

    McTavish, Sarah; Moore, Spencer; Harper, Sam; Lynch, John

    2010-12-01

    The United Nations Millennium Development Goals have identified improving women's access to maternal health care as a key target in reducing maternal mortality in sub-Saharan Africa (sSA). Although individual factors such as income and urban residence can affect maternal health care use, little is known about national-level factors associated with use. Yet, such knowledge may highlight the importance of global and national policies in improving use. This study examines the importance of national female literacy on women's maternal health care use in continental sSA. Data that come from the 2002-2003 World Health Survey. Multilevel logistic regression was used to examine the association between national female literacy and individual's non-use of maternal health care, while adjusting for individual-level factors and national economic development. Analyses also assessed effect modification of the association between income and non-use by female literacy. Effect modification was evaluated with the likelihood ratio test (G(2)). We found that within countries, individual age, education, urban residence and household income were associated with lack of maternal health care. National female literacy modified the association of household income with lack of maternal health care use. The strength of the association between income and lack of maternal health care was weaker in countries with higher female literacy. We conclude therefore that higher national levels of female literacy may reduce income-related inequalities in use through a range of possible mechanisms, including women's increased labour participation and higher status in society. National policies that are able to address female literacy and women's status in sub-Saharan Africa may help reduce income-related inequalities in maternal health care use. Copyright © 2010 Elsevier Ltd. All rights reserved.

  10. Maternal and foetal outcome in hellp syndrome at tertiary care hospital

    International Nuclear Information System (INIS)

    Sadaf, N.; Haq, G.; Din, S.S.U.

    2013-01-01

    Objective: To determine maternal and foetal outcome in patients of Haemolysis, Elevated Liver enzyme and Low Platelet Cont syndrome. Methods: The descriptive case series was conducted at the Gynae Unit II of Civil Hospital, Karachi, over a period of 12 months in two episodes; first from December 28, 2006, to February 28, 2007, and then from September 1, 2007, to June 30, 2008. It comprised 40 consecutive women with pre-ecampsia and eclampsia along with altered platelet count who met the syndrome criteria. A pre-designed proforma was administered for data collection. Maternal and foetal outcomes were noted. SPSS 10 was used for statistical analysis. Result: Among the 40 mothers, cesarean section was the most common outcome (n=24; 60%). Pulmonary oedema was found in 2 (5%) cases, acute renal failure in 10 (25%), disseminated intravascular coagulation in 6 (15%), and abruptio placenta in 5 (12.5%). Intrauterine growth restriction as a foetal outcome was observed in 18 (45%) cases. Pre-term birth was the result in 20 (50%) cases, and perinatal mortality was high (n=23; 57.5%). Conclusion: Management and delivery of HELLP syndrome patients should be performed at tertiary care centres, where highly trained obstetrician, neonatal intensive care unit personnel and Multi-disciplinary facilities are available. Correct diagnosis and timely intervention can decrease the risk of maternal and perinatal mortality. (author)

  11. An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina.

    Science.gov (United States)

    Buescher, P A; Roth, M S; Williams, D; Goforth, C M

    1991-12-01

    Care coordination is an important component of the enhanced prenatal care services provided under the recent expansions of the Medicaid program. The effect of maternity care coordination services on birth outcomes in North Carolina was assessed by comparing women on Medicaid who did and did not receive these services. Health program data files, including Medicaid claims paid for maternity care coordination, were linked to 1988 and 1989 live birth certificates. Simple comparisons of percentages and rates were supplemented by a logistic regression analysis. Among women on Medicaid who did not receive maternity care coordination services, the low birth weight rate was 21% higher, the very low birth weight rate was 62% higher, and the infant mortality rate was 23% higher than among women on Medicaid who did receive such services. It was estimated that, for each $1.00 spent on maternity care coordination, Medicaid saved $2.02 in medical costs for newborns up to 60 days of age. Among the women who did receive maternity care coordination, those receiving it for 3 or more months had better outcomes than those receiving it for less than 3 months. These results suggest that maternity care coordination can be effective in reducing low birth weight, infant mortality, and newborn medical care costs among babies born to women in poverty.

  12. Doing the Right Thing for Women and Babies: Policy Initiatives to Improve Maternity Care Quality and Value

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    Corry, Maureen P; Jolivet, Rima

    2009-01-01

    When defined within the context of maternity care, the Institute of Medicine's six aims for health-care quality improvement provide a framework for Childbirth Connection's Maternity Quality Matters Initiative, a multipronged program agenda intended to foster a maternity care system that delivers care of the highest quality and value in order to achieve optimal health outcomes and experiences for mothers and babies. These aims also provide childbirth educators and others in the maternity care community with an ethical framework for efforts to serve childbearing women and families and ensure the best outcomes for women, babies, and families. PMID:19436596

  13. Maternal and child health care in an underprivileged area of Bangalore city: Identifying the gaps in the continuum of care

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    Avita R Johnson

    2015-01-01

    Full Text Available Background With over 100 million Indians living in urban slums and high child mortality among low-income groups, focusing on maternal and child health (MCH among urban underprivileged is vital, if India is to achieve the fourth and fifth Millennium Development goals. Objectives To identify the gaps in the MCH Continuum of care, by assessing coverage and quality of Maternal and Child Health Services in an urban underprivileged area of Bangalore City. Methods A survey was conducted in an urban slum of Bangalore City, using systematic random sampling. A total of 178 subjects were interviewed with a pre-tested questionnaire. 88 were mothers who delivered in the last one year (to assess maternal care services, and 90 were mothers of a child aged 12-23 months (to assess immunization coverage. Breastfeeding practices and care during childhood illness were documented in both groups. Results Though institutional delivery rate was 97.7%, only 34.1% mothers had received full antenatal care. The quality of antenatal and postnatal services was poor, practices like prelacteal feeds and delayed initiation of breastfeeding were common. Less than 40 % of children were exclusively breastfed for at least 6 months. Only 53% of children aged 12-23 months were fully immunised. Primary immunisation drop-out rates were high. Mothers’ knowledge regarding vaccines was poor. Children with diarrhea received less fluids and food and only 61% received ORS. Conclusion This study identified the following gaps in the MCH Continuum of Care- lack of IFA consumption, poor quality of antenatal and postnatal care, high immunisation dropout rates, erroneous breastfeeding practices and inadequate care during diarrhoea. Further research may identify potential solutions to bridging these gaps in MCH care.

  14. Maternal and child health care in an underprivileged area of Bangalore city: Identifying the gaps in the continuum of care

    Directory of Open Access Journals (Sweden)

    Avita R Johnson

    2015-10-01

    Full Text Available Background With over 100 million Indians living in urban slums and high child mortality among low-­‐income groups, focusing on maternal and child health (MCH among urban underprivileged is vital, if India is to achieve the fourth and fifth Millennium Development goals. Objectives To identify the gaps in the MCH Continuum of care, by assessing coverage and quality of Maternal and Child Health Services in an urban underprivileged area of Bangalore City. Methods A survey was conducted in an urban slum of Bangalore City, using systematic random sampling. A total of 178 subjects were interviewed with a pre-­‐tested questionnaire. 88 were mothers who delivered in the last one year (to assess maternal care services, and 90 were mothers of a child aged 12-­‐23 months (to assess immunization coverage. Breastfeeding practices and care during childhood illness were documented in both groups. Results Though institutional delivery rate was 97.7%, only 34.1% mothers had received full antenatal care. The quality of antenatal and postnatal services was poor, practices like prelacteal feeds and delayed initiation of breastfeeding were common. Less than 40 % of children were exclusively breastfed for at least 6 months. Only 53% of children aged 12-­‐23 months were fully immunised. Primary immunisation drop-­‐out rates were high. Mothers’ knowledge regarding vaccines was poor. Children with diarrhea received less fluids and food and only 61% received ORS. Conclusion This study identified the following gaps in the MCH Continuum of Care-­‐ lack of IFA consumption, poor quality of antenatal and postnatal care, high immunisation dropout rates, erroneous breastfeeding practices and inadequate care during diarrhoea. Further research may identify potential solutions to bridging these gaps in MCH care.

  15. Assessing quality of maternity care in Hungary: expert validation and testing of the mother-centered prenatal care (MCPC) survey instrument.

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    Rubashkin, Nicholas; Szebik, Imre; Baji, Petra; Szántó, Zsuzsa; Susánszky, Éva; Vedam, Saraswathi

    2017-11-16

    Instruments to assess quality of maternity care in Central and Eastern European (CEE) region are scarce, despite reports of poor doctor-patient communication, non-evidence-based care, and informal cash payments. We validated and tested an online questionnaire to study maternity care experiences among Hungarian women. Following literature review, we collated validated items and scales from two previous English-language surveys and adapted them to the Hungarian context. An expert panel assessed items for clarity and relevance on a 4-point ordinal scale. We calculated item-level Content Validation Index (CVI) scores. We designed 9 new items concerning informal cash payments, as well as 7 new "model of care" categories based on mode of payment. The final questionnaire (N = 111 items) was tested in two samples of Hungarian women, representative (N = 600) and convenience (N = 657). We conducted bivariate analysis and thematic analysis of open-ended responses. Experts rated pre-existing English-language items as clear and relevant to Hungarian women's maternity care experiences with an average CVI for included questions of 0.97. Significant differences emerged across the model of care categories in terms of informal payments, informed consent practices, and women's perceptions of autonomy. Thematic analysis (N = 1015) of women's responses identified 13 priority areas of the maternity care experience, 9 of which were addressed by the questionnaire. We developed and validated a comprehensive questionnaire that can be used to evaluate respectful maternity care, evidence-based practice, and informal cash payments in CEE region and beyond.

  16. Maternity Care Update: Postpartum Care.

    Science.gov (United States)

    Smith, Andrew; Barr, Wendy B; Bassett-Novoa, Erin; LeFevre, Nicholas

    2018-04-01

    Family physicians are uniquely situated to play a major role in postpartum care. Postpartum issues that should be monitored and addressed include reproductive and contraceptive planning, breastfeeding counseling and support, and maternal mental health. All women should be screened for postpartum depression using a validated tool at the postpartum visit and/or at well-child visits. Patients with positive screening results should be offered support and treatment. Women are more likely to breastfeed if they are provided with breastfeeding support and counseling routinely during the prenatal and postpartum periods. All women should be asked about their reproductive life plans, counseled about potential risks associated with short and prolonged interpregnancy intervals, and offered contraception. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  17. Birth preparedness, complication readiness and fathers' participation in maternity care in a northern Nigerian community.

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    Iliyasu, Zubairu; Abubakar, Isa S; Galadanci, Hadiza S; Aliyu, Muktar H

    2010-03-01

    The role of men in maternity care in Africa is understudied, despite their economic dominance and decision making power. In a patriarchal society like northern Nigeria, pregnancy and childbirth are often regarded as exclusively women's affairs. Using data from interviewer administered questionnaires and in-depth interviews; we assessed birth preparedness, complication readiness and male participation in maternity care in Ungogo, a northern Nigerian community. Majority of pregnancies were unplanned (96%). Only 32.1% of men ever accompanied their spouses for maternity care. There was very little preparation for skilled assistance during delivery (6.2%), savings for emergencies (19.5%) or transportation during labour (24.2%). Young paternal age (adjusted odds ratio [AOR] = 1.5, 95% confidence interval [CI] = 1.2-2.6), formal education (AOR = 1.9, 95% CI=1.1-3.4) and non-Hausa Fulani ethnicity (AOR=2.3, 95% CI = 1.4-3.3) were independent predictors of male participation in maternity care. There is a need to increase involvement of men in their partner's maternity care through peer-led, culturally-sensitive community education and appropriate health system reforms.

  18. Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study

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    Samira Maerrawi Haddad

    2014-01-01

    Full Text Available Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI based on the severity of complication, and the standardized mortality ratio (SMR for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P<0.001, delays related to quality of medical care (P=0.012, absence of blood derivatives (P=0.013, difficulties of communication between health services (P=0.004, and any delay during the whole process (P=0.039. Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.

  19. Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative

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    Kwedza Ru K

    2011-03-01

    Full Text Available Abstract Background Australia's Aboriginal and Torres Strait Islander (Indigenous populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities. Methods We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4 were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems. Results The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician. Conclusion Participating services had both strengths and weaknesses in the delivery of maternal

  20. What does quality maternity care mean in a context of medical pluralism? Perspectives of women in Nigeria

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    Izugbara, Chimaraoke O; Wekesah, Frederick

    2018-01-01

    Abstract User priorities regarding quality care in contexts of medical pluralism are poorly documented. Drawing on group and individual interviews with women, we interrogate ideas of quality maternity care in the context of Nigeria’s medical pluralism. We found complex utilization patterns for conventional, complementary and alternative maternity care services as well as ideas of quality maternity care that stress effective coordination and integration of different typologies of maternity health services; socially sensitive and truthful providers; and socioeconomic, physical and parochial forms of safety. Informal providers were the commonly reported source of maternal health services in the study. Maternal health services in the country were also generally viewed as poor quality, characterized by pervasive abuse, quackery and lack of commitment to the needs and sensitivities of women. Convenience, availability and affordability of maternal health services, as well as sociocultural factors were major influences on women’s use of services. Results demonstrate the embeddedness of women’s quality of care notions in the vast socioeconomic inequities that typify Nigeria’s particular form of poorly regulated medical pluralism, raising need for strategies to strengthen the delivery, coordination and supervision of maternal health services in the country. PMID:29036530

  1. Safety and community: the maternity care needs of rural parturient women.

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    Kornelsen, Jude; Grzybowski, Stefan

    2005-06-01

    To investigate rural parturient women's experiences of obstetric care in the context of the social and economic realities of life in rural, remote, and small urban communities. Data collection for this exploratory qualitative study was carried out in 7 rural communities chosen to represent diversity of size, distance to hospital with Caesarean section capability and distance to secondary hospital, usual conditions for transport and access, and cultural and ethnic subpopulations. We interviewed 44 women who had given birth up to 24 months before the study began. When asked about their experiences of giving birth in rural communities, many participants spoke of unmet needs and their associated anxieties. Self-identified needs were largely congruent with the deficit categories of Maslow's hierarchy of needs, which recognizes the contingency and interdependence of physiological needs, the need for safety and security, the need for community and belonging, self-esteem needs, and the need for self-actualization. For many women, community was critical to meeting psychosocial needs, and women from communities that currently have (or have recently had) access to local maternity care said that being able to give birth in their own community or in a nearby community was necessary if their obstetric needs were to be met. Removing maternity care from a community creates significant psychosocial consequences that are imperfectly understood but that probably have physiological implications for women, babies, and families. Further research into rural women's maternity care that considers the loss of local maternity care from multiple perspectives is needed.

  2. Implementation of Fee-Free Maternal Health-Care Policy in Ghana: Perspectives of Users of Antenatal and Delivery Care Services From Public Health-Care Facilities in Accra.

    Science.gov (United States)

    Anafi, Patricia; Mprah, Wisdom K; Jackson, Allen M; Jacobson, Janelle J; Torres, Christopher M; Crow, Brent M; O'Rourke, Kathleen M

    2018-01-01

    In 2008, the government of Ghana implemented a national user fee maternal care exemption policy through the National Health Insurance Scheme to improve financial access to maternal health services and reduce maternal as well as perinatal deaths. Although evidence shows that there has been some success with this initiative, there are still issues relating to cost of care to beneficiaries of the initiative. A qualitative study, comprising 12 focus group discussions and 6 interviews, was conducted with 90 women in six selected urban neighborhoods in Accra, Ghana, to examine users' perspectives regarding the implementation of this policy initiative. Findings showed that direct cost of delivery care services was entirely free, but costs related to antenatal care services and indirect costs related to delivery care still limit the use of hospital-based midwifery and obstetric care. There was also misunderstanding about the initiative due to misinformation created by the government through the media.We recommend that issues related to both direct and indirect costs of antenatal and delivery care provided in public health-care facilities must be addressed to eliminate some of the lingering barriers relating to cost hindering the smooth operation and sustainability of the maternal care fee exemption policy.

  3. Perceived Safety, Quality and Cultural Competency of Maternity Care for Culturally and Linguistically Diverse Women in Queensland.

    Science.gov (United States)

    Mander, Sarah; Miller, Yvette D

    2016-03-01

    Various policies, plans and initiatives have been implemented to provide safe, quality and culturally competent care to patients within Queensland's health care system. A series of models of maternity care are available in Queensland that range from standard public care to private midwifery care. The current study aimed to determine whether identifying as culturally or linguistically diverse (CALD) was associated with the perceived safety, quality and cultural competency of maternity care from a consumer perspective, and to identify specific needs and preferences of CALD maternity care consumers. Secondary analysis of data collected in the Having a Baby in Queensland Survey 2012 was used to compare the experiences of 655 CALD women to those of 4049 non-CALD women in Queensland, Australia, across three stages of maternity care: pregnancy, labour and birth, and after birth. After adjustment for model of maternity care received and socio-demographic characteristics, CALD women were significantly more likely than non-CALD women to experience suboptimal staff technical competence in pregnancy, overall perceived safety in pregnancy and labour/birth, and interpersonal sensitivity in pregnancy and labour/birth. Approximately 50 % of CALD women did not have the choice to use a translator or interpreter, or the gender of their care provider, during labour and birth. Thirteen themes of preferences and needs of CALD maternity care consumers based on ethnicity, cultural beliefs, or traditions were identified; however, these were rarely met. Findings imply that CALD women in Queensland experience disadvantageous maternity care with regards to perceived staff technical competence, safety, and interpersonal sensitivity, and receive care that lacks cultural competence. Improved access to support persons, continuity and choice of carer, and staff availability and training is recommended.

  4. Influence of Maternal Care on Behavioural Development of Domestic Dogs (Canis Familiaris) Living in a Home Environment.

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    Guardini, Giovanna; Bowen, Jon; Mariti, Chiara; Fatjó, Jaume; Sighieri, Claudio; Gazzano, Angelo

    2017-12-05

    Maternal care has been shown to affect the development of the brain, behaviour, social skills and emotional systems of the young of many mammalian species including dogs. The aim of the present study was to determine the effects of maternal care on the behavioural responses of family dog puppies towards environmental and social stimuli. In order to do this, maternal care (licking puppy's ano-genital area, licking the puppy, nursing and mother-puppy contact) during the first three weeks after birth was assessed in 12 litters of domestic dog puppies reared in home environments (total = 72 puppies). The behavioural responses of puppies were assessed in an arena and an isolation test, which were performed when the puppies were two-month old. Data were analysed using principal components analysis and projection to latent structures regression. A systematic relationship was found between maternal care and behaviour in both tests. In the arena test, maternal care was found to be positively associated with approach to the stranger, attention oriented to the stranger, time spent near the enclosure, yawning, whining and yelping (R²Y = 0.613, p = 8.2 × 10 -9 ). Amount of maternal care was negatively associated with the number of squares crossed and the time spent individually playing with the rope. In the isolation test, the amount of maternal care was positively associated with standing posture, paw lifting, and howling, and it was negatively associated with yawning, lying down and nose licking (R²Y = 0.507, p = 0.000626). These results suggest that the amount of maternal care received during early life influences the pattern of behavioural responses and coping strategies of puppies at two-months of age. On the basis of these findings it could be speculated that early maternal care contributes to adaption to the environment in which family puppies are developing, with particular regard to social relationships with people.

  5. Maternity health care: The experiences of Sub-Saharan African women in Sub-Saharan Africa and Australia.

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    Mohale, Hlengiwe; Sweet, Linda; Graham, Kristen

    2017-08-01

    Increasing global migration is resulting in a culturally diverse population in the receiving countries. In Australia, it is estimated that at least four thousand Sub-Saharan African women give birth each year. To respond appropriately to the needs of these women, it is important to understand their experiences of maternity care. The study aimed to examine the maternity experiences of Sub-Saharan African women who had given birth in both Sub-Saharan Africa and in Australia. Using a qualitative approach, 14 semi-structured interviews with Sub-Saharan African women now living in Australia were conducted. Data was analysed using Braun and Clark's approach to thematic analysis. Four themes were identified; access to services including health education; birth environment and support; pain management; and perceptions of care. The participants experienced issues with access to maternity care whether they were located in Sub-Saharan Africa or Australia. The study draws on an existing conceptual framework on access to care to discuss the findings on how these women experienced maternity care. The study provides an understanding of Sub-Saharan African women's experiences of maternity care across countries. The findings indicate that these women have maternity health needs shaped by their sociocultural norms and beliefs related to pregnancy and childbirth. It is therefore arguable that enhancing maternity care can be achieved by improving women's health literacy through health education, having an affordable health care system, providing respectful and high quality midwifery care, using effective communication, and showing cultural sensitivity including family support for labouring women. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  6. Development of a Support Tool for Complex Decision-Making in the Provision of Rural Maternity Care

    Science.gov (United States)

    Hearns, Glen; Klein, Michael C.; Trousdale, William; Ulrich, Catherine; Butcher, David; Miewald, Christiana; Lindstrom, Ronald; Eftekhary, Sahba; Rosinski, Jessica; Gómez-Ramírez, Oralia; Procyk, Andrea

    2010-01-01

    manual was specifically intended to deal with rural maternity issues, the NH decision-makers feel the method can be easily adapted to assist decision-making in other contexts in medicine where there are conflicting objectives, values and opinions. Decisions on the location of new facilities or infrastructure, or enhancing or altering services such as surgical or palliative care, would be examples of complex decisions that might benefit from this methodology. PMID:21286270

  7. A sexually dimorphic hypothalamic circuit controls maternal care and oxytocin secretion.

    Science.gov (United States)

    Scott, Niv; Prigge, Matthias; Yizhar, Ofer; Kimchi, Tali

    2015-09-24

    It is commonly assumed, but has rarely been demonstrated, that sex differences in behaviour arise from sexual dimorphism in the underlying neural circuits. Parental care is a complex stereotypic behaviour towards offspring that is shared by numerous species. Mice display profound sex differences in offspring-directed behaviours. At their first encounter, virgin females behave maternally towards alien pups while males will usually ignore the pups or attack them. Here we show that tyrosine hydroxylase (TH)-expressing neurons in the anteroventral periventricular nucleus (AVPV) of the mouse hypothalamus are more numerous in mothers than in virgin females and males, and govern parental behaviours in a sex-specific manner. In females, ablating the AVPV TH(+) neurons impairs maternal behaviour whereas optogenetic stimulation or increased TH expression in these cells enhance maternal care. In males, however, this same neuronal cluster has no effect on parental care but rather suppresses inter-male aggression. Furthermore, optogenetic activation or increased TH expression in the AVPV TH(+) neurons of female mice increases circulating oxytocin, whereas their ablation reduces oxytocin levels. Finally, we show that AVPV TH(+) neurons relay a monosynaptic input to oxytocin-expressing neurons in the paraventricular nucleus. Our findings uncover a previously unknown role for this neuronal population in the control of maternal care and oxytocin secretion, and provide evidence for a causal relationship between sexual dimorphism in the adult brain and sex differences in parental behaviour.

  8. Utilization of maternal health-care services by tribal women in Kerala.

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    Jose, Jinu Annie; Sarkar, Sonali; Kumar, S Ganesh; Kar, Sitanshu Sekhar

    2014-01-01

    The coverage of maternal care services among the tribal women in Kerala is better as compared to other states in India. This study was done to identify the factors contributing to better coverage of maternal care services among the tribal women in Kerala and to study the reasons for remaining differences that exists in utilization of services between tribal and non-tribal pregnant women. This was a descriptive cum qualitative study conducted in Thariode Gramapanchayat in the Wayanad district of Kerala. Among all women who had registered their pregnancies in the 5 sub-centres under CHC Thariode and had delivered between September 2009 and October 2010, equal numbers of tribal and non-tribal ante-natal women, 35 each were interviewed in-depth using a semi-structured questionnaire. Quantitative data was analysed using SPSS Version 16.0. Content analysis was done for qualitative data. The determinants of utilization in tribal women were general awareness, affordability, accessibility and quality of services along with motivation by health workers. Among tribal antenatal women, 85% utilized maternal health care facilities fully compared to 100% among non-tribal women. Lower levels of education and lack of transport facilities were prime factors contributing to under utilization by tribal women. Affordable, accessible and good quality of services in the public health system in Kerala and motivation by health workers were important contributing factors for better utilization of maternal care services.

  9. Are Husbands Involving in Their Spouses’ Utilization of Maternal Care Services?: A Cross-Sectional Study in Yangon, Myanmar

    Science.gov (United States)

    Wai, Kyi Mar; Shibanuma, Akira; Oo, Nwe Nwe; Fillman, Toki Jennifer; Saw, Yu Mon; Jimba, Masamine

    2015-01-01

    Introduction Husbands can play a crucial role in pregnancy and childbirth, especially in patriarchal societies of developing countries. In Myanmar, despite the critical influence of husbands on the health of mothers and newborns, their roles in maternal health have not been well explored. Therefore, the aim of this study was to identify the factors associated with husbands’ involvement in maternal health in Myanmar. This study also examined the associations between husbands’ involvement and their spouses’ utilization of maternal care services during antenatal, delivery and postnatal periods. Methods A community-based, cross sectional study was conducted with 426 husbands in Thingangyun Township, Yangon, Myanmar. Participants were husbands aged 18 years or older who had at least one child within two years at the time of interview. Face to face interviews were conducted using a pretested structured questionnaire. Factors associated with the characteristics of husband’s involvement as well as their spouses’ utilization of maternal care services were analyzed by multivariable logistic regression models. Results Of 426 husbands, 64.8% accompanied their spouses for an antenatal visit more than once while 51.6% accompanied them for a postnatal visit. Husbands were major financial supporters for both antenatal (95.8%) and postnatal care (68.5%). Overall, 69.7% were involved in decision making about the place of delivery. Regarding birth preparedness, the majority of husbands prepared for skilled birth attendance (91.1%), delivery place (83.6%), and money saving (81.7%) before their spouses gave birth. In contrast, fewer planned for a potential blood donor (15.5%) and a safe delivery kit (21.1%). In the context of maternal health, predictors of husband’s involvement were parity, educational level, type of marriage, decision making level in family, exposure to maternal health education and perception of risk during pregnancy and childbirth. Increased utilization

  10. Irish midwives' experiences of providing maternity care to non-Irish women seeking asylum

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    Tobin CL

    2014-01-01

    Full Text Available Carolyn L Tobin,1 Jo Murphy-Lawless2 1Department of Nursing, College of Health and Human Services, University of New Hampshire, Durham, NH, USA; 2School of Nursing and Midwifery, Trinity College, Dublin, Ireland Background: Immigration and asylum seeking has been an important social and political phenomenon in Ireland since the mid 1990s. Inward migration to Ireland was seen in unprecedented numbers from 1995 onward, peaking in 2002 with 11,634 applications for refugee status. Asylum and immigration is an issue of national and international relevance as the numbers of displaced people worldwide continues to grow, reaching the highest level in 20 years at 45.2 million in 2012. Midwives provide the majority of care to childbearing women around the world, whether working as autonomous practitioners or under the direction of an obstetrician. Limited data currently exist on the perspectives of midwives who provide care to childbearing women while they are in the process of seeking asylum. Such data are important to midwifery leaders, educators, and policy-makers. The aims of this study were to explore midwives' perceptions and experiences of providing care to women in the asylum process and to gain insight into how midwives can be equipped and supported to provide more effective care to this group in the future.Methods: Data were collected via indepth unstructured interviews with a purposive sample of ten midwives from two sites, one a large urban inner city hospital, and the second, a smaller more rural maternity hospital. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using content analysis. Results: Five themes emerged from the data, barriers to communication, understanding cultural difference, challenges of caring for women who were unbooked, the emotional cost of caring, and structural barriers to effective care. Conclusion: Findings highlight a need to focus on support and education for midwives, improved

  11. Effects of Social Support and Self-Efficacy on Maternal Prenatal Cares Among the First-Time Pregnant Women, Iranshahr, Iran

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    Hossien Izadirad

    2017-10-01

    Full Text Available Objective: Social support and perceived self-efficacy affect health-related behaviors and play an important role on mothers' adaptability with pregnancy. This paper aims to study the impact of educational interventions based on social support and perceived self-efficacy on maternal prenatal care.Materials and methods: The present study is a before after experimental study in which 90 first-time pregnant women were randomly selected and divided into two 45- participants experimental and control groups. Data were collected from 21 January to 20 May 2016. Determining the validity and reliability of the questionnaire, we used the panel of experts and Cronbach's alpha. The data collected from the two groups were compared before and 3 months after intervention and were analyzed by SPSS 18.Results: Unlike the control subjects, there was a significant difference in maternal prenatal cares before and after an educational intervention between the scores of social support and perceived self-efficacy in the experimental group (p < 0.05. Before intervention, the average score of the experimental group was 12.62 ± 2.63 that rose to 17.71 ± 1.56, three months after the educational intervention, which is statistically significant (p < 0.05. There was a direct and positive relation between self-efficacy and maternal prenatal cares (p = 0.000, r = 0.538. Social support and self-efficacy predicted the variance of maternal cares by 69.2%.Conclusion: Developing an educational program based on social support and perceived self-efficacy on maternal prenatal cares is helpful and efficient. The health system, family and society are in charge of making facilities and opportunities to improve social support and perceived self-efficacy in pregnant women, resulting in improved maternal prenatal cares

  12. Revising acute care systems and processes to improve breastfeeding and maternal postnatal health: a pre and post intervention study in one English maternity unit

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    Bick Debra

    2012-06-01

    Full Text Available Abstract Background Most women in the UK give birth in a hospital labour ward, following which they are transferred to a postnatal ward and discharged home within 24 to 48 hours of the birth. Despite policy and guideline recommendations to support planned, effective postnatal care, national surveys of women’s views of maternity care have consistently found in-patient postnatal care, including support for breastfeeding, is poorly rated. Methods Using a Continuous Quality Improvement approach, routine antenatal, intrapartum and postnatal care systems and processes were revised to support implementation of evidence based postnatal practice. To identify if implementation of a multi-faceted QI intervention impacted on outcomes, data on breastfeeding initiation and duration, maternal health and women’s views of care, were collected in a pre and post intervention longitudinal survey. Primary outcomes included initiation, overall duration and duration of exclusive breastfeeding. Secondary outcomes included maternal morbidity, experiences and satisfaction with care. As most outcomes of interest were measured on a nominal scale, these were compared pre and post intervention using logistic regression. Results Data were obtained on 741/1160 (64% women at 10 days post-birth and 616 (54% at 3 months post-birth pre-intervention, and 725/1153 (63% and 575 (50% respectively post-intervention. Post intervention there were statistically significant differences in the initiation (p = 0.050, duration of any breastfeeding (p = 0.020 and duration of exclusive breastfeeding to 10 days (p = 0.038 and duration of any breastfeeding to three months (p = 0.016. Post intervention, women were less likely to report physical morbidity within the first 10 days of birth, and were more positive about their in-patient care. Conclusions It is possible to improve outcomes of routine in-patient care within current resources through continuous quality

  13. Dopamine antagonists during parturition disrupt maternal care and the retention of maternal behavior in rats.

    Science.gov (United States)

    Byrnes, Elizabeth M; Rigero, Beth A; Bridges, Robert S

    2002-11-01

    Brief contact with pups at parturition enables the female rat to establish and retain the full repertoire of maternal behaviors, allowing her to respond rapidly to pups in the future. To determine whether the dopamine system is involved in the retention of maternal behavior, females were continuously infused with dopamine antagonists during the periparturitional period and then allowed either a brief interaction period with pups (3 h) or no interaction with pups (pups removed as they were born). Females were exposed to either the D1-like antagonist SCH 23390 (0.1 or 1.0 mg/kg/day) or the D2-like antagonist clebopride (0.5 or 1.0 mg/kg/day). The high dose of either DA antagonist resulted in significant attenuation of maternal care immediately postpartum. When tested for the retention of maternal behavior 7 days later, however, only the females exposed to the D2 antagonist displayed a delayed response to shown full maternal behavior (FMB) towards donor pups. Thus, while both dopamine receptor subtypes appear necessary for the full and rapid expression of maternal behavior during the early postpartum period, only the D2 receptor subtype appears to be involved in the retention of this behavior.

  14. Antenatal counseling in maternal and newborn care: use of job aids to improve health worker performance and maternal understanding in Benin

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    Yebadokpo André

    2010-11-01

    Full Text Available Abstract Background Antenatal care provides an important opportunity to improve maternal understanding of care during and after pregnancy. Yet, studies suggest that communication is often insufficient. This research examined the effect of a job aids-focused intervention on quality of counseling and maternal understanding of care for mothers and newborns. Methods Counseling job aids were developed to support provider communication to pregnant women. Fourteen health facilities were randomized to control or intervention, where providers were trained to use job aids and provided implementation support. Direct observation of antenatal counseling sessions and patient exit interviews were undertaken to assess quality of counseling and maternal knowledge. Providers were also interviewed regarding their perceptions of the tools. Data were collected before and after the job aids intervention and analyzed using a difference-in-differences analysis to quantify relative changes over time. Results Mean percent of recommended messages provided to pregnant women significantly improved in the intervention arm as compared to the control arm in birth preparedness (difference-in-differences [ΔI-C] = +17.9, 95%CI: 6.7,29.1, danger sign recognition (ΔI-C = +26.0, 95%CI: 14.6,37.4, clean delivery (ΔI-C = +21.7, 95%CI: 10.9,32.6, and newborn care (ΔI-C = +26.2, 95%CI: 13.5,38.9. Significant gains were also observed in the mean percent of communication techniques applied (ΔI-C = +28.8, 95%CI: 22.5,35.2 and duration (minutes of antenatal consultations (ΔI-C = +5.9, 95%CI: 3.0,8.8. No relative increase was found for messages relating to general prenatal care (ΔI-C = +8.2, 95%CI: -2.6,19.1. The proportion of pregnant women with correct knowledge also significantly improved for birth preparedness (ΔI-C = +23.6, 95%CI: 9.8,37.4, danger sign recognition (ΔI-C = +28.7, 95%CI: 14.2,43.2, and clean delivery (ΔI-C = +31.1, 95%CI: 19.4,42.9. There were no significant

  15. EFFECT OF INDIVIDUAL AND COMMUNITY FACTORS ON MATERNAL HEALTH CARE SERVICE USE IN INDIA: A MULTILEVEL APPROACH.

    Science.gov (United States)

    Yadav, Awdhesh; Kesarwani, Ranjana

    2016-01-01

    This study aimed to assess empirically the influence of individual and community (neighbourhood) factors on the use of maternal health care services in India through three outcomes: utilization of full antenatal care (ANC) services, safe delivery and utilization of postnatal care services. Data were from the third round of the National Family Health Survey (2005-06). The study sample constituted ever-married women aged 15-49 from 29 Indian states. Multilevel logistic regression analysis was performed for the three outcomes of interest accounting for individual- and community-level factors associated with the use of maternal health care services. A substantial amount of variation was observed at the community level. About 45%, 51% and 62% of the total variance in the use of full ANC, safe delivery and postnatal care, respectively, could be attributed to differences across the community. There was significant variation in the use of maternal health care services at the individual level, with socioeconomic status and mother's education being the most prominent factors associated with the use of maternal health care services. At the community level, urban residence and poverty concentration were found to be significantly associated with maternal health care service use. The results suggest that an increased focus on community-level interventions could lead to an increase in the utilization of maternal health care services in India.

  16. Effect of the maternal care manual from the perinatal education ...

    African Journals Online (AJOL)

    Objectives. To assess changes in the quality of antenatal and intrapartum care rendered by midwives following intervention with the Maternal Care Manual from the Perinatal Education Programme (PEP). Design. A prospective controlled study. Setting. A study town and two control towns in the Eastern Cape. Subjects.

  17. The influence of women's empowerment on maternal health care utilization: evidence from Albania.

    Science.gov (United States)

    Sado, Lantona; Spaho, Alma; Hotchkiss, David R

    2014-08-01

    Women in Albania receive antenatal care and postnatal care at lower levels than in other countries in Europe. Moreover, there are large socio-economic and regional disparities in maternal health care use. Previous research in low- and middle-income countries has found that women's status within the household can be a powerful force for improving the health, longevity, and mental and physical capacity of mothers and the well-being of children, but there is very little research on this issue in the Balkans. The aim of this paper is to investigate the influence of women's empowerment within the household on antenatal and postnatal care utilization in Albania. The research questions are explored through the use of bivariate and multivariate analyses based on nationally representative data from the 2008-09 Albania Demographic and Health Survey. The linkages between women's empowerment and maternal health care utilization are analyzed using two types of indicators of women's empowerment: decision making power and attitudes toward domestic violence. The outcome variables are indicators of the utilization of antenatal care and postnatal care. The findings suggest that use of maternal health care services is influenced by women's roles in decision-making and the attitudes of women towards domestic violence, after controlling for a number of socio-economic and demographic factors which are organized at individual, household, and community level. The study results suggest that policy actions that increase women's empowerment at home could be effective in helping assure good maternal health. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Impact of Training of Traditional Birth Attendants on Maternal Health Care: A Community-based Study.

    Science.gov (United States)

    Satishchandra, D M; Naik, V A; Wantamutte, A S; Mallapur, M D; Sangolli, H N

    2013-12-01

    To study the impact of Training of Traditional Birth Attendants (TBAs) on maternal health care in a rural area. An interventional study in the Primary Health Center area was conducted over 1-year period between March 2006 and February 2007, which included all the 50 Traditional Birth Attendants (30 previously trained and 20 untrained), as study participants. Pretest evaluation regarding knowledge, attitude, and practices about maternal care was done. Post-test evaluation was done at the first month (early) and at the fifth month (late) after the training. Analysis was done by using Mc. Nemer's test, Chi-square test with Yates's correction and Fischer's exact test. Early and late post-test evaluation showed that there was a progressive improvement in the maternal health care provided by both the groups. Significant reduction in the maternal and perinatal deaths among the deliveries conducted by TBAs after the training was noted. Training programme for TBAs with regular follow-ups in the resource-poor setting will not only improve the quality of maternal care but also reduce perinatal deaths.

  19. Socially disadvantaged women's views of barriers to feeling safe to engage in decision-making in maternity care.

    Science.gov (United States)

    Ebert, Lyn; Bellchambers, Helen; Ferguson, Alison; Browne, Jenny

    2014-06-01

    Although midwifery literature suggests that woman-centred care can improve the birthing experiences of women and birth outcomes for women and babies, recent research has identified challenges in supporting socially disadvantaged women to engage in decision-making regarding care options in order to attain a sense of control within their maternity care encounters. The objective of this paper is to provide an understanding of the issues that affect the socially disadvantaged woman's ability to actively engage in decision-making processes relevant to her care. The qualitative approach known as Interpretative Phenomenological Analysis was used to gain an understanding of maternity care encounters as experienced by each of the following cohorts: socially disadvantaged women, registered midwives and student midwives. This paper focuses specifically on data from participating socially disadvantaged women that relate to the elements of woman-centred care-choice and control and their understandings of capacity to engage in their maternity care encounters. Socially disadvantaged women participants did not feel safe to engage in discussions regarding choice or to seek control within their maternity care encounters. Situations such as inadequate contextualised information, perceived risks in not conforming to routine procedures, and the actions and reactions of midwives when these women did seek choice or control resulted in a silent compliance. This response was interpreted as a consequence of women's decisions to accept responsibility for their baby's wellbeing by delegating health care decision-making to the health care professional. This research found that socially disadvantaged women want to engage in their care. However without adequate information and facilitation of choice by midwives, they believe they are outsiders to the maternity care culture and decision-making processes. Consequently, they delegate responsibility for maternity care choices to those who do belong

  20. Access and utilisation of maternity care for disabled women who experience domestic abuse: a systematic review

    Science.gov (United States)

    2014-01-01

    Background Although disabled women are significantly more likely to experience domestic abuse during pregnancy than non-disabled women, very little is known about how maternity care access and utilisation is affected by the co-existence of disability and domestic abuse. This systematic review of the literature explored how domestic abuse impacts upon disabled women’s access to maternity services. Methods Eleven articles were identified through a search of six electronic databases and data were analysed to identify: the factors that facilitate or compromise access to care; the consequences of inadequate care for pregnant women’s health and wellbeing; and the effectiveness of existing strategies for improvement. Results Findings indicate that a mental health diagnosis, poor relationships with health professionals and environmental barriers can compromise women’s utilisation of maternity services. Domestic abuse can both compromise, and catalyse, access to services and social support is a positive factor when accessing care. Delayed and inadequate care has adverse effects on women’s physical and psychological health, however further research is required to fully explore the nature and extent of these consequences. Only one study identified strategies currently being used to improve access to services for disabled women experiencing abuse. Conclusions Based upon the barriers and facilitators identified within the review, we suggest that future strategies for improvement should focus on: understanding women’s reasons for accessing care; fostering positive relationships; being women-centred; promoting environmental accessibility; and improving the strength of the evidence base. PMID:25029907

  1. Severe maternal morbidity in Zanzibar's referral hospital: Measuring the impact of in-hospital care.

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    Tanneke Herklots

    Full Text Available to analyse the impact of in-hospital care on severe maternal morbidity using WHO's near-miss approach in the low-resource, high mortality setting of Zanzibar's referral hospital.Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania.We identified all cases of morbidity and mortality in women admitted within 42 days after the end of pregnancy at Mnazi Mmoja Hospital in the period from April to October 2016. The severity of complications was classified using WHO's near-miss approach definitions: potentially life-threatening condition (PLTC, maternal near-miss (MNM or maternal death (MD. Quality of in-hospital care was assessed using the mortality index (MI defined as ratio between mortality and severe maternal outcome (SMO where SMO = MD + MNM, cause-specific case facility rates and comparison with predicted mortality based on the Maternal Severity Index model.5551 women were included. 569 (10.3% had a potentially life-threatening condition and 65 (1.2% a severe maternal outcome (SMO: 37 maternal near-miss cases and 28 maternal deaths. The mortality index was high at 0.43 and similar for women who developed a SMO within 12 hours of admission and women who developed a SMO after 12 hours. A standardized mortality ratio of 6.03 was found; six times higher than that expected in moderate maternal mortality settings given the same severity of cases. Obstetric haemorrhage was found to be the main cause of SMO. Ruptured uterus and admission to ICU had the highest case-fatality rates. Maternal death cases seemed to have received essential interventions less often.WHO's near-miss approach can be used in this setting. The high mortality index observed shows that in-hospital care is not preventing progression of disease adequately once a severe complication occurs. Almost one in two women experiencing life-threatening complications will die. This is six times higher than in moderate mortality settings.

  2. [Prenatal care and hospital maternal mortality in Tijuana, Baja California, Mexico].

    Science.gov (United States)

    Gonzaga-Soriano, María Rode; Zonana-Nacach, Abraham; Anzaldo-Campos, María Cecilia; Olazarán-Gutiérrez, Asbeidi

    2014-01-01

    To describe the prenatal care (PC) received in women with maternal hospital deaths from 2005 to 2011 in Tijuana, Baja California, Mexico. Were reviewed the medical chars and registrations of the maternal deaths by the local Committees of Maternal Mortality. There were 44 maternal hospital deaths. Thirty (68%) women assisted to PC appointments during pregnancy, the average number of PC visits was 3.8 and 18 (41%) had an adequate PC (≥ 5 visits). Six (14%) women didn't know they were pregnant; 19 (43%), 21 (48%) y 4 (9%) maternal deaths were due to direct, indirect obstetric cause or non-obstetric causes. Eighteen (18%), 2 (4 %) and 34 (77%) of the maternal deaths occurred during pregnancy, delivery or puerperium. It is necessary pregnancy women have an early, periodic and systematic PC to identify opportunely risk factors associated with pregnancy complications.

  3. Influence of Maternal Care on Behavioural Development of Domestic Dogs (Canis Familiaris Living in a Home Environment

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    Giovanna Guardini

    2017-12-01

    Full Text Available Maternal care has been shown to affect the development of the brain, behaviour, social skills and emotional systems of the young of many mammalian species including dogs. The aim of the present study was to determine the effects of maternal care on the behavioural responses of family dog puppies towards environmental and social stimuli. In order to do this, maternal care (licking puppy’s ano-genital area, licking the puppy, nursing and mother-puppy contact during the first three weeks after birth was assessed in 12 litters of domestic dog puppies reared in home environments (total = 72 puppies. The behavioural responses of puppies were assessed in an arena and an isolation test, which were performed when the puppies were two-month old. Data were analysed using principal components analysis and projection to latent structures regression. A systematic relationship was found between maternal care and behaviour in both tests. In the arena test, maternal care was found to be positively associated with approach to the stranger, attention oriented to the stranger, time spent near the enclosure, yawning, whining and yelping (R2Y = 0.613, p = 8.2 × 10−9. Amount of maternal care was negatively associated with the number of squares crossed and the time spent individually playing with the rope. In the isolation test, the amount of maternal care was positively associated with standing posture, paw lifting, and howling, and it was negatively associated with yawning, lying down and nose licking (R2Y = 0.507, p = 0.000626. These results suggest that the amount of maternal care received during early life influences the pattern of behavioural responses and coping strategies of puppies at two-months of age. On the basis of these findings it could be speculated that early maternal care contributes to adaption to the environment in which family puppies are developing, with particular regard to social relationships with people.

  4. Analysis of the maternal and child health care status in Suizhou City, Hubei Province, China, from 2005 to 2011.

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    Cui-Ling Li

    Full Text Available BACKGROUND: Improving the health and well-being of women and children has long been a common goal throughout the world. From 2005 to 2011, Suizhou City had an annual average of 22,405 pregnant and parturient women (1.04% of the population and 98,811 children under 5 years old (4.57% of the population. Understanding the status of maternal and child health care in Suizhou City during such period can provide the local health administrative department valid scientific bases upon which to construct effective policies. METHODS: Various types of annual reports on maternal and child health care were collected and analyzed retrospectively. RESULTS: Mortality rates for infants and children under 5 years showed a declining trend, while the rates of newborn home visiting, maternal health service coverage, and children health systematic management increased annually in Suizhou City from 2005 to 2011. The incidence of birth defect increased from 2.42 ‰ in 2005 to 3.89 ‰ in 2011. The maternal mortality ratio (MMR fluctuated from 8.39/100,000 to 28.77/100,000, which was much lower than the national MMR (30.0/100,000 in 2010. The rates of hospitalized delivery and births attended by trained health personnel for pregnant women increased to more than 90% in the past five years. CONCLUSIONS: The improvements in maternal and child health care work in Suizhou City are worthy of recognition. Thus, the government should continue to increase funding in these areas to promote the complete enhancement of the maternal and child health care system.

  5. Adult antisocial personality traits are associated with experiences of low parental care and maternal overprotection.

    Science.gov (United States)

    Reti, I M; Samuels, J F; Eaton, W W; Bienvenu, O J; Costa, P T; Nestadt, G

    2002-08-01

    To investigate the role of parenting in the development of adult antisocial personality traits. A total of 742 community-based subjects were assessed for adult DSM-IV antisocial personality disorder traits and for measures of parental behavior experienced as children, including by the Parental Bonding Instrument (PBI). Three fundamental dimensions of parental behavior - care, behavioral restrictiveness and denial of psychological autonomy - were derived by factor analysis from the PBI. These dimensions significantly correlated with measures of parental behavior considered influential in later antisocial behavior. Adult antisocial traits in males were associated with low maternal care and high maternal behavioral restrictiveness, and in females, antisocial traits were associated with low paternal care and high maternal denial of psychological autonomy. These dimensions did not, however, explain all variance parental behavior has on adult antisocial personality traits. Adult antisocial personality traits are associated with experiences of low parental care and maternal overprotection.

  6. Patterns of maternity care service utilization in Southern Ethiopia ...

    African Journals Online (AJOL)

    Patterns of maternity care service utilization in Southern Ethiopia: Evidence from a community ... PROMOTING ACCESS TO AFRICAN RESEARCH ... Result: The study revealed that only 26.1 % and 3.3% of the women received antenatal and ...

  7. High maternal mortality in rural south-west Ethiopia: estimate by using the sisterhood method

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    Yaya Yaliso

    2012-11-01

    Full Text Available Abstract Background Estimation of maternal mortality is difficult in developing countries without complete vital registration. The indirect sisterhood method represents an alternative in places where there is high fertility and mortality rates. The objective of the current study was to estimate maternal mortality indices using the sisterhood method in a rural district in south-west Ethiopia. Method We interviewed 8,870 adults, 15–49 years age, in 15 randomly selected rural villages of Bonke in Gamo Gofa. By constructing a retrospective cohort of women of reproductive age, we obtained sister units of risk exposure to maternal mortality, and calculated the lifetime risk of maternal mortality. Based on the total fertility for the rural Ethiopian population, the maternal mortality ratio was approximated. Results We analyzed 8503 of 8870 (96% respondents (5262 [62%] men and 3241 ([38%] women. The 8503 respondents reported 22,473 sisters (average = 2.6 sisters for each respondent who survived to reproductive age. Of the 2552 (11.4% sisters who had died, 819 (32% occurred during pregnancy and childbirth. This provided a lifetime risk of 10.2% from pregnancy and childbirth with a corresponding maternal mortality ratio of 1667 (95% CI: 1564–1769 per 100,000 live births. The time period for this estimate was in 1998. Separate analysis for male and female respondents provided similar estimates. Conclusion The impoverished rural area of Gamo Gofa had very high maternal mortality in 1998. This highlights the need for strengthening emergency obstetric care for the Bonke population and similar rural populations in Ethiopia.

  8. Women with a BMI ≥ 30kg/m² and their experience of maternity care: A meta ethnographic synthesis.

    Science.gov (United States)

    Jones, Catriona; Jomeen, Julie

    2017-10-01

    this paper is a report of a systematic review and meta-ethnography of the experiences of women with body mass index (BMI) ≥ 30kg/m² and their experience of maternity care. systematic review methods identified 12 qualitative studies about women's experiences of maternity care when their BMI ≥ 30kg/m². Findings from the identified studies were synthesised into themes, using metaethnography. SYNTHESIS AND FINDINGS: the meta-ethnography produced four key concepts; Initial encounters, Negotiating risk, Missing out and The positive intervention, which represent the experiences of maternity care for women with BMI ≥ 30kg/m² KEY CONCLUSION: many women with BMI ≥ 30kg/m² appear to be dissatisfied with the approaches taken to discuss weight status during maternity encounters. When weight is not addressed during these encounters women appear to be equally dissatisfied. The absence of open and honest discussions about weight, the feeling of being denied of a normal experience, and an over emphasis on the risks imposed upon pregnancy and childbirth by obesity, leave women feeling dissatisfied and disenfranchised. Sensitive care and practical advice about diet and exercise can help women move towards feeling more in control of their weight management. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  9. A hands-on experience of the voice of customer analysis in maternity care from Iran.

    Science.gov (United States)

    Aghlmand, Siamak; Lameei, Aboulfath; Small, Rhonda

    2010-01-01

    The purpose of this paper is to describe the use of voice of customer (VoC) analysis in a maternity care case study, where the aim was to identify the most important requirements of women giving birth and to determine targets for the improvement of maternity care in Fayazbakhsh Hospital in Tehran, Iran. The tools of VoC analysis were used to identify: the main customer segment of maternity care; the most important of women's needs and requirements; the level of maternal satisfaction with delivered services at the study hospital and at a competitor; the nature of women's of requirements (termed Kano levels: assumed, expected, and unexpected); and the priorities of the study hospital for meeting these requirements. Women identified the well-being of mother and baby as the most important requirements. Women's satisfaction with the services was, with a few exceptions, low to moderate. Services related to most of the maternal requirements were ranked better in the competitor hospital than the study hospital. The results form a solid basis for achieving improvements in the processes of care for mothers and babies. The paper presents a systematic approach to VoC analysis in health care settings as a basis for clinical process improvement initiatives.

  10. Urban poverty and utilization of maternal and child health care services in India.

    Science.gov (United States)

    Prakash, Ravi; Kumar, Abhishek

    2013-07-01

    Drawing upon data from the third round of the National Family Health Survey (NFHS-3) conducted in India during 2005-06, this study compares the utilization of selected maternal and child health care services between the urban poor and non-poor in India and across selected Indian states. A wealth index was created, separately for urban areas, using Principal Component Analysis to identify the urban poor. The findings suggest that the indicators of maternal and child health care are worse among the urban poor than in their non-poor counterparts. For instance, the levels of antenatal care, safe delivery and childhood vaccinations are much lower among the urban poor than non-poor, especially in socioeconomically disadvantageous states. Among all the maternal and child health care indicators, the non-poor/poor difference is most pronounced for delivery care in the country and across the states. Other than poverty status, utilization of antenatal services by mothers increases the chances of safe delivery and child immunization at both national and sub-national levels. The poverty status of the household emerged as a significant barrier to utilization of health care services in urban India.

  11. Experiencing maternity care: the care received and perceptions of women from different ethnic groups.

    Science.gov (United States)

    Henderson, Jane; Gao, Haiyan; Redshaw, Maggie

    2013-10-22

    According to the Office for National Statistics, approximately a quarter of women giving birth in England and Wales are from minority ethnic groups. Previous work has indicated that these women have poorer pregnancy outcomes than White women and poorer experience of maternity care, sometimes encountering stereotyping and racism. The aims of this study were to examine service use and perceptions of care in ethnic minority women from different groups compared to White women. Secondary analysis of data from a survey of women in 2010 was undertaken. The questionnaire asked about women's experience of care during pregnancy, labour and birth, and the postnatal period, as well as demographic factors. Ethnicity was grouped into eight categories: White, Mixed, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African, and Other ethnicity. A total of 24,319 women completed the survey. Compared to White women, women from minority ethnic groups were more likely to be younger, multiparous and without a partner. They tended to access antenatal care later in pregnancy, have fewer antenatal checks, fewer ultrasound scans and less screening. They were less likely to receive pain relief in labour and, Black African women in particular, were more likely to deliver by emergency caesarean section. Postnatally, women from minority ethnic groups had longer lengths of hospital stay and were more likely to breastfeed but they had fewer home visits from midwives. Throughout their maternity care, women from minority ethnic groups were less likely to feel spoken to so they could understand, to be treated with kindness, to be sufficiently involved in decisions and to have confidence and trust in the staff. Women in all minority ethnic groups had a poorer experience of maternity services than White women. That this was still the case following publication of a number of national policy documents and local initiatives is a cause for concern.

  12. Correlates of Maternal Health Care Utilization in Rohilkhand Region ...

    African Journals Online (AJOL)

    Bareilly district, Uttar Pradesh to cover maximum number of women. All currently ... inequalities in the utilization of maternal health care services have been ..... With regard to work status, one study made in four Indian states supports our ...

  13. AN OBSERVATIONAL STUDY OF MATERNAL NEAR MISS CASES IN A TERTIARY CARE CENTRE

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    Elizabeth Joseph

    2016-12-01

    Full Text Available BACKGROUND DM WIMS is the only tertiary care referral hospital in the hilly tribal district of Wayanad. This is an observational study of 20 maternal near miss cases that presented in our hospital over a period of 4 months. MATERIALS AND METHODS This study was conducted by collecting data over a period of 4 months. Total number of live births in this period was 373. There were 20 cases of maternal near miss cases. Maternal near miss cases were chosen based on the inclusion criteria provided by WHO near miss approach for maternal health. RESULTS There were 373 live births in the 4-month observational period. In these 4 months, there were 20 cases of maternal near miss cases in our hospital. That is, maternal near miss ratio was 53.6/1000 live births. The majority were referred cases with MNM ratio of intrahospital cases being 13.4/1000 live births. The potentially life-threatening complications were obstetric haemorrhage and hypertensive disorders, which coexisted in majority of the women. The obstetric haemorrhage was mainly due to abruptio placenta, which can be attributed to the hypertensive complications. Preexisting anaemia was present in 35% of the MNM cases increasing their morbidity. CONCLUSION The maternal near miss ratio was 53.6/1000 live births, which is high. This can be attributed to the fact that our hospital is the only tertiary referral hospital in the hilly tribal district of Wayanad. Despite the MNM ratio being high, there were no cases of maternal death in this period. Low maternal mortality indicates the good first line of management given at the periphery hospital.

  14. [Effects of Kangaroo Care on anxiety, maternal role confidence, and maternal infant attachment of mothers who delivered preterm infants].

    Science.gov (United States)

    Lee, Sang Bok; Shin, Hye Sook

    2007-10-01

    The purpose of this study was to examine the effects of Kangaroo Care(KC) on anxiety, maternal role confidence, and maternal infant attachment of mothers who delivered preterm infants. The research design was a nonequivalent control group pretest-posttest. Data was collected from September 1. 2006 to June 20. 2007. The participants were 22 mothers in the experimental group and 21 in the control group. KC was applied three times per day, for a total of ten times in 4 days to the experimental group. The degree of anxiety was statistically significantly different between the two groups but maternal role confidence and maternal infant attachment was statistically insignificant. This data suggests that KC was effective for mothers anxiety relief but it was not effective for maternal role confidence and maternal infant attachment of mothers. The implications for nursing practice and directions for future research need to be discussed.

  15. Maternal singing during kangaroo care led to autonomic stability in preterm infants and reduced maternal anxiety.

    Science.gov (United States)

    Arnon, Shmuel; Diamant, Chagit; Bauer, Sofia; Regev, Rivka; Sirota, Gisela; Litmanovitz, Ita

    2014-10-01

    Kangaroo care (KC) and maternal singing benefit preterm infants, and we investigated whether combining these benefitted infants and mothers. A prospective randomised, within-subject, crossover, repeated-measures study design was used, with participants acting as their own controls. We evaluated the heart rate variability (HRV) of stable preterm infants receiving KC, with and without maternal singing. This included low frequency (LF), high frequency (HF) and the LF/HF ratio during baseline (10 min), singing or quiet phases (20 min) and recovery (10 min). Physiological parameters, maternal anxiety and the infants' behavioural state were measured. We included 86 stable preterm infants, with a postmenstrual age of 32-36 weeks. A significant change in LF and HF, and lower LF/HF ratio, was observed during KC with maternal singing during the intervention and recovery phases, compared with just KC and baseline (all p-values singing than just KC (p = 0.04). No differences in the infants' behavioural states or physiological parameters were found, with or without singing. Maternal singing during KC reduces maternal anxiety and leads to autonomic stability in stable preterm infants. This effect is not detected in behavioural state or physiological parameters commonly used to monitor preterm infants. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  16. Women's, midwives' and obstetricians' experiences of a structured process to document refusal of recommended maternity care.

    Science.gov (United States)

    Jenkinson, Bec; Kruske, Sue; Stapleton, Helen; Beckmann, Michael; Reynolds, Maree; Kildea, Sue

    2016-12-01

    Ethical and professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy; the right to refuse care is well established. However, the existing literature is largely silent on the appropriate clinical responses when pregnant women refuse recommended care, and accounts of disrespectful interactions and conflict are numerous. Policies and processes to support women and maternity care providers are rare and unstudied. To document the perspectives of women, midwives and obstetricians following the introduction of a structured process (Maternity Care Plan; MCP) to document refusal of recommended maternity care in a large tertiary maternity unit. A qualitative, interpretive study involved thematic analysis of in-depth semi-structured interviews with women (n=9), midwives (n=12) and obstetricians (n=9). Four major themes were identified including: 'Reassuring and supporting clinicians'; 'Keeping the door open'; 'Varied awareness, criteria and use of the MCP process' and 'No guarantees'. Clinicians felt protected and reassured by the structured documentation and communication process and valued keeping women engaged in hospital care. This, in turn, protected women's access to maternity care. However, the process could not guarantee favourable responses from other clinicians subsequently involved in the woman's care. Ongoing discussions of risk, perceived by women and some midwives to be pressure to consent to recommended care, were still evident. These limitations may have been attributable to the absence of agreed criteria for initiating the MCP process and fragmented care. Varying awareness and use of the process also diminished women's access to it. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  17. The Contribution of Maternal Care and Control to Adolescents' Adjustment Following War

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    Dekel, Rachel; Solomon, Dan

    2016-01-01

    This study examined the contribution of maternal bonding to the adjustment of Israeli adolescents following the 2006 Lebanon War. In all, 2,858 seventh and eighth graders who lived in areas that were exposed to missile attacks completed the Parental Bonding Instrument (assessing maternal care and control) and questionnaires evaluating…

  18. Process Evaluation: Standard, Effectiveness, Efficiency and Sustainability of Maternity Nursing Care

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    Laili Rahayuwati

    2017-09-01

    Full Text Available Although globally there is a change in the trend of epidemiology from infectious diseases to chronic diseases, the prevalence and incidence of infectious diseases as well as MMR (Maternal Mortality Rate and IMR (infant mortality rate in Indonesia is still high. In year 2000, Faculty of Nursing of the Universitas Padjadjaran in collaboration with Hasan Sadikin Hospital built a model of treatment room, which was affiliated with obstetric gynecology room for improving integrated quality of health care services and education. The model built in this room aimed to : 1 Improve the quality of health care service; 2 to develop the student’s experiences with patients; 3 Provide quality nurse education to support students; 4 encourage students to improve the results of clinical prctice. The objective of process evaluation in this study was to give an insight to an appropriate model for maternity nursing service. This results showed on the one hand , there are some records not yet achieved an ideal standard , lack of effectiveness and efficiency of care delivery, namely: 1 the ratio of midwives and patients are not ideal ; 2 No one consultant obstetrician gynecologist and one doctor for every room . As well as challenges to sustainability care that meets the standards of maternity care. Conclusion: this study recommends to take a comprehensive strategic planning for improving nursing and midwifery services that involve all relevant stakeholders in the government, civil society, service delivery, education, and professional organizations.

  19. Maternal health care utilization in Viet Nam: increasing ethnic inequity.

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    Målqvist, Mats; Lincetto, Ornella; Du, Nguyen Huy; Burgess, Craig; Hoa, Dinh Thi Phuong

    2013-04-01

    To investigate changes that took place between 2006 and 2010 in the inequity gap for antenatal care attendance and delivery at health facilities among women in Viet Nam. Demographic, socioeconomic and obstetric data for women aged 15-49 years were extracted from Viet Nam's Multiple Indicator Cluster Survey for 2006 (MICS3) and 2010-2011 (MICS4). Multivariate logistic regression was performed to determine if antenatal care attendance and place of delivery were significantly associated with maternal education, maternal ethnicity (Kinh/Hoa versus other), household wealth and place of residence (urban versus rural). These independent variables correspond to the analytical framework of the Commission on Social Determinants of Health. Large discrepancies between urban and rural populations were found in both MICS3 and MICS4. Although antenatal care attendance and health facility delivery rates improved substantially between surveys (from 86.3 to 92.1% and from 76.2 to 89.7%, respectively), inequities increased, especially along ethnic lines. The risk of not giving birth in a health facility increased significantly among ethnic minority women living in rural areas. In 2006 this risk was nearly five times higher than among women of Kinh/Hoa (majority) ethnicity (odds ratio, OR: 4.67; 95% confidence interval, CI: 2.94-7.43); in 2010-2011 it had become nearly 20 times higher (OR: 18.8; 95% CI: 8.96-39.2). Inequity in maternal health care utilization has increased progressively in Viet Nam, primarily along ethnic lines, and vulnerable groups in the country are at risk of being left behind. Health-care decision-makers should target these groups through affirmative action and culturally sensitive interventions.

  20. Giant Panda Maternal Care: A Test of the Experience Constraint Hypothesis

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    Snyder, Rebecca J.; Perdue, Bonnie M.; Zhang, Zhihe; Maple, Terry L.; Charlton, Benjamin D.

    2016-01-01

    The body condition constraint and the experience condition constraint hypotheses have both been proposed to account for differences in reproductive success between multiparous (experienced) and primiparous (first-time) mothers. However, because primiparous mothers are typically characterized by both inferior body condition and lack of experience when compared to multiparous mothers, interpreting experience related differences in maternal care as support for either the body condition constraint hypothesis or the experience constraint hypothesis is extremely difficult. Here, we examined maternal behaviour in captive giant pandas, allowing us to simultaneously control for body condition and provide a rigorous test of the experience constraint hypothesis in this endangered animal. We found that multiparous mothers spent more time engaged in key maternal behaviours (nursing, grooming, and holding cubs) and had significantly less vocal cubs than primiparous mothers. This study provides the first evidence supporting the experience constraint hypothesis in the order Carnivora, and may have utility for captive breeding programs in which it is important to monitor the welfare of this species’ highly altricial cubs, whose survival is almost entirely dependent on receiving adequate maternal care during the first few weeks of life. PMID:27272352

  1. HIV self-care practices during pregnancy and maternal health outcomes among HIV-positive postnatal mothers aged 18-35 years at Mbuya Nehanda maternity hospital.

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    Dodzo, Lilian Gertrude; Mahaka, Hilda Tandazani; Mukona, Doreen; Zvinavashe, Mathilda; Haruzivishe, Clara

    2017-06-01

    HIV-related conditions are one of the indirect causes of maternal deaths in Zimbabwe and the prevalence rate was estimated to be 13.63% in 2009. The study utilised a descriptive correlational design on 80 pregnant women who were HIV positive at Mbuya Nehanda maternity hospital in Harare, Zimbabwe. Participants comprised a random sample of 80 postnatal mothers. Permission to carry out the study was obtained from the respective review boards. Participants signed an informed consent. Data were collected using a structured questionnaire and record review from 1 to 20 March 2012. Interviews were done in a private room and code numbers were used to identify the participants. Completed questionnaires were kept in a lockable cupboard and the researcher had sole access to them. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 12. Descriptive statistics were used to analyse data on demographics, maternal health outcomes and self-care practices. Inferential statistics (Pearson's correlation and regression analysis) were used to analyse the relationship between self-care practices and maternal health outcomes. Self-care practices were good with a mean score of 8 out of 16. Majority (71.3%) fell within the good category. Maternal outcomes were poor with a mean score of 28 out of 62 and 67.5% falling in the poor category. Pearson's correlation indicated a weak significant positive relationship (r = .317, p = <.01). Regression analysis (R 2 ) was .10 implying that self-care practices explained 10% of the variance observed in maternal health outcomes. More research needs to be carried out to identify other variables affecting maternal outcomes in HIV-positive pregnant women.

  2. The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review

    Science.gov (United States)

    Hunter, Benjamin M.; Harrison, Sean; Portela, Anayda; Bick, Debra

    2017-01-01

    Background Cash transfers and vouchers are forms of ‘demand-side financing’ that have been widely used to promote maternal and newborn health in low- and middle-income countries during the last 15 years. Methods This systematic review consolidates evidence from seven published systematic reviews on the effects of different types of cash transfers and vouchers on the use and quality of maternity care services, and updates the systematic searches to June 2015 using the Joanna Briggs Institute approach for systematic reviewing. The review protocol for this update was registered with PROSPERO (CRD42015020637). Results Data from 51 studies (15 more than previous reviews) and 22 cash transfer and voucher programmes suggest that approaches tied to service use (either via payment conditionalities or vouchers for selected services) can increase use of antenatal care, use of a skilled attendant at birth and in the case of vouchers, postnatal care too. The strongest evidence of positive effect was for conditional cash transfers and uptake of antenatal care, and for vouchers for maternity care services and birth with a skilled birth attendant. However, effects appear to be shaped by a complex set of social and healthcare system barriers and facilitators. Studies have typically focused on an initial programme period, usually two or three years after initiation, and many lack a counterfactual comparison with supply-side investment. There are few studies to indicate that programmes have led to improvements in quality of maternity care or maternal and newborn health outcomes. Conclusion Future research should use multiple intervention arms to compare cost-effectiveness with similar investment in public services, and should look beyond short- to medium-term service utilisation by examining programme costs, longer-term effects on service utilisation and health outcomes, and the equity of those effects. PMID:28328940

  3. Neonatal pain and reduced maternal care: Early-life stressors interacting to impact brain and behavioral development.

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    Mooney-Leber, Sean M; Brummelte, Susanne

    2017-02-07

    Advances in neonatal intensive care units (NICUs) have drastically increased the survival chances of preterm infants. However, preterm infants are still exposed to a wide range of stressors during their stay in the NICU, which include painful procedures and reduced maternal contact. The activation of the hypothalamic-pituitary-adrenal (HPA) axis, in response to these stressors during this critical period of brain development, has been associated with many acute and long-term adverse biobehavioral outcomes. Recent research has shown that Kangaroo care, a non-pharmacological analgesic based on increased skin-to-skin contact between the neonate and the mother, negates the adverse outcomes associated with neonatal pain and reduced maternal care, however the biological mechanism remains widely unknown. This review summarizes findings from both human and rodent literature investigating neonatal pain and reduced maternal care independently, primarily focusing on the role of the HPA axis and biobehavioral outcomes. The physiological and positive outcomes of Kangaroo care will also be discussed in terms of how dampening of the HPA axis response to neonatal pain and increased maternal care may account for positive outcomes associated with Kangaroo care. Copyright © 2016 IBRO. Published by Elsevier Ltd. All rights reserved.

  4. The Effects of Prenatal Care Utilization on Maternal Health and Health Behaviors.

    Science.gov (United States)

    Yan, Ji

    2017-08-01

    While many economic studies have explored the role of prenatal care in infant health production, the literature is sporadic on the effects of prenatal care on the mother. This research contributes to this understudied but important area using a unique large dataset of sibling newborns delivered by 0.17 million mothers. We apply within-mother estimators to find robust evidence that poor prenatal care utilization due to late onset of care, low frequency of care visits, or combinations of the two significantly increases the risks of maternal insufficient gestational weight gain, prenatal smoking, premature rupture of membranes, precipitous labor, no breastfeeding, postnatal underweight, and postpartum smoking. The magnitude of the estimates relative to the respective sample means of the outcome variables ranges from 3% to 33%. The results highlight the importance of receiving timely and sufficient prenatal care in improving maternal health and health behaviors during pregnancy as well as after childbirth. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  5. Maternal Death Reviews of a Tertiary Care Hospital

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    Indira Upadhyaya

    2014-03-01

    Full Text Available Introduction: All pregnant women are at risk of obstetrical complications which occurs during labour and delivary that lead to maternal death. Here to report a 10 year review of maternal mortality ratio in "Paropakar Maternity and Women's Hospital (PMWH" Thapathali Kathmandu, Nepal. Methods: Medical records of 66 maternal deaths were reviewed to study the likely cause of each death over the study period. Results: There were a total of 66 maternal deaths. While 192487 deliveries conducted over the 10 year period. The maternal mortality ratio (MMR was 356.64/100000 live birth. The highest MMR of 74.22/100,000 was observed in 2059 and lowest was 17.42/100,000 in 2068 B.S. Leading cause of MMR was remained hemorrhage accounting for 30.30% followed by eclampsia 24.24%. Sepsis, suspected cases of pulmonary embolism and amniotic fluid embolism each contributing 15.15%, 4.54% and 3.03% respectively. Where as anesthetic complication and abortion constiuates 6.06 % each equally for maternal death. The death noted in older women (30+year were 36.36%. Primipara accounted for more deaths (51.51%. Conclusions: The fall in maternal mortality rate has been observed except for year 2063 BS. Haemorrhage is the main contributing cause behind maternal mortality.

  6. Maternal mood and concordant maternal and infant salivary cortisol during heel lance while in kangaroo care.

    Science.gov (United States)

    Castral, T C; Warnock, F; Dos Santos, C B; Daré, M F; Moreira, A C; Antonini, S R R; Scochi, C G S

    2015-03-01

    Maternal kangaroo care (MKC) is a naturalistic intervention that alleviates neonatal pain, and mothers are assumed to play a stress regulatory role in MKC. Yet, no MKC infant pain study has examined relationship between maternal and infant stress reactivity concurrently, or whether post-partum depression and/or anxiety (PPDA) alters maternal and neonatal stress response and the regulatory effects of MKC. To examine the concordance of salivary cortisol reactivity between 42 mothers and their stable preterm infants during routine infant heel lance (HL) while in MKC and to compare salivary cortisol between groups of mothers with and without PPDA and their infants. Maternal and infant salivary cortisol samples were collected pre-HL and 20 min post-HL with two additional maternal samples at night and in the morning. Mothers and infants were allocated to with PPDA versus without PPDA study groups on the basis of maternal post-natal mental health assessment scores. Higher mothers' cortisol pre-HL was weakly associated with higher infants' salivary cortisol in response to the HL procedure. Maternal depression and/or anxiety were not associated with infants' cortisol. During HL, both groups of mothers and infants showed no change in salivary cortisol. Concordance between mother and infant salivary cortisol supports the maternal stress regulatory role in MKC. MKC may have stress regulatory benefits for mothers and their preterm infants during HL independent of PPDA. Future MKC studies that target mothers with altered mood will help to build on these findings. © 2014 European Pain Federation - EFIC®

  7. Effect of Free Maternal Health Care Program on Health-seeking Behavior of Women during Pregnancy, Intra-partum and Postpartum Periods in Cross River State of Nigeria: A Mixed Method Study

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    Betta Edu

    2017-06-01

    CONCLUSION: Reasons for Maternal health care utilisation even under a cost-removal policy is multi-factorial. Therefore, in addition to fee-removal, the government must be committed to addressing other deterrents so as to significantly increase maternal health care service utilisation.

  8. Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria: a retrospective study

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    Al Chamat Ahmad

    2010-10-01

    Full Text Available Abstract Background Investigating severe maternal morbidity (near-miss is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. This study aims to i. document the frequency and nature of maternal near-miss at hospital level in Damascus, Capital of Syria, ii. evaluate the level of care at maternal life-saving emergency services by comparatively analysing near-misses and maternal mortalities. Methods Retrospective facility-based review of cases of near-miss and maternal mortality that took place in the years 2006-2007 at Damascus Maternity University Hospital, Syria. Near-miss cases were defined based on disease-specific criteria (Filippi 2005 including: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. Main outcomes included maternal mortality ratio (MMR, maternal near miss ratio (MNMR, mortality indices and proportion of near-miss cases and mortality cases to hospital admissions. Results There were 28 025 deliveries, 15 maternal deaths and 901 near-miss cases. The study showed a MNMR of 32.9/1000 live births, a MMR of 54.8/100 000 live births and a relatively low mortality index of 1.7%. Hypertensive disorders (52% and haemorrhage (34% were the top causes of near-misses. Late pregnancy haemorrhage was the leading cause of maternal mortality (60% while sepsis had the highest mortality index (7.4%. Most cases (93% were referred in critical conditions from other facilities; namely traditional birth attendants homes (67%, primary (5% and secondary (10% healthcare unites and private practices (11%. 26% of near-miss cases were admitted to Intensive Care Unit (ICU. Conclusion Near-miss analyses provide valuable information on obstetric care. The study highlights the need to improve antenatal care which would help early identification of high risk pregnancies. It also emphasises the importance of both: developing protocols to

  9. Maternal autonomy and child health care utilization in India: results from the National Family Health Survey.

    Science.gov (United States)

    Malhotra, Chetna; Malhotra, Rahul; Østbye, Truls; Subramanian, S V

    2014-07-01

    The objective of this study was to examine the association of maternal autonomy with preventive and curative child health care utilization in India. Data from the National Family Health Survey 2005-2006 were used to ascertain association of maternal autonomy (in 3 dimensions: decision making, access to financial resources, freedom of movement) with child's primary immunization status (indicative of preventive health care use) and treatment seeking for child's acute respiratory infection (indicative of curative health care use). Low maternal freedom of movement was associated with higher odds of incomplete primary immunization of the child and for not seeking treatment for the child's acute respiratory infection. Low maternal financial access was associated with increased odds for incomplete primary immunization of the child. The findings show that improvement in autonomy of Indian mothers, especially their freedom of movement, may help improve utilization of health care for their children. © 2012 APJPH.

  10. Maternal and fetal outcome in women with hypertensive disorders of pregnancy: the impact of prenatal care.

    Science.gov (United States)

    Barbosa, Isabela Roberta Cruz; Silva, Wesley Bruno Merencio; Cerqueira, Grace Sanches Gutierrez; Novo, Neil Ferreira; Almeida, Fernando Antonio; Novo, Joe Luiz Vieira Garcia

    2015-08-01

    Hypertensive disorders of pregnancy (HDP) are the most important cause of maternal and fetal death and pregnancy complications in Latin America and the Caribbean. The objective of this study was to characterize the epidemiological profile of women with HDP admitted to a Brazilian tertiary reference hospital, and to evaluate maternal and fetal outcome in each HDP and the impact of prenatal care on the maternal and fetal outcome. HDP in 1501 women were classified according to usual definitions as chronic hypertension (n = 564), pre-eclampsia (n = 579), eclampsia (n = 74) and pre-eclampsia/eclampsia superimposed on chronic hypertension (n = 284). Adverse maternal and fetal outcomes registered as maternal death and near miss and fetal outcomes documented as stillbirth, neonatal death and newborn respiratory complications were compiled. Prenatal care was classified as complete (⩾ 6 visits), incomplete (prenatal care or prenatal not done had progressive higher mortality rates and greater frequency of near miss cases, and their children had higher mortality rates. In a tertiary reference hospital, eclampsia and chronic hypertension superimposed on pre-eclampsia are associated with a worst outcome for mothers and fetuses, whereas complete prenatal care is associated with a better maternal and fetal outcome in HDP. © The Author(s), 2015.

  11. Determinants of maternity care services utilization among married adolescents in rural India.

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    Prashant Kumar Singh

    Full Text Available Coupled with the largest number of maternal deaths, adolescent pregnancy in India has received paramount importance due to early age at marriage and low contraceptive use. The factors associated with the utilization of maternal healthcare services among married adolescents in rural India are poorly discussed.Using the data from third wave of National Family Health Survey (2005-06, available in public domain for the use by researchers, this paper examines the factors associated with the utilization of maternal healthcare services among married adolescent women (aged 15-19 years in rural India. Three components of maternal healthcare service utilization were measured: full antenatal care, safe delivery, and postnatal care within 42 days of delivery for the women who gave births in the last five years preceding the survey. Considering the framework on causes of maternal mortality proposed by Thaddeus and Maine (1994, selected socioeconomic, demographic, and cultural factors influencing outcome events were included as the predictor variables. Bi-variate analyses including chi-square test to determine the difference in proportion, and logistic regression to understand the net effect of predictor variables on selected outcomes were applied. Findings indicate the significant differences in the use of selected maternal healthcare utilization by educational attainment, economic status and region of residence. Muslim women, and women belonged to Scheduled Castes, Scheduled Tribes, and Other Backward Classes are less likely to avail safe delivery services. Additionally, adolescent women from the southern region utilizing the highest maternal healthcare services than the other regions.The present study documents several socioeconomic and cultural factors affecting the utilization of maternal healthcare services among rural adolescent women in India. The ongoing healthcare programs should start targeting household with married adolescent women belonging to

  12. The use of salutogenesis theory in empirical studies of maternity care for healthy mothers and babies.

    Science.gov (United States)

    Perez-Botella, Mercedes; Downe, Soo; Magistretti, Claudia Meier; Lindstrom, Bengt; Berg, Marie

    2015-03-01

    Health care outcomes used in service evaluation and research tend to measure morbidity and mortality. This is the case even in maternity care, where most women and babies are healthy. Salutogenesis theory recognises that health is a continuum, with explicit inclusion of well-being as well as illness and pathology. This offers the potential to reframe the outcomes and therefore, the focus of, maternity care research and provision. The aim of this study was to identify how salutogenesis has been defined and used in maternity care research undertaken with healthy women. A scoping review was undertaken, using a formal pre-defined search strategy. Inclusion criteria encompassed research papers relating to the maternity episode up to 1 year after birth, using salutogenesis or any of its associated concepts, focused on healthy women, and written in a language which any of the members of the group could understand. The search was undertaken in two phases (database inception--April 2011 and May 2011-February 2013). Included studies were subject to narrative analysis. Eight papers met the inclusion criteria. They covered seven topics, spanning the antenatal, intrapartum and postnatal periods. Only two papers employed both positive health orientation and explicit use of Antonovsky's theory. The remaining studies used discrete aspects of the theory. Salutogenic framing is rarely used in maternity care research with healthy participants. An increase in research that measures salutogenically orientated outcomes could, eventually, provide a balance to the current over-emphasis on pathology in maternity care design and provision worldwide. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Striving to promote male involvement in maternal health care in rural and urban settings in Malawi - a qualitative study.

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    Kululanga, Lucy I; Sundby, Johanne; Malata, Address; Chirwa, Ellen

    2011-12-02

    Understanding the strategies that health care providers employ in order to invite men to participate in maternal health care is very vital especially in today's dynamic cultural environment. Effective utilization of such strategies is dependent on uncovering the salient issues that facilitate male participation in maternal health care. This paper examines and describes the strategies that were used by different health care facilities to invite husbands to participate in maternal health care in rural and urban settings of southern Malawi. The data was collected through in-depth interviews from sixteen of the twenty health care providers from five different health facilities in rural and urban settings of Malawi. The health facilities comprised two health centres, one district hospital, one mission hospital, one private hospital and one central hospital. A semi-structured interview guide was used to collect data from health care providers with the aim of understanding strategies they used to invite men to participate in maternal health care. Four main strategies were used to invite men to participate in maternal health care. The strategies were; health care provider initiative, partner notification, couple initiative and community mobilization. The health care provider initiative and partner notification were at health facility level, while the couple initiative was at family level and community mobilization was at village (community) level. The community mobilization had three sub-themes namely; male peer initiative, use of incentives and community sensitization. The sustainability of each strategy to significantly influence behaviour change for male participation in maternal health care is discussed. Strategies to invite men to participate in maternal health care were at health facility, family and community levels. The couple strategy was most appropriate but was mostly used by educated and city residents. The male peer strategy was effective and sustainable at

  14. Development of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) for migrants to Western societies: an international Delphi consensus process.

    Science.gov (United States)

    Gagnon, Anita J; DeBruyn, Rebecca; Essén, Birgitta; Gissler, Mika; Heaman, Maureen; Jeambey, Zeinab; Korfker, Dineke; McCourt, Christine; Roth, Carolyn; Zeitlin, Jennifer; Small, Rhonda

    2014-06-10

    Through the World Health Assembly Resolution, 'Health of Migrants', the international community has identified migrant health as a priority. Recommendations for general hospital care for international migrants in receiving-countries have been put forward by the Migrant Friendly Hospital Initiative; adaptations of these recommendations specific to maternity care have yet to be elucidated and validated. We aimed to develop a questionnaire measuring migrant-friendly maternity care (MFMC) which could be used in a range of maternity care settings and countries. This study was conducted in four stages. First, questions related to migrant friendly maternity care were identified from existing questionnaires including the Migrant Friendliness Quality Questionnaire, developed in Europe to capture recommended general hospital care for migrants, and the Mothers In a New Country (MINC) Questionnaire, developed in Australia and revised for use in Canada to capture the maternity care experiences of migrant women, and combined to create an initial MFMC questionnaire. Second, a Delphi consensus process in three rounds with a panel of 89 experts in perinatal health and migration from 17 countries was undertaken to identify priority themes and questions as well as to clarify wording and format. Third, the draft questionnaire was translated from English to French and Spanish and back-translated and subsequently culturally validated (assessed for cultural appropriateness) by migrant women. Fourth, the questionnaire was piloted with migrant women who had recently given birth in Montreal, Canada. A 112-item questionnaire on maternity care from pregnancy, through labour and birth, to postpartum care, and including items on maternal socio-demographic, migration and obstetrical characteristics, and perceptions of care, has been created--the Migrant Friendly Maternity Care Questionnaire (MFMCQ)--in three languages (English, French and Spanish). It is completed in 45 minutes via interview

  15. Postnatal undernutrition in rats: attempts to develop alternative methods to food deprive pups without maternal behavioral alteration.

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    Codo, W; Carlini, E A

    1979-09-01

    Two methods were investigated as attempts to undernourish rat pups without the disturbances in maternal behavior that accompany the procedures used to date for this purpose. In the 1st method, a litter of 12 pups was raised by both a lactating mother and a "sensitized" female. The sensitized female was provided under the assumption that she could correct for the deficit in maternal care when 1 mother raises a large litter. The results showed that the pups raised by the 2 females were constantly removed by the females from each other's nests; the females engaged in constant fighting and showed altered maternal behavior. As a consequence the pups lost more weight than control underfed young. The 2nd method consisted of removing 6-8 nipples from virgin females which were mated 10 days later. After delivery these females raised litters of 6 pups. Their maternal behavior was equal to that of unoperated controls, and at weaning the pups had 20-50% less body weight. This method could be useful to study undernutrition effects on behavior, without confounding experimental variables.

  16. Listening to women's voices: the quality of care of women experiencing severe maternal morbidity, in Accra, Ghana.

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    Ozge Tunçalp

    Full Text Available BACKGROUND: Women who survive severe obstetric complications can provide insight into risk factors and potential strategies for prevention of maternal morbidity as well as maternal mortality. We interviewed 32 women, in an urban facility in Ghana, who had experienced severe morbidity defined using a standardized WHO near-miss definition and identification criteria. Women provided personal accounts of their experiences of severe maternal morbidity and perceptions of the care they received. METHODS AND FINDINGS: The study took place in a referral facility in urban Accra, and semi-structured interviews were conducted with women who had either a maternal near miss (n = 17 or a potentially life-threatening complication (n = 15. The most common themes surrounding the traumatic delivery were the fear of dying and concern over the potential (or actual loss of the baby. For many women, the loss of a baby negatively influenced how they viewed and coped with this experience. Women's perceptions of the quality of the care highlighted several key factors such as the importance of information, good communication and attitudes, and availability of human (i.e., more doctors and physical resources (i.e., more beds, water at the facility. CONCLUSIONS: Our results suggest that experiences of women with severe maternal morbidity may inform different aspects of quality improvement in the facilities, which in turn have a positive impact on future health seeking behavior, service utilization and reduction in maternal morbidity and mortality.

  17. The perinatal and maternal outcome in pregnancy with advanced maternal age 35 years and >35 years

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    Pallavi S. Kalewad; Trupti Nadkarni

    2016-01-01

    Background: Purpose of this study is to evaluate maternal and perinatal outcome in advanced maternal age women. As numbers of pregnancies in advanced maternal age continue to grow, obstetric care provider would benefit from up to date outcome data to enhance their preconceptional and antenatal counseling. Methods: It is observational prospective analytic study, conducted in Nowrosjee Wadia maternity hospital, Parel, Mumbai. Total 100 patients were included in study, fulfilling inclusion cr...

  18. Maternal health care use among married women in Hossaina, Ethiopia.

    Science.gov (United States)

    Dutamo, Zeleke; Assefa, Nega; Egata, Gudina

    2015-09-10

    Pregnancy and child birth are natural process of continuity of life. For many it is a normal process, for some it puts life at risk impending complications. Provision of skilled care for all women before, during, and after childbirth is a key in saving women's life and ensuring delivery of healthy baby. Maternal health service drop-out through the course of pregnancy is widely claimed, yet by how much it is dropped is not known. The main aim of this study was to identify the use of maternal health service over the course of pregnancy and child birth in a comprehensive manner. A community based cross-sectional quantitative study on 623 women supported by qualitative inquiry was conducted Hossaian town, South Ethiopia during January 1-31, 2014. A structured questionnaire was used to generate the quantitative data and 4 Focus Group Discussions (FGD) were carried out to support the finding. Multiple logistic regression was used to control the effect of confounding. Odds ratios with 95% CI used to display the result of analysis. Data generated from the FGD was analyzed using thematic analysis. The study revealed that 87.6% of women attended at least one antenatal care (ANC). Among 546 women who attended ANC, 61.3% of the women made their first visit during second and third trimester of pregnancy and 49% had less than four antenatal visits. The study also revealed that 62.6% of deliveries were assisted by skilled attendants and 51.4% of the women received at least one postnatal check-up. Parity, pregnancy intention and awareness on danger signs of pregnancy during pregnancy were significantly associated (p Skilled delivery attendance was significantly associated with some socio-demographic, economic and obstetric factors. Average family monthly income, awareness on obstetric danger signs of pregnancy during recent pregnancy, and frequency of ANC were positive predictors of Postnatal Care (PNC) utilization. Though use of maternal health care services is relatively higher

  19. Committee Opinion No. 726: Hospital Disaster Preparedness for Obstetricians and Facilities Providing Maternity Care.

    Science.gov (United States)

    2017-12-01

    Large-scale catastrophic events and infectious disease outbreaks highlight the need for disaster planning at all community levels. Features unique to the obstetric population (including antepartum, intrapartum, postpartum and neonatal care) warrant special consideration in the event of a disaster. Pregnancy increases the risks of untoward outcomes from various infectious diseases. Trauma during pregnancy presents anatomic and physiologic considerations that often can require increased use of resources such as higher rates of cesarean delivery. Recent evidence suggests that floods and human-influenced environmental disasters increase the risks of spontaneous miscarriages, preterm births, and low-birth-weight infants among pregnant women. The potential surge in maternal and neonatal patient volume due to mass-casualty events, transfer of high-acuity patients, or redirection of patients because of geographic barriers presents unique challenges for obstetric care facilities. These circumstances require that facilities plan for additional increases in necessary resources and staffing. Although emergencies may be unexpected, hospitals and obstetric delivery units can prepare to implement plans that will best serve maternal and pediatric care needs when disasters occur. Clear designation of levels of maternal and neonatal care facilities, along with establishment of a regional network incorporating hospitals that provide maternity services and those that do not, will enable rapid transport of obstetric patients to the appropriate facilities, ensuring the right care at the right time. Using common terminology for triage and transfer and advanced knowledge of regionalization and levels of care will facilitate disaster preparedness.

  20. Modifying effect of prenatal care on the association between young maternal age and adverse birth outcomes.

    Science.gov (United States)

    Vieira, C L; Coeli, C M; Pinheiro, R S; Brandão, E R; Camargo, K R; Aguiar, F P

    2012-06-01

    The objectives were to investigate the prevalence of adverse birth outcomes according to maternal age range in the city of Rio de Janeiro, Brazil, in 2002, and to evaluate the association between maternal age range and adverse birth outcomes using additive interaction to determine whether adequate prenatal care can attenuate the harmful effect of young age on pregnancy outcomes. A cross-sectional analysis was performed in women up to 24 years of age who gave birth to live children in 2002 in the city of Rio de Janeiro. To evaluate adverse outcomes, the exposure variable was maternal age range, and the outcome variables were very preterm birth, low birth weight, prematurity, and low 5-minute Apgar score. The presence of interaction was investigated with the composite variable maternal age plus prenatal care. The proportions and respective 95% confidence intervals were calculated for adequate schooling, delivery in a public maternity hospital, and adequate prenatal care, and the outcomes according to maternal age range. The chi-square test was used. The association between age range and birth outcomes was evaluated with logistic models adjusted for schooling and type of hospital for each prenatal stratum and outcome. Attributable proportion was calculated in order to measure additive interaction. Of the 40,111 live births in the sample, 1.9% corresponded to children of mothers from 10-14 years of age, 38% from 15-19 years, and 59.9% from 20-24 years. An association between maternal age and adverse outcomes was observed only in adolescent mothers with inadequate prenatal care, and significant additive interaction was observed between prenatal care and maternal age for all the outcomes. Adolescent mothers and their newborns are exposed to greater risk of adverse outcomes when prenatal care fails to comply with current guidelines. Copyright © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  1. Maternal care and paternal protection influence response to psychotherapy treatment for adult depression.

    Science.gov (United States)

    Johnstone, Jeanette M; Carter, Janet D; Luty, Suzanne E; Mulder, Roger T; Frampton, Christopher M; Joyce, Peter R

    2013-07-01

    Adverse childhood experiences of neglect, overprotection and abuse, well-recognized risk factors for the development of adult psychopathology, were examined as predictors of response to psychotherapy treatment for adults with depression. Outpatients in a randomized clinical trial of interpersonal psychotherapy (IPT) or cognitive-behavioral therapy (CBT) completed the parental bonding instrument (PBI) at baseline to establish levels of care and protection. Childhood abuse was asked about using clinical interviews. The PBI variables were examined in tertiles while the abuse variables were categorized as "none," "some," and "severe." Associations between these childhood adversities and treatment response were examined in those who completed the trial. Of 177 outpatients with depression who were randomized, 159 completed an adequate trial of therapy. Within these 159 patients, 57% were categorized as responders to treatment. The mean percentage improvement on the MADRS was 57.7% (±31.4). Across both treatments, patients reporting intermediate levels of maternal care had the best response to treatment. Also across both treatments, the interaction effects of maternal care and paternal protection by treatment were statistically significant. Examining the two therapies independently, maternal care and paternal protection were associated with a differential response to IPT but not CBT. Reports of abuse, whether physical, emotional or sexual, did not impact treatment response. This study examined patients who completed treatment, which may have attenuated the findings. Two categories of childhood adversity were measured although a range of other adverse childhood experiences exist. The results were from exploratory analyses and require replication. Maternal care, demonstrating a robust main effect across treatments, appears to be the childhood variable most strongly associated with response to psychotherapy in this sample. In addition, maternal care and paternal protection

  2. The development of an instrument to measure global dimensions of maternal care in rhesus macaques (Macaca mulatta).

    Science.gov (United States)

    McCormack, K; Howell, B R; Guzman, D; Villongco, C; Pears, K; Kim, H; Gunnar, M R; Sanchez, M M

    2015-01-01

    One of the strongest predictors of healthy child development is the quality of maternal care. Although many measures of observation and self-report exist in humans to assess global aspects of maternal care, such qualitative measures are lacking in nonhuman primates. In this study, we developed an instrument to measure global aspects of maternal care in rhesus monkeys, with the goal of complementing the individual behavioral data collected using a well-established rhesus macaque ethogram during the first months postpartum. The 22 items of the instrument were adapted from human maternal sensitivity assessments and a maternal Q-sort instrument already published for macaques. The 22 items formed four dimensions with high levels of internal reliability that represented major constructs of maternal care: (1) Sensitivity/Responsivity, (2) Protectiveness, (3) Permissiveness, and (4) Irritability. These dimensions yielded high construct validity when correlated with mother-infant frequency and duration behavior that was collected from focal observations across the first 3 postnatal months. In addition, comparisons of two groups of mothers (Maltreating vs. Competent mothers) showed significant differences across the dimensions suggesting that this instrument has strong concurrent validity, even after controlling for focal observation variables that have been previously shown to significantly differentiate these groups. Our findings suggest that this Instrument of Macaque Maternal Care has the potential to capture global aspects of the mother-infant relationship that complement individual behaviors collected through focal observations. © 2014 Wiley Periodicals, Inc.

  3. The Development of an Instrument to Measure Global Dimensions of Maternal Care in Rhesus Macaques (Macaca mulatta)

    Science.gov (United States)

    McCormack, K.; Howell, B. R.; Guzman, D.; Villongco, C.; Pears, K.; Kim, H.; Gunnar, M.R.; Sanchez, M.M.

    2014-01-01

    One of the strongest predictors of healthy child development is the quality of maternal care. Although many measures of observation and self-report exist in humans to assess global aspects of maternal care, such qualitative measures are lacking in nonhuman primates. In this study we developed an instrument to measure global aspects of maternal care in rhesus monkeys, with the goal of complementing the individual behavioral data collected using a well-established rhesus macaque ethogram during the first months postpartum. The 22 items of the instrument were adapted from human maternal sensitivity assessments and a maternal Q-sort instrument already published for macaques. The 22 items formed four dimensions with high levels of internal reliability that represented major constructs of maternal care: 1) Sensitivity/Responsivity, 2) Protectiveness, 3) Permissiveness, and 4) Irritability. These dimensions yielded high construct validity when correlated with mother-infant frequency and duration behavior that was collected from focal observations across the first three postnatal months. In addition, comparisons of two groups of mothers (Maltreating versus Competent mothers), showed significant differences across the dimensions suggesting that this instrument has strong concurrent validity, even after controlling for focal observation variables that have been previously shown to significantly differentiate these groups. Our findings suggest that this Instrument of Macaque Maternal Care (IMMC) has the potential to capture global aspects of the mother-infant relationship that complement individual behaviors collected through focal observations. PMID:25066041

  4. Maternal care affects the phenotype of a rat model for schizophrenia

    Directory of Open Access Journals (Sweden)

    Ruben W M Van Vugt

    2014-08-01

    Full Text Available Schizophrenia is a complex mental disorder caused by an interplay between genetic and environmental factors, including early postnatal stressors. To explore this issue, we use two rat lines, apomorphine-susceptible (APO-SUS rats that display schizophrenia-relevant features and their phenotypic counterpart, apomorphine-unsusceptible (APO-UNSUS rats. These rat lines differ not only in their gnawing response to apomorphine, but also in their behavioral response to novelty (APO-SUS: high, APO-UNSUS: low. In this study, we examined the effects of early postnatal cross-fostering on maternal care and on the phenotypes of the cross-fostered APO-SUS and APO-UNSUS animals later in life. Cross-fostered APO-UNSUS animals showed decreased body weights as pups and decreased novelty-induced locomotor activity as adults (i.e., more extreme behavior, in accordance with the less appropriate maternal care provided by APO-SUS versus their own APO-UNSUS mothers (i.e., the APO-SUS mother displayed less non-arched-back nursing and more self-grooming, and was more away from its nest. In contrast, cross-fostered APO-SUS animals showed increased body weights as pups and reduced apomorphine-induced gnawing later in life (i.e., normalisation of their extreme behavior, in line with the more appropriate maternal care provided by APO-UNSUS relative to their own APO-SUS mothers (i.e., the APO-UNSUS mother displayed more non-arched-back nursing and similar self-grooming, and was not more away. Furthermore, we found that, in addition to arched-back nursing, non-arched-back nursing was an important feature of maternal care, and that cross-fostering APO-SUS mothers, but not cross-fostering APO-UNSUS mothers, displayed increased apomorphine-induced gnawing. Thus, cross-fostering not only causes early postnatal stress shaping the phenotypes of the cross-fostered animals later in life, but also affects the phenotypes of the cross-fostering mothers.

  5. Is the Prediction of Adolescent Outcomes From Early Child Care Moderated by Later Maternal Sensitivity? Results From the NICHD Study of Early Child Care and Youth Development

    Science.gov (United States)

    Burchinal, Margaret R.; Vandell, Deborah Lowe; Belsky, Jay

    2016-01-01

    Longitudinal data are used to examine whether effects of early child care are amplified and/or attenuated by later parenting. Analyses tested these interactions using parenting as both a categorical and continuous variable to balance power and flexibility in testing moderation. The most consistent finding was that maternal sensitivity during adolescence accentuated the association between child care quality and adolescent academic-cognitive skills at age 15 years when maternal sensitivity during adolescence was high. This interaction was obtained in analyses with maternal sensitivity as both a categorical and continuous variable. Relations between early child care hours and adolescent behavioral outcomes also were moderated by maternal sensitivity, with longer child care hours predicting more impulsivity and externalizing at age 15 when maternal sensitivity during middle childhood, scored as a categorical variable, was low to moderate and when maternal sensitivity during adolescence, scored as a continuous variable, was lower. These findings suggest that some child care effects are moderated by subsequent parenting and that this moderation may take both linear and nonlinear forms. PMID:23937381

  6. Immigrant women's experiences of maternity-care services in Canada: a systematic review using a narrative synthesis.

    Science.gov (United States)

    Higginbottom, Gina M A; Morgan, Myfanwy; Alexandre, Mirande; Chiu, Yvonne; Forgeron, Joan; Kocay, Deb; Barolia, Rubina

    2015-02-11

    Canada's diverse society and its statutory commitment to multiculturalism means that a synthesis of knowledge related to the healthcare experiences of immigrants is essential to realise the health potential for future Canadians. Although concerns about the maternity experiences of immigrants in Canada are relatively new, recent national guidelines explicitly call for the tailoring of services to user needs. We therefore assessed the experiences of immigrant women accessing maternity-care services in Canada. In particular, we investigated the experiences of immigrant women in Canada in accessing and navigating maternity and related healthcare services from conception to 6 months postpartum in Canada. Our focus was on (a) the accessibility and acceptability of maternity-care services for immigrant women and (b) the effects of the perceptions and experiences of these women on their birth and postnatal outcomes. We conducted a systematic review using a systematic search and narrative synthesis of peer-reviewed and non-peer-reviewed reports of empirical research, with the aim of providing stakeholders with perspectives on maternity-care services as experienced by immigrant women. We partnered with key stakeholders ('integrated knowledge users') to ensure the relevancy of topics and to tailor recommendations for effective translation into future policy, practice and programming. Two search phases and a three-stage selection process for published and grey literature were conducted prior to appraisal of literature quality and narrative synthesis of the findings. Our knowledge synthesis of maternity care among immigrants to Canada provided a coherent evidence base for (a) eliciting a better understanding of the factors that generate disparities in accessibility, acceptability and outcomes during maternity care; and (b) improving culturally based competency in maternity care. Our synthesis also identified pertinent issues in multiple sectors that should be addressed to

  7. Effectiveness of an intervention on uptake of maternal care in four counties in Ningxia, China.

    Science.gov (United States)

    Zhou, Hong; Zhao, Chun-Xia; Wang, Xiao-Li; Xv, Yi-Chong; Shi, Ling; Wang, Yan

    2012-12-01

    To understand the utilisation of prenatal care and hospitalised delivery among pregnant Muslim women in Ningxia, China, and to explore the effectiveness of the integrated interventions to reduce maternal mortality. Cross-sectional surveys before and after the intervention were carried out. Using multistage sampling, 1215 mothers of children <5 years old were recruited: 583 in the pre-intervention survey and 632 in the post-intervention study. Data on prenatal care and delivery were collected from face-to-face interviews. Maternal mortality ratio (MMR) data were obtained from the local Maternal and Child Mortality Report System. After the intervention, the MMR significantly decreased (45.5 deaths per 100,000 live births to 32.7 deaths). Fewer children were born at home after the intervention than before the intervention (OR, 0.11; 95% CI, 0.08-0.15). The proportion of women who attended prenatal care at least once increased from 78.2% to 98.9% (OR, 24.55; 95% CI, 11.37-53.12). The proportion of women who had prenatal visit(s) in the first trimester of pregnancy increased from 35.1% to 82.6% (OR, 8.77; 95% CI, 6.58-11.69). The quality of prenatal care was greatly improved. Effects of the intervention on the utilisation of maternal care remained significant after adjusting for education level and household possessions. The findings suggest that integrated strategies can effectively reduce maternal mortality. © 2012 Blackwell Publishing Ltd.

  8. The influence of maternal care and overprotection on youth adrenocortical stress response: a multiphase growth curve analysis.

    Science.gov (United States)

    Vergara-Lopez, Chrystal; Chaudoir, Stephenie; Bublitz, Margaret; O'Reilly Treter, Maggie; Stroud, Laura

    2016-11-01

    We examined the association between two dimensions of maternal parenting style (care and overprotection) and cortisol response to an acute laboratory-induced stressor in healthy youth. Forty-three participants completed the Parental Bonding Instrument and an adapted version of the Trier Social Stress Test-Child (TSST-C). Nine cortisol samples were collected to investigate heterogeneity in different phases of youth's stress response. Multiphase growth-curve modeling was utilized to create latent factors corresponding to individual differences in cortisol during baseline, reactivity, and recovery to the TSST-C. Youth report of maternal overprotection was associated with lower baseline cortisol levels, and a slower cortisol decline during recovery, controlling for maternal care, puberty, and gender. No additive or interactive effects involving maternal care emerged. These findings suggest that maternal overprotection may exert a unique and important influence on youth's stress response.

  9. Maternal care determines rapid effects of stress mediators on synaptic plasticity in adult rat hippocampal dentate gyrus

    NARCIS (Netherlands)

    Bagot, R.C.; van Hasselt, F.N.; Champagne, D.L.; Meaney, M.J.; Krugers, H.J.; Joëls, M.

    2009-01-01

    Maternal care in the rat influences hippocampal development, synaptic plasticity and cognition. Previous studies, however, have examined animals under minimally stressful conditions. Here we tested the hypothesis that maternal care influences hippocampal function differently when this structure is

  10. Associations between birth health, maternal employment, and child care arrangement among a community sample of mothers with young children.

    Science.gov (United States)

    Chiao, Chi; Chyu, Laura; Ksobiech, Kate

    2014-01-01

    Although a large body of literature exists on how different types of child care arrangements affect a child's subsequent health and sociocognitive development, little is known about the relationship between birth health and subsequent decisions regarding type of nonparental child care as well as how this relationship might be influenced by maternal employment. This study used data from the Los Angeles Families and Neighborhoods Survey (L.A.FANS). Mothers of 864 children (ages 0-5) provided information regarding birth weight, maternal evaluation of a child's birth health, child's current health, maternal employment, type of child care arrangement chosen, and a variety of socioeconomic variables. Child care options included parental care, relative care, nonrelative care, and daycare center. Multivariate analyses found that birth weight and subjective rating of birth health had similar effects on child care arrangement. After controlling for a child's age and current health condition, multinomial logit analyses found that mothers with children with poorer birth health are more likely to use nonrelative and daycare centers than parental care when compared to mothers with children with better birth health. The magnitude of these relationships diminished when adjusting for maternal employment. Working mothers were significantly more likely to use nonparental child care than nonemployed mothers. Results suggest that a child's health early in life is significantly but indirectly related to subsequent decisions regarding child care arrangements, and this association is influenced by maternal employment. Development of social policy aimed at improving child care service should take maternal and family backgrounds into consideration.

  11. Non-western women in maternity care in the Netherlands: Exploring 'inadequate' use of prenatal care and the experiences of care professionals

    NARCIS (Netherlands)

    Boerleider, A.W.

    2015-01-01

    Non-western women in the Netherlands are more likely to make inadequate use of prenatal care than native Dutch women. Furthermore, non-western women are diverse in origin which implies diversity in their needs and expectations for maternity care. This thesis examines the factors and reasons

  12. Care decision making of frontline providers of maternal and newborn health services in the greater Accra region of Ghana.

    Directory of Open Access Journals (Sweden)

    Ebenezer Oduro-Mensah

    Full Text Available To explore the "how" and "why" of care decision making by frontline providers of maternal and newborn services in the Greater Accra region of Ghana and determine appropriate interventions needed to support its quality and related maternal and neonatal outcomes.A cross sectional and descriptive mixed method study involving a desk review of maternal and newborn care protocols and guidelines availability, focus group discussions and administration of a structured questionnaire and observational checklist to frontline providers of maternal and newborn care.Tacit knowledge or 'mind lines' was an important primary approach to care decision making. When available, protocols and guidelines were used as decision making aids, especially when they were simple handy tools and in situations where providers were not sure what their next step in management had to be. Expert opinion and peer consultation were also used through face to face discussions, phone calls, text messages, and occasional emails depending on the urgency and communication medium access. Health system constraints such as availability of staff, essential medicines, supplies and equipment; management issues (including leadership and interpersonal relations among staff, and barriers to referral were important influences in decision making. Frontline health providers welcomed the idea of interventions to support clinical decision making and made several proposals towards the development of such an intervention. They felt such an intervention ought to be multi-faceted to impact the multiple influences simultaneously. Effective interventions would also need to address immediate challenges as well as more long-term challenges influencing decision-making.Supporting frontline worker clinical decision making for maternal and newborn services is an important but neglected aspect of improved quality of care towards attainment of MDG 4 & 5. A multi-faceted intervention is probably the best way to make a

  13. Maternal Health Care Utilization Among Syrian Refugees in Lebanon and Jordan.

    Science.gov (United States)

    Tappis, Hannah; Lyles, Emily; Burton, Ann; Doocy, Shannon

    2017-09-01

    Purpose The influx of Syrian refugees into Jordan and Lebanon over the last 5 years presents an immense burden to national health systems. This study was undertaken to assess utilization of maternal health services among Syrian refugees in both countries. Description A cross-sectional survey of Syrian refugees living in urban and rural (non-camp) settings was conducted using a two-stage cluster survey design with probability proportional to size sampling in 2014-2015. Eighty-six percent of surveyed households in Lebanon and 88% of surveyed households in Jordan included women with a live birth in the last year. Information from women in this sub-set of households was analyzed to understand antenatal and intrapartum health service utilization. Assessment A majority of respondents reported seeking antenatal care, 82% and 89% in Jordan and Lebanon, respectively. Women had an average of at least six antenatal care visits. Nearly all births (98% in Jordan and 94% in Lebanon) took place in a health facility. Cesarean rates were similar in both countries; approximately one-third of all births were cesarean deliveries. A substantial proportion of women incurred costs for intrapartum care; 33% of Syrian women in Jordan and 94% of Syrian women in Lebanon reported paying out of pocket for their deliveries. The proportion of women incurring costs for intrapartum care was higher in Jordan both countries for women with cesarean deliveries compared to those with vaginal deliveries; however, this difference was not statistically significant in either country (Jordan p-value = 0.203; Lebanon p-value = 0.099). Conclusion Syrian refugees living in Jordan and Lebanon had similar levels of utilization of maternal health services, despite different health systems and humanitarian assistance provisions. As expected, a substantial proportion of households incurred out-of-pocket costs for essential maternal and newborn health services, making cost a major factor in care

  14. Women's maternity care needs and related service models in rural areas: A comprehensive systematic review of qualitative evidence.

    Science.gov (United States)

    Hoang, Ha; Le, Quynh; Ogden, Kathryn

    2014-12-01

    Understanding the needs of rural women in maternity care and service models available to them is significant for the development of effective policies and the sustainability of rural communities. Nevertheless, no systematic review of studies addressing these needs has been conducted. To synthesise the best available evidence on the experiences of women's needs in maternity care and existing service models in rural areas. Literature search of ten electronic databases, digital theses, and reference lists of relevant studies applying inclusion/exclusion criteria was conducted. Selected papers were assessed using standardised critical appraisal instruments from JBI-QARI. Data extracted from these studies were synthesised using thematic synthesis. 12 studies met the inclusion criteria. There were three main themes and several sub-themes identified. A comprehensive set of the maternity care expectations of rural women was reported in this review including safety (7), continuity of care (6) and quality of care (6), and informed choices needs (4). In addition, challenges in accessing maternity services also emerged from the literature such as access (6), risk of travelling (9) and associated cost of travel (9). Four models of maternity care examined in the literature were medically led care (5), GP-led care (4), midwifery-led care (7) and home birth (6). The systematic review demonstrates the importance of including well-conducted qualitative studies in informing the development of evidence-based policies to address women's maternity care needs and inform service models. Synthesising the findings from qualitative studies offers important insight for informing effective public health policy. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  15. 'Even when you are afraid, you stay': Provision of maternity care during the Ebola virus epidemic: A qualitative study.

    Science.gov (United States)

    Jones, Susan; Sam, Betty; Bull, Florence; Pieh, Steven Bagie; Lambert, Jaki; Mgawadere, Florence; Gopalakrishnan, Somasundari; Ameh, Charles A; van den Broek, Nynke

    2017-09-01

    to explore nurse-midwives understanding of their role in and ability to continue to provide routine and emergency maternity services during the time of the Ebola virus disease epidemic in Sierra Leone. a hermenuetic phenomenological approach was used to discover the lived experiences of nurse-midwives through 66 face to face interviews. Following verbatim transcription, an iterative approach to data analysis was adopted using framework analysis to discover the essence of the lived experience. health facilities designated to provide maternity care across all 14 districts of Sierra Leone. nurses, midwives, medical staff and managers providing maternal and newborn care during the Ebola epidemic in facilities designated to provide basic or emergency obstetric care. the healthcare system in Sierra Leone was ill prepared to cope with the epidemic. Fear of Ebola and mistrust kept women from accessing care at a health facility. Healthcare providers continued to provide maternity care because of professional duty, responsibility to the community and religious beliefs. nurse-midwives faced increased risks of catching Ebola compared to other health workers but continued to provide essential maternity care. future preparedness plans must take into account the impact that epidemics have on the ability of the health system to continue to provide vital routine and emergency maternal and newborn health care. Healthcare providers need to have a stronger voice in health system rebuilding and planning and management to ensure that health service can continue to provide vital maternal and newborn care during epidemics. Copyright © 2017 The Author. Published by Elsevier Ltd.. All rights reserved.

  16. Maternity care for trafficked women: Survivor experiences and clinicians' perspectives in the United Kingdom's National Health Service.

    Science.gov (United States)

    Bick, Debra; Howard, Louise M; Oram, Sian; Zimmerman, Cathy

    2017-01-01

    Although trafficked women and adolescents are at risk of unprotected or forced sex, there is little research on maternity care among trafficking survivors. We explored health care needs, service use and challenges among women who became pregnant while in the trafficking situation in the United Kingdom (UK) and clinicians' perspectives of maternity care for trafficked persons. Cross-sectional survey and qualitative interviews with trafficking survivors recruited from statutory and voluntary sector organisations in England and qualitative interviews with maternity clinicians and family doctors undertaken to offer further insight into experiences reported by these women. Twenty-eight (29%) of 98 women who took part in a large study of trafficking survivors reported one or more pregnancies while trafficked, whose data are reported here. Twelve (42.8%) of these women reported at least one termination of pregnancy while in the trafficking situation and 25 (89.3%) experienced some form of mental health disorder. Nineteen (67.9%) women experienced pre-trafficking physical abuse and 9 (32.%) sexual abuse. A quarter of women were trafficked for sexual exploitation, six for domestic servitude and two for manual labour. Survivors and clinicians described service challenges, including restrictions placed on women's movements by traffickers, poor knowledge on how to access maternity care, poor understanding of healthcare entitlements and concerns about confidentiality. Maternity care clinicians recognised potential indicators of trafficking, but considered training would help them identify and respond to victims. Main limitations include that findings reflect women who had exited the trafficking situation, however as some had only recently exited the trafficking situation, difficulties with recall were likely to be low. More than one in four women became pregnant while trafficked, indicating that maternity services offer an important contact point for identification and care

  17. The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda.

    Science.gov (United States)

    Wang, Wenjuan; Temsah, Gheda; Mallick, Lindsay

    2017-04-01

    While research has assessed the impact of health insurance on health care utilization, few studies have focused on the effects of health insurance on use of maternal health care. Analyzing nationally representative data from the Demographic and Health Surveys (DHS), this study estimates the impact of health insurance status on the use of maternal health services in three countries with relatively high levels of health insurance coverage-Ghana, Indonesia and Rwanda. The analysis uses propensity score matching to adjust for selection bias in health insurance uptake and to assess the effect of health insurance on four measurements of maternal health care utilization: making at least one antenatal care visit; making four or more antenatal care visits; initiating antenatal care within the first trimester and giving birth in a health facility. Although health insurance schemes in these three countries are mostly designed to focus on the poor, coverage has been highly skewed toward the rich, especially in Ghana and Rwanda. Indonesia shows less variation in coverage by wealth status. The analysis found significant positive effects of health insurance coverage on at least two of the four measures of maternal health care utilization in each of the three countries. Indonesia stands out for the most systematic effect of health insurance across all four measures. The positive impact of health insurance appears more consistent on use of facility-based delivery than use of antenatal care. The analysis suggests that broadening health insurance to include income-sensitive premiums or exemptions for the poor and low or no copayments can increase use of maternal health care. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

  18. The home-based maternal record: a tool for family involvement in health care.

    Science.gov (United States)

    Shah, P M; Shah, K P; Belsey, M A

    1988-04-01

    The home-based maternal record offers an opportunity for family involvement in health care. Home-based records of maternal health have been used in several developing countries, and have led to increased detection and monitoring of women at high risk for complications during pregnancy. Home-based cards that include menstrual information remind health workers to educate and motivate women for family planning, and serve as a source of health statistics. Records that use pictures and symbols have been used by illiterate traditional birth attendants, and had an accurate completion rate of over 90%. The WHO has prepared a prototype record and guidelines for local adaptation. The objectives were to provide continuity of care throughout pregnancy, ensure recognition of at-risk women, encourage family participation in health care, an provide data on maternal health, breastfeeding, and family planning. The guidelines have been evaluated and results show that the records have improved the coverage, acceptability, and quality of MCH/FP care. The records have also led to an increase in diagnosis and referral of at-risk women and newborns, and the use of family planning and tetanus toxoid immunization has increased in the 13 centers where the reports are being used. Focus group discussions have shown that mothers, community members, primary health workers, and doctors and nurses liked the records. It is important to adapt criteria for high-risk conditions to the local areas where the records will be used to ensure the relevance of risk diagnosis. The evidence shows that home-based maternal and child records can be an important tool in the promotion of self-reliance and family participation in health care. In addition, home-based records can be used for the implementation of primary health care at the local level, and serve as a resource for data collection.

  19. Provision of care to clients of migrant origin: the experiences of maternity care providers.

    NARCIS (Netherlands)

    Boerleider, A.W.; Francke, A.L.; Wiegers, T.A.; Manniën, J.; Devillé, W.L.J.M.

    2012-01-01

    Background: Women of non-western migrant origin comprise a substantial part of the client population in maternity care. According to Statistics Netherlands, mothers of non-western migrant origin contribute to 17% of all live births. This group is very diverse in origin which implies a variety in

  20. How Communication Among Members of the Health Care Team Affects Maternal Morbidity and Mortality.

    Science.gov (United States)

    Brennan, Rita Allen; Keohane, Carol Ann

    In the United States, rates of severe maternal morbidity and mortality have escalated in the past decade. Communication failure among members of the health care team is one associated factor that can be modified. Nurses can promote effective communication. We provide strategies that incorporate team training principles and structured communication processes for use by providers and health care systems to improve the quality and safety of patient care and reduce the incidence of maternal mortality and morbidity. Copyright © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  1. The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review

    OpenAIRE

    Hunter, Benjamin M.; Harrison, Sean; Portela, Anayda; Bick, Debra

    2017-01-01

    BackgroundCash transfers and vouchers are forms of `demand-side financing' that have been widely used to promote maternal and newborn health in low- and middle-income countries during the last 15 years.MethodsThis systematic review consolidates evidence from seven published systematic reviews on the effects of different types of cash transfers and vouchers on the use and quality of maternity care services, and updates the systematic searches to June 2015 using the Joanna Briggs Institute appr...

  2. Maternal employment in child-care institutions and the risk of infant wheeze and atopic dermatitis in the offspring

    DEFF Research Database (Denmark)

    Hersoug, L.G.; Benn, C.S.; Simonsen, J.B.

    2008-01-01

    in the Danish National Birth Cohort were followed prospectively. Information on wheezing episodes, AD, maternal employment, and other variables were collected by interview at 12 and 30 wk of gestation, and 6 and 18 months of age, and by linkage to the Danish Medical Birth Register and the Child-care Database......% CI: 1.05-1.77), and 1.03 (95% CI: 0.81-1.31), respectively, for first-born infants of mothers employed in child-care institutions compared with infants of mothers not so employed. There was no effect of maternal employment in child-care institutions among infants with older siblings. In conclusion......, the results did not support the hypothesis that maternal microbial exposure before or during pregnancy as reflected by maternal employment in child-care institutions protects the offspring against infant wheeze and AD....

  3. [Analysis of obstetric-pediatric care in the perinatal period. Are births before 31 weeks' gestation in level 2B maternity units avoidable?

    Science.gov (United States)

    Martin, I; Roussel, A; Olieric, M-F; Feldmann, M; Wallerich, Y; Trabelsi, N; Miton, A; Zuily-Lamy, C; Valdès, V; Fresson, J

    2017-12-01

    Regionalization of perinatal care has been developed to improve the survival of preterm babies. The mortality rate is higher among very premature infants born outside level-3 maternity units. The objective of this study was to evaluate the preventability of these very premature births occurring outside recommendations within level-2B maternity units. The secondary objective was to describe the care of premature infants between 23 and 24 weeks. This is a single-center retrospective qualitative study of the care delivery pathways. Thirty-one deliveries in which the fetus was alive between 23 and 30 weeks+6 days occurred in a level-2B maternity unit in Thionville, France, between 1 January 2013 and 31 December 2015. After oral presentation of the cases, a level 2-3 multidisciplinary committee of experts in Lorraine evaluated the preventability criteria and reasons, and divided the deliveries into three groups: (i) birth in level-2B institutions avoidable, (ii) inevitable with factors related to the mother or the organization of care, (iii) with no inevitable factors. Out of the 31 deliveries included, the committee classified six deliveries as preventable, 14 as inevitable with factors, and 11 as inevitable with no factors. The criteria for preventability of birth in a level-2B unit were underestimation of maternal and fetal risk, an erroneous initial estimate of term or preterm labor, and two births in the upper limits of the French recommendations for in utero transfer. Nineteen of the 35 premature infants before 31 weeks' gestation died, 16 children were transferred to a level-3 maternity ward, and 16 children were allowed to go home. Analysis of the obstetrical-pediatric care course by an expert committee determined the preventability of the average birth and prematurity in level-2B maternity units in Lorraine for a small but significant number of cases. The local regionalization of neonatal care could be improved by the application of this method of analysis to

  4. The state of emergency obstetric care services in Nairobi informal settlements and environs: Results from a maternity health facility survey

    Directory of Open Access Journals (Sweden)

    Saliku Teresa

    2009-03-01

    Full Text Available Abstract Background Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1 delay in making the decision to seek care; 2 delay in reaching an appropriate obstetric facility; and 3 delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies. Methods We used data from a survey of 25 maternity health facilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system. Results Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden

  5. Correlates of maternal health care utilization in Rohilkhand region ...

    African Journals Online (AJOL)

    Maternal health care service utilization from health personnel was significantly associated with age at marriage ≥18 years, family size ≤3, birth order ≤2, nuclear family and higher socio‑economic status. Most of the pregnancy related complications were found among women aged >30 years, with birth order ≥3, having ...

  6. Committee Opinion No. 726 Summary: Hospital Disaster Preparedness for Obstetricians and Facilities Providing Maternity Care.

    Science.gov (United States)

    2017-12-01

    Large-scale catastrophic events and infectious disease outbreaks highlight the need for disaster planning at all community levels. Features unique to the obstetric population (including antepartum, intrapartum, postpartum and neonatal care) warrant special consideration in the event of a disaster. Pregnancy increases the risks of untoward outcomes from various infectious diseases. Trauma during pregnancy presents anatomic and physiologic considerations that often can require increased use of resources such as higher rates of cesarean delivery. Recent evidence suggests that floods and human-influenced environmental disasters increase the risks of spontaneous miscarriages, preterm births, and low-birth-weight infants among pregnant women. The potential surge in maternal and neonatal patient volume due to mass-casualty events, transfer of high-acuity patients, or redirection of patients because of geographic barriers presents unique challenges for obstetric care facilities. These circumstances require that facilities plan for additional increases in necessary resources and staffing. Although emergencies may be unexpected, hospitals and obstetric delivery units can prepare to implement plans that will best serve maternal and pediatric care needs when disasters occur. Clear designation of levels of maternal and neonatal care facilities, along with establishment of a regional network incorporating hospitals that provide maternity services and those that do not, will enable rapid transport of obstetric patients to the appropriate facilities, ensuring the right care at the right time. Using common terminology for triage and transfer and advanced knowledge of regionalization and levels of care will facilitate disaster preparedness.

  7. Introducing Evidence-Based Medicine and guidelines for maternal and newborn care in the Republic of Moldova

    DEFF Research Database (Denmark)

    Bacci, A; Wyn Huws, D; Baltag, V

    2005-01-01

    Familiarity with Evidence-Based Medicine (EBM) concepts is low amongst key maternal and newborn care clinicians in Moldova. Simple interventions can increase the knowledge of EBM concepts there.......Familiarity with Evidence-Based Medicine (EBM) concepts is low amongst key maternal and newborn care clinicians in Moldova. Simple interventions can increase the knowledge of EBM concepts there....

  8. Utilization of maternal health care services among indigenous women in Bangladesh: A study on the Mru tribe.

    Science.gov (United States)

    Islam, Rakibul M

    2017-01-01

    Despite startling developments in maternal health care services, use of these services has been disproportionately distributed among different minority groups in Bangladesh. This study aimed to explore the factors associated with the use of these services among the Mru indigenous women in Bangladesh. A total of 374 currently married Mru women were interviewed using convenience sampling from three administrative sub-districts of the Bandarban district from June to August of 2009. Associations were assessed using Chi-square tests, and a binary logistic regression model was employed to explore factors associated with the use of maternal health care services. Among the women surveyed, 30% had ever visited maternal health care services in the Mru community, a very low proportion compared with mainstream society. Multivariable logistic regression analyses revealed that place of residence, religion, school attendance, place of service provided, distance to the service center, and exposure to mass media were factors significantly associated with the use of maternal health care services among Mru women. Considering indigenous socio-cultural beliefs and practices, comprehensive community-based outreach health programs are recommended in the community with a special emphasis on awareness through maternal health education and training packages for the Mru adolescents.

  9. Estimation of maternal mortality using the indirect sisterhood method ...

    African Journals Online (AJOL)

    FinePrint

    is also useful for monitoring the trends of maternal mortality and evaluating the impact of safe motherhood initiative and improving maternal survival and achieving the MDGs. REFERENCES. 1. Lech M and Zwane A. Survey on maternal mortality in Swaziland using the Sisterhood method. Paedr Perinat Epidemiol; 2002: 16:.

  10. Maternity care professionals' perceptions of supporting employed women in Norway.

    Science.gov (United States)

    Alstveit, Marit; Severinsson, Elisabeth; Karlsen, Bjørg

    2011-09-01

    The World Health Organization calls on health professionals to support women in combining maternity and work. The aim of this study was to explore midwives' and public health nurses' perceptions of supporting employed women to balance work and family life during pregnancy and early motherhood. An exploratory design, including multistage focus group interviews, was used. The focus group consisted of five midwives and one public health nurse who was working in maternity care. The data were analyzed by using qualitative content analysis. The comprehensive theme, "empowering the women when they are in 'another' state of normality", was based on two themes, "being in dialogue with the women" and "supporting the women to manage daily activities". The first theme was based on the subthemes, "perceiving the women to be in 'another' state of normality" and "providing an open atmosphere for dialogue", while the second subtheme was based on "confirming self-esteem" and "suggesting adjustments at work". The midwives and public health nurse empowered the women by enhancing their ability to carry out the self-care that was necessary in order to manage both their work and family life. Collaboration between maternity healthcare providers and employers should be developed in order to support employed women. © 2011 Blackwell Publishing Asia Pty Ltd.

  11. Effects of nursing process-based simulation for maternal child emergency nursing care on knowledge, attitude, and skills in clinical nurses.

    Science.gov (United States)

    Kim, Sunghee; Shin, Gisoo

    2016-02-01

    Since previous studies on simulation-based education have been focused on fundamental nursing skills for nursing students in South Korea, there is little research available that focuses on clinical nurses in simulation-based training. Further, there is a paucity of research literature related to the integration of the nursing process into simulation training particularly in the emergency nursing care of high-risk maternal and neonatal patients. The purpose of this study was to identify the effects of nursing process-based simulation on knowledge, attitudes, and skills for maternal and child emergency nursing care in clinical nurses in South Korea. Data were collected from 49 nurses, 25 in the experimental group and 24 in the control group, from August 13 to 14, 2013. This study was an equivalent control group pre- and post-test experimental design to compare the differences in knowledge, attitudes, and skills for maternal and child emergency nursing care between the experimental group and the control group. The experimental group was trained by the nursing process-based simulation training program, while the control group received traditional methods of training for maternal and child emergency nursing care. The experimental group was more likely to improve knowledge, attitudes, and skills required for clinical judgment about maternal and child emergency nursing care than the control group. Among five stages of nursing process in simulation, the experimental group was more likely to improve clinical skills required for nursing diagnosis and nursing evaluation than the control group. These results will provide valuable information on developing nursing process-based simulation training to improve clinical competency in nurses. Further research should be conducted to verify the effectiveness of nursing process-based simulation with more diverse nurse groups on more diverse subjects in the future. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. The neighbourhood method for measuring differences in maternal mortality, infant mortality and other rare demographic events.

    Directory of Open Access Journals (Sweden)

    Nurul Alam

    Full Text Available In the absence of reliable systems for registering rare types of vital events large surveys are required to measure changes in their rates. However some events such as maternal deaths are widely known about in the community. This study examined the utility of asking respondents about events in their neighbourhood as an efficient method for measuring relative rates of rare health events such as maternal and infant deaths. A survey was conducted in the health and demographic surveillance system (HDSS in Matlab, Bangladesh, which includes two areas with different health care regimes. Adult women were asked about any maternal deaths; multiple births; infant deaths, live births and some other events they knew of in a small specified area around their home. Agreement between HDSS records and survey responses was moderate or better (kappa≥0.44 for all the events and greatest for maternal deaths (kappa = 0.77 with 84% being reported. Most events were more likely to be reported if they were recent (p<0.05. Infant mortality rate in one area was 0.56 times that in the other which was well reflected by the ratio of survey results (0.53. Simulations were used to study the ability of the method to detect differences in maternal mortality ratio. These suggested that a sample size around 5000 would give 80% power to detect a 50% decrease from a baseline of 183 which compared well with an estimated sample size around 10 times larger using the direct sisterhood method. The findings suggest that the Neighbourhood Method has potential for monitoring relative differences between areas or changes over time in the rates of rare demographic events, requiring considerably smaller sample sizes than traditional methods. This raises the possibility for interventions to demonstrate real effects on outcomes such as maternal deaths where previously this was only feasible by indirect methods.

  13. Preconception health and care (PHC)-a strategy for improved maternal and child health.

    Science.gov (United States)

    Berglund, Anna; Lindmark, Gunilla

    2016-06-20

    Maternal health status before pregnancy is a decisive factor for pregnancy outcomes and for risk for maternal and infant complications. Still, maternity care does not start until the pregnancy is established and in most low-income settings not until more than half of the pregnancy has passed, which often is too late to impact outcomes. In Western societies preconception care (PCC) is widely recognized as a way to optimize women's health through biomedical and behavioural changes prior to conception with the aim of improving pregnancy outcomes. But the content of PCC is inconsistent and limited to single interventions or preconception counselling to women with chronic illnesses. It has been suggested that PCC should be extended to preconception health and care (PHC), including interventions prior to pregnancy in order to optimize women's health in general, and thereby subsequent pregnancy outcomes, the well-being of the family, and the health of the future child. With this definition, almost every activity that can improve the health of girls and women can be included in the concept. In the World Health Report of 2005 a longitudinal approach to women's wellness and reproductive health was highlighted, and the World Health Organization has proposed a more comprehensive maternal and child health care, also including psychosocial issues and intimate partner violence. The present article gives an overview of the recent literature and discusses contents and delivery of PCC/PHC in Western as well as low-income countries. The article puts special emphasis on why violence against women is an issue for PHC.

  14. Attitudes and behaviours of maternal health care providers in interactions with clients: a systematic review.

    Science.gov (United States)

    Mannava, P; Durrant, K; Fisher, J; Chersich, M; Luchters, S

    2015-08-15

    High maternal mortality and morbidity persist, in large part due to inadequate access to timely and quality health care. Attitudes and behaviours of maternal health care providers (MHCPs) influence health care seeking and quality of care. Five electronic databases were searched for studies from January 1990 to December 2014. Included studies report on types or impacts of MHCP attitudes and behaviours towards their clients, or the factors influencing these attitudes and behaviours. Attitudes and behaviours mentioned in relation to HIV infection, and studies of health providers outside the formal health system, such as traditional birth attendants, were excluded. Of 967 titles and 412 abstracts screened, 125 full-text papers were reviewed and 81 included. Around two-thirds used qualitative methods and over half studied public-sector facilities. Most studies were in Africa (n = 55), followed by Asia and the Pacific (n = 17). Fifty-eight studies covered only negative attitudes or behaviours, with a minority describing positive provider behaviours, such as being caring, respectful, sympathetic and helpful. Negative attitudes and behaviours commonly entailed verbal abuse (n = 45), rudeness such as ignoring or ridiculing patients (n = 35), or neglect (n = 32). Studies also documented physical abuse towards women, absenteeism or unavailability of providers, corruption, lack of regard for privacy, poor communication, unwillingness to accommodate traditional practices, and authoritarian or frightening attitudes. These behaviours were influenced by provider workload, patients' attitudes and behaviours, provider beliefs and prejudices, and feelings of superiority among MHCPs. Overall, negative attitudes and behaviours undermined health care seeking and affected patient well-being. The review documented a broad range of negative MHCP attitudes and behaviours affecting patient well-being, satisfaction with care and care seeking. Reported negative patient

  15. Maternal deaths in the Nordic countries

    DEFF Research Database (Denmark)

    Vangen, Siri; Bødker, Birgit; Ellingsen, Liv

    2017-01-01

    reporting from hospitals. Each case was then assessed to determine the cause of death, and level of care provided. Potential improvements to care were evaluated. RESULTS: We registered 168 maternal deaths, 90 direct and 78 indirect cases. The maternal mortality ratio was 7.2/100 000 live births ranging from......INTRODUCTION: Despite the seriousness of the event, maternal deaths are substantially underreported. There is often a missed opportunity to learn from such tragedies. The aim of the study was to identify maternal deaths in the five Nordic countries, to classify causes of death based...... on internationally acknowledged criteria, and to identify areas that would benefit from further teaching, training or research to possibly reduce the number of maternal deaths. MATERIAL AND METHODS: We present data for the years 2005-2013. National audit groups collected data by linkage of registers and direct...

  16. Substandard care in maternal mortality due to hypertensive disease in pregnancy in the Netherlands

    NARCIS (Netherlands)

    Schutte, J. M.; Schuitemaker, N. W. E.; van Roosmalen, J.; Steegers, E. A. P.

    Objective To review the standard of care in cases of maternal mortality due to hypertensive diseases in pregnancy and to make recommendations for its improvement. Design Care given to women with hypertensive disease in pregnancy was audited and substandard care factors identified. Setting

  17. Post-up study : Postpartum depression screening in well-child care and maternal outcomes

    NARCIS (Netherlands)

    Van Der Zee-Van Den Berg, Angarath I.; Boere-Boonekamp, Magda M.; Groothuis-Oudshoorn, Catharina G.M.; IJzerman, Maarten J.; Haasnoot-Smallegange, Riet M.E.; Reijneveld, Sijmen A.

    2017-01-01

    OBJECTIVES: Postpartum depression often remains unaddressed. Screening in well-child care (WCC) may improve early detection, promote maternal recovery, and reduce effects on child development. We assessed the effectiveness of screening for postpartum depression in WCC compared with care as usual

  18. Post-Up Study : Postpartum Depression Screening in Well-Child Care and Maternal Outcomes

    NARCIS (Netherlands)

    van der Zee-van den Berg, Angarath I; Boere-Boonekamp, Magda M; Groothuis-Oudshoorn, Catharina G M; IJzerman, Maarten J; Haasnoot-Smallegange, Riet M E; Reijneveld, Sijmen A

    2017-01-01

    OBJECTIVES: Postpartum depression often remains unaddressed. Screening in well-child care (WCC) may improve early detection, promote maternal recovery, and reduce effects on child development. We assessed the effectiveness of screening for postpartum depression in WCC compared with care as usual

  19. Maternal Medical Complexity: Impact on Prenatal Health Care Spending among Women at Low Risk for Cesarean Section.

    Science.gov (United States)

    Cunningham, Shayna D; Herrera, Carolina; Udo, Ifeyinwa E; Kozhimannil, Katy B; Barrette, Eric; Magriples, Urania; Ickovics, Jeannette R

    Obstetric procedures are among the most expensive health care services, yet relatively little is known about health care spending among pregnant women, particularly the commercially-insured. The objective of this study was to examine the association between maternal medical complexity, as a result of having one or more comorbid conditions, and health care spending during the prenatal period among a national sample of 95,663 commercially-insured women at low risk for cesarean delivery. We conducted secondary analyses of 2010-2011 inpatient, outpatient, and professional claims for health care services from the Health Care Cost Institute. Allowed charges were summed for the prenatal and childbirth periods. Ordinary least squares regressions tested associations between maternal health conditions and health care expenditures during pregnancy. Thirty-four percent of pregnant women had one or more comorbidities; 8% had two or more. Pregnant women with one or more comorbidities had significantly higher allowed charges than those without comorbidities (p prenatal period was nearly three times higher for women with preexisting diabetes compared with women with no comorbid conditions. Average levels of prenatal period spending associated with maternal comorbidities were similar for women who had vaginal and cesarean deliveries. Patient characteristics accounted for 30% of the variance in prenatal period expenditures. The impact of maternal comorbidities, and in particular preexisting diabetes, on prenatal care expenditures should be taken into account as provider payment reforms, such as pay-for performance incentives and bundled payments for episodes of care, extend to maternal and child health-related services. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  20. Antenatal counseling in maternal and newborn care: use of job aids to improve health worker performance and maternal understanding in Benin.

    Science.gov (United States)

    Jennings, Larissa; Yebadokpo, André Sourou; Affo, Jean; Agbogbe, Marthe

    2010-11-22

    Antenatal care provides an important opportunity to improve maternal understanding of care during and after pregnancy. Yet, studies suggest that communication is often insufficient. This research examined the effect of a job aids-focused intervention on quality of counseling and maternal understanding of care for mothers and newborns. Counseling job aids were developed to support provider communication to pregnant women. Fourteen health facilities were randomized to control or intervention, where providers were trained to use job aids and provided implementation support. Direct observation of antenatal counseling sessions and patient exit interviews were undertaken to assess quality of counseling and maternal knowledge. Providers were also interviewed regarding their perceptions of the tools. Data were collected before and after the job aids intervention and analyzed using a difference-in-differences analysis to quantify relative changes over time. Mean percent of recommended messages provided to pregnant women significantly improved in the intervention arm as compared to the control arm in birth preparedness (difference-in-differences [ΔI-C] = +17.9, 95%CI: 6.7,29.1), danger sign recognition (ΔI-C = +26.0, 95%CI: 14.6,37.4), clean delivery (ΔI-C = +21.7, 95%CI: 10.9,32.6), and newborn care (ΔI-C = +26.2, 95%CI: 13.5,38.9). Significant gains were also observed in the mean percent of communication techniques applied (ΔI-C = +28.8, 95%CI: 22.5,35.2) and duration (minutes) of antenatal consultations (ΔI-C = +5.9, 95%CI: 3.0,8.8). No relative increase was found for messages relating to general prenatal care (ΔI-C = +8.2, 95%CI: -2.6,19.1). The proportion of pregnant women with correct knowledge also significantly improved for birth preparedness (ΔI-C = +23.6, 95%CI: 9.8,37.4), danger sign recognition (ΔI-C = +28.7, 95%CI: 14.2,43.2), and clean delivery (ΔI-C = +31.1, 95%CI: 19.4,42.9). There were no significant changes in maternal knowledge of general

  1. Quality of care provided in two Scottish rural community maternity units: a retrospective case review.

    Science.gov (United States)

    Denham, Sara; Humphrey, Tracy; Taylor, Ruth

    2017-06-21

    Women in Scotland with uncomplicated pregnancies are encouraged by professional bodies and national guidelines to access community based models of midwife-led care for their labour and birth. The evidence base for these guidelines relates to comparisons of predominantly urban birth settings in England. There appears to be little evidence available about the quality of the care during the antenatal, birth and post birth periods available for women within the Scottish Community Maternity Unit (CMU) model. The research aim was to explore the safety and effectiveness of the maternity services provided at two rural Community Maternity Units in Scotland, both 40 miles by main road access from a tertiary obstetric unit. Following appropriate NHS and University ethical approval, an anonymous retrospective review of consecutive maternity records for all women who accessed care at the CMUs over a 12 month period (June 2011 to May 2012) was undertaken in 2013 -14. Data was extracted using variables chosen to provide a description of the socio-demographics of the cohort and the process and outcomes of the care provided. Data were analysed using descriptive statistics. Regarding effectiveness, the correct care pathway was allocated to 97.5% of women, early access to antenatal care achieved by 95.7% of women, 94.8% of women at one CMU received continuity of carer and 78.6% of those clinically eligible accessed care in labour. 11.9% were appropriately transferred to obstetrician-led care antenatally and 16.9% were transferred in labour. All women received one-to one care in labour and 67.1% of babies born at the CMUs were breastfed at birth. Regarding safety, severe morbidity for women was rare, perineal trauma of 3rd degree tear occurred for 0.3% of women and 1.0% experienced an episiotomy. Severe post partum haemorrhage occurred for 0.3% of women. Babies admitted to the Neonatal unit were discharged within 48 hrs. These findings support the recommendations of professional

  2. Maternal care and birth outcomes among ethnic minority women in Finland

    Directory of Open Access Journals (Sweden)

    Gissler Mika

    2009-03-01

    Full Text Available Abstract Background Care during pregnancy and labour is of great importance in every culture. Studies show that people of migrant origin have barriers to obtaining accessible and good quality care compared to people in the host society. The aim of this study is to compare the access to and use of maternity services, and their outcomes among ethnic minority women having a singleton birth in Finland. Methods The study is based on data from the Finnish Medical Birth Register in 1999–2001 linked with the information of Statistics Finland on woman's country of birth, citizenship and mother tongue. Our study data included 6,532 women of foreign origin (3.9% of all singletons giving singleton birth in Finland during 1999–2001 (compared to 158,469 Finnish origin singletons. Results Most women have migrated during the last fifteen years, mainly from Russia, Baltic countries, Somalia and East Europe. Migrant origin women participated substantially in prenatal care. Interventions performed or needed during pregnancy and childbirth varied between ethnic groups. Women of African and Somali origin had most health problems resulted in the highest perinatal mortality rates. Women from East Europe, the Middle East, North Africa and Somalia had a significant risk of low birth weight and small for gestational age newborns. Most premature newborns were found among women from the Middle East, North Africa and South Asia. Primiparous women from Africa, Somalia and Latin America and Caribbean had most caesarean sections while newborns of Latin American origin had more interventions after birth. Conclusion Despite good general coverage of maternal care among migrant origin women, there were clear variations in the type of treatment given to them or needed by them. African origin women had the most health problems during pregnancy and childbirth and the worst perinatal outcomes indicating the urgent need of targeted preventive and special care. These study results

  3. Illness recognition, decision-making, and care-seeking for maternal and newborn complications: a qualitative study in Sarlahi District, Nepal.

    Science.gov (United States)

    Lama, Tsering P; Khatry, Subarna K; Katz, Joanne; LeClerq, Steven C; Mullany, Luke C

    2017-12-21

    Identification of maternal and newborn illness and the decision-making and subsequent care-seeking patterns are poorly understood in Nepal. We aimed to characterize the process and factors influencing recognition of complications, the decision-making process, and care-seeking behavior among families and communities who experienced a maternal complication, death, neonatal illness, or death in a rural setting of Nepal. Thirty-two event narratives (six maternal/newborn deaths each and 10 maternal/newborn illnesses each) were collected using in-depth interviews and small group interviews. We purposively sampled across specific illness and complication definitions, using data collected prospectively from a cohort of women and newborns followed from pregnancy through the first 28 days postpartum. The event narratives were coded and analyzed for common themes corresponding to three main domains of illness recognition, decision-making, and care-seeking; detailed event timelines were created for each. While signs were typically recognized early, delays in perceiving the severity of illness compromised prompt care-seeking in both maternal and newborn cases. Further, care was often sought initially from informal health providers such as traditional birth attendants, traditional healers, and village doctors. Key decision-makers were usually female family members; husbands played limited roles in decisions related to care-seeking, with broader family involvement in decision-making for newborns. Barriers to seeking care at any type of health facility included transport problems, lack of money, night-time illness events, low perceived severity, and distance to facility. Facility care was often sought only after referral or following treatment failure from an informal provider and private facilities were sought for newborn care. Respondents characterized government facility-based care as low quality and reported staff rudeness and drug type and/or supply stock shortages. Delaying

  4. Weight stigma in maternity care: Women’s experiences and care providers’ attitudes

    OpenAIRE

    Mulherin, K.; Miller, Y. D.; Barlow, F. K.; Diedrichs, P. C.; Thompson, R.

    2013-01-01

    Abstract Background Weight stigma is pervasive in Western society and in healthcare settings, and has a negative impact on victims’ psychological and physical health. In the context of an increasing focus on the management of overweight and obese women during and after pregnancy in research and clinical practice, the current studies aimed to examine the presence of weight stigma in maternity care. Addressing previous limitations in the weight stigma literature, this paper quantitatively explo...

  5. Estimating Maternal Mortality Rate Using Sisterhood Methods in ...

    African Journals Online (AJOL)

    ... maternal and child morbidity and mortality, which could serve as a surveillance strategy to identify the magnitude of the problem and to mobilize resources to areas where the problems are most prominent for adequate control. KEY WORDS: Maternal Mortality Rate, Sisterhood Method. Highland Medical Research Journal ...

  6. The contribution of maternal care and control, and community type to children's adjustment to political violence.

    Science.gov (United States)

    Tangir, Gali; Dekel, Rachel; Lavi, Tamar; Gewirtz, Abigail H; Zamir, Osnat

    2017-08-01

    This study explored the behavioral and emotional adjustment of Israeli school-age children who are exposed to political violence. Based on Bronfenbrenner's (1986) ecological model and ecological model of psychosocial trauma (Harvey, 2007), we examined the direct contribution of exposure, gender, maternal characteristics (mother's posttraumatic stress symptoms [PTSS], maternal care and maternal control), and community type (development town vs. kibbutz), to school-age children's adjustment. In addition, we examined whether maternal characteristics and community type moderated the association between exposure and adjustment. There were 121 mother-child dyads from the development town of Sderot (n = 62) and from the surrounding kibbutzim (n = 58) participated. Revealed that being a boy, living in Sderot, and mothers' higher PTSS, contributed directly to children's total difficulties (i.e., externalizing and internalizing problems), and that maternal control moderated the association between personal exposure and children's total difficulties. Furthermore, being a girl and mother's higher PTSS and higher maternal control contributed directly to children's PTSS. Mother's PTSS moderated the association between personal exposure and children's PTSS. Maternal care was not associated with children's adjustment. Both the child's gender and the type of community in which he or she lives are associated with maternal distress and children's adjustment to political violence. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  7. Culture and maternity care in Kazakhstan: what new mothers expected.

    Science.gov (United States)

    Craig, Brett J; Kabylbekova, Zhanar

    2015-01-01

    Maternity care in the developing nation of Kazakhstan has been characterized as low in quality, with mothers having low levels of health knowledge. Some nongovernmental organizations have been offering childbirth preparation courses to address the lack of knowledge and encourage participation and decision making among expecting mothers. The participants of this study, however, report that information is more for preparation than for decision making, and that the relational aspects of their care, namely, emotional support and trust, are most important. This emphasis reflects the cultural and historical influences that need to be considered when adopting foreign models of care and health education.

  8. Methodology for a mixed-methods multi-country study to assess recognition of and response to maternal and newborn illness.

    Science.gov (United States)

    Moran, Allisyn C; Charlet, Danielle; Madhavan, Supriya; Aruldas, Kumudha; Donaldson, Marie; Manzi, Fatuma; Okuga, Monica; Rosales, Alfonso; Sharma, Vandana; Celone, Michael; Brandes, Neal; Sherry, James M

    2017-12-21

    Although maternal and newborn mortality have decreased 44 and 46% respectively between 1990 and 2015, achievement of ambitious Sustainable Development Goal targets requires accelerated progress. Mortality reduction requires a renewed focus on the continuum of maternal and newborn care from the household to the health facility. Although barriers to accessing skilled care are documented for specific contexts, there is a lack of systematic evidence on how women and families identify maternal and newborn illness and make decisions and subsequent care-seeking patterns. The focus of this multi-country study was to identify and describe illness recognition, decision-making, and care-seeking patterns across various contexts among women and newborns who survived and died to ultimately inform programmatic priorities moving forward. This study was conducted in seven countries-Ethiopia, Tanzania, Uganda, Nigeria, India, Indonesia, and Nepal. Mixed-methods were utilized including event narratives (group interviews), in-depth interviews (IDIs), focus group discussions (FDGs), rapid facility assessments, and secondary analyses of existing program data. A common protocol and tools were developed in collaboration with study teams and adapted for each site, as needed. Sample size was a minimum of five cases of each type (e.g., perceived postpartum hemorrhage, maternal death, newborn illness, and newborn death) for each study site, with a total of 84 perceived PPH, 45 maternal deaths, 83 newborn illness, 55 newborn deaths, 64 IDIs/FGDs, and 99 health facility assessments across all sites. Analysis included coding within and across cases, identifying broad themes on recognition of illness, decision-making, and patterns of care seeking, and corresponding contextual factors. Technical support was provided throughout the process for capacity building, quality assurance, and consistency across sites. This study provides rigorous evidence on how women and families recognize and respond to

  9. Integration of HIV care into maternal health services: a crucial change required in improving quality of obstetric care in countries with high HIV prevalence.

    Science.gov (United States)

    Madzimbamuto, Farai D; Ray, Sunanda; Mogobe, Keitshokile D

    2013-06-10

    The failure to reduce preventable maternal deaths represents a violation of women's right to life, health, non-discrimination and equality. Maternal deaths result from weaknesses in health systems: inadequate financing of services, poor information systems, inefficient logistics management and most important, the lack of investment in the most valuable resource, the human resource of health workers. Inadequate senior leadership, poor communication and low staff morale are cited repeatedly in explaining low quality of healthcare. Vertical programmes undermine other service areas by creating competition for scarce skilled staff, separate reporting systems and duplication of training and tasks. Confidential enquiries and other quality-improvement activities have identified underlying causes of maternal deaths, but depend on the health system to respond with remedies. Instead of separate vertical programmes for management of HIV, tuberculosis, and reproductive health, integration of care and joint management of pregnancy and HIV would be more effective. Addressing health system failures that lead to each woman's death would have a wider impact on improving the quality of care provided in the health service as a whole. More could be achieved if existing resources were used more effectively. The challenge for African countries is how to get into practice interventions known from research to be effective in improving quality of care. Advocacy and commitment to saving women's lives are crucial elements for campaigns to influence governments and policy -makers to act on the findings of these enquiries. Health professional training curricula should be updated to include perspectives on patients' rights, communication skills, and integrated approaches, while using adult learning methods and problem-solving techniques. In countries with high rates of Human Immunodeficiency Virus (HIV), indirect causes of maternal deaths from HIV-associated infections now exceed direct causes

  10. Substandard emergency obstetric care - a confidential enquiry into maternal deaths at a regional hospital in Tanzania

    DEFF Research Database (Denmark)

    Sorensen, Bjarke Lund; Elsass, Peter; Nielsen, Brigitte Bruun

    2010-01-01

    for major substandard care. Hospital based maternal deaths between 2006 and 2008 (35 months) were included. Of 68 registered maternal deaths sufficient information for reviewing was retrieved for 62 cases (91%). As a supplement, in-depth interviews with staff about the underlying causes of substandard care...... in 46 (74%) of the 62 cases reviewed. During the same time period MDA identified substandard care in 18 cases. Staff perceived poor organization of work and lack of training as important causes for substandard care. Local MDA was considered useful although time-consuming and sometimes threatening......, and staff dedication to the process was questioned. CONCLUSION: Quality assurance of emergency obstetric care might be strengthened by supplementing internal MDA with external CE....

  11. [Inequality in primary care interventions in maternal and child health care in Mexico].

    Science.gov (United States)

    Ramírez-Tirado, Laura Alejandra; Tirado-Gómez, Laura Leticia; López-Cervantes, Malaquías

    2014-04-01

    To analyze the principal indicators associated with maternal mortality and mortality in children under 1 year of age and evaluate coverage levels and variability among the federative entities of Mexico. Eight interventions in maternal and child primary health care (variables) were studied: complete vaccination series, measles vaccine, and pentavalent vaccine in children under 1 year of age; early breast-feeding; prenatal care with at least one check-up by trained staff; prevalence of contraceptive use among married women of reproductive age; obstetric care in delivery by trained staff; and the administration of tetanus toxoid (TT) to pregnant women. The average and standard deviation of national coverage for each variable was calculated. Within each federative entity the proportion of municipalities with high, medium, and low marginalization was determined. States were ranked by the proportion of municipalities with high marginalization (highest to lowest) and divided into quintiles. Absolute inequality was measured using the observed difference and relative inequality, using the ratio of each variable studied. The average national coverage for the eight variables studied ranged from 86.5% to 97.5%, with administration of TT to pregnant women the lowest and administration of measles vaccine to children under 1 year of age the highest. Obstetric care in delivery, prevalence of contraceptive use, and prenatal checkup were the variables with less equitable coverage. In states with higher levels of marginalization, activities dependent on a structured health system-e.g., obstetric care in delivery-showed lower levels of coverage compared to preventive activities not requiring costly inputs or infrastructure-e.g., early breast-feeding. Interventions exhibiting greater inequity are associated with the lack of medical infrastructure and are more accentuated in federative entities with higher levels of marginalization. Greater public health expenditure is urgently needed

  12. Supply-side barriers to maternity-care in India: a facility-based analysis.

    Directory of Open Access Journals (Sweden)

    Santosh Kumar

    Full Text Available BACKGROUND: Health facilities in many low- and middle-income countries face several types of barriers in delivering quality health services. Availability of resources at the facility may significantly affect the volume and quality of services provided. This study investigates the effect of supply-side determinants of maternity-care provision in India. METHODS: Health facility data from the District-Level Household Survey collected in 2007-2008 were analyzed to explore the effects of supply-side factors on the volume of delivery care provided at Indian health facilities. A negative binomial regression model was applied to the data due to the count and over-dispersion property of the outcome variable (number of deliveries performed at the facility. RESULTS: Availability of a labor room (Incidence Rate Ratio [IRR]: 1.81; 95% Confidence Interval [CI]: 1.68-1.95 and facility opening hours (IRR: 1.43; CI: 1.35-1.51 were the most significant predictors of the volume of delivery care at the health facilities. Medical and paramedical staff were found to be positively associated with institutional deliveries. The volume of deliveries was also higher if adequate beds, essential obstetric drugs, medical equipment, electricity, and communication infrastructures were available at the facility. Findings were robust to the inclusion of facility's catchment area population and district-level education, health insurance coverage, religion, wealth, and fertility. Separate analyses were performed for facilities with and without a labor room and results were qualitatively similar across these two types of facilities. CONCLUSIONS: Our study highlights the importance of supply-side barriers to maternity-care India. To meet Millennium Development Goals 4 and 5, policymakers should make additional investments in improving the availability of medical drugs and equipment at primary health centers (PHCs in India.

  13. Severe acute maternal morbidity and maternal death audit - a rapid ...

    African Journals Online (AJOL)

    Severe acute maternal morbidity and maternal death audit - a rapid diagnostic tool for evaluating maternal care. L Cochet, R.C. Pattinson, A.P. Macdonald. Abstract. Objective. To analyse severe acute maternal morbidity (SAMM) and maternal mortality in the Pretoria region over a 2-year period (2000 - 2001). Setting.

  14. Direct maternal deaths in Norway 1976-1995

    DEFF Research Database (Denmark)

    Andersgaard, Alice Beate; Langhoff-Roos, J.; Oian, P.

    2008-01-01

    AIMS: To report direct maternal mortality ratio (MMR) in Norway between 1976 and 1995 including a description of the underlying complications in pregnancy, the causes of death and assessment of standard of care. METHODS: The maternal deaths were identified through the Cause of Death Registry......, Statistics Norway, and Medical Birth Registry of Norway. We requested copies of the hospital case records and the maternal death autopsies. The direct maternal deaths were classified on the basis underlying causes and assessed for substandard care according to the guidelines at the time of death...... and preventability provided optimal conditions and up to date guidelines. RESULTS: In the period 1976-1995 we identified 61 direct maternal deaths in Norway. The direct MMR was 5.5/100,000 births. Sufficient information was available for analysis in 51 of these cases. Six deaths occurred in early pregnancy. Among...

  15. Are Husbands Involving in Their Spouses' Utilization of Maternal Care Services?: A Cross-Sectional Study in Yangon, Myanmar.

    Directory of Open Access Journals (Sweden)

    Kyi Mar Wai

    Full Text Available Husbands can play a crucial role in pregnancy and childbirth, especially in patriarchal societies of developing countries. In Myanmar, despite the critical influence of husbands on the health of mothers and newborns, their roles in maternal health have not been well explored. Therefore, the aim of this study was to identify the factors associated with husbands' involvement in maternal health in Myanmar. This study also examined the associations between husbands' involvement and their spouses' utilization of maternal care services during antenatal, delivery and postnatal periods.A community-based, cross sectional study was conducted with 426 husbands in Thingangyun Township, Yangon, Myanmar. Participants were husbands aged 18 years or older who had at least one child within two years at the time of interview. Face to face interviews were conducted using a pretested structured questionnaire. Factors associated with the characteristics of husband's involvement as well as their spouses' utilization of maternal care services were analyzed by multivariable logistic regression models.Of 426 husbands, 64.8% accompanied their spouses for an antenatal visit more than once while 51.6% accompanied them for a postnatal visit. Husbands were major financial supporters for both antenatal (95.8% and postnatal care (68.5%. Overall, 69.7% were involved in decision making about the place of delivery. Regarding birth preparedness, the majority of husbands prepared for skilled birth attendance (91.1%, delivery place (83.6%, and money saving (81.7% before their spouses gave birth. In contrast, fewer planned for a potential blood donor (15.5% and a safe delivery kit (21.1%. In the context of maternal health, predictors of husband's involvement were parity, educational level, type of marriage, decision making level in family, exposure to maternal health education and perception of risk during pregnancy and childbirth. Increased utilization of maternal health services

  16. Are Husbands Involving in Their Spouses' Utilization of Maternal Care Services?: A Cross-Sectional Study in Yangon, Myanmar.

    Science.gov (United States)

    Wai, Kyi Mar; Shibanuma, Akira; Oo, Nwe Nwe; Fillman, Toki Jennifer; Saw, Yu Mon; Jimba, Masamine

    2015-01-01

    Husbands can play a crucial role in pregnancy and childbirth, especially in patriarchal societies of developing countries. In Myanmar, despite the critical influence of husbands on the health of mothers and newborns, their roles in maternal health have not been well explored. Therefore, the aim of this study was to identify the factors associated with husbands' involvement in maternal health in Myanmar. This study also examined the associations between husbands' involvement and their spouses' utilization of maternal care services during antenatal, delivery and postnatal periods. A community-based, cross sectional study was conducted with 426 husbands in Thingangyun Township, Yangon, Myanmar. Participants were husbands aged 18 years or older who had at least one child within two years at the time of interview. Face to face interviews were conducted using a pretested structured questionnaire. Factors associated with the characteristics of husband's involvement as well as their spouses' utilization of maternal care services were analyzed by multivariable logistic regression models. Of 426 husbands, 64.8% accompanied their spouses for an antenatal visit more than once while 51.6% accompanied them for a postnatal visit. Husbands were major financial supporters for both antenatal (95.8%) and postnatal care (68.5%). Overall, 69.7% were involved in decision making about the place of delivery. Regarding birth preparedness, the majority of husbands prepared for skilled birth attendance (91.1%), delivery place (83.6%), and money saving (81.7%) before their spouses gave birth. In contrast, fewer planned for a potential blood donor (15.5%) and a safe delivery kit (21.1%). In the context of maternal health, predictors of husband's involvement were parity, educational level, type of marriage, decision making level in family, exposure to maternal health education and perception of risk during pregnancy and childbirth. Increased utilization of maternal health services was found

  17. Two decades of maternity care fee exemption policies in Ghana: have they benefited the poor?

    Science.gov (United States)

    Johnson, Fiifi Amoako; Frempong-Ainguah, Faustina; Padmadas, Sabu S

    2016-02-01

    To investigate, the impact of maternity-related fee payment policies on the uptake of skilled birth care amongst the poor in Ghana. Population data representing 12 288 births between November 1990 and October 2008 from four consecutive rounds of the Ghana demographic and health surveys were used to examine the impact of four major maternity-related payment policies: the full-cost recovery 'cash and carry' scheme; 'antenatal care fee exemption'; 'delivery care fee exemption' and the 'National Health Insurance Scheme (NHIS)'. Concentration curves were used to analyse the rich-poor gap in the use of skilled birth care by the four policy interventions. Multilevel logistic regression was used to examine the effect of the policies on the uptake of skilled birth care, adjusting for relevant predictors and clustering within communities and districts. The uptake of skilled birth care over the policy periods for the poorest women was trivial when compared with their non-poor counterparts. The rich-poor gap in skilled birth care use was highly pronounced during the 'cash and carry' and 'free antenatal care' policies period. The benefits during the 'free delivery care' and ' NHIS' policy periods accrued more for the rich than the poor. There exist significant differences in skilled birth care use between and within communities and districts, even after adjusting for policy effects and other relevant predictors. The maternal care fee exemption policies specifically targeted towards the poorest women had limited impact on the uptake of skilled birth care. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

  18. The association of maternal social factors and antenatal care with ...

    African Journals Online (AJOL)

    Zinc is a crucial micronutrient in early childhood survival and the development of innate and acquired immunity. The objective is to determine the relationship between of maternal social class and antenatal care to serum zinc level in newborns in a tertiary and a rural hospital. It is prospective study using questionnaires on ...

  19. Patient-reported Communication Quality and Perceived Discrimination in Maternity Care.

    Science.gov (United States)

    Attanasio, Laura; Kozhimannil, Katy B

    2015-10-01

    High-quality communication and a positive patient-provider relationship are aspects of patient-centered care, a crucial component of quality. We assessed racial/ethnic disparities in patient-reported communication problems and perceived discrimination in maternity care among women nationally and measured racial/ethnic variation in the correlates of these outcomes. Data for this analysis came from the Listening to Mothers III survey, a national sample of women who gave birth to a singleton baby in a US hospital in 2011-2012. Outcomes were reluctance to ask questions and barriers to open discussion in prenatal care, and perceived discrimination during the birth hospitalization, assessed using multinomial and logistic regression. We also estimated models stratified by race/ethnicity. Over 40% of women reported communication problems in prenatal care, and 24% perceived discrimination during their hospitalization for birth. Having hypertension or diabetes was associated with higher levels of reluctance to ask questions and higher odds of reporting each type of perceived discrimination. Black and Hispanic (vs. white) women had higher odds of perceived discrimination due to race/ethnicity. Higher education was associated with more reported communication problems among black women only. Although having diabetes was associated with perceptions of discrimination among all women, associations were stronger for black women. Race/ethnicity was associated with perceived racial discrimination, but diabetes and hypertension were consistent predictors of communication problems and perceptions of discrimination. Efforts to improve communication and reduce perceived discrimination are an important area of focus for improving patient-centered care in maternity services.

  20. The Cues and Care Trial: A randomized controlled trial of an intervention to reduce maternal anxiety and improve developmental outcomes in very low birthweight infants

    Directory of Open Access Journals (Sweden)

    Dunkley David

    2008-09-01

    Full Text Available Abstract Background Very low birthweight infants are at risk for deficits in cognitive and language development, as well as attention and behaviour problems. Maternal sensitive behaviour (i.e. awareness of infant cues and appropriate responsiveness to those cues in interaction with her very low birthweight infant is associated with better outcomes in these domains; however, maternal anxiety interferes with the mother's ability to interact sensitively with her very low birthweight infant. There is a need for brief, cost-effective and timely interventions that address both maternal psychological distress and interactive behaviour. The Cues and Care trial is a randomized controlled trial of an intervention designed to reduce maternal anxiety and promote sensitive interaction in mothers of very low birthweight infants. Methods and design Mothers of singleton infants born at weights below 1500 g are recruited in the neonatal intensive care units of 2 tertiary care hospitals, and are randomly assigned to the experimental (Cues intervention or to an attention control (Care condition. The Cues intervention teaches mothers to attend to their own physiological, cognitive, and emotional cues that signal anxiety and worry, and to use cognitive-behavioural strategies to reduce distress. Mothers are also taught to understand infant cues and to respond sensitively to those cues. Mothers in the Care group receive general information about infant care. Both groups have 6 contacts with a trained intervener; 5 of the 6 sessions take place during the infant's hospitalization, and the sixth contact occurs after discharge, in the participant mother's home. The primary outcome is maternal symptoms of anxiety, assessed via self-report questionnaire immediately post-intervention. Secondary outcomes include maternal sensitive behaviour, maternal symptoms of posttraumatic stress, and infant development at 6 months corrected age. Discussion The Cues and Care trial will

  1. The Cues and Care Trial: A randomized controlled trial of an intervention to reduce maternal anxiety and improve developmental outcomes in very low birthweight infants

    Science.gov (United States)

    Zelkowitz, Phyllis; Feeley, Nancy; Shrier, Ian; Stremler, Robyn; Westreich, Ruta; Dunkley, David; Steele, Russell; Rosberger, Zeev; Lefebvre, Francine; Papageorgiou, Apostolos

    2008-01-01

    Background Very low birthweight infants are at risk for deficits in cognitive and language development, as well as attention and behaviour problems. Maternal sensitive behaviour (i.e. awareness of infant cues and appropriate responsiveness to those cues) in interaction with her very low birthweight infant is associated with better outcomes in these domains; however, maternal anxiety interferes with the mother's ability to interact sensitively with her very low birthweight infant. There is a need for brief, cost-effective and timely interventions that address both maternal psychological distress and interactive behaviour. The Cues and Care trial is a randomized controlled trial of an intervention designed to reduce maternal anxiety and promote sensitive interaction in mothers of very low birthweight infants. Methods and design Mothers of singleton infants born at weights below 1500 g are recruited in the neonatal intensive care units of 2 tertiary care hospitals, and are randomly assigned to the experimental (Cues) intervention or to an attention control (Care) condition. The Cues intervention teaches mothers to attend to their own physiological, cognitive, and emotional cues that signal anxiety and worry, and to use cognitive-behavioural strategies to reduce distress. Mothers are also taught to understand infant cues and to respond sensitively to those cues. Mothers in the Care group receive general information about infant care. Both groups have 6 contacts with a trained intervener; 5 of the 6 sessions take place during the infant's hospitalization, and the sixth contact occurs after discharge, in the participant mother's home. The primary outcome is maternal symptoms of anxiety, assessed via self-report questionnaire immediately post-intervention. Secondary outcomes include maternal sensitive behaviour, maternal symptoms of posttraumatic stress, and infant development at 6 months corrected age. Discussion The Cues and Care trial will provide important information

  2. Travel time to maternity care and its effect on utilization in rural Ghana: a multilevel analysis.

    Science.gov (United States)

    Masters, Samuel H; Burstein, Roy; Amofah, George; Abaogye, Patrick; Kumar, Santosh; Hanlon, Michael

    2013-09-01

    Rates of neonatal and maternal mortality are high in Ghana. In-facility delivery and other maternal services could reduce this burden, yet utilization rates of key maternal services are relatively low, especially in rural areas. We tested a theoretical implication that travel time negatively affects the use of in-facility delivery and other maternal services. Empirically, we used geospatial techniques to estimate travel times between populations and health facilities. To account for uncertainty in Ghana Demographic and Health Survey cluster locations, we adopted a novel approach of treating the location selection as an imputation problem. We estimated a multilevel random-intercept logistic regression model. For rural households, we found that travel time had a significant effect on the likelihood of in-facility delivery and antenatal care visits, holding constant education, wealth, maternal age, facility capacity, female autonomy, and the season of birth. In contrast, a facility's capacity to provide sophisticated maternity care had no detectable effect on utilization. As the Ghanaian health network expands, our results suggest that increasing the availability of basic obstetric services and improving transport infrastructure may be important interventions. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Immigrants' experiences of maternity care in Japan.

    Science.gov (United States)

    Igarashi, Yukari; Horiuchi, Shigeko; Porter, Sarah E

    2013-08-01

    Language and cultural differences can negatively impact immigrant women's birth experience. However, little is known about their experiences in Japan's highly homogenous culture. This cross-sectional study used survey data from a purposive sampling of immigrant women from 16 hospitals in several Japanese prefectures. Meeting the criteria and recruited to this study were 804 participants consisting of 236 immigrant women: Chinese (n = 83), Brazilian (n = 62), Filipino (n = 43), South Korean (n = 29) and from variety of English speaking nations (n = 19) and 568 Japanese women. The questionnaire was prepared in six languages: Japanese (kana syllables), Chinese, English, Korean, Portuguese, and Tagalog (Filipino). Associations among quality of maternity care, Japanese literacy level, loneliness and care satisfaction were explored using analysis of variance and multiple linear regression. The valid and reliable instruments used were Quality of Care for Pregnancy, Delivery and Postpartum Questionnaire, Rapid Estimate of Adult Literacy in Medicine Japanese version, the revised UCLA Loneliness Scale-Japanese version and Care satisfaction. Care was evaluated across prenatal, labor and delivery and post-partum periods. Immigrant women scored higher than Japanese women for both positive and negative aspects. When loneliness was strongly felt, care satisfaction was lower. Some competence of Japanese literacy was more likely to obstruct positive communication with healthcare providers, and was associated with loneliness. Immigrant women rated overall care as satisfactory. Japanese literacy decreased communication with healthcare providers, and was associated with loneliness presumably because some literacy unreasonably increased health care providers' expectations of a higher level of communication.

  4. The buck stops here: midwives and maternity care in rural Scotland.

    Science.gov (United States)

    Harris, Fiona M; van Teijlingen, Edwin; Hundley, Vanora; Farmer, Jane; Bryers, Helen; Caldow, Jan; Ireland, Jillian; Kiger, Alice; Tucker, Janet

    2011-06-01

    To explore and understand what it means to provide midwifery care in remote and rural Scotland. Qualitative interviews with 72 staff from 10 maternity units, analysed via a case study approach. Remote and rural areas of Scotland. Predominantly midwives, with some additional interviews with paramedics, general surgeons, anaesthetists and GPs. Remote and rural maternity care includes a range of settings and models of care. However, the impact of rural geographies on decision-making and risk assessment is common to all settings. Making decisions and dealing with the implications of these decisions is, in many cases, done without onsite specialist support. This has implications for the skills and competencies that are needed to practice midwifery in remote and rural settings. Whereas most rural midwives reported that their skills in risk assessment and decisions to transfer were well developed and appropriate to practising in their particular settings, they perceived these decisions to be under scrutiny by urban-based colleagues and felt the need to stress their competence in the face of what they imagined to be stereotypes of rural incompetence. This study shows that skills in risk assessment and decision-making are central to high quality remote and rural midwifery care. However, linked to different perspectives on care, there is a risk that these skills can be undermined by contact with colleagues in large urban units, particularly when staff do not know each other well. There is a need to develop a professional understanding between midwives in different locations. It is important for the good working relationships between urban and rural maternity units that all midwives understand the importance of contextual knowledge in both decisions to transfer from rural locations and the position of midwives in receiving units. Multiprofessional CPD courses have been effective in bringing together teams around obstetric emergencies; we suggest that a similar format may be

  5. Maternity Care Update: Prenatal Care and Specific Conditions.

    Science.gov (United States)

    Smith, Andrew; Barr, Wendy B; Bassett-Novoa, Erin; LeFevre, Nicholas

    2018-04-01

    Early initiation of prenatal care is associated with improved health outcomes for women and newborns. An essential element of prenatal care is determining the estimated due date, ideally using a first-trimester ultrasound. Laboratory tests should be obtained to screen for conditions that can affect pregnancy. Routine immunizations for all pregnant women include influenza vaccine; tetanus toxoid, reduced diphtheria, acellular pertussis (Tdap) vaccine. All women should be screened for gestational diabetes mellitus in midpregnancy. Women with risk factors also should be screened in the first trimester. Aspirin (ie, 60 to 150 mg/day) starting at 12 to 16 weeks reduces the risk of preeclampsia for women at high risk. Chronic medical conditions should be managed according to guidelines to promote optimal control. Women with such conditions may require testing in the late third trimester. Induction of labor may be offered to these women before 41 weeks, based on the condition and relative risks and benefits of continued pregnancy. Women without maternal or fetal indications should not be offered elective delivery before 39 weeks, but should be offered induction at 41 weeks with a recommendation for delivery before 42 weeks. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  6. Frontline health worker motivation in the provision of maternal and neonatal health care in Ghana

    NARCIS (Netherlands)

    Aberese-Ako, Matilda

    2016-01-01

    The health of mothers and neonates is a concern for many countries, because they form the future of every society. In Ghana efforts have been made to address quality health care in order to accelerate progress in maternal and child health and reduce maternal and

  7. First-time mothers' experiences of early labour in Italian maternity care services.

    Science.gov (United States)

    Cappelletti, Giulia; Nespoli, Antonella; Fumagalli, Simona; Borrelli, Sara E

    2016-03-01

    The aim of this study is to explore first-time mothers' experiences of early labour in Italian maternity care services when admitted to hospital or advised to return home after maternity triage assessment. The study was conducted in a second-level maternity hospital in northern Italy with an obstetric unit for both low- and high-risk women. The participants included 15 first-time mothers in good general health with spontaneous labour at term of a low-risk pregnancy who accessed maternity triage during early labour, and were either admitted to hospital or advised to return home. A qualitative interpretive phenomenological study was conducted. A face-to-face recorded semi-structured interview was conducted with each participant 48-72h after birth. Four key themes emerged from the interviews: (a) recognising signs of early labour; (b) coping with pain at home; (c) seeking reassurance from healthcare professionals; and (d) being admitted to hospital versus returning home. Uncertainty about the progression of labour and the need for reassurance were cited by women as the main reasons for hospital visit in early labour. An ambivalent feeling was reported by the participants when admitted to hospital in early labour. In fact, while the women felt reassured in the first instance, some women subsequently felt dissatisfied due to the absence of one-to-one dedicated care during early labour. When advised to return home, a number of women reported feelings of disappointment, anger, fear, discouragement and anxiety about not being admitted to hospital; however, some of these women reported a subsequent feeling of comfort due to being at home and putting in place the suggestions made by the midwives during the maternity triage assessment. The guidance provided by midwives during triage assessment seemed to be the key factor influencing women׳s satisfaction when advised either to return home or to stay at the hospital during early labour. During antenatal classes and clinics

  8. Health Care Engagement and Follow-up After Perceived Discrimination in Maternity Care.

    Science.gov (United States)

    Attanasio, Laura; Kozhimannil, Katy B

    2017-09-01

    Negative experiences in the health care system, including perceived discrimination, can result in patient disengagement from health care. Four million US women give birth each year, and the perinatal period is a time of sustained interaction with the health care system, but potential consequences of negative experiences have not been examined in this context. We assessed whether perceived discrimination during the birth hospitalization were associated with postpartum follow-up care. Data were from the Listening to Mothers III survey, a nationally drawn sample of 2400 women with singleton births in US hospitals in 2011-2012. We used multivariate logistic regression to estimate adjusted odds of having a postpartum visit in the 8 weeks following birth by perceptions of discrimination due to (1) race/ethnicity; (2) insurance type; and (3) a difference of opinion with a provider about care. Women who experienced any of the 3 types of perceived discrimination had more than twice the odds of postpartum visit nonattendance (adjusted odds ratio=2.28, P=0.001), after adjusting for socioeconomic and medical characteristics. The postpartum visit is an opportunity for a patient and clinician to address continuing health problems following birth, discuss contraception, and screen for chronic disease. Forgoing this care may have negative health effects. The findings from this study underscore the need to reduce discrimination and improve maternity care experiences.

  9. Gestational diabetes mellitus: The prevalence, associated factors and foeto-maternal outcome of women attending antenatal care.

    Directory of Open Access Journals (Sweden)

    Mohd Azahadi Bin Omar

    2017-08-01

    Full Text Available Objective: The aim of the study is to determine the prevalence of gestational diabetes mellitus (GDM, its associated risk factors, foeto-maternal outcomes and prevalence of postnatal diabetes mellitus (DM. Methods: This is a cross-sectional study using retrospective data from existing antenatal records of new antenatal women who registered at 72 public health clinics in Selangor in January 2014. Results: A total of 745 antenatal records were reviewed. The prevalence of GDM women was 27.9% (n = 184. GDM risks were higher in women aged 35 years old and above and in those with maternal obesity. GDM women had a higher risk of having a non-spontaneous vaginal delivery compared to non-GDM women. The prevalence of postnatal DM among GDM mother was 12.1%. Working GDM mothers were at higher risk of developing postnatal DM. Conclusion: The prevalence of GDM among newly registered women attending antenatal public health care in Selangor was higher than previous studies. Health care personnel need to be vigilant in screening women with risk factors.

  10. Applicability of the ReproQ client experiences questionnaire for quality improvement in maternity care

    Science.gov (United States)

    Scheerhagen, Marisja; Tholhuijsen, Dominique J.C.; Birnie, Erwin; Franx, Arie; Bonsel, Gouke J.

    2016-01-01

    Background. The ReproQuestionnaire (ReproQ) measures the client’s experience with maternity care, following the WHO responsiveness model. In 2015, the ReproQ was appointed as national client experience questionnaire and will be added to the national list of indicators in maternity care. For using the ReproQ in quality improvement, the questionnaire should be able to identify best and worst practices. To achieve this, ReproQ should be reliable and able to identify relevant differences. Methods and Findings. We sent questionnaires to 17,867 women six weeks after labor (response 32%). Additionally, we invited 915 women for the retest (response 29%). Next we determined the test–retest reliability, the Minimally Important Difference (MID) and six known group comparisons, using two scorings methods: the percentage women with at least one negative experience and the mean score. The reliability for the percentage negative experience and mean score was both ‘good’ (Absolute agreement = 79%; intraclass correlation coefficient = 0.78). The MID was 11% for the percentage negative and 0.15 for the mean score. Application of the MIDs revealed relevant differences in women’s experience with regard to professional continuity, setting continuity and having travel time. Conclusions. The measurement characteristics of the ReproQ support its use in quality improvement cycle. Test–retest reliability was good, and the observed minimal important difference allows for discrimination of good and poor performers, also at the level of specific features of performance. PMID:27478690

  11. Transferring responsibility and accountability in maternity care: clinicians defining their boundaries of practice in relation to clinical handover

    Science.gov (United States)

    Chin, Georgiana S M; Warren, Narelle; Kornman, Louise; Cameron, Peter

    2012-01-01

    Objective This exploratory study reports on maternity clinicians’ perceptions of transfer of their responsibility and accountability for patients in relation to clinical handover with particular focus transfers of care in birth suite. Design A qualitative study of semistructured interviews and focus groups of maternity clinicians was undertaken in 2007. De-indentified data were transcribed and coded using the constant comparative method. Multiple themes emerged but only those related to responsibility and accountability are reported in this paper. Setting One tertiary Australian maternity hospital. Participants Maternity care midwives, nurses (neonatal, mental health, bed managers) and doctors (obstetric, neontatology, anaesthetics, internal medicine, psychiatry). Primary outcome measures Primary outcome measures were the perceptions of clinicians of maternity clinical handover. Results The majority of participants did not automatically connect maternity handover with the transfer of responsibility and accountability. Once introduced to this concept, they agreed that it was one of the roles of clinical handover. They spoke of complete transfer, shared and ongoing responsibility and accountability. When clinicians had direct involvement or extensive clinical knowledge of the patient, blurring of transition of responsibility and accountability sometimes occurred. A lack of ‘ownership’ of a patient and their problems were seen to result in confusion about who was to address the clinical issues of the patient. Personal choice of ongoing responsibility and accountability past the handover communication were described. This enabled the off-going person to rectify an inadequate handover or assist in an emergency when duty clinicians were unavailable. Conclusions There is a clear lack of consensus about the transition of responsibility and accountability—this should be explicit at the handover. It is important that on each shift and new workplace environment

  12. "Being flexible and creative": a qualitative study on maternity care assistants' experiences with non-Western immigrant women.

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    Boerleider, Agatha W; Francke, Anneke L; van de Reep, Merle; Manniën, Judith; Wiegers, Therese A; Devillé, Walter L J M

    2014-01-01

    Several studies conducted in developed countries have explored postnatal care professionals' experiences with non-western women. These studies reported different cultural practices, lack of knowledge of the maternity care system, communication difficulties, and the important role of the baby's grandmother as care-giver in the postnatal period. However, not much attention has been paid in existing literature to postnatal care professionals' approaches to these issues. Our main objective was to gain insight into how Dutch postnatal care providers--'maternity care assistants' (MCA)--address issues encountered when providing care for non-western women. A generic qualitative research approach was used. Two researchers interviewed fifteen MCAs individually, analysing the interview material separately and then comparing and discussing their results. Analytical codes were organised into main themes and subthemes. MCAs perceive caring for non-western women as interesting and challenging, but sometimes difficult too. To guarantee the health and safety of mother and baby, they have adopted flexible and creative approaches to address issues concerning traditional practices, socioeconomic status and communication. Furthermore, they employ several other strategies to establish relationships with non-western clients and their families, improve women's knowledge of the maternity care system and give health education. Provision of postnatal care to non-western clients may require special skills and measures. The quality of care for non-western clients might be improved by including these skills in education and retraining programmes for postnatal care providers on top of factual knowledge about traditional practices.

  13. Approaches to improve the quality of maternal and newborn health care: an overview of the evidence.

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    Austin, Anne; Langer, Ana; Salam, Rehana A; Lassi, Zohra S; Das, Jai K; Bhutta, Zulfiqar A

    2014-09-04

    Despite progress in recent years, an estimated 273,500 women died as a result of maternal causes in 2010. The burden of these deaths is disproportionately bourne by women who reside in low income countries or belong to the poorest sectors of the population of middle or high income ones, and it is particularly acute in regions where access to and utilization of facility-based services for childbirth and newborn care is lowest. Evidence has shown that poor quality of facility-based care for these women and newborns is one of the major contributing factors for their elevated rates of morbidity and mortality. In addition, women who perceive the quality of facilty-based care to be poor,may choose to avoid facility-based deliveries, where life-saving interventions could be availble. In this context, understanding the underlying factors that impact the quality of facility-based services and assessing the effectiveness of interventions to improve the quality of care represent critical inputs for the improvement of maternal and newborn health. This series of five papers assesses and summarizes information from relevant systematic reviews on the impact of various approaches to improve the quality of care for women and newborns. The first paper outlines the conceptual framework that guided this study and the methodology used for selecting the reviews and for the analysis. The results are described in the following three papers, which highlight the evidence of interventions to improve the quality of maternal and newborn care at the community, district, and facility level. In the fifth and final paper of the series, the overall findings of the review are discussed, research gaps are identified, and recommendations proposed to impove the quality of maternal and newborn health care in resource-poor settings.

  14. Maternal health-care seeking behavior in North India

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    Anjali Jain

    2017-01-01

    Full Text Available Introduction: Pregnancy and labour, if not kept under constant vigil, can end in serious complications or even death at any moment. The aim of the study was done to know the practices of community regarding maternity care during pregnancy, delivery and postnatal period. Methods: A cross-sectional, community based study was conducted on 120 rural, 120 urban elite and 120 urban slum areas mothers, who delivered within last three months. Results: One-fourth mothers in rural area faced one or the other problem during antenatal period while in urban slum and urban elite only 15% and 9.2% mothers had some problems, this percentage being 19.4 at district level. 14.5% respondents faced some kind of complication during delivery and more problems were faced by rural (17.5% while least common by urban elite (7.5% but the area wise difference was not significant. The most common source of treatment was ANM/ LHV/ Nurse (47.1% in rural, 40% in urban elite and 60% in urban slum. 12.8%, mothers took treatment from doctor (Government- 7.2%; Private- 5.6%. More than 10% did not take any treatment (11.8% in rural, 20% in urban elite. Conclusion: Still the large numbers of mothers are not seeking care of their ailments, during prenatal, natal or postnatal especially rural mothers

  15. Neuroendocrine Regulation of Maternal Behavior

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    Bridges, Robert S.

    2015-01-01

    The expression of maternal behavior in mammals is regulated by the developmental and experiential events over a female’s lifetime. In this review the relationships between the endocrine and neural systems that play key roles in these developmental and experiential that affect both the establishment and maintenance of maternal care are presented. The involvement of the hormones estrogen, progesterone, and lactogens are discussed in the context of ligand, receptor, and gene activity in rodents and to a lesser extent in higher mammals. The roles of neuroendocrine factors, including oxytocin, vasopressin, classical neurotransmitters, and other neural gene products that regulate aspects of maternal care are set forth, and the interactions of hormones with central nervous system mediators of maternal behavior are discussed. The impact of prior developmental factors, including epigenetic events, and maternal experience on subsequent maternal care are assessed over the course of the female’s lifespan. It is proposed that common neuroendocrine mechanisms underlie the regulation of maternal care in mammals. PMID:25500107

  16. Advancing a conceptual model to improve maternal health quality: The Person-Centered Care Framework for Reproductive Health Equity.

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    Sudhinaraset, May; Afulani, Patience; Diamond-Smith, Nadia; Bhattacharyya, Sanghita; Donnay, France; Montagu, Dominic

    2017-11-06

    Background: Globally, substantial health inequities exist with regard to maternal, newborn and reproductive health. Lack of access to good quality care-across its many dimensions-is a key factor driving these inequities. Significant global efforts have been made towards improving the quality of care within facilities for maternal and reproductive health. However, one critically overlooked aspect of quality improvement activities is person-centered care. Main body: The objective of this paper is to review existing literature and theories related to person-centered reproductive health care to develop a framework for improving the quality of reproductive health, particularly in low and middle-income countries. This paper proposes the Person-Centered Care Framework for Reproductive Health Equity, which describes three levels of interdependent contexts for women's reproductive health: societal and community determinants of health equity, women's health-seeking behaviors, and the quality of care within the walls of the facility. It lays out eight domains of person-centered care for maternal and reproductive health. Conclusions: Person-centered care has been shown to improve outcomes; yet, there is no consensus on definitions and measures in the area of women's reproductive health care. The proposed Framework reviews essential aspects of person-centered reproductive health care.

  17. Maternal care receptivity and its relation to perinatal and neonatal mortality. A rural study.

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    Bhardwaj, N; Hasan, S B; Zaheer, M

    1995-04-01

    A longitudinal study was conducted on 212 pregnant women from May 1987 to April 1988. Maternal Care Receptivity (MCR) "an innovative approach" was adopted for the assessment of maternal care services provided to pregnant mothers at their door steps. During follow-up, scores were allotted to each of the services rendered and antenatal status of pregnant women. Depending on the score--MCR was classified as high (11 to 8), moderate (7 to 4) or poor (3 to 0). Perinatal and neonatal deaths were recorded and an inverse relationship between MCR and perinatal and mortalities was observed (z = 5.46, p women with high MCR. One of the most important cause of high PNMR and neonatal mortality rate in developing countries is poor MCR, i.e., under utilization of even the existing maternal health services. The main reasons for this under utilization appear to be poverty, illiteracy, ignorance and lack of faith in modern medicine.

  18. Creating the next steps to care: Maternal heath, improvisation, and Fulani women in Niamey, Niger.

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    Burgess, Sarah

    2016-12-01

    On paper, Niger's maternal healthcare system is extensively outlined by policies which assure access to certain services and create hierarchical referral chains. In practice it remains intensely improvisational: actors in the system must frequently make up the next steps to giving and receiving care, often outside the existing policies and procedures. Although population health in Niger has improved since the recently enacted gratuité des soins policy (which guarantees free access to certain material and child health services), care on the ground is still dictated by difficult circumstances and scarce resources. Health workers often lack the required medications and supplies; nevertheless, they must find ways to deliver services. Patients seeking maternal health services are frequently dissatisfied with the care they receive and so move forward of their own volition, by negotiating with health workers or by looking for services elsewhere. This research builds on recent scholarly work on improvisation, and asks us to further look at the ways that improvisation can be informed by the identity of the actors. Examining case studies of women from the Fulani ethnic group illustrates how particular cultural differences can inform improvisation. Analysing improvisation can also have policy implications; identifying typical points of departure from the official maternal health care system can reveal points where Niger can bolster its commitment to a universally high quality of care.

  19. An ethnographic study of communication challenges in maternity care for immigrant women in rural Alberta.

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    Higginbottom, Gina M A; Safipour, Jalal; Yohani, Sophie; O'Brien, Beverley; Mumtaz, Zubia; Paton, Patricia

    2015-02-01

    many immigrant and ethno-cultural groups in Canada face substantial barriers to accessing health care including language barriers. The negative consequences of miscommunication in health care settings are well documented although there has been little research on communication barriers facing immigrant women seeking maternity care in Canada. This study identified the nature of communication difficulties in maternity services from the perspectives of immigrant women, health care providers and social service providers in a small city in southern Alberta, Canada. a focused ethnography was undertaken incorporating interviews with 31 participants recruited using purposive and snowball sampling. A community liaison and several gatekeepers within the community assisted with recruitment and interpretation where needed (n=1). All interviews were recorded and audio files were transcribed verbatim by a professional transcriptionist. The data was analysed drawing upon principles expounded by Roper and Shapira (2000) for the analysis of ethnographic data, because of (1) the relevance to ethnographic data, (2) the clarity and transparency of the approach, (3) the systematic approach to analysis, and (4) the compatibility of the approach with computer-assisted qualitative analysis software programs such as Atlas.ti (ATLAS.ti Scientific Software Development GmbH, Germany). This process included (1) coding for descriptive labels, (2) sorting for patterns, (3) identification of outliers, (4) generation of themes, (5) generalising to generate constructs and theories, and (6) memoing including researcher reflections. four main themes were identified including verbal communication, unshared meaning, non-verbal communication to build relationships, and trauma, culture and open communication. Communication difficulties extended beyond matters of language competency to those encompassing non-verbal communication and its relation to shared meaning as well as the interplay of underlying pre

  20. Developing supplemental activities for primary health care maternity services.

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    Panitz, E

    1990-12-01

    Supplemental health care activities are described in the context of the augmented product. The potential benefits of supplemental services to recipients and provider are discussed. The author describes a study that was the basis for (re)developing a supplemental maternity service. The implementation of the results in terms of changes in the marketing mix of this supplemental program is discussed. The effects of the marketing mix changes on program participation are presented.

  1. Eclampsia: Feto-Maternal Outcomes in A Tertiary Care Centre in Eastern Nepal

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    Sita Ghimire

    2016-03-01

    Conclusions: Although the obstetric care facilities are improving with time, the feto-maternal outcomes are still poor in our country. Therefore early recognition and proper management are vital to tackle this challenge. Keywords: eclampsia; fetomaternal outcomes; retrospective analysis. | PubMed

  2. Variations in maternal care alter corticosterone and 17beta-estradiol levels, estrous cycle and folliculogenesis and stimulate the expression of estrogen receptors alpha and beta in the ovaries of UCh rats

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    Amorim João PA

    2011-12-01

    Full Text Available Abstract Background Variations in maternal care are associated with neonatal stress, hormonal disturbances and reproductive injuries during adulthood. However, the effects of these variations on sex hormones and steroid receptors during ovary development remain undetermined. This study aimed to investigate whether variations in maternal care are able to influence the hormonal profile, follicular dynamics and expression of AR, ER-alpha and ER-beta in the ovaries of UCh rat offspring. Methods Twenty-four adult UCh rats, aged 120 days, were randomly divided into two groups (UChA and UChB and mated. Maternal care was assessed from birth (day 0 to the 10th postnatal day (PND. In adulthood, twenty adult female rats (UChA and UChB offspring; n = 10/group, aged 120 days, were euthanized by decapitation during the morning estrus. Results UChA females (providing high maternal care more frequently displayed the behaviors of carrying pups, as well as licking/grooming and arched back nursing cares. Also, mothers providing high care had elevated corticosterone levels. Additionally, offspring receiving low maternal care showed the highest estrous cycle duration, increased corticosterone and 17beta-estradiol levels, overexpression of receptors ER-alpha and ER-beta, increased numbers of primordial, antral and mature follicles and accentuated granulosa cell proliferation. Conclusions Our study suggests that low maternal care alters corticosterone and 17beta-estradiol levels, disrupting the estrous cycle and folliculogenesis and differentially regulating the expression of ER-alpha and ER-beta in the ovaries of adult rats.

  3. Validity and reliability of the Turkish version of the Optimality Index-US (OI-US) to assess maternity care outcomes.

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    Yucel, Cigdem; Taskin, Lale; Low, Lisa Kane

    2015-12-01

    Although obstetrical interventions are used commonly in Turkey, there is no standardized evidence-based assessment tool to evaluate maternity care outcomes. The Optimality Index-US (OI-US) is an evidence-based tool that was developed for the purpose of measuring aggregate perinatal care processes and outcomes against an optimal or best possible standard. This index has been validated and used in Netherlands, USA and UK until now. The objective of this study was to adapt the OI-US to assess maternity care outcomes in Turkey. Translation and back translation were used to develop the Optimality Index-Turkey (OI-TR) version. To evaluate the content validity of the OI-TR, an expert panel group (n=10) reviewed the items and evidence-based quality of the OI-TR for application in Turkey. Following the content validity process, the OI-TR was used to assess 150 healthy and 150 high-risk pregnant women who gave birth at a high volume, urban maternity hospital in Turkey. The scores between the two groups were compared to assess the discriminant validity of the OI-TR. The percentage of agreement between two raters and the Kappa statistic were calculated to evaluate the reliability. Content validity was established for the OI-TR by an expert group. Discriminant validity was confirmed by comparing the OI scores of healthy pregnant women (mean OI score=77.65%) and those of high-risk pregnant women (mean OI score=78.60%). The percentage of agreement between the two raters was 96.19, and inter-rater agreement was provided for each item in the OI-TR. OI-TR is a valid and reliable tool that can be used to assess maternity care outcomes in Turkey. The results of this study indicate that although the risk statuses of the women differed, the type of care they received was essentially the same, as measured by the OI-TR. Care was not individualised based on risk and for a majority of items was inconsistent with evidence based practice, which is not optimal. Use of the OI-TR will help to

  4. Litter size reduction accentuates maternal care and alters behavioral and physiological phenotypes in rat adult offspring.

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    Enes-Marques, Silvia; Giusti-Paiva, Alexandre

    2018-01-27

    Maternal behavior has a substantial impact on the behavioral, endocrine, and neural development of the pups. This study investigated the effect of altering the neonatal nutritional environment by modifying the litter size on maternal care and anxiety- and fear-like behaviors in rats during adulthood. On postnatal day (PND) 2, litters were adjusted to a small litter (SL) size of three pups per dam or normal litter (NL) size of 12 pups per dam. Maternal behaviors were scored daily during lactation (PND2-21). The weight gain, food intake, adiposity, and biochemical landmarks of offspring rats were evaluated. On PND60, performances in the open field, elevated plus-maze (EPM), and fear conditioning test were measured. The reduction of the litter size enhanced maternal care in lactating rats, increasing the arched-back posture and licking pups. SL offspring exhibited accelerated weight gain, hyperphagia, increased visceral fat mass, dyslipidemia, and hyperleptinemia in adulthood. The SL offspring of both sexes showed an increase in the anti-thigmotactic effect in the open field, an intact anxious-phenotype in the EPM, and a decrease in the time spent freezing during the fear-conditioning test, compared to NL. The neonatal environment as determined by litter size plays a crucial role in programming the adult metabolic phenotype as well as behavioral responses to stressful stimuli, with an impact on anxiety-like and fear behaviors. These behavioral changes in offspring may be, at least in part, a result of increased maternal care.

  5. Transgenerational effects of maternal care interact with fetal growth and influence attention skills at 18 months of age.

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    Neuwald, Marla F; Agranonik, Marilyn; Portella, André K; Fleming, Alison; Wazana, Ashley; Steiner, Meir; Levitan, Robert D; Meaney, Michael J; Silveira, Patrícia P

    2014-05-01

    Evidence suggests that there is an association between being born small for gestational age (SGA) and an increased risk of internalizing and externalizing problems, such as ADHD. Additionally, individuals who report having received a lower quality of maternal care show an increased prevalence of depression and anxiety, and they are generally worse caregivers of their offspring. Therefore, an interaction between the birth weight status and the quality of maternal care perceived by the mother could affect behavioral outcomes of the children. Evaluate the influence of being born SGA and parental bonding, as perceived by the mother during her infancy, on the children's behavior at 18 months of age. Nested cross-sectional study within a Canadian prenatal cohort (MAVAN, Maternal Adversity, Vulnerability and Neurodevelopment) recruited from 2003 to 2010. Data from 305 children who were evaluated at 18 months of age. Early Childhood Behavior Questionnaire--ECBQ and Infant-Toddler Social and Emotional Assessment--ITSEA) were included. Children born SGA whose mothers reported low maternal care during her infancy (using the Parental Bonding Instrument--PBI) showed lower scores in the attentional set shifting trait (ECBQ, p=0.002) and attention construct (ITSEA, p=0.05) at 18 months of age. We also found that SGA increases decreases cuddliness (p=0.011) and poor perceived maternal care decreases low intensity pleasure (p=0.016) on the ECBQ. These findings suggest a complex transgenerational transmission whereby mother's own care interacts with the fetal growth of her offspring to predict its attentional skills at 18 months of age. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Maternity care practices and breastfeeding experiences of women in different racial and ethnic groups: Pregnancy Risk Assessment and Monitoring System (PRAMS).

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    Ahluwalia, Indu B; Morrow, Brian; D'Angelo, Denise; Li, Ruowei

    2012-11-01

    Research shows that maternity care practices are important to promoting breastfeeding in the early post partum period; however, little is known about the association between maternity care practices and breastfeeding among different racial and ethnic groups. We examined the association between maternity care practices and breastfeeding duration to ≥10 weeks overall and among various racial and ethnic groups using data from the Pregnancy Risk Assessment and Monitoring System (PRAMS). PRAMS is a state, population-based surveillance system that collects information on maternal behaviors. We used maternity care practices data from 11 states and New York City with response rates ≥70% from 2004 to 2006. Multiple maternity care practices were examined and the analysis adjusted for demographic characteristics, participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), lifestyle, and infant variables. The outcome variable for multivariable analysis was breastfeeding duration to ethnic groups. One practice, that of giving newborns breast milk only, was positively associated with breastfeeding duration of ≥10 weeks across all three groups. Maternity care practices associated with breastfeeding continuation to ≥10 weeks varied by race/ethnicity. For example: breastfeeding within the first hour, baby given a pacifier, and assistance from hospital staff, were significantly associated with breastfeeding duration among black and white women and not Hispanics. The practice of breastfeeding on demand was significantly associated with breastfeeding to ≥10 weeks for black and Hispanic women and not for whites. Hospitals may want to examine the implementation of specific practices in relation to the cultural backgrounds of women to promote breastfeeding.

  7. Mobile-health tool to improve maternal and neonatal health care in Bangladesh: a cluster randomized controlled trial.

    Science.gov (United States)

    Tobe, Ruoyan Gai; Haque, Syed Emdadul; Ikegami, Kiyoko; Mori, Rintaro

    2018-04-16

    In Bangladesh, the targets on reduction of maternal mortality and utilization of related obstetric services provided by skilled health personnel in Millennium Development Goals 5 remains unmet, and the progress in reduction of neonatal mortality lag behind that in the reduction of infant and under-five mortalities, remaining as an essential issue towards the achievement of maternal and neonatal health targets in health related Sustainable Development Goals (SDGs). As access to appropriate perinatal care is crucial to reduce maternal and neonatal deaths, recently several mobile platform-based health programs sponsored by donor countries and Non-Governmental Organizations have targeted to reduce maternal and child mortality. On the other hand, good health-care is necessary for the development. Thus, we designed this implementation research to improve maternal and child health care for targeting SDGs. This cluster randomized trial will be conducted in Lohagora of Narail District and Dhamrai of Dhaka District. Participants are pregnant women in the respective areas. The total sample size is 3000 where 500 pregnant women will get Mother and Child Handbook (MCH) and messages using mobile phone on health care during pregnancy and antenatal care about one year in each area. The other 500 in each area will get health education using only MCH book. The rest 1000 participants will be controlled; it means 500 in each area. We randomly assigned the intervention and controlled area based on smallest administrative area (Unions) in Bangladesh. The data collection and health education will be provided through trained research officers starting from February 2017 to August 2018. Each health education session is conducting in their house. The study proposal was reviewed and approved by NCCD, Japan and Bangladesh Medical Research Council (BMRC), Bangladesh. The data will be analyzed using STATA and SPSS software. For the improvement of maternal and neonatal care, this community

  8. Care-Related and Maternal Risk Factors Associated with the Antenatal Nondetection of Intrauterine Growth Restriction: A Case-Control Study from Bremen, Germany

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    Sinja Alexandra Ernst

    2017-01-01

    Full Text Available Objective. To identify care-related and maternal risk factors for the antenatal nondetection of IUGR. Methods. In this hospital-based case-control study we compared antenatally undetected IUGR neonates (cases to detected IUGR neonates (controls. Data were collected using newborn documentation sheets and standardized personal interviews with the mothers. We calculated antenatal detection rates and used uni- and multivariable logistic regression models to assess the association of antenatal nondetection of IUGR and maternal and care-related factors. Results. A total of 161 neonates from three hospitals were included in the study. Suboptimal fetal growth was identified antenatally in n=77 pregnancies while in n=84 it was not detected antenatally (antenatal detection rate: 47.8%. Severity of IUGR, maternal complications, and a Doppler examination during the course of pregnancy were associated with IUGR detection. We did not find statistically significant differences regarding parental socioeconomic status and maternal migration background. Conclusions. In our study, about half of all pregnancies affected by suboptimal growth remained undetected. Future in-depth studies with larger study populations should further examine factors that could increase antenatal detection rates for IUGR.

  9. Assessing the performance of maternity care in Europe: a critical exploration of tools and indicators.

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    Escuriet, Ramón; White, Joanna; Beeckman, Katrien; Frith, Lucy; Leon-Larios, Fatima; Loytved, Christine; Luyben, Ans; Sinclair, Marlene; van Teijlingen, Edwin

    2015-11-02

    This paper critically reviews published tools and indicators currently used to measure maternity care performance within Europe, focusing particularly on whether and how current approaches enable systematic appraisal of processes of minimal (or non-) intervention in support of physiological or "normal birth". The work formed part of COST Actions IS0907: "Childbirth Cultures, Concerns, and Consequences: Creating a dynamic EU framework for optimal maternity care" (2011-2014) and IS1405: Building Intrapartum Research Through Health - an interdisciplinary whole system approach to understanding and contextualising physiological labour and birth (BIRTH) (2014-). The Actions included the sharing of country experiences with the aim of promoting salutogenic approaches to maternity care. A structured literature search was conducted of material published between 2005 and 2013, incorporating research databases, published documents in english in peer-reviewed international journals and indicator databases which measured aspects of health care at a national and pan-national level. Given its emergence from two COST Actions the work, inevitably, focused on Europe, but findings may be relevant to other countries and regions. A total of 388 indicators were identified, as well as seven tools specifically designed for capturing aspects of maternity care. Intrapartum care was the most frequently measured feature, through the application of process and outcome indicators. Postnatal and neonatal care of mother and baby were the least appraised areas. An over-riding focus on the quantification of technical intervention and adverse or undesirable outcomes was identified. Vaginal birth (no instruments) was occasionally cited as an indicator; besides this measurement few of the 388 indicators were found to be assessing non-intervention or "good" or positive outcomes more generally. The tools and indicators identified largely enable measurement of technical interventions and undesirable

  10. Emotional labour and aboriginal maternal infant care workers: The invisible load.

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    Kirkham, R; Rumbold, A; Hoon, E; Stuart-Butler, D; Moore, V

    2018-04-01

    The term 'emotional labour' has been used to describe the competing demands on midwives to empathize with clients whilst maintaining a level of professional detachment. Previous research indicates that when individuals experience difficulty managing these emotions, burnout may result. Aboriginal health care workers often have roles with large emotional demands, as they are relied upon heavily to engage clients in care. However, the concept of emotional labour has received little attention in relation to this group. To explore potential sources of emotional labour for Aboriginal Maternal Infant Care workers in a maternity care program for Aboriginal women in South Australia. The program involves these workers providing care for women in partnership with midwives. We employed a phenomenological approach. Thirty in-depth interviews were conducted with staff and clients of the program. Recorded interviews were transcribed and coded and emerging themes identified. This workforce undertakes extensive emotional labour. Key sources include the cultural and family obligations they have to clients, complex social needs of many clients, and potential for community backlash when poor perinatal outcomes occur. A lack of respect for the role within the workplace further contributes to these experiences. This study found that the responsibilities inherent to the role as both cultural broker and carer create significant emotional labour for workers. Recommendations to address this and enhance the sustainability of this workforce include: recognition and valuing of emotional work by management and other staff, enhancing cultural awareness training, and building stress-relieving activities into the workplace. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  11. Comparison of maternal milk (breastmilk) expression methods in an African nursery.

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    Slusher, Tina M; Slusher, Ida L; Keating, Elizabeth M; Curtis, Beverly A; Smith, Eleanor A; Orodriyo, Elizabeth; Awori, Sussane; Nakakeeto, Margaret K

    2012-04-01

    This study compares maternal milk volumes (MMVs) of Ugandan mothers whose infants were in a special care nursery and who used one of three maternal milk expression techniques: double electric breast pump, single non-electric manual breast pump, and hand breastmilk expression. A convenience sample of 161 Ugandan mothers of infants who were either too immature or ill to independently feed from the breast yet healthy enough to survive in an environment without ventilator support (birth weights, 0.84-3.8 kg) were assigned to one of three maternal milk expressions: Group 1, double electric breast pump (n=55); Group 2, single non-electric manual breast pump (n=59); and Group 3, hand breastmilk expression (n=47). Data were collected over a 7-day period (from day 1 postpartum to day 7 postpartum), and mean MMVs were measured and compared among the groups. The mean daily MMVs were as follows: Group 1, mean=647 mL (SD=310); Group 2, mean=520 mL (SD=298); and Group 3, mean=434 mL (SD=291). Results from one-way analysis of variance revealed significant differences in the mean MMV based on the method of maternal milk expression (p=0.0019). Further analysis using Tukey's HSD Test revealed significant differences in the MMV between Groups 1 and 3 (p < 0.01), but not between Groups 1 and 2 or between Groups 2 and 3. Electric breast pumps provided the highest mean MMV; however, many mothers obtained adequate feeding volumes for their infants' daily nutritional needs with the single non-electric manual breast pump and hand breastmilk expression.

  12. The role of civil society in strengthening intercultural maternal health care in local health facilities: Puno, Peru

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    Jeannie Samuel

    2016-12-01

    Full Text Available Background and objective: Peru's Ministry of Health has made efforts to increase the cultural inclusiveness of maternal health services. In 2005, the Ministry adopted an intercultural birthing policy (IBP that authorizes and encourages the use of culturally acceptable birthing practices in government-run health facilities. However, studies suggest that indigenous women may receive inconsistent benefits from these kinds of policies. This article examines whether a grassroots accountability initiative based on citizen monitoring of local health facilities by indigenous women can help to promote the objectives of the IBP and improve intercultural maternal health care. Design: Findings are drawn from a larger qualitative research study completed in 2015 that included fieldwork done between 2010 and 2011. Semi-structured interviews were conducted with 23 women working as citizen monitors in local health facilities in Puno and 30 key informants, including frontline health workers, health officials, and civil society actors in Puno and Lima, and human rights lawyers from the Defensoría del Pueblo Office in Puno. Results: Monitors confirmed from their own personal experiences in the 1990s and early 2000s that respect for intercultural aspects of maternal health care, including traditional indigenous birthing practices, were not readily accepted in publicly funded health facilities. It was also common for indigenous women to face discrimination when seeking health service provided by the state. Although the government's adoption of the IBP in 2005 was a positive step, considerable efforts are still needed to ensure high-quality, culturally appropriate maternal health care is consistently available in local health facilities. Conclusions: Despite important progress in the past two decades, policies aimed at improving intercultural maternal health care are unevenly implemented in local health facilities. Civil society, in particular indigenous women

  13. The role of civil society in strengthening intercultural maternal health care in local health facilities: Puno, Peru

    Science.gov (United States)

    Samuel, Jeannie

    2016-01-01

    Background and objective Peru's Ministry of Health has made efforts to increase the cultural inclusiveness of maternal health services. In 2005, the Ministry adopted an intercultural birthing policy (IBP) that authorizes and encourages the use of culturally acceptable birthing practices in government-run health facilities. However, studies suggest that indigenous women may receive inconsistent benefits from these kinds of policies. This article examines whether a grassroots accountability initiative based on citizen monitoring of local health facilities by indigenous women can help to promote the objectives of the IBP and improve intercultural maternal health care. Design Findings are drawn from a larger qualitative research study completed in 2015 that included fieldwork done between 2010 and 2011. Semi-structured interviews were conducted with 23 women working as citizen monitors in local health facilities in Puno and 30 key informants, including frontline health workers, health officials, and civil society actors in Puno and Lima, and human rights lawyers from the Defensoría del Pueblo Office in Puno. Results Monitors confirmed from their own personal experiences in the 1990s and early 2000s that respect for intercultural aspects of maternal health care, including traditional indigenous birthing practices, were not readily accepted in publicly funded health facilities. It was also common for indigenous women to face discrimination when seeking health service provided by the state. Although the government's adoption of the IBP in 2005 was a positive step, considerable efforts are still needed to ensure high-quality, culturally appropriate maternal health care is consistently available in local health facilities. Conclusions Despite important progress in the past two decades, policies aimed at improving intercultural maternal health care are unevenly implemented in local health facilities. Civil society, in particular indigenous women themselves, can play an

  14. A Comparison of Medical Birth Register Outcomes between Maternity Health Clinics and Integrated Maternity and Child Health Clinics in Southwest Finland.

    Science.gov (United States)

    Tuominen, Miia; Kaljonen, Anne; Ahonen, Pia; Mäkinen, Juha; Rautava, Päivi

    2016-07-08

    Primary maternity care services are globally provided according to various organisational models. Two models are common in Finland: a maternity health clinic and an integrated maternity and child health clinic. The aim of this study was to clarify whether there is a relation between the organisational model of the maternity health clinics and the utilisation of maternity care services, and certain maternal and perinatal health outcomes. A comparative, register-based cross-sectional design was used. The data of women (N = 2741) who had given birth in the Turku University Hospital area between 1 January 2009 and 31 December 2009 were collected from the Finnish Medical Birth Register. Comparisons were made between the women who were clients of the maternity health clinics and integrated maternity and child health clinics. There were no clinically significant differences between the clients of maternity health clinics and integrated maternity and child health clinics regarding the utilisation of maternity care services or the explored health outcomes. The organisational model of the maternity health clinic does not impact the utilisation of maternity care services or maternal and perinatal health outcomes. Primary maternity care could be provided effectively when integrated with child health services.

  15. The effect of maternal substance abuse on the cost of neonatal care.

    Science.gov (United States)

    Norton, E C; Zarkin, G A; Calingaert, B; Bradley, C J

    1996-01-01

    This study addresses the effect of maternal substance abuse on the cost of neonatal care in a sample of all singleton live births in Maryland in 1991. Most other cost studies have analyzed data from only one hospital; we analyzed data from 54 hospitals and therefore can control for individual hospital effects and correlation of observations within hospitals. We find that maternal drug abuse has a significant positive effect on total hospital charges, length of stay, and average daily charges, with the increase in length of stay being proportionally greater than the increase in average daily charges. Maternal alcohol abuse also has a positive effect on hospital charges and length of stay, but the effects are not statistically significant. About half the effect of drug abuse on total charges works indirectly through premature birth and other comorbidities.

  16. Are stipulated requirements for the quality of maternity care complied with?

    Science.gov (United States)

    Johansen, Lars T; Pay, Aase Serine Devold; Broen, Lise; Roland, Brit; Øian, Pål

    2017-09-19

    The Directorate of Health’s national guide Et trygt fødetilbud – kvalitetskrav til fødselsomsorgen [A safe maternity service – requirements regarding the quality of maternity care] was published in December 2010 and was intended to provide a basis for an improved and more predictable maternity service. This article presents data from the maternity institutions on compliance with the quality requirements, including information on selection, fetal monitoring, organisation, staffing and competencies. The information was acquired with the aid of an electronic questionnaire in the period January–May 2015. The form was sent by e-mail to the medical officer in charge at all maternity units in Norway as at 1 January 2015 (n=47). There was a 100 % response to the questionnaire. The criteria for selecting where pregnant women should give birth were stated to be in conformity with the quality requirements. Some maternity institutions failed to describe the areas of responsibilities of doctors and midwives (38.5 % and 15.4 %, respectively). Few institutions recorded whether the midwife was present with the patient during the active phase. Half of the maternity departments (level 2 birth units) reported unfilled doctors’ posts, and a third of the university hospitals/central hospitals (level 1 birth units) reported a severe shortage of locum midwives. Half of the level 2 birth units believed that the quality requirements had resulted in improved training, but reported only a limited degree of interdisciplinary or mandatory instruction. The study reveals that there are several areas in which the health enterprises have procedures that conform to national quality requirements, but where it is still unclear whether they are observed in practice. Areas for improvement relate to routines describing areas of responsibility, availability of personnel resources and staff training.

  17. The Relationship between Maternal-Fetal Attachment and Mother-Infant Attachment Behaviors in Primiparous Women Referring to Mashhad Health Care Centers

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    Mahin Taffazoli

    2015-04-01

    Full Text Available Background & aim: Mother-infant bonding and interactions after childbirth are shaped by maternal-fetal attachment during pregnancy. Although many studies have shown the positive correlation between maternal-fetal attachment and mother-infant attachment behaviors, some controversial studies have shown otherwise. Therefore, this study aimed to evaluate the correlation between maternal-fetal attachment and mother-infant attachment behaviors in primiparous women. Methods:This descriptive correlational study was conducted on 100 primiparous women, referring to the selected heath care centers of Mashhad. Data were collected using Cranley's maternal–fetal attachment scale, Avant’s mother-infant attachment tool, Edinburgh postnatal depression scale, and a demographic/obstetric questionnaire including demographic data, obstetric information, delivery outcomes, and postpartum data. Pregnant women with a gestational age of 35-41 weeks, who met the inclusion criteria, completed Cranley's questionnaire, as well as the demographic/obstetric questionnaire. Four and eight weeks after delivery, the subjects were asked to complete the Edinburgh questionnaire and postpartum information; then, they were asked to breastfeed their infants on a chair in a quiet place for 15 minutes. The researcher observed the mothers’ behaviors toward their neonates. For data analysis, descriptive and analytical tests were performed, using SPSS version 16. Results: There was a direct positive relationship between maternal-fetal attachment and mothers’ emotional behaviors toward infants four and eight weeks after delivery. However, four and eight weeks after childbirth, no significant correlation was found between maternal-fetal attachment and mothers’ caring behaviors. Conclusion: According to the findings, maternal-fetal attachment is one of the most important factors for mother-infant attachment. These findings could be applied for enriching mother-infant attachment

  18. Age affects the expression of maternal care and subsequent behavioural development of offspring in a precocial bird.

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    Florent Pittet

    Full Text Available Variations of breeding success with age have been studied largely in iteroparous species and particularly in birds: survival of offspring increases with parental age until senescence. Nevertheless, these results are from observations of free-living individuals and therefore, it remains impossible to determine whether these variations result from parental investment or efficiency or both, and whether these variations occur during the prenatal or the postnatal stage or during both. Our study aimed first, to determine whether age had an impact on the expression of maternal breeding care by comparing inexperienced female birds of two different ages, and second, to define how these potential differences impact chicks' growth and behavioural development. We made 22 2-month-old and 22 8-month-old female Japanese quail foster 1-day-old chicks. We observed their maternal behaviour until the chicks were 11 days old and then tested these chicks after separation from their mothers. Several behavioural tests estimated their fearfulness and their sociality. We observed first that a longer induction was required for young females to express maternal behaviour. Subsequently as many young females as elder females expressed maternal behaviour, but young females warmed chicks less, expressed less covering postures and rejected their chicks more. Chicks brooded by elder females presented higher growth rates and more fearfulness and sociality. Our results reveal that maternal investment increased with age independently of maternal experience, suggesting modification of hormone levels implied in maternal behaviour. Isolated effects of maternal experience should now be assessed in females of the same age. In addition, our results show, for first time in birds, that variations in maternal care directly induce important differences in the behavioural development of chicks. Finally, our results confirm that Japanese quail remains a great laboratory model of avian

  19. Experimental evidence for convergent evolution of maternal care heuristics in industrialized and small-scale populations.

    Science.gov (United States)

    Kushnick, Geoff; Hanowell, Ben; Kim, Jun-Hong; Langstieh, Banrida; Magnano, Vittorio; Oláh, Katalin

    2015-06-01

    Maternal care decision rules should evolve responsiveness to factors impinging on the fitness pay-offs of care. Because the caretaking environments common in industrialized and small-scale societies vary in predictable ways, we hypothesize that heuristics guiding maternal behaviour will also differ between these two types of populations. We used a factorial vignette experiment to elicit third-party judgements about likely caretaking decisions of a hypothetical mother and her child when various fitness-relevant factors (maternal age and access to resources, and offspring age, sex and quality) were varied systematically in seven populations-three industrialized and four small-scale. Despite considerable variation in responses, we found that three of five main effects, and the two severity effects, exhibited statistically significant industrialized/ small-scale population differences. All differences could be explained as adaptive solutions to industrialized versus small-scale caretaking environments. Further, we found gradients in the relationship between the population-specific estimates and national-level socio-economic indicators, further implicating important aspects of the variation in industrialized and small-scale caretaking environments in shaping heuristics. Although there is mounting evidence for a genetic component to human maternal behaviour, there is no current evidence for interpopulation variation in candidate genes. We nonetheless suggest that heuristics guiding maternal behaviour in diverse societies emerge via convergent evolution in response to similar selective pressures.

  20. Women with disability: the experience of maternity care during pregnancy, labour and birth and the postnatal period

    Science.gov (United States)

    2013-01-01

    Background It has been estimated that 9.4% of women giving birth in the United Kingdom have one or more limiting longstanding illness which may cause disability, affecting pregnancy, birth and early parenting. No large scale studies on a nationally representative population have been carried out on the maternity experiences of disabled women to our knowledge. Method Secondary analysis of data from a survey of women in 2010 by English National Health Service Trusts on behalf of the Care Quality Commission was undertaken. 144 trusts in England took part in the postal survey. Women self-identified with disability and were excluded if less than 16 years of age or if their baby had died. The 12 page structured questionnaire with sections on antenatal, labour and birth and postnatal care covered access, information, communication and choice. Descriptive and adjusted analyses compared disabled and non-disabled groups. Comparisons were made separately for five disability subgroups: physical disability, sensory impairment, mental health conditions, learning disability and women with more than one type of disability. Results Disabled women comprised 6.14% (1,482) of the total sample (24,155) and appeared to use maternity services more than non-disabled women. Most were positive about their care and reported sufficient access and involvement, but were less likely to breastfeed. The experience of women with different types of disability varied: physically disabled women used antenatal and postnatal services more, but had less choice about labour and birth; the experience of those with a sensory impairment differed little from the non-disabled women, but they were more likely to have met staff before labour; women with mental health disabilities also used services more, but were more critical of communication and support; women with a learning disability and those with multiple disabilities were least likely to report a positive experience of maternity care. Conclusion This

  1. Quality of care and its effects on utilisation of maternity services at ...

    African Journals Online (AJOL)

    Quality of care and its effects on utilisation of maternity services at health centre level. ... in general, 97% with working hours, but only 37% were satisfied with privacy. ... long waiting time (OR 1.6, p = 0.02) and lack of privacy (OR l.5, p = 0.01).

  2. The Quality of Clinical Maternal and Neonatal Healthcare – A Strategy for Identifying ‘Routine Care Signal Functions’

    Science.gov (United States)

    Brenner, Stephan; De Allegri, Manuela; Gabrysch, Sabine; Chinkhumba, Jobiba; Sarker, Malabika; Muula, Adamson S.

    2015-01-01

    Background A variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH) programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs), a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC), the ‘EmOC signal functions’, a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example. Methods We first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal complications. We then tested this indicator set in a study assessing MNH quality of clinical care in 33 health facilities in Malawi. Results Our strategy identified 51 routine care processes: 23 related to initial patient risk assessment, 17 to risk monitoring, 11 to risk prevention. During the clinical performance assessment a total of 82 cases were observed. Birth attendants’ adherence to clinical standards was lowest in relation to risk monitoring processes. In relation to major complications, routine care processes addressing fetal and newborn distress were performed relatively consistently, but there were major gaps in the performance of routine care processes addressing bleeding, infection, and pre-eclampsia risks. Conclusion The identified set of process indicators could identify major gaps in the quality of obstetric and neonatal care provided during the intra- and immediate postpartum period. We hope our suggested indicators for essential routine care processes

  3. The effect of community maternal and newborn health family meetings on type of birth attendant and completeness of maternal and newborn care received during birth and the early postnatal period in rural Ethiopia.

    Science.gov (United States)

    Barry, Danika; Frew, Aynalem Hailemichael; Mohammed, Hajira; Desta, Binyam Fekadu; Tadesse, Lelisse; Aklilu, Yeshiwork; Biadgo, Abera; Buffington, Sandra Tebben; Sibley, Lynn M

    2014-01-01

    Maternal and newborn deaths occur predominantly in low-resource settings. Community-based packages of evidence-based interventions and skilled birth attendance can reduce these deaths. The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) used community-level health workers to conduct prenatal Community Maternal and Newborn Health family meetings to build skills and care-seeking behaviors among pregnant women and family caregivers. Baseline and endline surveys provided data on a random sample of women with a birth in the prior year. An intention-to-treat analysis, plausible net effect calculation, and dose-response analysis examined increases in completeness of care (mean percentage of 17 maternal and newborn health care elements performed) over time and by meeting participation. Regression models assessed the relationship between meeting participation, completeness of care, and use of skilled providers or health extension workers for birth care-controlling for sociodemographic and health service utilization factors. A 151% increase in care completeness occurred from baseline to endline. At endline, women who participated in 2 or more meetings had more complete care than women who participated in fewer than 2 meetings (89% vs 76% of care elements; P care completeness (P care were nearly 3 times more likely to have used a skilled provider or health extension worker for birth care. Women who had additionally attended 2 or more meetings with family members were over 5 times as likely to have used these providers, compared to women without antenatal care and who attended fewer than 2 meetings (odds ratio, 5.19; 95% confidence interval, 2.88-9.36; P care by engaging women and family caregivers in self-care and care-seeking, resulting in greater completeness of care and more highly skilled birth care. © 2014 by the American College of Nurse-Midwives.

  4. Effective non-drug interventions for improving outcomes and quality of maternal health care in sub-Saharan Africa: a systematic review.

    Science.gov (United States)

    Wekesah, Frederick M; Mbada, Chidozie E; Muula, Adamson S; Kabiru, Caroline W; Muthuri, Stella K; Izugbara, Chimaraoke O

    2016-08-15

    Many interventions have been implemented to improve maternal health outcomes in sub-Saharan Africa (SSA). Currently, however, systematic information on the effectiveness of these interventions remains scarce. We conducted a systematic review of published evidence on non-drug interventions that reported effectiveness in improving outcomes and quality of care in maternal health in SSA. African Journals Online, Bioline, MEDLINE, Ovid, Science Direct, and Scopus databases were searched for studies published in English between 2000 and 2015 and reporting on the effectiveness of interventions to improve quality and outcomes of maternal health care in SSA. Articles focusing on interventions that involved drug treatments, medications, or therapies were excluded. We present a narrative synthesis of the reported impact of these interventions on maternal morbidity and mortality outcomes as well as on other dimensions of the quality of maternal health care (as defined by the Institute of Medicine 2001 to comprise safety, effectiveness, efficiency, timeliness, patient centeredness, and equitability). Seventy-three studies were included in this review. Non-drug interventions that directly or indirectly improved quality of maternal health and morbidity and mortality outcomes in SSA assumed a variety of forms including mobile and electronic health, financial incentives on the demand and supply side, facility-based clinical audits and maternal death reviews, health systems strengthening interventions, community mobilization and/or peer-based programs, home-based visits, counseling and health educational and promotional programs conducted by health care providers, transportation and/or communication and referrals for emergency obstetric care, prevention of mother-to-child transmission of HIV, and task shifting interventions. There was a preponderance of single facility and community-based studies whose effectiveness was difficult to assess. Many non-drug interventions have been

  5. Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria: a retrospective study.

    Science.gov (United States)

    Almerie, Yara; Almerie, Muhammad Q; Matar, Hosam E; Shahrour, Yasser; Al Chamat, Ahmad Abo; Abdulsalam, Asmaa

    2010-10-19

    Investigating severe maternal morbidity (near-miss) is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. This study aims to i. document the frequency and nature of maternal near-miss at hospital level in Damascus, Capital of Syria, ii. evaluate the level of care at maternal life-saving emergency services by comparatively analysing near-misses and maternal mortalities. Retrospective facility-based review of cases of near-miss and maternal mortality that took place in the years 2006-2007 at Damascus Maternity University Hospital, Syria. Near-miss cases were defined based on disease-specific criteria (Filippi 2005) including: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. Main outcomes included maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality indices and proportion of near-miss cases and mortality cases to hospital admissions. There were 28,025 deliveries, 15 maternal deaths and 901 near-miss cases. The study showed a MNMR of 32.9/1000 live births, a MMR of 54.8/100,000 live births and a relatively low mortality index of 1.7%. Hypertensive disorders (52%) and haemorrhage (34%) were the top causes of near-misses. Late pregnancy haemorrhage was the leading cause of maternal mortality (60%) while sepsis had the highest mortality index (7.4%). Most cases (93%) were referred in critical conditions from other facilities; namely traditional birth attendants homes (67%), primary (5%) and secondary (10%) healthcare unites and private practices (11%). 26% of near-miss cases were admitted to Intensive Care Unit (ICU). Near-miss analyses provide valuable information on obstetric care. The study highlights the need to improve antenatal care which would help early identification of high risk pregnancies. It also emphasises the importance of both: developing protocols to prevent/manage post-partum haemorrhage and training health

  6. Trends and inequities in use of maternal health care services in Bangladesh, 1991-2011.

    Directory of Open Access Journals (Sweden)

    Iqbal Anwar

    Full Text Available Monitoring use-inequity is important to measure progress in efforts to address health-inequities. Using data from six Bangladesh Demographic and Health Surveys (BDHS, we examine trends, inequities and socio-demographic determinants of use of maternal health care services in Bangladesh between 1991 and 2011.Access to maternal health care services has improved in the last two decades. The adjusted yearly trend was 9.0% (8.6%-9.5% for any antenatal care (ANC, 11.9% (11.1%-12.7% for institutional delivery, and 18.9% (17.3%-20.5% for C-section delivery which is above the WHO recommended rate of 5-15%. Use-inequity was significant for all three indicators but is reducing over time. Between 1991-1994 and 2007-2011 the rich:poor ratio reduced from 3.65 to 1.65 for ANC and from 15.80 to 6.77 for institutional delivery. Between 1995-1998 and 2007-2011, the concentration index reduced from 0.27 (0.25-0.29 to 0.15 (0.14-0.16 for ANC, and from 0.65 (0.60-0.71 to 0.39 (0.37-0.41 for institutional delivery during that period. For use of c-section, the rich:poor ratio reduced from 18.17 to 13.39 and the concentration index from 0.66 (0.57-0.75 to 0.47 (0.45-0.49. In terms of rich:poor differences, there was equity-gain for ANC but not for facility delivery or C-section delivery. All socio-demographic variables were significant predictors of use; of them, maternal education was the most powerful. In addition, the contribution of for-profit private sector is increasingly growing in maternal health.Both access and equity are improving in maternal health. We recommend strengthening ongoing health and non-health interventions for the poor. Use-inequity should be monitored using multiple indicators which are incorporated into routine health information systems. Rising C-section rate is alarming and indication of C-sections should be monitored both in private and public sector facilities.

  7. Choice in maternity: rhetoric, reality and resistance.

    Science.gov (United States)

    Mander, Rosemary; Melender, Hanna-Leena

    2009-12-01

    to inform the organisation of the maternity services in Scotland, a phenomenological study was planned to examine maternity decision making in two similarly small countries. The aim was to examine the experience of contributing to decisions at clinical, organisational and policy-making levels. When examples were needed the informants were asked to use their experience of place of birth decisions. a hermeneutic phenomenological approach was employed. In-depth, semi-structured conversations were used. The fieldwork extended over a 4-month period in 2005. The data were analysed using Colaizzi's method. Finland and New Zealand were chosen because the parallels in their health care and maternity care systems would limit disparities. In one of the Finnish centres, the findings were particularly homogeneous and exemplified many of the issues arising in other settings. The findings of the fieldwork in this Finnish centre are the focus of this paper. the informants were mothers, midwife managers/policy makers, midwives and other maternity care providers. The findings of 12 conversations, including mothers and all groups of staff, are reported here. the background theme which emerged was 'trusting the system'. The informants were aware of the extent to which change is happening. One of the sub-themes contrasted the informants' perceptions of their lack of strength and courage with Finnish stereotypes. Being safe proved to be another crucial issue. The final sub-theme was 'playing the system'. trust in a well-respected health-care system was necessary for the informants to be able to subvert or resist that system. While such resistance has been documented in other disciplines, such as nursing, reference has not been found in relation to maternity. The resistance to the system was, at the time of the fieldwork, neither co-ordinated nor collaborative. the findings of this study carry important implications for women's and midwives' input into maternity care.

  8. Perceptions and experiences of parenthood and maternal health care among Latin American women living in Spain: a qualitative study.

    Science.gov (United States)

    Barona-Vilar, Carmen; Más-Pons, Rosa; Fullana-Montoro, Ana; Giner-Monfort, Jordi; Grau-Muñoz, Arantxa; Bisbal-Sanz, Josep

    2013-04-01

    to explore the experiences and perceptions of parenthood and maternal health care among Latin American women living in Spain. an exploratory qualitative research using focus groups and thematic analysis of the discussion. three focus groups with 26 women from Bolivia and Ecuador and three focus groups with 24 midwives were performed in three towns in the Valencian Community receiving a large influx of immigrants. the women interpreted motherhood as the role through which they achieve fulfilment and assumed that they were the ones who could best take care of their children. They perceived that men usually make decisions about sex and pregnancy and recognised a poor or inadequate use of contraceptive methods in planning their pregnancies. Women reported that it was not necessary to go as soon and as frequently for health examinations during pregnancy as the midwives suggested. The main barriers identified to health-care services were linked to insecure or illegal employment status, inflexible appointment timetables for prenatal checkups and sometimes to ignorance about how public services worked. empowering immigrant women is essential to having a long-term positive effect on their reproductive health. Antenatal care providers should be trained to build maternity care that is culturally sensitive and responds better to the health needs of different pregnant women and their newborns. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. Counseling about gestational weight gain and healthy lifestyle during pregnancy: Canadian maternity care providers' self-evaluation

    Directory of Open Access Journals (Sweden)

    Ferraro ZM

    2013-09-01

    Full Text Available Zachary M Ferraro,1 Kaitlin S Boehm,1 Laura M Gaudet,2,3 Kristi B Adamo1,4,5 1Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; 2Horizon Health Network, Saint John, New Brunswick, Canada; 3Department of Obstetrics and Gynaecology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; 4School of Human Kinetics, Faculty of Health Sciences, 5Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada Introduction: There is discord between the recall of maternity care providers and patients when it comes to discussion of gestational weight gain (GWG and obesity management. Few women report being advised on GWG, physical activity (PA, and nutrition, yet the majority of health care providers report discussing these topics with patients. We evaluated whether various Canadian maternal health care providers can identify appropriate GWG targets for patients with obesity and determine if providers report counseling on GWG, physical activity, and nutrition. Methods: A valid and reliable e-survey was created using SurveyMonkey software and distributed by the Society of Obstetricians and Gynaecologists of Canada listserve. A total of 174 health care providers finished the survey. Respondents self-identified as general practitioners, obstetricians, maternal-fetal medicine specialists, midwives, or registered nurses. Results: GWG recommendations between disciplines for all body mass index categories were similar and fell within Health Canada/Institute of Medicine (IOM guidelines. Of those who answered this question, 110/160 (68.8% were able to correctly identify the maximum IOM GWG recommended for patients with obesity, yet midwives tended to recommend 0.5–1 kg more GWG (P = 0.05. PA counseling during pregnancy differed between disciplines (P < 0.01, as did nutrition counseling during pregnancy (P < 0.05. Conclusion: In

  10. Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors

    Directory of Open Access Journals (Sweden)

    Mohammad Afzal Mahmood

    2018-01-01

    Full Text Available Background. Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants. Method. Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records’ review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays. Findings. The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals. Conclusion. There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped.

  11. Severe maternal morbidity for 2004-2005 in the three Dublin maternity hospitals.

    LENUS (Irish Health Repository)

    Murphy, Cliona M

    2012-02-01

    OBJECTIVE: To assess the prevalence and causes of severe maternal morbidity in Dublin over a two year period from 2004 to 2005. STUDY DESIGN: A prospective cohort study from January 2004 to December 2005 was undertaken in the three large maternity hospitals in Dublin, which serve a population of 1.5 million people. All are tertiary referral centres for obstetrics and neonatology and have an annual combined delivery rate of circa 23,000 births. Cases of severe maternal morbidity were identified. A systems based classification was used. The primary cause of maternal morbidity and the number of events experienced per patient was recorded. RESULTS: We identified 158 women who fulfilled the definition for severe maternal morbidity, giving a rate of 3.2 per 1000 maternities. There were two maternal deaths during the time period giving mortality to morbidity ratio of 1:79. The commonest cause of severe morbidity was vascular dysfunction related to obstetric haemorrhage. Eclampsia comprised 15.4% of cases. Intensive care or coronary care admission occurred in 12% of cases. CONCLUSION: The prevalence of severe maternal morbidity in this population is 3.2\\/1000 maternities. Obstetric haemorrhage was the main cause of severe maternal morbidity.

  12. Rural women's perspectives of maternity services in the Midland Region of New Zealand.

    Science.gov (United States)

    Gibbons, Veronique; Lancaster, Gytha; Gosman, Kim; Lawrenson, Ross

    2016-09-01

    INTRODUCTION Rural women face many challenges with regards to maternity services. Many rural primary birthing facilities in New Zealand have closed. The Lead Maternity Carer (LMC) model of maternity care, introduced in 1990, has moved provision of rural maternity care from doctors to independent midwifery services. Shortages of rural midwives in the Midland region led to rural maternity care being seen as a vulnerable service. AIM To understand the views and experiences of rural women concerning maternity care, to inform the future design and provision of rural maternity services. METHODS Participants were drawn from areas purposively selected to represent the five District Health Boards comprising the Midland health region. A demographic questionnaire, focus groups and individual interviews explored rural women's perspectives of antenatal care provision. These were analysed thematically. RESULTS Sixty-two women were recruited. Key themes emerging from focus groups and interviews included: access to services, the importance of safety and quality of care, the need for appropriate information at different stages, and the role of partners, family and friends in the birthing journey. While most women were happy with access to services, quality of care, provision of information, and the role of family in their care, for some women, this experience could be enhanced. CONCLUSION Midwives are the frontline service for women seeking antenatal services. Support for rural midwives and for local birthing units is needed to ensure rural women receive services equal to that of their urban counterparts.

  13. The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review.

    Directory of Open Access Journals (Sweden)

    Benjamin M Hunter

    Full Text Available Cash transfers and vouchers are forms of 'demand-side financing' that have been widely used to promote maternal and newborn health in low- and middle-income countries during the last 15 years.This systematic review consolidates evidence from seven published systematic reviews on the effects of different types of cash transfers and vouchers on the use and quality of maternity care services, and updates the systematic searches to June 2015 using the Joanna Briggs Institute approach for systematic reviewing. The review protocol for this update was registered with PROSPERO (CRD42015020637.Data from 51 studies (15 more than previous reviews and 22 cash transfer and voucher programmes suggest that approaches tied to service use (either via payment conditionalities or vouchers for selected services can increase use of antenatal care, use of a skilled attendant at birth and in the case of vouchers, postnatal care too. The strongest evidence of positive effect was for conditional cash transfers and uptake of antenatal care, and for vouchers for maternity care services and birth with a skilled birth attendant. However, effects appear to be shaped by a complex set of social and healthcare system barriers and facilitators. Studies have typically focused on an initial programme period, usually two or three years after initiation, and many lack a counterfactual comparison with supply-side investment. There are few studies to indicate that programmes have led to improvements in quality of maternity care or maternal and newborn health outcomes.Future research should use multiple intervention arms to compare cost-effectiveness with similar investment in public services, and should look beyond short- to medium-term service utilisation by examining programme costs, longer-term effects on service utilisation and health outcomes, and the equity of those effects.

  14. The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review.

    Science.gov (United States)

    Hunter, Benjamin M; Harrison, Sean; Portela, Anayda; Bick, Debra

    2017-01-01

    Cash transfers and vouchers are forms of 'demand-side financing' that have been widely used to promote maternal and newborn health in low- and middle-income countries during the last 15 years. This systematic review consolidates evidence from seven published systematic reviews on the effects of different types of cash transfers and vouchers on the use and quality of maternity care services, and updates the systematic searches to June 2015 using the Joanna Briggs Institute approach for systematic reviewing. The review protocol for this update was registered with PROSPERO (CRD42015020637). Data from 51 studies (15 more than previous reviews) and 22 cash transfer and voucher programmes suggest that approaches tied to service use (either via payment conditionalities or vouchers for selected services) can increase use of antenatal care, use of a skilled attendant at birth and in the case of vouchers, postnatal care too. The strongest evidence of positive effect was for conditional cash transfers and uptake of antenatal care, and for vouchers for maternity care services and birth with a skilled birth attendant. However, effects appear to be shaped by a complex set of social and healthcare system barriers and facilitators. Studies have typically focused on an initial programme period, usually two or three years after initiation, and many lack a counterfactual comparison with supply-side investment. There are few studies to indicate that programmes have led to improvements in quality of maternity care or maternal and newborn health outcomes. Future research should use multiple intervention arms to compare cost-effectiveness with similar investment in public services, and should look beyond short- to medium-term service utilisation by examining programme costs, longer-term effects on service utilisation and health outcomes, and the equity of those effects.

  15. Antenatal Care Strengthening in Jimma, Ethiopia: A Mixed-Method Needs Assessment

    Directory of Open Access Journals (Sweden)

    Sarah Fredsted Villadsen

    2014-01-01

    Full Text Available Objective. We assessed how health system priorities matched user expectations and what the needs for antenatal care (ANC strengthening were for improved maternal health in Jimma, Ethiopia. Methods. A questionnaire survey among all recent mothers in the study area was conducted to study the content of ANC and to identify the predictors of low ANC satisfaction. Further, a qualitative approach was applied to understand perceptions, practices, and policies of ANC. Results. There were no national guidelines for ANC in Ethiopia. Within the health system, the teaching of health professional students was given high priority, and that contributed to a lack of continuity and privacy. To the women, poor user-provider interaction was a serious concern hindering the trust in the health care providers. Further, the care provision was compromised by the inadequate laboratory facilities, unstructured health education, and lack of training of health professionals. Conclusions. Health system trials are needed to study the feasibility of ANC strengthening in the study area. Nationally and internationally, the leadership needs to be strengthened with supportive supervision geared towards building trust and mutual respect to protect maternal and infant health.

  16. The Mother's Autonomy in Decision Making (MADM) scale: Patient-led development and psychometric testing of a new instrument to evaluate experience of maternity care.

    Science.gov (United States)

    Vedam, Saraswathi; Stoll, Kathrin; Martin, Kelsey; Rubashkin, Nicholas; Partridge, Sarah; Thordarson, Dana; Jolicoeur, Ganga

    2017-01-01

    To develop and validate a new instrument that assesses women's autonomy and role in decision making during maternity care. Through a community-based participatory research process, service users designed, content validated, and administered a cross-sectional quantitative survey, including 31 items on the experience of decision-making. Pregnancy experiences (n = 2514) were reported by 1672 women who saw a single type of primary maternity care provider in British Columbia. They described care by a midwife, family physician or obstetrician during 1, 2 or 3 maternity care cycles. We conducted psychometric testing in three separate samples. We assessed reliability, item-to-total correlations, and the factor structure of the The Mothers' Autonomy in Decision Making (MADM) scale. We report MADM scores by care provider type, length of prenatal appointments, preferences for role in decision-making, and satisfaction with experience of decision-making. The MADM scale measures a single construct: autonomy in decision-making during maternity care. Cronbach alphas for the scale exceeded 0.90 for all samples and all provider groups. All item-to-total correlations were replicable across three samples and exceeded 0.7. Eigenvalue and scree plots exhibited a clear 90-degree angle, and factor analysis generated a one factor scale. MADM median scores were highest among women who were cared for by midwives, and 10 or more points lower for those who saw physicians. Increased time for prenatal appointments was associated with higher scale scores, and there were significant differences between providers with respect to average time spent in prenatal appointments. Midwifery care was associated with higher MADM scores, even during short prenatal appointments (maternity care. This new scale was developed and content validated by community members representing various populations of childbearing women in BC including women from vulnerable populations. MADM measures women's ability to lead

  17. Health surveys and use of maternal and child health care services in three municipalities within the São Paulo metropolitan area

    OpenAIRE

    de Carvalho, Wladithe Organ; Galvao Cesar, Chester Luiz; Carandina, Luana [UNESP; de Azevedo Barros, Marilisa Berti; Goi Porto Alves, Maria Cecilia; Goldbaum, Moises

    2008-01-01

    Objectives. To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboao da Serra-in the São Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes.Methods. Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in ...

  18. Care around birth, infant and mother health and maternal health investments – Evidence from a nurse strike

    DEFF Research Database (Denmark)

    Kronborg, Hanne; Sievertsen, Hans Henrik; Wüst, Miriam

    2016-01-01

    Care around birth may impact child and mother health and parental health investments. We exploit the 2008 national strike among Danish nurses to identify the effects of care around birth on infant and mother health (proxied by health care usage) and maternal investments in the health...... not find strong effects of strike exposure on infant and mother GP contacts in the longer run, this result suggests that parents substitute one type of care for another. While we lack power to identify the effects of care around birth on hospital readmissions and diagnoses, our results for maternal health...... of their newborns. We use administrative data from the population register on 39,810 Danish births in the years 2007–2010 and complementary survey and municipal administrative data on 8288 births in the years 2007–2009 in a differences-in-differences framework. We show that the strike reduced the number of mothers...

  19. Delivering at the right price - the costs of primary maternity care at ...

    African Journals Online (AJOL)

    This paper reports on a study of the costs of primary maternity care services at the Diepkloof Conmmnity Health Centre (DK) in Soweto. DK, the Soweto connnunity health centre system as a whole and nmnerous other non-hospital settings provide a wide range of Illaternal health services to substantial numbers of women, ...

  20. Factors affecting Latina immigrants' perceptions of maternal health care: findings from a qualitative study.

    Science.gov (United States)

    Gurman, Tilly A; Becker, Davida

    2008-05-01

    Due to the influx of Latino immigration in the United States, health care services are faced with the challenge of meeting the needs of this growing population. In this qualitative study, we explored Latina immigrants' experiences with maternal health care services. We found that despite enduring language barriers and problems, Spanish-speaking women expressed satisfaction with their care. Factors influencing women's perceptions of care included sociocultural norms (respeto, personalismo, and familismo), previous experiences with care in their countries of origin, having healthy babies, and knowledge about entitlement to interpreter services. We offer recommendations for public health practice and research.

  1. Improving obstetric care in low-resource settings: implementation of facility-based maternal death reviews in five pilot hospitals in Senegal

    Directory of Open Access Journals (Sweden)

    Fournier Pierre

    2009-07-01

    Full Text Available Abstract Background In sub-Saharan Africa, maternal and perinatal mortality and morbidity are major problems. Service availability and quality of care in health facilities are heterogeneous and most often inadequate. In resource-poor settings, the facility-based maternal death review or audit is one of the most promising strategies to improve health service performance. We aim to explore and describe health workers' perceptions of facility-based maternal death reviews and to identify barriers to and facilitators of the implementation of this approach in pilot health facilities of Senegal. Methods This study was conducted in five reference hospitals in Senegal with different characteristics. Data were collected from focus group discussions, participant observations of audit meetings, audit documents and interviews with the staff of the maternity unit. Data were analysed by means of both quantitative and qualitative approaches. Results Health professionals and service administrators were receptive and adhered relatively well to the process and the results of the audits, although some considered the situation destabilizing or even threatening. The main barriers to the implementation of maternal deaths reviews were: (1 bad quality of information in medical files; (2 non-participation of the head of department in the audit meetings; (3 lack of feedback to the staff who did not attend the audit meetings. The main facilitators were: (1 high level of professional qualifications or experience of the data collector; (2 involvement of the head of the maternity unit, acting as a moderator during the audit meetings; (3 participation of managers in the audit session to plan appropriate and realistic actions to prevent other maternal deaths. Conclusion The identification of the barriers to and the facilitators of the implementation of maternal death reviews is an essential step for the future adaptation of this method in countries with few resources. We

  2. The provision of spiritual and pastoral care following stillbirth in Ireland: a mixed methods study.

    Science.gov (United States)

    Nuzum, Daniel; Meaney, Sarah; O'Donoghue, Keelin

    2016-06-01

    The death of a baby is recognised as one of the most difficult bereavements with life-long impact for parents. How bereaved parents are cared for influences their grief journey. Optimal holistic care is provided when the physical, emotional, spiritual and social needs of parents are attended to. This study reviewed how spiritual care is provided to bereaved parents following stillbirth in maternity units in Ireland and the impact of stillbirth on healthcare chaplains. This was a mixed methods study using semistructured qualitative interviews with hospital chaplains in Irish maternity units. Quantitative data about the provision of services to bereaved parents were collated from the interviews. Qualitative data were analysed thematically to identify key themes. 20 chaplains from 17 units participated in the study (85% of Irish maternity units). 12 chaplains (60%) are formally accredited chaplains; only one has received specialist training in perinatal bereavement care. 11 chaplains (55%) provide follow-up bereavement care. Seven chaplains (35%) did not feel part of the multidisciplinary team. The main themes that emerged were the impact of stillbirth, suffering and the challenge to faith creating inner conflict and doubt. The provision of spiritual care following stillbirth in Ireland is diverse. Spiritual care in this specialised area by chaplains who are not professionally trained and accredited potentially impacts quality and depth of care. Chaplains experience considerable impact and challenge to personal faith and belief as they provide care. Recommendations are made for ongoing education and greater support for chaplains. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  3. The role of the parents’ perception of the postpartum period and knowledge of maternal mortality in uptake of postnatal care: a qualitative exploration in Malawi

    Directory of Open Access Journals (Sweden)

    Zamawe CF

    2015-06-01

    Full Text Available Collins F Zamawe, Gibson C Masache, Albert N Dube Parent and Child Health Initiative (PACHI, Research Centre, Lilongwe, Malawi Background: Postpartum is the most risky period for both mothers and newborn babies. However, existing evidence suggests that utilization of postnatal care is relatively lower when compared to uptake of other similar health care services. Therefore, the aim of this study was to examine the perceptions of parents toward the postpartum period and postnatal care in order to deepen our understanding of the maternal care-seeking practices after childbirth. Methods: A descriptive qualitative study, comprising four focus group discussions with 50 parents aged between 18 and 35 years, was conducted in Malawi between January and March 2014. Only young men and women who had either given birth or fathered a baby within 12 months prior to the study were eligible to participate in this study. This was to ensure that only participants who had recent first-hand postpartum experience were included. Local leaders purposively identified all parents who met the inclusion criteria and then simple random sampling was used to select participants from this pool of parents. Data analysis followed the six steps of thematic approach developed by Braun and Clarke, and NVivo software aided the process. Findings: The parents interviewed described the various factors relating to pregnancy, childbirth, and postpartum periods that may possibly influence uptake of postnatal care. These factors were categorized into the following three themes: beliefs about the causes of maternal morbidity and mortality; risks associated with the pregnancy, childbirth and postpartum periods; and the importance of and barriers to postnatal care. Most participants perceived pregnancy and childbirth as the most risky periods to women, and their understanding of the causes of maternal death differed considerably from the existing evidence. In addition, segregation of mother

  4. Maternal health care utilization in Nairobi and Ouagadougou: evidence from HDSS

    Directory of Open Access Journals (Sweden)

    Clémentine Rossier

    2014-07-01

    Full Text Available Background: Maternal mortality is higher and skilled attendance at delivery is lower in the slums of Nairobi (Kenya compared to Ouagadougou (Burkina Faso. Lower numbers of public health facilities, greater distance to facilities, and higher costs of maternal health services in Nairobi could explain these differences. Objective: By comparing the use of maternal health care services among women with similar characteristics in the two cities, we will produce a more nuanced picture of the contextual factors at play. Design: We use birth statistics collected between 2009 and 2011 in all households living in several poor neighborhoods followed by the Nairobi and the Ouagadougou Health and Demographic Surveillances Systems (n=3,346 and 4,239 births. We compare the socioeconomic characteristics associated with antenatal care (ANC use and deliveries at health facilities, controlling for demographic variables. Results: ANC use is greater in Nairobi than in Ouagadougou for every category of women. In Ouagadougou, there are few differentials in having at least one ANC visit and in delivering at a health facility; however, differences are observed for completing all four ANC visits. In Nairobi, less-educated, poorer, non-Kikuyu women, and women living in the neighborhood farther from public health services have poorer ANC and deliver more often outside of a health facility. Conclusions: These results suggest that women are more aware of the importance of ANC utilization in Nairobi compared to Ouagadougou. The presence of numerous for-profit health facilities within slums in Nairobi may also help women have all four ANC visits, although the services received may be of substandard quality. In Ouagadougou, the lack of socioeconomic differentials in having at least one ANC visit and in delivering at a health facility suggests that these practices stem from the application of well-enforced maternal health regulations; however, these regulations do not cover the

  5. Gestational Exposure to the Synthetic Cathinone Methylenedioxypyrovalerone Results in Reduced Maternal Care and Behavioral Alterations in Mouse Pups

    Directory of Open Access Journals (Sweden)

    László I. Gerecsei

    2018-02-01

    Full Text Available The member of synthetic cathinone family, methylenedioxypyrovalerone (MDPV, is a frequently used psychoactive drug of abuse. The objective of our study was to determine the effect of MDPV (administered from the 8th to the 14th day of gestation on the behavior of neonatal and adolescent mice, as well as its effect on maternal care. We measured maternal care (pup retrieval test, nest building, locomotor activity (open field test, and motor coordination (grip strength test of dams, whereas on pups we examined locomotor activity at postnatal day 7 and day 21 (open field test and motor coordination on day 21 (grip strength test. On fresh-frozen brain samples of the dams we examined the expression of two important peptides implicated in the regulation of maternal behavior and lactation: tuberoinfundibular peptide 39 (TIP39 mRNA in the thalamic posterior intralaminar complex, and amylin mRNA in the medial preoptic nucleus. We detected decreased birth rate and survival of offspring, and reduced maternal care in the drug-treated animals, whereas there was no difference between the motility of treated and control mothers. Locomotor activity of the pups was increased in the MDPV treated group both at 7 and 21 days of age, while motor coordination was unaffected by MDPV treatment. TIP39 and amylin were detected in their typical location but failed to show a significant difference of expression between the drug-treated and control groups. The results suggest that chronic systemic administration of the cathinone agent MDPV to pregnant mice can reduce birth rate and maternal care, and it also enhances motility (without impairment of motor coordination of the offspring.

  6. [Coverage for birth care in Mexico and its interpretation within the context of maternal mortality].

    Science.gov (United States)

    Lazcano-Ponce, Eduardo; Schiavon, Raffaela; Uribe-Zúñiga, Patricia; Walker, Dilys; Suárez-López, Leticia; Luna-Gordillo, Rufino; Ulloa-Aguirre, Alfredo

    2013-01-01

    To evaluate health coverage for birth care in Mexico within the frame of maternal mortality reduction. Two information sources were used: 1) The comparison between the results yield by the Mexican National Health and Nutrition Surveys 2006 and 2012 (ENSANUT 2006 and 2012), and 2) the databases monitoring maternal deaths during 2012 (up to December 26), and live births (LB) in Mexico as estimated by the Mexican National Population Council (Conapo). The national coverage for birth care by medical units is nearly 94.4% at the national level, but in some federal entities such as Chiapas (60.5%), Nayarit (87.8%), Guerrero (91.2%), Durango (92.5%), Oaxaca (92.6%), and Puebla (93.4%), coverage remains below the national average. In women belonging to any social security system (eg. IMSS, IMSS Oportunidades, ISSSTE), coverage is almost 99%, whereas in those affiliated to the Mexican Popular Health Insurance (which depends directly from the Federal Ministry of Health), coverage reached 92.9%. In terms of Maternal Mortality Ratio (MMR), there are still large disparities among federal states in Mexico, with a national average of 47.0 per 100 000 LB (preliminary data for 2012, up to December 26). The MMR estimation has been updated using the most recent population projections. There is no correlation between the level of institutional birth care and the MMR in Mexico. It is thus necessary not only to guarantee universal birth care by health professionals, but also to provide obstetric care by qualified personnel in functional health services networks, to strengthen the quality of obstetric care, family planning programs, and to promote the implementation of new and innovative health policies that include intersectoral actions and human rights-based approaches targeted to reduce the enormous social inequity still prevailing in Mexico.

  7. A review of cultural influence on maternal mortality in the developing world.

    Science.gov (United States)

    Evans, Emily C

    2013-05-01

    identify research examining the effect of culture on maternal mortality rates. literature review of CINAHL, Cochrane, PsychInfo, OVID Medline and Web of Science databases. developing countries with typically higher rates of maternal mortality. women, birth attendants, family members, nurse midwives, health-care workers, and community members. reviews, qualitative and mixed-methods research have identified components of culture that have a direct impact on maternal mortality. Examples of culture are given in the text and categorised according to the way in which they impact maternal mortality. cultural customs, practices, beliefs and values profoundly influence women's behaviours during the perinatal period and in some cases increase the likelihood of maternal death in childbirth. The four ways in which culture may increase MMR are as follows: directly harmful acts, inaction, use of care and social status. understanding the specifics of how the culture surrounding childbirth contributes to maternal mortality can assist nurses, midwives and other health-care workers in providing culturally competent care and designing effective programs to help decrease MMR, especially in the developing world. Interventions designed without accounting for these cultural factors are likely to be less effective in reducing maternal mortality. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. Maternal care and subsocial behaviour in spiders.

    Science.gov (United States)

    Yip, Eric C; Rayor, Linda S

    2014-05-01

    While most spiders are solitary and opportunistically cannibalistic, a variety of social organisations has evolved in a minority of spider species. One form of social organisation is subsociality, in which siblings remain together with their parent for some period of time but disperse prior to independent reproduction. We review the literature on subsocial and maternal behaviour in spiders to highlight areas in which subsocial spiders have informed our understanding of social evolution and to identify promising areas of future research. We show that subsocial behaviour has evolved independently at least 18 times in spiders, across a wide phylogenetic distribution. Subsocial behaviour is diverse in terms of the form of care provided by the mother, the duration of care and sibling association, the degree of interaction and cooperation among siblings, and the use of vibratory and chemical communication. Subsocial spiders are useful model organisms to study various topics in ecology, such as kin recognition and the evolution of cheating and its impact on societies. Further, why social behaviour evolved in some lineages and not others is currently a topic of debate in behavioural ecology, and we argue that spiders offer an opportunity to untangle the ecological causes of parental care, which forms the basis of many other animal societies. © 2013 The Authors. Biological Reviews © 2013 Cambridge Philosophical Society.

  9. 'Every pregnant woman needs a midwife'--the experiences of HIV affected women in maternity care.

    Science.gov (United States)

    Kelly, Carmel; Alderdice, Fiona; Lohan, Maria; Spence, Dale

    2013-02-01

    'Every pregnant woman needs a midwife'-the experiences of HIV affected women in Northern Ireland. to explore HIV positive women's experiences of pregnancy and maternity care, with a focus on their interactions with midwives. a prospective qualitative study. regional HIV unit in Northern Ireland. 22 interviews were conducted with 10 women at different stages of their reproductive trajectories. the pervasive presence of HIV related stigma threatened the women's experience of pregnancy and care. The key staff attributes that facilitated a positive experience were knowledge and experience, empathy and understanding of their unique needs and continuity of care. pregnancy in the context of HIV, whilst offering a much needed sense of normality, also increases woman's sense of anxiety and vulnerability and therefore the need for supportive interventions that affirm normality is intensified. A maternity team approach, with a focus on providing 'balanced care' could meet all of the woman and child's medical needs, whilst also emphasising the normalcy of pregnancy. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

  10. Implementation research to improve quality of maternal and newborn health care, Malawi.

    Science.gov (United States)

    Brenner, Stephan; Wilhelm, Danielle; Lohmann, Julia; Kambala, Christabel; Chinkhumba, Jobiba; Muula, Adamson S; De Allegri, Manuela

    2017-07-01

    To evaluate the impact of a performance-based financing scheme on maternal and neonatal health service quality in Malawi. We conducted a non-randomized controlled before and after study to evaluate the effects of district- and facility-level performance incentives for health workers and management teams. We assessed changes in the facilities' essential drug stocks, equipment maintenance and clinical obstetric care processes. Difference-in-difference regression models were used to analyse effects of the scheme on adherence to obstetric care treatment protocols and provision of essential drugs, supplies and equipment. We observed 33 health facilities, 23 intervention facilities and 10 control facilities and 401 pregnant women across four districts. The scheme improved the availability of both functional equipment and essential drug stocks in the intervention facilities. We observed positive effects in respect to drug procurement and clinical care activities at non-intervention facilities, likely in response to improved district management performance. Birth assistants' adherence to clinical protocols improved across all studied facilities as district health managers supervised and coached clinical staff more actively. Despite nation-wide stock-outs and extreme health worker shortages, facilities in the study districts managed to improve maternal and neonatal health service quality by overcoming bottlenecks related to supply procurement, equipment maintenance and clinical performance. To strengthen and reform health management structures, performance-based financing may be a promising approach to sustainable improvements in quality of health care.

  11. Are infants differentially sensitive to parenting? Early maternal care, DRD4 genotype and externalizing behavior during adolescence.

    Science.gov (United States)

    Nikitopoulos, Jörg; Zohsel, Katrin; Blomeyer, Dorothea; Buchmann, Arlette F; Schmid, Brigitte; Jennen-Steinmetz, Christine; Becker, Katja; Schmidt, Martin H; Esser, Günter; Brandeis, Daniel; Banaschewski, Tobias; Laucht, Manfred

    2014-12-01

    Insensitive and unresponsive caregiving during infancy has been linked to externalizing behavior problems during childhood and adolescence. The 7-repeat (7r) allele of the dopamine D4 receptor (DRD4) gene has meta-analytically been associated with a heightened susceptibility to adverse as well as supportive environments. In the present study, we examined long-term effects of early maternal care, DRD4 genotype and the interaction thereof on externalizing and internalizing psychopathology during adolescence. As part of an ongoing epidemiological cohort study, early maternal care was assessed at child's age 3 months during a nursing and playing situation. In a sample of 296 offspring, externalizing and internalizing symptoms were assessed using a psychiatric interview conducted at age 15 years. Parents additionally filled out a questionnaire on their children's psychopathic behaviors. Results indicated that adolescents with the DRD4 7r allele who experienced less responsive and stimulating early maternal care exhibited more symptoms of ADHD and CD/ODD as well as higher levels of psychopathic behavior. In accordance with the hypothesis of differential susceptibility, 7r allele carriers showed fewer ADHD symptoms and lower levels of psychopathic behavior when exposed to especially beneficial early caregiving. In contrast, individuals without the DRD4 7r allele proved to be insensitive to the effects of early maternal care. This study replicates earlier findings with regard to an interaction between DRD4 genotype and early caregiving on externalizing behavior problems in preschoolers. It is the first one to imply continuity of this effect until adolescence. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Behavioral counseling to prevent childhood obesity – study protocol of a pragmatic trial in maternity and child health care

    OpenAIRE

    Mustila, Taina; Keskinen, Päivi; Luoto, Riitta

    2012-01-01

    Abstract Background Prevention is considered effective in combating the obesity epidemic. Prenatal environment may increase offspring's risk for obesity. A child starts to adopt food preferences and other behavioral habits affecting weight gain during preschool years. We report the study protocol of a pragmatic lifestyle intervention aiming at primary prevention of childhood obesity. Methods/Design A non-randomized controlled pragmatic trial in maternity and child health care clinics. The con...

  13. Unpredictability dictates quality of maternal and newborn care provision in rural Tanzania-A qualitative study of health workers' perspectives.

    Science.gov (United States)

    Baker, Ulrika; Hassan, Farida; Hanson, Claudia; Manzi, Fatuma; Marchant, Tanya; Swartling Peterson, Stefan; Hylander, Ingrid

    2017-02-06

    Health workers are the key to realising the potential of improved quality of care for mothers and newborns in the weak health systems of Sub Saharan Africa. Their perspectives are fundamental to understand the effectiveness of existing improvement programs and to identify ways to strengthen future initiatives. The objective of this study was therefore to examine health worker perspectives of the conditions for maternal and newborn care provision and their perceptions of what constitutes good quality of care in rural Tanzanian health facilities. In February 2014, we conducted 17 in-depth interviews with different cadres of health workers providing maternal and newborn care in 14 rural health facilities in Tandahimba district, south-eastern Tanzania. These facilities included one district hospital, three health centres and ten dispensaries. Interviews were conducted in Swahili, transcribed verbatim and translated into English. A grounded theory approach was used to guide the analysis, the output of which was one core category, four main categories and several sub-categories. 'It is like rain' was identified as the core category, delineating unpredictability as the common denominator for all aspects of maternal and newborn care provision. It implies that conditions such as mothers' access to and utilisation of health care are unreliable; that availability of resources is uncertain and that health workers have to help and try to balance the situation. Quality of care was perceived to vary as a consequence of these conditions. Health workers stressed the importance of predictability, of 'things going as intended', as a sign of good quality care. Unpredictability emerged as a fundamental condition for maternal and newborn care provision, an important determinant and characteristic of quality in this study. We believe that this finding is also relevant for other areas of care in the same setting and may be an important defining factor of a weak health system. Increasing

  14. Impact of maternal mild hyperglycemia on maternal care and offspring development and behavior of Wistar rats.

    Science.gov (United States)

    Kiss, Ana Carolina Inhasz; Woodside, Barbara; Felício, Luciano Freitas; Anselmo-Franci, Janete; Damasceno, Débora Cristina

    2012-10-10

    The aim of the present study was to evaluate the effect of maternal mild hyperglycemia on maternal behavior, as well as the development, behavior, reproductive function, and glucose tolerance of the offspring. At birth, litters were assigned either to Control (subcutaneous (sc)-citrate buffer) or STZ groups (streptozotocin (STZ)-100mg/kg-sc.). On PND 90 both STZ-treated and Control female rats were mated. Glucose tolerance tests (GTT) and insulin tolerance tests (ITT) were performed during pregnancy. Pregnancy duration, litter size and sex ratio were assessed. Newborns were classified according to birth weight as small (SPA), adequate (APA), or large for pregnancy age (LPA). Maternal behavior was analyzed on PND 5 and 10. Offspring body weight, length, and anogenital distance were measured and general activity was assessed in the open field. Sexual behavior was tested in both male and female offspring. Levels of reproductive hormones and estrous cycle duration were evaluated in female offspring. Female offspring were mated and both a GTT and ITT performed during pregnancy. Neonatal STZ administration caused mild hyperglycemia during pregnancy and changed some aspects of maternal care. The hyperglycemic intrauterine milieu impaired physical development and increased immobility in the open field in the offspring although the latter effect appeared at different ages for males (adulthood) and females (infancy). There was no impairment in the sexual behavior of either male or female offspring. As adults, female offspring of STZ-treated mothers did not show glucose intolerance during pregnancy. Thus, offspring of female rats that show mild hyperglycemia in pregnancy have fewer behavioral and developmental impairments than previously reported in the offspring of severely diabetic dams suggesting that the degree of impairment is directly related to the mother glycemic intensity. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Maternal care, mother-offspring aggregation and age-dependent coadaptation in the European earwig.

    Science.gov (United States)

    Gómez, Y; Kölliker, M

    2013-09-01

    Benefits and costs of parental care are expected to change with offspring development and lead to age-dependent coadaptation expressed as phenotypic (behavioural) matches between offspring age and parental reproductive stage. Parents and offspring interact repeatedly over time for the provision of parental care. Their behaviours should be accordingly adjusted to each other dynamically and adaptively, and the phenotypic match between offspring age and parental stage should stabilize the repeated behavioural interactions. In the European earwig (Forficula auricularia), maternal care is beneficial for offspring survival, but not vital, allowing us to investigate the extent to which the stability of mother-offspring aggregation is shaped by age-dependent coadaptation. In this study, we experimentally cross-fostered nymphs of different age classes (younger or older) between females in early or late reproductive stage to disrupt age-dependent coadaptation, thereby generating female-nymph dyads that were phenotypically matched or mismatched. The results revealed a higher stability in aggregation during the first larval instar when care is most intense, a steeper decline in aggregation tendency over developmental time and a reduced developmental rate in matched compared with mismatched families. Furthermore, nymph survival was positively correlated with female-nymph aggregation stability during the early stages when maternal care is most prevalent. These results support the hypothesis that age-related phenotypically plastic coadaptation affects family dynamics and offspring developmental rate. © 2013 The Authors. Journal of Evolutionary Biology © 2013 European Society For Evolutionary Biology.

  16. Epidemiology of Maternal Mortality in Malawi

    African Journals Online (AJOL)

    live births. Causes and determinants of maternal mortal- ity. Global causes of maternal mortality. Across the globe the causes of maternal deaths are strik- ..... at home”. Findings from Thyolo, Mangochi and Chik- wawa were similar". Perceived qua/ity of care. Like anywhere in the world, the perceived quality of care in ...

  17. Social differentiation and embodied dispositions: a qualitative study of maternal care-seeking behaviour for near-miss morbidity in Bolivia

    Directory of Open Access Journals (Sweden)

    Liljestrand Jerker

    2009-07-01

    Full Text Available Abstract Background Use of maternal health care in low-income countries has been associated with several socioeconomic and demographic factors, although contextual analyses of the latter have been few. A previous study showed that 75% of women with severe obstetric morbidity (near-miss identified at hospitals in La Paz, Bolivia were in critical conditions upon arrival, underscoring the significance of pre-hospital barriers also in this setting with free and accessible maternal health care. The present study explores how health care-seeking behaviour for near-miss morbidity is conditioned in La Paz, Bolivia. Methods Thematic interviews with 30 women with a near-miss event upon arrival at hospital. Near-miss was defined based on clinical and management criteria. Modified analytic induction was applied in the analysis that was further influenced by theoretical views that care-seeking behaviour is formed by predisposing characteristics, enabling factors, and perceived need, as well as by socially shaped habitual behaviours. Results The self-perception of being fundamentally separated from "others", meaning those who utilise health care, was typical for women who customarily delivered at home and who delayed seeking medical assistance for obstetric emergencies. Other explanations given by these women were distrust of authority, mistreatment by staff, such as not being kept informed about their condition or the course of their treatment, all of which reinforced their dissociation from the health-care system. Conclusion The findings illustrate health care-seeking behaviour as a practise that is substantially conditioned by social differentiation. Social marginalization and the role health institutions play in shaping care-seeking behaviour have been de-emphasised by focusing solely on endogenous cultural factors in Bolivia.

  18. Comparative study analysing women's childbirth satisfaction and obstetric outcomes across two different models of maternity care

    Science.gov (United States)

    Conesa Ferrer, Ma Belén; Canteras Jordana, Manuel; Ballesteros Meseguer, Carmen; Carrillo García, César; Martínez Roche, M Emilia

    2016-01-01

    Objectives To describe the differences in obstetrical results and women's childbirth satisfaction across 2 different models of maternity care (biomedical model and humanised birth). Setting 2 university hospitals in south-eastern Spain from April to October 2013. Design A correlational descriptive study. Participants A convenience sample of 406 women participated in the study, 204 of the biomedical model and 202 of the humanised model. Results The differences in obstetrical results were (biomedical model/humanised model): onset of labour (spontaneous 66/137, augmentation 70/1, p=0.0005), pain relief (epidural 172/132, no pain relief 9/40, p=0.0005), mode of delivery (normal vaginal 140/165, instrumental 48/23, p=0.004), length of labour (0–4 hours 69/93, >4 hours 133/108, p=0.011), condition of perineum (intact perineum or tear 94/178, episiotomy 100/24, p=0.0005). The total questionnaire score (100) gave a mean (M) of 78.33 and SD of 8.46 in the biomedical model of care and an M of 82.01 and SD of 7.97 in the humanised model of care (p=0.0005). In the analysis of the results per items, statistical differences were found in 8 of the 9 subscales. The highest scores were reached in the humanised model of maternity care. Conclusions The humanised model of maternity care offers better obstetrical outcomes and women's satisfaction scores during the labour, birth and immediate postnatal period than does the biomedical model. PMID:27566632

  19. Association of maternal periodontitis with low birth weight in newborns in a tertiary care hospital

    International Nuclear Information System (INIS)

    Khan, N.S.; Ashraf, R.N.; Rahman, M.U.; Mashhadi, S.F.; Rashid, Z.; Nazar, A.F.; Syed, R.

    2016-01-01

    Background: Low birth weight is a major public health problem in Pakistan. So there is a need for identification of its modifiable risk factors like periodontitis which will reduce its burden on the society. The objectives of the study were to find out the association between maternal periodontitis and low birth weight in new-borns of all gestational ages delivered in a tertiary care hospital of Abbottabad as well as to see the frequency of periodontitis severity in these subjects. Methods: A hospital-based matched case-control study was conducted among 160 postpartum mothers in Gynaecology/Obstetrics-B ward Ayub Teaching Hospital, Abbottabad. The 80 cases were mothers of low birth weight babies (<2,500 g), the 80 controls were mothers of normal weight babies (=2,500 g) matched with maternal age and gestational age. Data was collected through the hospital records, interview and a periodontal examination. Results: Periodontitis was more in the cases than in the controls (OR: 4.167, 95 percentage CI: 2.142-8.109, ρ=0.000). On multivariate logistic regression, periodontitis was found to be a significant independent risk factor for low birth weight (aOR: 3.173, 95 percentage CI: 1.429-7.047, ρ=0.005). Other significant risk factors were educational level (aOR: 3.408, 95 percentage CI: 1.452-7.996, ρ=0.005), socioeconomic status (aOR: 3.173, 95 percentage CI: 1.366-7.368, ρ=0.007), maternal nutrition (aOR: 3.071, 95 percentage CI: 1.392-6.778, ρ=0.005) and moderate/severe anaemia (aOR: 3.035, 95 percentage CI: 1.052-8.756, p=0.040). Conclusions: Periodontitis is found to be a strong, independent, and clinically significant risk factor for low birth weight. So periodontal therapy should form a part of the antenatal care of the pregnant women in Abbottabad. (author)

  20. Improving quality for maternal care - a case study from Kerala, India [version 1; referees: 2 approved

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    Ioana Vlad

    2016-02-01

    Full Text Available Background: The implementation of maternal health guidelines remains unsatisfactory, even for simple, well established interventions. In settings where most births occur in health facilities, as is the case in Kerala, India, preventing maternal mortality is linked to quality of care improvements. Context: Evidence-informed quality standards (QS, including quality statements and measurable structure and process indicators, are one innovative way of tackling the guideline implementation gap. Having adopted a zero tolerance policy to maternal deaths, the Government of Kerala worked in partnership with the Kerala Federation of Obstetricians & Gynaecologists (KFOG and NICE International to select the clinical topic, develop and initiate implementation of the first clinical QS for reducing maternal mortality in the state. Description of practice: The NICE QS development framework was adapted to the Kerala context, with local ownership being a key principle. Locally generated evidence identified post-partum haemorrhage as the leading cause of maternal death, and as the key priority for the QS. A multidisciplinary group (including policy-makers, gynaecologists and obstetricians, nurses and administrators was established. Multi-stakeholder workshops convened by the group ensured that the statements, derived from global and local guidelines, and their corresponding indicators were relevant and acceptable to clinicians and policy-makers in Kerala. Furthermore, it helped identify practical methods for implementing the standards and monitoring outcomes. Lessons learned: An independent evaluation of the project highlighted the equal importance of a strong evidence-base and an inclusive development process. There is no one-size-fits-all process for QS development; a principle-based approach might be a better guide for countries to adapt global evidence to their local context.

  1. Male partners’ views of involvement in maternal healthcare services at Makhado Municipality clinics, Limpopo Province, South Africa

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    Kenneth Nesane

    2016-05-01

    Full Text Available Background: Male partners have a strong influence on pregnant partners’ health and their access to care. Their involvement is critical in the delivery and uptake of maternal healthcare services and improving maternal and child health outcomes. Aim: The study sought to determine male partners’ views on their involvement in maternal healthcare services. Setting: The Makhado Municipality’s Kutama, Madombidzha and Vleifontein clinics. Methods: A qualitative study design, which is exploratory, descriptive and contextual in nature, was used. The population comprised 15 men whose partners had been pregnant within the last 2 years. A non-probability, purposive sampling procedure was used. Data were collected via in-depth individual interviews using a voice recorder and an interview schedule guide. Tesch’s open coding method was used to analyse data. Results: The findings revealed one major theme, namely that maternal health issues are viewed as a woman’sdomain; and three sub-themes: culture and participation in childbirth, male partners’ employment status, and male partners’ unwillingness to participate in maternal health issues. Conclusions: The involvement of male partners in maternal healthcare services, and further research in promoting this activity, should be proposed to policymakers. Keywords: Views, partners, involvement, maternal health care services, antenatal care, labour and postnatal care.

  2. Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital.

    Science.gov (United States)

    Arnold, R; van Teijlingen, E; Ryan, K; Holloway, I

    2015-01-01

    To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies. Qualitative ethnographic study. A maternity hospital, Afghanistan. Doctors, midwives and care assistants. Six weeks of observation followed by 22 semi-structured interviews and four informal group discussions with staff, two focus group discussions with women and 41 background interviews with Afghan and non-Afghan medical and cultural experts. The culture of care in an Afghan maternity hospital. A large workload, high proportion of complicated cases and poor staff organisation affected the quality of care. Cultural values, social and family pressures influenced the motivation and priorities of healthcare providers. Nepotism and cronyism created inequality in clinical training and support and undermined the authority of management to improve standards of care. Staff without powerful connections were vulnerable in a punitive inequitable environment-fearing humiliation, blame and the loss of employment. Suboptimal care put the lives of women and babies at risk and was, in part, the result of conflicting priorities. The underlying motivation of staff appeared to be the socio-economic survival of their own families. The hospital culture closely mirrored the culture and core values of Afghan society. In setting priorities for women's health post-2015 Millennium Development Goals, understanding the context-specific pressures on staff is key to more effective programme interventions and sustainability. © 2014 Royal College of Obstetricians and Gynaecologists.

  3. The world health organization multicountry survey on maternal and newborn health: study protocol

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    Souza João

    2011-10-01

    Full Text Available Abstract Background Effective interventions to reduce mortality and morbidity in maternal and newborn health already exist. Information about quality and performance of care and the use of critical interventions are useful for shaping improvements in health care and strengthening the contribution of health systems towards the Millennium Development Goals 4 and 5. The near-miss concept and the criterion-based clinical audit are proposed as useful approaches for obtaining such information in maternal and newborn health care. This paper presents the methods of the World Health Organization Multicountry Study in Maternal and Newborn Health. The main objectives of this study are to determine the prevalence of maternal near-miss cases in a worldwide network of health facilities, evaluate the quality of care using the maternal near-miss concept and the criterion-based clinical audit, and develop the near-miss concept in neonatal health. Methods/Design This is a large cross-sectional study being implemented in a worldwide network of health facilities. A total of 370 health facilities from 29 countries will take part in this study and produce nearly 275,000 observations. All women giving birth, all maternal near-miss cases regardless of the gestational age and delivery status and all maternal deaths during the study period comprise the study population. In each health facility, medical records of all eligible women will be reviewed during a data collection period that ranges from two to three months according to the annual number of deliveries. Discussion Implementing the systematic identification of near-miss cases, mapping the use of critical evidence-based interventions and analysing the corresponding indicators are just the initial steps for using the maternal near-miss concept as a tool to improve maternal and newborn health. The findings of projects using approaches similar to those described in this manuscript will be a good starter for a more

  4. The Rise and Need for Mobile Apps for Maternal and Child Health Care in China: Survey Based on App Markets.

    Science.gov (United States)

    Zhang, Puhong; Dong, Le; Chen, Huan; Chai, Yanling; Liu, Jianbo

    2018-06-08

    Mobile health services are thriving in the field of maternal and child health in China due to expansions in the field of electronic health and the introduction of the two-child policy. There are numerous maternal and child health apps in computer stores, but the exact number of apps, number of downloads, and features of these apps is not known. This study aimed to explore the use of maternal and child health apps in Android and iOS app stores and to describe the key functional features of the most popular apps, with the purpose of providing insight into further research and development of maternal and child health mobile health products. The researchers conducted a search in the 3 most popular Android app stores (Tencent MyApp, Baidu Mobile Assistant, and 360 Mobile Assistant) and the iTunes App Store in China. All apps regarding family planning (contraception and preparing for pregnancy), pregnancy and perinatal care, neonatal care and health, and development for children under 6 years were included in the initial analysis. Maternal and child health mobile apps with predominant features of product marketing, children's songs, animation, or games were excluded from the study. The 50 most frequently used apps in each of the Android stores as well as the iTunes store (a total of 78 deduplicated apps) were selected and downloaded for an in-depth analysis. A total of 5276 Android apps and 877 iOS apps developed for maternal and child health care were identified. Of the 78 most frequently used apps, 43 (55%) apps focused on one stage of MCH care, mainly targeting child care (25 apps) and before pregnancy care (11 apps), whereas 35 (45%) of the apps covered 2 or more stages, most of which (32 apps) included both pregnancy and child care services. The app features that were commonly adopted by the popular apps were health education, communication, health status self-monitoring, a diary, reminders, and counseling. Within the app feature of "health status self

  5. [Estimations of maternal mortality using the sisterhood survival method: Latin American experience].

    Science.gov (United States)

    Wong, L R; Simons, H; Graham, W; Schkolnik, S

    1990-08-01

    The method of surviving sisters for indirectly estimating maternal mortality is still under development but shows promise for countries lacking alternative sources of data and good statistics. This work uses census or survey data to apply the method to rural villages in Gambia; Mapuche settlements in Cautin, Chile; marginal populations on the outskirts of Lima, Peru; and rural villages of Avaroa, Bolivia. The method is explained in detail following presentation of the results. The necessary basic information is outlined, and the particularities of its application to each Latin American case are discussed. The surviving sisters method was developed by Graham and Brass to derive indicators of maternal mortality based on the proportion of sisters who arrive at fertile age and die during pregnancy, delivery, or the postpartum period. The method transforms the proportions of sisters who died of maternal causes obtained from a census or survey into conventional probabilities of death. The basic information required concerns the numbers of sisters entering the reproductive period (excluding the respondent is she is a woman), the number surviving and decreased at the survey data, and the number who died during pregnancy, delivery, or the postpartum period. The probabilities of dying from a maternal cause were estimated on the basis of the sister survival method at 1/98 in Lima, 1/53 in Cautin, 1/17 in Gambia, and 1/10 in Bolivia. These probabilities correspond to ratios of maternal mortality per 100,000 live births of 286 in Lima, 414 in Cautin, 1005 in Gambia, and 1379 in Bolivia. The results demonstrate great variability in maternal mortality rates. In the cases of Lima and Cautin there were significant differences between estimates derived from the sister survival method and those derived from vital statistics. The 4 cases demonstrated the familiar association between maternal and infant mortality, fertility, and overall female mortality expressed in life expectancy at

  6. Measuring client experiences in maternity care under change: development of a questionnaire based on the WHO Responsiveness model.

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    Marisja Scheerhagen

    Full Text Available Maternity care is an integrated care process, which consists of different services, involves different professionals and covers different time windows. To measure performance of maternity care based on clients' experiences, we developed and validated a questionnaire.We used the 8-domain WHO Responsiveness model, and previous materials to develop a self-report questionnaire. A dual study design was used for development and validation. Content validity of the ReproQ-version-0 was determined through structured interviews with 11 pregnant women (≥28 weeks, 10 women who recently had given birth (≤12 weeks, and 19 maternity care professionals. Structured interviews established the domain relevance to the women; all items were separately commented on. All Responsiveness domains were judged relevant, with Dignity and Communication ranking highest. Main missing topic was the assigned expertise of the health professional. After first adaptation, construct validity of the ReproQ-version-1 was determined through a web-based survey. Respondents were approached by maternity care organizations with different levels of integration of services of midwives and obstetricians. We sent questionnaires to 605 third trimester pregnant women (response 65%, and 810 women 6 weeks after delivery (response 55%. Construct validity was based on: response patterns; exploratory factor analysis; association of the overall score with a Visual Analogue Scale (VAS, known group comparisons. Median overall ReproQ score was 3.70 (range 1-4 showing good responsiveness. The exploratory factor analysis supported the assumed domain structure and suggested several adaptations. Correlation of the VAS rating and overall ReproQ score (antepartum, postpartum supported validity (r = 0.56; 0.59, p<0.001 Spearman's correlation coefficient. Pre-stated group comparisons confirmed the expected difference following a good vs. adverse birth outcome. Fully integrated organizations performed

  7. Policies for care during the third stage of labour: a survey of maternity units in Syria

    Science.gov (United States)

    2010-01-01

    Background Care for women during the third stage aims to reduce the risk of major haemorrhage, but is very variable. The current World Health Organisation (WHO) recommendation is that care should include administration of a uterotonic (oxytocin, if it is available) soon after birth of the baby, delayed cord clamping, and delivery of the placenta by controlled cord traction. Methods To ascertain care policies used during the third stage of labour in maternity units in Syria, we conducted a survey of 69 maternity units in obstetric and general public hospitals. A brief questionnaire was administered by face to face interview or telephone with senior obstetricians and midwives. Outcome measures were the use of prophylactic uterotonic drugs, timing of cord clamping, use of controlled cord traction, and treatment for postpartum haemorrhage. Obstetricians were asked about both vaginal and caesarean births, midwives only about vaginal births. Results Responses were obtained for 66 (96%) hospitals: a midwife and an obstetrician were interviewed in 40; an obstetrician only in 20; a midwife only in 6. Responses were similar, although midwives were more likely to report that the umbilical cord was clamped after 1-3 minutes or after cessation of pulsation (2/40 obstetricians and 9/40 midwives). Responses have therefore been combined. One hospital reported never using a prophylactic uterotonic drug. The uterotonic was Syntometrine® (oxytocin and ergometrine) in two thirds of hospitals; given after delivery of the placenta in 60 (91%) for vaginal births, and in 47 (78%) for caesarean births. Cord clamping was within 20 seconds at 42 hospitals 64%) for vaginal births and 45 (75%) for caesarean births. Controlled cord traction was never used in a quarter (17/66) of hospitals for vaginal births and a half (32/60) for caesarean births. 68% of respondents (45/66) thought there was a need for more randomised trials of interventions during the third stage of labour. Conclusion Most

  8. Kesinambungan Pemanfaatan Pelayanan Kesehatan Maternal di Indonesia

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    Ning Sulistiyowati

    2017-11-01

    Full Text Available AbstractIn an effort to decrease the maternal mortality rate in Indonesia, the government implements a lot of strategies and health programs by means of continum of care. This article aims to determine the factors of mothers affecting sustainable maternal health services using the 2013 Riskesdasdata. Data analyses were done by calculating the difference in the percentage of coverage of health indicators in each district/city and continuing to find a model determining the relationship of maternalcharacteristics factors related to the continuation of maternal health care by logistic regression. The sustainability of maternal health service utilization in Indonesia is only 46%. The factors are the mother's education (OR = 1.79 and 2.58, the work of mothers (OR = 1.38, economic status (OR= 1.65, pregnancy status (OR = 1.33, method of delivery (OR = 0.71 and 0.37, complications of pregnancy (OR = 1.13, birth complications (OR = 0.79, the travel time to health facilities (OR = 0.61 and 1.59, age at delivery (OR = 1.23. The study reveals that continuity of maternal healthservices remain unsatisfactory. Government should pay more attention to improve the quality and access to maternal health services as to encourage mothers to sustain their health care.Keywords: continuum of care, maternal health, Riskesdas 2013AbstrakDalam upaya menurunkan angka kematian ibu di Indonesia, pemerintah melakukan banyak strategi dan program kesehatan di antaranya continum of care. Artikel ini bertujuan untuk mengetahui faktor dan karakteristik ibu yang mempengaruhi kesinambungan pelayanan kesehatan maternal. Data yang digunakan dalam analisis ini adalah data Riskesdas 2013. Analisis dilakukan dengan menghitung selisih persentase cakupan indikator kesehatan di tiap kabupaten/kota. Analisis kemudian dilanjutkandengan mencari model untuk mengetahui hubungan karakteristik ibu dan faktor terkait lain dengan kelanjutan perawatan kesehatan ibu dengan regresi logistik. Persentase

  9. The implementation of security in distributed infant and maternity care.

    Science.gov (United States)

    Kouri, P; Kemppainen, E

    2000-11-01

    According to the Finnish National Fund for Research and Development in the information society, knowledge is the basis of education and culture and the most important production factor. ICT significantly promotes interaction and exchange between individuals, business enterprises and other organisations, utilisation of information, and provision of services and access to them. Our project is one of approximately 300 projects which are developing seamless social and health care ICT services in Finland [P. Ruotsalainen, Asiakaslähtöinen palveluketju ja tietote-knologia, Kirjassa: Nouko-S. Juvonen, P. Ruotsalainen, I. Kiikkala (toim), Hyvinvointivaltion palveluketjut. Hygieia. Kustannusosakeyhtiö Tammi, Tammer-Paino Oy, Tampere, 2000]. The principal aim is both to research and create a new model for social and health care services and to disseminate the know-how brought about for the benefit of software enterprises and educational institutes. A product called Maternity Clinic on the Net is developed in the project, and it can be applied to the national and international social and health care services.

  10. Interventions that improve maternity care for immigrant women in the UK: protocol for a narrative synthesis systematic review.

    Science.gov (United States)

    Higginbottom, Gina Marie Awoko; Evans, Catrin; Morgan, Myfanwy; Bharj, Kuldip Kaur; Eldridge, Jeanette; Hussain, Basharat

    2017-07-12

    A quarter of all births in the UK are to mothers born outside the UK. There is also evidence that immigrant women have higher maternal and infant death rates and of inequalities in the provision and uptake of maternity services/birth centres. The topic is of great significance to the National Health Service because of directives that address inequalities and the changing patterns of migration to the UK. Our main question for the systematic review is 'what interventions exist that are specifically focused on improving maternity care for immigrant women in the UK?' The primary objective of this synthesis is to generate new interpretations of research evidence. Second, the synthesis will provide substantive base to guide developments and implementation of maternity services/birth centres which are acceptable and effective for immigrant women in the UK. We are using a narrative synthesis (NS) approach to identify, assess scientific quality and rigour, and synthesise empirical data focused on access and interventions that enhance quality of maternity care/birth centres for the UK immigrant women. The inclusion criteria include: publication date 1990 to present, English language, empirical research and findings are focused on women who live in the UK, participants of the study are immigrant women, is related to maternity care/birth centres access or interventions or experiences of maternity.In order to ensure the robustness of the NS, the methodological quality of key evidence will be appraised using the Center for Evidence-Based Management tools and review confidence with CERQual (Confidence in the Evidence from Reviews of Qualitative Research). Two reviewers will independently screen studies and extract relevant evidence. We will synthesise evidence studying relationships between included studies using a range of tools. Dissemination plan includes: an e-workshop for policymakers, collaborative practitioner workshops, YouTube video and APP, scientific papers and

  11. Social Determinants of Maternal Health in Afghanistan: A Review

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    Said Ahmad Maisam Najafizada

    2017-03-01

    Methods: This narrative review was conducted using Arksey and O’Malley’s framework of (1 defining the question, (2 searching the literature, (3 assessing the studies, (4 synthesizing selected evidence in context, and (5 summarizing potential programmatic implication of the context. We searched Medline, CABI global health database, and Google Scholar for relevant publications. Results: A total of 38 articles/reports were included in this review. We found that social determinants such as maternal education, sociocultural practices, and social infrastructure have a significant impact on maternal health. Health care may be the immediate determinant, but it is influenced by other determinants that must be addressed in order to alleviate the burden on health care, as well as to achieve long-term reduction in maternal mortality. Conclusion: Because of the importance of social factors for maternal health outcomes, committed involvement of multiple government sectors (i.e. education, labor and social affairs, information and culture, transport and rural development among others, alongside health care is the long-term solution to the maternal health problems in Afghanistan. National and international organizations’ long-term commitment to social investment such as education, local economy, cultural change, and social infrastructure is recommended for Afghanstan and globally.

  12. Maternal deaths in Denmark 2002-2006

    DEFF Research Database (Denmark)

    Bødker, Birgit; Hvidman, Lone; Weber, Tom

    2009-01-01

    OBJECTIVE: To describe a method for identification, classification and assessment of maternal deaths in Denmark and to identify substandard care. DESIGN: Register study and case audit based on data from the Registers of the Danish Medical Health Board, death certificates and hospital records. SET...

  13. Facility-Based Maternal Death in Western Africa: A Systematic Review

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    Nathali Gunawardena

    2018-02-01

    Full Text Available BackgroundFor exploring maternal death, supply and demand-side factors can be characterized by the three delays model developed by Thaddeus and Maine (1994. The model comprises delay in deciding to seek care (delay 1, delay in reaching the health facility (delay 2, and delay in receiving quality care once at the health facility (delay 3. Few studies have comprehensively dealt with the health systems delays that prevent the receipt of timely and appropriate obstetric care once a woman reaches a health facility (phase III delays. The objective of the present study was to identify facility-level barriers in West African health facilities.MethodsElectronic databases (Medline, cumulative index to nursing and allied health literature, Centre for Agriculture and Biosciences International Global Health, EMBASE were searched to identify original research articles from 1996 to 2016. Search terms (and synonyms related to (1 maternal health care (e.g., obstetric care, perinatal care, maternal health services; (2 facility level (e.g., maternity unit, health facility, phase III, hospital; and (3 Western Africa (e.g., Nigeria, Burkina Faso were combined. This review followed the preferred reporting items for systematic reviews and meta-analyses.ResultsOf the 2103 citations identified, 13 studies were eligible. Studies were conducted in Nigeria, Burkina Faso, Gambia, Guinea, Senegal, and Sierra Leone. 30 facility-level barriers were identified and grouped into 6 themes (human resources, supply and equipment, referral-related, infrastructure, cost-related, patient-related. The most obvious barriers included staff shortages, lack of maternal health services and procedures offered to patients, and lack of necessary medical equipment and supplies in the health-care facilities.ConclusionThis review emphasizes that phase I and phase II barriers are not the only factors preventing women from accessing proper emergency obstetric care. Health-care facilities in Western

  14. [Introduction of the psychoprophylactic method and its influence on the prenatal care program for institutional parturition in Japan: the practice in the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, 1953-1964].

    Science.gov (United States)

    Fujihara, Satoko; Tsukisawa, Miyoko

    2014-03-01

    The psychoprophylactic method is one of the methods for providing 'painless childbirth without drugs' and was invented by applying I. Pavlov's theory of higher nervous activity. In 1951, it was adopted as a national policy in the Union of Soviet Socialist Republics. This method was then introduced in the People's Republic of China in 1952. In 1953, it was brought to Japan by Masatomo SUGAI, an obstetrician, and was introduced into the Central Hospital of Maternity of the Japanese Red Cross Society with the support of the director, Naotarou KUJI. The practice of this method by the research team, which consisted of the obstetricians and midwives of the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, resulted in the initiation and characterization of the prenatal care program to encourage the autonomy of the pregnant women for normal parturition in the institutions of Japan.

  15. Stakeholders' views on maternity care shortcomings in rural Ghana: An ethnographic study among women, providers, public, and quasiprivate policy sector actors.

    Science.gov (United States)

    Ayanore, Martin Amogre; Pavlova, Milena; Biesma, Regien; Groot, Wim

    2018-01-01

    Access to skilled provider and emergency obstetric care is not universal across all districts in Ghana. The lived experiences of 3 stakeholder groups on maternity care shortcomings in 3 rural Ghanaian districts are examined in this study. We applied an ethnographic study approach where field data were collected between March to May 2015 in 3 rural districts of northern Ghana. Data were collected among women with recent births experiences (n = 90), health care providers (n = 16), and policy actors (n = 6). Transcripts were read through to identify similar and divergent stakeholders' views. Significant expressions and experiences of stakeholders on maternity care shortcomings were extracted and evaluated to define key themes. Four themes emerged: social/community factors, payments for health care, facility level factors, and policy level factors. The results show that traditional women's roles divest time for maternity care. Poor transport arrangements, insufficient health workforce, health funding gaps, insurance reimbursements delays, and catastrophic health expenditures on travel and drugs are attested as major barriers across all stakeholder groups in all districts studied. The discussion of the study findings suggests it is important to ascertain the scale of informal payments and their impacts on health access. Investments in health workforce and reliable ambulatory service systems could help address poor referral difficulties in rural areas of the country. Social support for community initiatives that pool funds could provide extra resources and relieve cost access-related challenges for using maternity care in rural settings in Ghana. Copyright © 2017 John Wiley & Sons, Ltd.

  16. Obstacles in the Utilisation of Maternal Health Care Services in Murarai-II C.D. Block, Birbhum District, West Bengal, India

    OpenAIRE

    Alokananda Ghosh; Dr.Biswaranjan Mistri

    2017-01-01

    Improving maternal health was one of the eight Millennium Development Goals (MDGs) and now it is one of the targets of 17 point Sustainable Development Goals (SDGs). The utilisation of Maternal Health Care Services (MHCSs) is a complex phenomenon and it is influenced by several factors, like-health care seeking behaviour of the cohorts belonging to different socio-economic and cultural background, distance of the facility centres, type and conditions of the roads including undulating surface,...

  17. A qualitative study of the experiences and expectations of women receiving in-patient postnatal care in one English maternity unit

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    Bick Debra

    2010-10-01

    Full Text Available Abstract Background Studies consistently highlight in-patient postnatal care as the area of maternity care women are least satisfied with. As part of a quality improvement study to promote a continuum of care from the birthing room to discharge home from hospital, we explored women's expectations and experiences of current in-patient care. Methods For this part of the study, qualitative data from semi-structured interviews were transcribed and analysed using content analyses to identify issues and concepts. Women were recruited from two postnatal wards in one large maternity unit in the South of England, with around 6,000 births a year. Results Twenty women, who had a vaginal or caesarean birth, were interviewed on the postnatal ward. Identified themes included; the impact of the ward environment; the impact of the attitude of staff; quality and level of support for breastfeeding; unmet information needs; and women's low expectations of hospital based postnatal care. Findings informed revision to the content and planning of in-patient postnatal care, results of which will be reported elsewhere. Conclusions Women's responses highlighted several areas where changes could be implemented. Staff should be aware that how they inter-act with women could make a difference to care as a positive or negative experience. The lack of support and inconsistent advice on breastfeeding highlights that units need to consider how individual staff communicate information to women. Units need to address how and when information on practical aspects of infant care is provided if women and their partners are to feel confident on the woman's transfer home from hospital.

  18. Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda

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    Gertrude Namazzi

    2015-03-01

    Full Text Available Background: In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities. Objective: This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme. Design: This health system strengthening study, part of the Uganda Newborn Study (UNEST, aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening. Results: Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with

  19. Effects of early maternal employment on maternal health and well-being

    Science.gov (United States)

    Markowitz, Sara; Brooks-Gunn, Jeanne

    2012-01-01

    This study uses data from the National Institute of Child Health and Human Development Study on Early Child Care to examine the effects of maternal employment on maternal mental and overall health, self-reported parenting stress, and parenting quality. These outcomes are measured when children are 6 months old. Among mothers of 6-month-old infants, maternal work hours are positively associated with depressive symptoms and parenting stress and negatively associated with self-rated overall health. However, maternal employment is not associated with quality of parenting at 6 months, based on trained assessors’ observations of maternal sensitivity. PMID:23645972

  20. [Nursing practice in maternity intensive care units. Severe pre-eclampsia in a primigravida].

    Science.gov (United States)

    Carmona-Guirado, A J; Escaño-Cardona, V; García-Cañedo, F J

    2015-01-01

    39 year old woman, pregnant for 31+5 weeks, who came to our intensive care unit (ICU) referred from the emergency department of the hospital, having swollen ankles, headache and fatigue at moderate effort. We proceeded to take blood pressure (158/96 mmHg) and assess lower limb edema. The fetal heart rate monitoring was normal. Knowledgeable and user of healthy guidelines during her pregnancy, she did not follow any treatment. Single mother, she worried about her fetus (achieved through in vitro fertilization), her mother offered to help for any mishap. We developed an Individualized Care Plan. For data collection we used: Rating 14 Virginia Henderson Needs and diagnostic taxonomy NANDA, NOC, NIC. Nursing diagnoses of "fluid volume excess" and "risk of impaired maternal-fetal dyad" were detected, as well as potential complications such as eclampsia and fetal prematurity. Our overall objectives (NOC) were to integrate the woman in the process she faced and that she knew how to recognize the risk factors inherent in her illness. Nursing interventions (NIC) contemplated the awareness and treatment of her illness and the creation of new healthy habits. The work of nursing Maternal ICU allowed women to help maintain maximum maternal and fetal well-being by satisfying any of her needs. Mishandling of the situation leads into a framework of high morbidity and mortality in our units. Copyright © 2014 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  1. Factors associated with women's autonomy regarding maternal and child health care utilization in Bale Zone: a community based cross-sectional study.

    Science.gov (United States)

    Nigatu, Dabere; Gebremariam, Abebe; Abera, Muluemebet; Setegn, Tesfaye; Deribe, Kebede

    2014-07-03

    Women's autonomy in health-care decision is a prerequisite for improvements in maternal and child health. Little is known about women's autonomy and its influencing factors on maternal and child health care in Ethiopia. Therefore, this study was conducted to assess women's autonomy and identify associated factors in Southeast Ethiopia. A community based cross-sectional study was conducted from March 19th until March 28th, 2011. A total of 706 women were selected using stratified sampling technique from rural and urban kebeles. The quantitative data were collected by interviewer administered questionnaire and analyzed using SPSS for window version 16.0. Descriptive statistics, bivariate and multiple logistic regression analyses were carried out to identify factors associated with women's autonomy for health care utilization. Out of 706 women less than half (41.4%) had higher autonomy regarding their own and their children's health. In the multiple logistic regression model monthly household income >1000 ETB [adjusted odds ratio(AOR):3.32(95% C.I: 1.62-6.78)], having employed husband [AOR: 3.75 (95% C.I:1.24-11.32)], being in a nuclear family structure [AOR: 0.53(95% C.I: 0.33-0.87)], being in monogamous marriage [AOR: 3.18(95% C.I: 1.35-7.50)], being knowledgeable and having favorable attitude toward maternal and child health care services were independently associated with an increased odds of women's autonomy. Socio-demographic and maternal factors (knowledge and attitude) were found to influence women's autonomy. Interventions targeting women's autonomy with regards to maternal and child health care should focus on addressing increasing awareness and priority should be given to women with a lower socioeconomic status.

  2. Agenda-setting for Canadian caregivers: using media analysis of the maternity leave benefit to inform the compassionate care benefit.

    Science.gov (United States)

    Dykeman, Sarah; Williams, Allison M

    2014-04-24

    The Compassionate Care Benefit was implemented in Canada in 2004 to support employed informal caregivers, the majority of which we know are women given the gendered nature of caregiving. In order to examine how this policy might evolve over time, we examine the evolution of a similar employment insurance program, Canada's Maternity Leave Benefit. National media articles were reviewed (n = 2,698) and, based on explicit criteria, were analyzed using content analysis. Through the application of Kingdon's policy agenda-setting framework, the results define key recommendations for the Compassionate Care Benefit, as informed by the developmental trajectory of the Maternity Leave Benefit. Recommendations for revising the Compassionate Care Benefit are made.

  3. Reducing maternal mortality in Nigeria: the need for urgent changes in financing for maternal health in the Nigerian health system.

    Science.gov (United States)

    Ebeigbe, P N

    2013-06-01

    Nigeria's maternal mortality indices are among the worst in the world. Various approaches aimed at combatting the persistently high maternal mortality rates in the past have been ineffective. The objective of this article was to evaluate the fairness and equitability of financing for maternal health in the Nigerian health system. A review of the performance of the Nigerian Health system with regards to financing for maternal healthcare and comparison with other health systems utilising internationally accepted criteria was done. Household out-of -pocket payment was found to be the largest source of health care financing in the Nigerian health system contributing as much as 65.6 % of total health expenditure. This is in sharp contrast to the performance of more effective health systems like that in South Africa where health care is free for pregnant and breast feeding mothers. The result is that South Africa reports less than a tenth of total maternal mortalities reported from Nigeria annually. The current Nigeria health financing system is not equitable and appears to encourage maternal mortalities since it does not cater for the most vulnerable. There is an urgent need for a review of financing of maternal health in Nigeria to achieve universal access to maternal health care. An urgent overhaul of the currently under performing National Health Insurance scheme or adoption of the simpler system based on funding from taxation with universal access for health care including maternal care and services free at the point of access is suggested.

  4. Transgenerational effects of social environment on variations in maternal care and behavioral response to novelty.

    Science.gov (United States)

    Champagne, Frances A; Meaney, Michael J

    2007-12-01

    Cross-fostering studies in the rat have illustrated the importance of the postnatal environment in mediating the transmission of maternal licking/grooming (LG) from mother to offspring. The authors addressed the question of how postweaning social conditions can alter the patterns of maternal behavior. Juvenile female offspring of high LG and low LG mothers were placed in either standard, enriched, or impoverished postweaning environments for 50 consecutive days and then mated and observed with their own litters. Analysis of LG behavior indicated that the effect of postweaning environment was dependent on the level of postnatal mother-infant interaction. Postweaning isolation reduced exploratory behavior, maternal LG, and oxytocin receptor binding in the offspring of high LG mothers, whereas social enrichment enhanced exploration, LG behavior, and oxytocin receptor binding of low LG offspring. These effects were also transmitted to the next generation of offspring. Thus, maternal LG and the neural mechanisms that regulate this behavior exhibited a high degree of plasticity in response to changes in environment both within and beyond the postnatal period, with implications for the transmission of behavioral response to novelty and maternal care across generations.

  5. Achieving the Millennium Development Goal of reducing maternal mortality in rural Africa: an experience from Burundi.

    OpenAIRE

    Tayler-Smith, K; Zachariah, R; Manzi, M; Van den Boogaard, W; Nyandwi, G; Reid, T; Van den Bergh, R; De Plecker, E; Lambert, V; Nicolai, M; Goetghebuer, S; Christaens, B; Ndelema, B; Kabangu, A; Manirampa, J

    2012-01-01

    OBJECTIVES: To estimate the reduction in maternal mortality associated with the emergency obstetric care provided by Médecins Sans Frontières (MSF) and to compare this to the fifth Millennium Development Goal of reducing maternal mortality. METHODS: The impact of MSF's intervention was approximated by estimating how many deaths were averted among women transferred to and treated at MSF's emergency obstetric care facility in Kabezi, Burundi, with a severe acute maternal morbidity. Using this e...

  6. Inefficiency, heterogeneity and spillover effects in maternal care in India: a spatial stochastic frontier analysis.

    Science.gov (United States)

    Kinfu, Yohannes; Sawhney, Monika

    2015-03-25

    Institutional delivery is one of the key and proven strategies to reduce maternal deaths. Since the 1990s, the government of India has made substantial investment on maternal care to reduce the huge burden of maternal deaths in the country. However, despite the effort access to institutional delivery in India remains below the global average. In addition, even in places where health investments have been comparable, inter- and intra-state difference in access to maternal care services remain wide and substantial. This raises a fundamental question on whether the sub-national units themselves differ in terms of the efficiency with which they use available resources, and if so, why? Data obtained from round 3 of the country's District Level Health and Facility Survey was analyzed to measure the level and determinants of inefficiency of institutional delivery in the country. Analysis was conducted using spatial stochastic frontier models that correct for heterogeneity and spatial interactions between sub-national units. Inefficiency differences in maternal care services between and within states are substantial. The top one third of districts in the country has a mean efficiency score of 90 per cent or more, while the bottom 10 per cent of districts exhibit mean inefficiency score of as high as over 75 per cent or more. Overall mean inefficiency is about 30 per cent. The result also reveals the existence of both heterogeneity and spatial correlation in institutional delivery in the country. Given the high level of inefficiency in the system, further progress in improving coverage of institutional delivery in the country should focus both on improving the efficiency of resource utilization--especially where inefficiency levels are extremely high--and on bringing new resources in to the system. The additional investment should specifically focus on those parts of the country where coverage rates are still low but efficiency levels are already at a high level. In

  7. National data system on near miss and maternal death: shifting from maternal risk to public health impact in Nigeria

    Directory of Open Access Journals (Sweden)

    Oladapo Olufemi T

    2009-06-01

    Full Text Available Abstract Background The lack of reliable and up-to-date statistics on maternal deaths and disabilities remains a major challenge to the implementation of Nigeria's Road Map to Accelerate the Millennium Development Goal related to Maternal Health (MDG-5. There are currently no functioning national data sources on maternal deaths and disabilities that could serve as reference points for programme managers, health advocates and policy makers. While awaiting the success of efforts targeted at overcoming the barriers facing establishment of population-based data systems, referral institutions in Nigeria can contribute their quota in the quest towards MDG-5 by providing good quality and reliable information on maternal deaths and disabilities on a continuous basis. This project represents the first opportunity to initiate a scientifically sound and reliable quantitative system of data gathering on maternal health profile in Nigeria. Objective The primary objective is to create a national data system on maternal near miss (MNM and maternal mortality in Nigerian public tertiary institutions. This system will conduct periodically, both regionally and at country level, a review of the magnitude of MNM and maternal deaths, nature of events responsible for MNM and maternal deaths, indices for the quality of care for direct obstetric complications and the health service events surrounding these complications, in an attempt to collectively define and monitor the standard of comprehensive emergency obstetric care in the country. Methods This will be a nationwide cohort study of all women who experience MNM and those who die from pregnancy, childbirth and puerperal complications using uniform criteria among women admitted in tertiary healthcare facilities in the six geopolitical zones in Nigeria. This will be accomplished by establishing a network of all public tertiary obstetric referral institutions that will prospectively collect specific information on

  8. A wall of information? Exploring the public health component of maternity care in England.

    Science.gov (United States)

    Sanders, Julia; Hunter, Billie; Warren, Lucie

    2016-03-01

    midwives have traditionally had an important role in providing public health messages to women. The range and diversity of the public health remit within maternity services has expanded rapidly over the past decade and maternity support workers as well as midwives are now engaged in public health work in many areas. Given these changes a review of current practice was indicated. to identify student midwives׳, midwives׳ and midwifery support workers׳ current knowledge of and involvement in the public health agenda in England. descriptive qualitative study using online discussion forums. England, United Kingdom undergraduate student midwives, midwives and maternity support workers employed by the National Health Service in England and University employed Leads for Midwifery Education. key themes identified were: the scope of the midwives׳ public health role, training and support for public health role, barriers and facilitators, specific client groups, specialist referral services. Student midwives, midwives and maternity support workers view engagement with, and delivery of, public health initiatives as an integral component of their roles, but are on occasions frustrated by constraints of time, training and public engagement. the National Health Service in England aims to engage pregnant women and new mothers in a diverse range of population based and individualised, public health initiatives. Currently, there are high levels of involvement in the public health agenda from the maternity workforce across a wide range of activities. However, midwives and maternity support workers are restricted by barriers of time, training and resources. These barriers will need addressing for optimal maternity care engagement in public health to be realised. policy makers, commissioners and National Health Service providers need to provide clear guidance on the expectations of the public health remit of midwives and maternity support workers and ensure that such expectations

  9. Care Groups I: An Innovative Community-Based Strategy for Improving Maternal, Neonatal, and Child Health in Resource-Constrained Settings.

    Science.gov (United States)

    Perry, Henry; Morrow, Melanie; Borger, Sarah; Weiss, Jennifer; DeCoster, Mary; Davis, Thomas; Ernst, Pieter

    2015-09-01

    In view of the slow progress being made in reducing maternal and child mortality in many priority countries, new approaches are urgently needed that can be applied in settings with weak health systems and a scarcity of human resources for health. The Care Group approach uses facilitators, who are a lower-level cadre of paid workers, to work with groups of 12 or so volunteers (the Care Group), and each volunteer is responsible for 10-15 households. The volunteers share messages with the mothers of the households to promote important health behaviors and to use key health services. The Care Groups create a multiplying effect, reaching all households in a community at low cost. This article describes the Care Group approach in more detail, its history, and current NGO experience with implementing the approach across more than 28 countries. A companion article also published in this journal summarizes the evidence on the effectiveness of the Care Group approach. An estimated 1.3 million households—almost entirely in rural areas—have been reached using Care Groups, and at least 106,000 volunteers have been trained. The NGOs with experience implementing Care Groups have achieved high population coverage of key health interventions proven to reduce maternal and child deaths. Some of the essential criteria in applying the Care Group approach include: peer-to-peer health promotion (between mothers), selection of volunteers by mothers, limited workload for the volunteers, limited number of volunteers per Care Group, frequent contact between the volunteers and mothers, use of visual teaching tools and participatory behavior change methods, and regular supervision of volunteers. Incorporating Care Groups into ministries of health would help sustain the approach, which would require creating posts for facilitators as well as supervisors. Although not widely known about outside the NGO child survival and food security networks, the Care Group approach deserves broader

  10. Perceived Quality of Maternal Care in Childhood and Structure and Function of Mothers' Brain

    Science.gov (United States)

    Kim, Pilyoung; Leckman, James F.; Mayes, Linda C.; Newman, Michal-Ann; Feldman, Ruth; Swain, James E.

    2010-01-01

    Animal studies indicate that early maternal care has long-term effects on brain areas related to social attachment and parenting, whereas neglectful mothering is linked with heightened stress reactivity in the hippocampus across the lifespan. The present study explores the possibility, using magnetic resonance imaging, that perceived quality of…

  11. The potential of task shifting selected maternal interventions to auxiliary midwives in Myanmar: a mixed-method study.

    Science.gov (United States)

    Than, Kyu Kyu; Tin, Khaing Nwe; La, Thazin; Thant, Kyaw Soe; Myint, Theingi; Beeson, James G; Luchters, Stanley; Morgan, Alison

    2018-01-03

    An estimated 282 women die for every 100,000 live births in Myanmar, most due to preventable causes. Auxiliary Midwives (AMWs) in Myanmar are responsible for providing a package of care during pregnancy and childbirth to women in rural hard to reach areas where skilled birth attendants (Midwives) are not accessible. This study aims to examine the role of AMWs in Myanmar and to assess the current practices of three proposed essential maternal interventions (oral supplement distribution to pregnant women; administration of misoprostol to prevent postpartum haemorrhage; management of puerperal sepsis with oral antibiotics) in order to facilitate a formal integration of these tasks to AMWs in Myanmar. A mixed methods study was conducted in Magwe Region, Myanmar involving a survey of 262 AMWs, complemented by 15 focus group discussions with midwives (MWs), AMWs, mothers and community members, and 10 key informant interviews with health care providers at different levels within the health care system. According to current government policy, AMWs are responsible for identifying pregnant women, screening for danger signs and facilitating early referral, provision of counselling on nutrition and birth preparedness for women in hard-to-reach areas. AMWs also assist at normal deliveries and help MWs provide immunization services. In practice, they also provide oral supplements to pregnant women (84%), provide antibiotics to mothers during the puerperium (43%), and provide misoprostol to prevent postpartum haemorrhage (41%). The current practices of AMWs demonstrate the potential for task shifting on selected essential maternal interventions. However, to integrate these interventions into formal practice they must be complemented with appropriate training, clear guidelines on drug use, systematic recording and reporting, supportive monitoring and supervision and a clear political commitment towards task shifting. With the current national government's commitment towards one

  12. Operationalising the Lean principles in maternity service design using 3P methodology.

    Science.gov (United States)

    Smith, Iain

    2016-01-01

    The last half century has seen significant changes to Maternity services in England. Though rates of maternal and infant mortality have fallen to very low levels, this has been achieved largely through hospital admission. It has been argued that maternity services may have become over-medicalised and service users have expressed a preference for more personalised care. NHS England's national strategy sets out a vision for a modern maternity service that continues to deliver safe care whilst also adopting the principles of personalisation. Therefore, there is a need to develop maternity services that balance safety with personal choice. To address this challenge, a maternity unit in North East England considered improving their service through refurbishment or building new facilities. Using a design process known as the production preparation process (or 3P), the Lean principles of understanding user value, mapping value-streams, creating flow, developing pull processes and continuous improvement were applied to the design of a new maternity department. Multiple stakeholders were engaged in the design through participation in a time-out (3P) workshop in which an innovative pathway and facility for maternity services were co-designed. The team created a hybrid model that they described as "wrap around care" in which the Lean concept of pull was applied to create a service and facility design in which expectant mothers were put at the centre of care with clinicians, skills, equipment and supplies drawn towards them in line with acuity changes as needed. Applying the Lean principles using the 3P method helped stakeholders to create an innovative design in line with the aspirations and objectives of the National Maternity Review. The case provides a practical example of stakeholders applying the Lean principles to maternity services and demonstrates the potential applicability of the Lean 3P approach to design healthcare services in line with policy requirements.

  13. 'No more strangers': Investigating the experiences of women, midwives and others during the establishment of a new model of maternity care for remote dwelling aboriginal women in northern Australia.

    Science.gov (United States)

    Josif, Cathryn M; Barclay, Lesley; Kruske, Sue; Kildea, Sue

    2014-03-01

    to describe the experiences of women, midwives and others during the establishment of a new model of maternity care for remote dwelling Aboriginal women transferred to a regional centre in northern Australia for maternity care and birth. a mixed method design within a Participatory Action Research approach was used. Qualitative findings are presented here. Data for this paper were collected from semi-structured interviews, field notes and observations and analysed thematically. the 'top end' of the Northern Territory of Australia. a total of 66 participants included six MGP midwives, two Aboriginal Health Workers and one Senior Aboriginal Woman working in the new model; eight hospital midwives; 34 Department of Health staff, three staff from other agencies; and 12 remote dwelling Aboriginal women who used the service. the study generated one overarching theme, it's not a perfect system but it's changing. This encompassed improvements to the services evident to all participants. Core themes related to the previous maternity service which was described as the arduous journey, the new model was seen as a new way of working and a resultant very different journey occurred for Aboriginal women using the service. there was a dissonance between the previous culture of maternity services and the woman centred focus of the new model. Over 12 months initial resistance to the new model diminished and it became highly valued. The transfer of information between the regional service and remote community health centres improved as did the safety and quality of care. Aboriginal women can access continuity of carer in the regional centre for the first time and reported a more positive experience with maternity services. The new model appears to have changed the cultural responsiveness of the regional maternity service; and care provided for remote dwelling women within this service. The qualitative findings inform others seeking to implement a similar model of care for remote

  14. 'I used to fight with them but now I have stopped!': conflict and doctor-nurse anaesthetists' motivation in maternal and neonatal care provision in a specialist referral hospital

    NARCIS (Netherlands)

    Aberese-Ako, M.; Agyepong, I.A.; Gerrits, T.; van Dijk, H.

    2015-01-01

    Background and Objectives: This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. Methodology: The study used ethnographic methods including participant

  15. A qualitative evaluation of the choice of traditional birth attendants for maternity care in 2008 Sierra Leone: implications for universal skilled attendance at delivery.

    Science.gov (United States)

    Oyerinde, Koyejo; Harding, Yvonne; Amara, Philip; Garbrah-Aidoo, Nana; Kanu, Rugiatu; Oulare, Macoura; Shoo, Rumishael; Daoh, Kizito

    2013-07-01

    Maternal and newborn death is common in Sierra Leone; significant reductions in both maternal and newborn mortality require universal access to a skilled attendant during labor and delivery. When too few women use health facilities MDGs 4 and 5 targets will not be met. Our objectives were to identify why women use services provided by TBAs as compared to health facilities; and to suggest strategies to improve utilization of health facilities for maternity and newborn care services. Qualitative data from focus group discussions in communities adjacent to health facilities collected during the 2008 Emergency Obstetric and Newborn Care Needs Assessment were analyzed for themes relating to decision-making on the utilization of TBAs or health facilities. The prohibitive cost of services, and the geographic inaccessibility of health facilities discouraged women from using them while trust in the vast experience of TBAs as well as their compassionate care drew patients to them. Poor facility infrastructure, often absent staff, and the perception that facilities were poorly stocked and could not provide continuum of care services were barriers to facility utilization for maternity and newborn care. Improvements in infrastructure and the 24-hour provision of free, quality, comprehensive, and respectful care will minimize TBA preference in Sierra Leone.

  16. The knowledge of pregnant teenagers on Speech Therapy related to maternal-infant health care - doi:10.5020/18061230.2007.p207

    Directory of Open Access Journals (Sweden)

    Daniela Carvalho Neves

    2012-01-01

    Full Text Available This study had as its objective to investigate the knowledge of pregnant teenagers on Speech Therapy related to maternal-infant health care. A qualitative analysis was made based on a thematic investigation of the subject matter. Ten pregnant teenagers with chronological age between ten and nineteen years old joined in the survey. They found themselves around the fifth and ninth months of gestation age, being attended at the Center of Pregnant TeenagersAttention Care at Fortaleza General Hospital. The collection of data involved the application of a semi-structured interview broaching topics that could identify what the pregnant teenagers knew about Speech Therapy and maternal-infant care. Education interventions, related to Speech Therapy health promotion, were also accomplished. The results pointed out that the pregnant teenagers’ level of knowledge on aspects such as: food transition and utensils, oral habits, language stimulation and hearing loss detection, was still incipient and unsatisfactory. It is concluded that the knowledge of the pregnant teenagers on Speech Therapy related to maternal-infant health care was unsatisfactory, which demonstrates the importance of education interventions related to human communication health care for this studied sample.

  17. Maternal complications and women's behavior in seeking care from skilled providers in North Gondar, Ethiopia.

    Directory of Open Access Journals (Sweden)

    Abebaw Gebeyehu Worku

    Full Text Available BACKGROUND: Maternal complications are morbidities suffered during pregnancy through the postpartum period of 42 days. In Ethiopia, little is known about women's experience of complications and their care-seeking behavior. This study attempted to assess experiences related to obstetric complication and seeking assistance from a skilled provider among women who gave birth in the last 12 months preceding the study. METHODS: This study was a cross-sectional survey of women who gave birth within one year preceding the study regardless of their delivery place. The study was carried out in six selected districts in North Gondar Zone, Amhara Region. Data was collected house-to-house in 12 selected clusters (kebeles using a pretested Amharic questionnaire. During the survey, 1,668 women were interviewed. Data entry was done using Epi Info version 3.5.3 and was exported to SPSS for analysis. Logistic regression was applied to control confounders. RESULTS: Out of the total sample, 476 women (28.5%, 95% CI: 26.4%, 30.7% reported some kind of complication. The most common complications reported were; excessive bleeding and prolonged labor that occurred mostly at the time of delivery and postpartum period. Out of the total women who faced complications, 248 (52.1%, 95% CI: 47.6%, 56.6% sought assistance from a skilled provider. Inability to judge the severity of morbidities, distance/transport problems, lack of money/cost considerations and use of traditional options at home were the major reasons for not seeking care from skilled providers. Belonging to a wealthier quintile, getting antenatal care from a skilled provider and agreement of a woman in planning for possible complications were significantly associated with seeking assistance from a skilled provider. CONCLUSION: Nearly half of the women who faced complications did not use skilled providers at the time of obstetric complications. Cognitive, geographic, economic and cultural barriers were involved

  18. Systematic review of effect of community-level interventions to reduce maternal mortality

    Directory of Open Access Journals (Sweden)

    Deeks Jonathan J

    2009-01-01

    Full Text Available Abstract Background The objective was to provide a systematic review of the effectiveness of community-level interventions to reduce maternal mortality. Methods We searched published papers using Medline, Embase, Cochrane library, CINAHL, BNI, CAB ABSTRACTS, IBSS, Web of Science, LILACS and African Index Medicus from inception or at least 1982 to June 2006; searched unpublished works using National Research Register website, metaRegister and the WHO International Trial Registry portal. We hand searched major references. Selection criteria were maternity or childbearing age women, comparative study designs with concurrent controls, community-level interventions and maternal death as an outcome. We carried out study selection, data abstraction and quality assessment independently in duplicate. Results We found five cluster randomised controlled trials (RCT and eight cohort studies of community-level interventions. We summarised results as odds ratios (OR and confidence intervals (CI, combined using the Peto method for meta-analysis. Two high quality cluster RCTs, aimed at improving perinatal care practices, showed a reduction in maternal mortality reaching statistical significance (OR 0.62, 95% CI 0.39 to 0.98. Three equivalence RCTs of minimal goal-oriented versus usual antenatal care showed no difference in maternal mortality (1.09, 95% CI 0.53 to 2.25. The cohort studies were of low quality and did not contribute further evidence. Conclusion Community-level interventions of improved perinatal care practices can bring about a reduction in maternal mortality. This challenges the view that investment in such interventions is not worthwhile. Programmes to improve maternal mortality should be evaluated using randomised controlled techniques to generate further evidence.

  19. "Quality of prenatal and maternal care: bridging the know-do gap" (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa.

    Science.gov (United States)

    Blank, Antje; Prytherch, Helen; Kaltschmidt, Jens; Krings, Andreas; Sukums, Felix; Mensah, Nathan; Zakane, Alphonse; Loukanova, Svetla; Gustafsson, Lars L; Sauerborn, Rainer; Haefeli, Walter E

    2013-04-10

    Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline "Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice". The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on

  20. Distribution of maternity units and spatial access to specialised care for women delivering before 32 weeks of gestation in Europe

    DEFF Research Database (Denmark)

    Pilkington, Hugo; Blondel, Béatrice; Papiernik, Emile

    2009-01-01

    Survival and quality of life are improved for very preterm babies when delivery occurs in a maternity unit with on-site neonatal intensive care (level III unit). We investigated the impact of distance on the probability of delivering in such a unit for births before 32 weeks of gestation from 9...... European regions with diverse perinatal health systems (the MOSAIC cohort). We analysed distances between women's homes, and the nearest level III in population quartiles, adjusting for maternal and pregnancy characteristics. Living farther away from a level III reduced access to specialised care...

  1. Maternal mortality and serious maternal morbidity in Jehovah's witnesses in The Netherlands

    NARCIS (Netherlands)

    van Wolfswinkel, M. E.; Zwart, J. J.; Schutte, J. M.; Duvekot, J. J.; Pel, M.; van Roosmalen, J.

    2009-01-01

    To determine the risk of maternal mortality and serious maternal morbidity because of major obstetric haemorrhage in Jehovah's witnesses in The Netherlands. A retrospective study of case notes. All tertiary care centres, general teaching hospitals and other general hospitals in The Netherlands. All

  2. Maternal mortality and serious maternal morbidity in Jehovah's witnesses in the Netherlands

    NARCIS (Netherlands)

    Van Wolfswinkel, M. E.; Zwart, J. J.; Schutte, J. M.; Duvekot, J. J.; Pel, M.; Van Roosmalen, J.

    To determine the risk of maternal mortality and serious maternal morbidity because of major obstetric haemorrhage in Jehovah's witnesses in the Netherlands. A retrospective study of case notes. All tertiary care centres, general teaching hospitals and other general hospitals in the Netherlands. All

  3. Policies for care during the third stage of labour: a survey of maternity units in Syria

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    Abdulsalam Asma

    2010-06-01

    Full Text Available Abstract Background Care for women during the third stage aims to reduce the risk of major haemorrhage, but is very variable. The current World Health Organisation (WHO recommendation is that care should include administration of a uterotonic (oxytocin, if it is available soon after birth of the baby, delayed cord clamping, and delivery of the placenta by controlled cord traction. Methods To ascertain care policies used during the third stage of labour in maternity units in Syria, we conducted a survey of 69 maternity units in obstetric and general public hospitals. A brief questionnaire was administered by face to face interview or telephone with senior obstetricians and midwives. Outcome measures were the use of prophylactic uterotonic drugs, timing of cord clamping, use of controlled cord traction, and treatment for postpartum haemorrhage. Obstetricians were asked about both vaginal and caesarean births, midwives only about vaginal births. Results Responses were obtained for 66 (96% hospitals: a midwife and an obstetrician were interviewed in 40; an obstetrician only in 20; a midwife only in 6. Responses were similar, although midwives were more likely to report that the umbilical cord was clamped after 1-3 minutes or after cessation of pulsation (2/40 obstetricians and 9/40 midwives. Responses have therefore been combined. One hospital reported never using a prophylactic uterotonic drug. The uterotonic was Syntometrine® (oxytocin and ergometrine in two thirds of hospitals; given after delivery of the placenta in 60 (91% for vaginal births, and in 47 (78% for caesarean births. Cord clamping was within 20 seconds at 42 hospitals 64% for vaginal births and 45 (75% for caesarean births. Controlled cord traction was never used in a quarter (17/66 of hospitals for vaginal births and a half (32/60 for caesarean births. 68% of respondents (45/66 thought there was a need for more randomised trials of interventions during the third stage of labour

  4. Quadrivalent human papillomavirus vaccine uptake in adolescent boys and maternal utilization of preventive care and history of sexually transmitted infections.

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    Hechter, Rulin C; Chao, Chun; Sy, Lina S; Ackerson, Bradley K; Slezak, Jeff M; Sidell, Margo A; Jacobsen, Steven J

    2013-09-01

    We examined whether maternal utilization of preventive care and history of sexually transmitted infections (STIs) predicted quadrivalent human papillomavirus vaccine (HPV4) uptake among adolescent boys 1 year following the recommendation for permissive use of HPV4 for males. We linked maternal information with electronic health records of 254 489 boys aged 9 to 17 years who enrolled in Kaiser Permanente Southern California health plan from October 21, 2009, through December 21, 2010. We used multivariable Poisson regression with robust error variance to examine whether HPV4 initiation was associated with maternal uptake of influenza vaccine, Papanicolaou (Pap) screening, and history of STIs. We identified a modest but statistically significant association between initiation of HPV4 series and maternal receipt of influenza vaccine (rate ratio [RR] = 1.16; 95% confidence interval [CI] = 1.07, 1.26) and Pap screening (RR = 1.13; 95% CI = 1.01, 1.26). Boys whose mothers had a history of genital warts were more likely to initiate HPV4 (RR = 1.47; 95% CI = 0.93, 2.34), although the association did not reach statistical significance (P = .1). Maternal utilization of preventive care and history of genital warts may influence HPV4 uptake among adolescent boys. The important role of maternal health characteristics and health behaviors needs be considered in intervention efforts to increase vaccine uptake among boys.

  5. Priorities and strategies for improving disabled women's access to maternity services when they are affected by domestic abuse: a multi-method study using concept maps.

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    Bradbury-Jones, Caroline; Breckenridge, Jenna P; Devaney, John; Duncan, Fiona; Kroll, Thilo; Lazenbatt, Anne; Taylor, Julie

    2015-12-28

    Domestic abuse is a significant public health issue. It occurs more frequently among disabled women than those without a disability and evidence suggests that a great deal of domestic abuse begins or worsens during pregnancy. All women and their infants are entitled to equal access to high quality maternity care. However, research has shown that disabled women who experience domestic abuse face numerous barriers to accessing care. The aim of the study was to identify the priority areas for improving access to maternity services for this group of women; develop strategies for improved access and utilisation; and explore the feasibility of implementing the identified strategies. This multi-method study was the third and final part of a larger study conducted in the UK between 2012 and 2014. The study used a modified concept mapping approach and was theoretically underpinned by Andersen's model of healthcare use. Seven focus group interviews were conducted with a range of maternity care professionals (n = 45), incorporating quantitative and qualitative components. Participants ranked perceived barriers to women's access and utilisation of maternity services in order of priority using a 5-point Likert scale. Quantitative data exploration used descriptive and non-parametric analyses. In the qualitative component of each focus group, participants discussed the barriers and identified potential improvement strategies (and feasibility of implementing these). Qualitative data were analysed inductively using a framework analysis approach. The three most highly ranked barriers to women's access and utilisation of maternity services identified in the quantitative component were: 1) staff being unaware and not asking about domestic abuse and disability; 2) the impact of domestic abuse on women; 3) women's fear of disclosure. The top two priority strategies were: providing information about domestic abuse to all women and promoting non-judgemental staff attitude. These were

  6. Patients' perceptions of safety and quality of maternity clinical handover

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    Chin Georgiana SM

    2011-08-01

    Full Text Available Abstract Background Maternity clinical handover serves to address the gaps in knowledge existing when transitions between individuals or groups of clinicians occur throughout the antenatal, intra-partum and postnatal period. There are limited published studies on maternity handover and a paucity of information about patients' perceptions of the same. This paper reports postnatal patients' perceptions of how maternity handover contributes to the quality and safety of maternity care. Methods This paper reports on a mixed-methods study consisting of qualitative interviews and quantitative medical record analysis. Thirty English-speaking postnatal patients who gave birth at an Australian tertiary maternity hospital participated in a semi-structured interview prior to discharge from hospital. Interview data were coded thematically using the constant comparative method and managed via NVivo software; this data set was supplemented by medical record data analysed using STATA. Results Almost half of the women were aware of a handover process. Clinician awareness of patient information was seen as evidence that handover had taken place and was seen as representing positive aspects of teamwork, care and communication by participants, all important factors in the perception of quality health care. Collaborative cross-checking, including the use of cognitive artefacts such as hand held antenatal records and patient-authored birth plans, and the involvement of patients and their support people in handover were behaviours described by participants to be protective mechanisms that enhanced quality and safety of care. These human factors also facilitated team situational awareness (TSA, shared decision making and patient motivation in labour. Conclusions This study illustrates that many patients are aware of handover processes. For some patients, evidence of handover, through clinician awareness of information, represented positive aspects of teamwork, care and

  7. Disadvantaged populations in maternal health in China who and why?

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    Beibei Yuan

    2013-04-01

    Full Text Available Background: China has made impressive progress towards the Millennium Development Goal (MDG for maternal and reproductive health, but ensuring that progress reaches all segments of the population remains a challenge for policy makers. The aim of this review is to map disadvantaged populations in terms of maternal health in China, and to explain the causes of these inequities to promote policy action. Methods: We searched PUBMED, Popline, Proquest and WanFang and included primary studies conducted in mainland China. Experts were also contacted to identify additional studies. Disadvantaged populations in terms of MDG 5 and the reasons for this disadvantage explored by authors were identified and coded based on the conceptual framework developed by the WHO Commission on the Social Determinants of Health. Results: In China, differences in maternal health service utilization and the maternal mortality ratio among different income groups, and among regions with different socio-economic development still exist, although these differences are narrowing. Groups with low levels of education and ethnic minorities utilize maternal health care less frequently and experience higher maternal mortality, although we could not determine whether these differences have changed in the last decade. Rural-to-urban migrants use maternal health care and contraception to a lower extent than permanent residents of cities, and differential maternal mortality shows a widening trend among these groups. Gender inequity also contributes to the disadvantaged position of women. Intermediary factors that explain these inequities include material circumstances such as long distances to health facilities for women living in remote areas, behavioral factors such as traditional beliefs that result in reduced care seeking among ethnic minorities, and health system determinants such as out-of-pocket payments posing financial barriers for the poor. Conclusions: Inequity in maternal

  8. Cost-effectiveness of clinical decision support system in improving maternal health care in Ghana.

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    Maxwell Ayindenaba Dalaba

    Full Text Available This paper investigated the cost-effectiveness of a computer-assisted Clinical Decision Support System (CDSS in the identification of maternal complications in Ghana.A cost-effectiveness analysis was performed in a before- and after-intervention study. Analysis was conducted from the provider's perspective. The intervention area was the Kassena- Nankana district where computer-assisted CDSS was used by midwives in maternal care in six selected health centres. Six selected health centers in the Builsa district served as the non-intervention group, where the normal Ghana Health Service activities were being carried out.Computer-assisted CDSS increased the detection of pregnancy complications during antenatal care (ANC in the intervention health centres (before-intervention = 9 /1,000 ANC attendance; after-intervention = 12/1,000 ANC attendance; P-value = 0.010. In the intervention health centres, there was a decrease in the number of complications during labour by 1.1%, though the difference was not statistically significant (before-intervention =107/1,000 labour clients; after-intervention = 96/1,000 labour clients; P-value = 0.305. Also, at the intervention health centres, the average cost per pregnancy complication detected during ANC (cost -effectiveness ratio decreased from US$17,017.58 (before-intervention to US$15,207.5 (after-intervention. Incremental cost -effectiveness ratio (ICER was estimated at US$1,142. Considering only additional costs (cost of computer-assisted CDSS, cost per pregnancy complication detected was US$285.Computer -assisted CDSS has the potential to identify complications during pregnancy and marginal reduction in labour complications. Implementing computer-assisted CDSS is more costly but more effective in the detection of pregnancy complications compared to routine maternal care, hence making the decision to implement CDSS very complex. Policy makers should however be guided by whether the additional benefit is worth

  9. Inequalities in maternal health care utilization in sub-Saharan African countries: a multiyear and multi-country analysis.

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    Nazmul Alam

    Full Text Available To assess social inequalities in the use of antenatal care (ANC, facility based delivery (FBD, and modern contraception (MC in two contrasting groups of countries in sub-Saharan Africa divided based on their progress towards maternal mortality reduction. Six countries were included in this study. Three countries (Ethiopia, Madagascar, and Uganda had 4.5% average annual reduction rate while another three (Cameroon, Zambia, and Zimbabwe had >550 MMR in 2010 with only <1.5% average annual reduction rate. All of these countries had at least three rounds of Demographic and Health Surveys (DHS before 2012. We measured rate ratios and differences, as well as relative and absolute concentration indices in order to examine within-country geographical and wealth-based inequalities in the utilization of ANC, FBD, and MC. In the countries which have made sufficient progress (i.e. Ethiopia, Madagascar, and Uganda, ANC use increased by 8.7, 9.3 and 5.7 percent, respectively, while the utilization of FBD increased by 4.7, 0.7 and 20.2 percent, respectively, over the last decade. By contrast, utilization of these services either plateaued or decreased in countries which did not make progress towards reducing maternal mortality, with the exception of Cameroon. Utilization of MC increased in all six countries but remained very low, with a high of 40.5% in Zimbabwe and low of 16.1% in Cameroon as of 2011. In general, relative measures of inequalities were found to have declined overtime in countries making progress towards reducing maternal mortality. In countries with insufficient progress towards maternal mortality reduction, these indicators remained stagnant or increased. Absolute measures for geographical and wealth-based inequalities remained high invariably in all six countries. The increasing trend in the utilization of maternal care services was found to concur with a steady decline in maternal mortality. Relative inequality declined overtime in countries

  10. Effect of Village Health Team Home Visits and Mobile Phone Consultations on Maternal and Newborn Care Practices in Masindi and Kiryandongo, Uganda: A Community-Intervention Trial

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    Mangwi Ayiasi, Richard; Kolsteren, Patrick; Batwala, Vincent; Criel, Bart; Orach, Christopher Garimoi

    2016-01-01

    Introduction The World Health Organisation recommends home visits conducted by Community Health Workers (in Uganda known as Village Health Teams—VHTs) in order to improve maternal and newborn health. This study measured the effect of home visits combined with mobile phone consultations on maternal and newborn care practices. Method In a community intervention trial design 16 health centres in Masindi and Kiryandongo districts, Uganda were randomly and equally allocated to one of two arms: control and intervention arms. Eight control health centres received the usual maternal and newborn educational messages offered by professional health workers and eight intervention health centres that received an intervention package for maternal care and essential newborn care practices. In the intervention arm VHTs made two prenatal and one postnatal home visit to households. VHTs were provided with mobile phones to enable them make regular telephone consultations with health workers at the health centre serving the catchment area. The primary outcome was health facility delivery. Other outcomes included antenatal attendances, birth preparedness, cord and thermal care and breastfeeding practices. Analysis was by intention-to-treat. Results A total of 1385 pregnant women were analysed: 758 and 627 in the control and intervention arms respectively. Significant post-intervention differences were: delivery place [adjusted Odds Ratio aOR: 17.94(95%CI: 6.26–51.37); pcare [aOR: 3.05(95%CI: 1.81–5.12); pcare [aOR: 7.58(95%CI: 2.52–22.82); pcare-seeking for newborn illness [aOR: 4.93(95%CI: 1.59–15.31); p = 0.006]. Conclusion VHTs can have an effect in promoting proper cord and thermal care for the newborn and improve timely care-seeking for health facility delivery and newborn illness, because they could answer questions and refer patients correctly. However, VHTs should be supported by professional health workers through the use of mobile phones. Trial Registration Clinical

  11. Severe maternal morbidity: A population-based study of an expanded measure and associated factors.

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    Victoria Lazariu

    Full Text Available Severe maternal morbidity conditions such as sepsis, embolism and cardiac arrest during the delivery hospitalization period can lead to extended length of hospital stays, life-long maternal health problems, and high medical costs. Most importantly, these conditions also contribute to the risk of maternal death. This population-based observational study proposed and evaluated the impact of expanding the Centers for Disease Control and Prevention (CDC measure of severe maternal morbidity by including additional comorbidities and intensive care admissions during delivery hospitalizations and examined associated factors. A New York State linked hospitalization and birth record database was used. Study participants included all New York State female residents, ages 10 to 55 years, who delivered a live infant in a New York acute care hospital between 2008 and 2013, inclusive. Incidence trends for both severe maternal morbidity measures were evaluated longitudinally. Associations between covariates and the two severe maternal morbidity measures were examined with logistic regression models, solved using generalized estimating equations and stratified by method of delivery. The New York expanded severe maternal morbidity measure identified 34,478 cases among 1,352,600 hospital deliveries (estimated incidence 2.55% representing a 3% increase in the number of cases compared to the CDC measure. Both estimates increased over the study period (p 1.5 included most measured comorbidities (e.g., pregnancy-induced hypertension, placentation disorder, multiple births, preterm birth, no prenatal care, hospitalization prior to delivery, higher levels of perinatal care birthing facilities and race/ethnicity. Expanding the measure for severe maternal morbidity during delivery to capture intensive care admissions provides a more sensitive estimate of disease burden. Perinatal regionalization in New York appears effective in routing high risk pregnancies to higher

  12. Influences of maternal overprotection.

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    Parker, G; Lipscombe, P

    1981-04-01

    While maternal overprotection appears associated with several neurotic and psychotic disorders, little is known about determinants of such a parental characteristic. Several hypotheses have been tested in a large nonclinical sample. Maternal and cultural factors seemed of greater relevance than characteristics in the child. Overprotective mothers gave evidence of marked maternal preoccupations before having children, of showing a capacity to be overprotective after the active stage of mothering, and of having personality characteristics of high anxiety, obsessionality and a need to control. Maternal overprotection appears associated with low, rather than with high maternal care. This has important primary prevention and treatment implications.

  13. Evidence from district level inputs to improve quality of care for maternal and newborn health: interventions and findings.

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    Salam, Rehana A; Lassi, Zohra S; Das, Jai K; Bhutta, Zulfiqar A

    2014-09-04

    District level healthcare serves as a nexus between community and district level facilities. Inputs at the district level can be broadly divided into governance and accountability mechanisms; leadership and supervision; financial platforms; and information systems. This paper aims to evaluate the effectivness of district level inputs for imporving maternal and newborn health. We considered all available systematic reviews published before May 2013 on the pre-defined district level interventions and included 47 systematic reviews. Evidence suggests that supervision positively influenced provider's practice, knowledge and client/provider satisfaction. Involving local opinion leaders to promote evidence-based practice improved compliance to the desired practice. Audit and feedback mechanisms and tele-medicine were found to be associated with improved immunization rates and mammogram uptake. User-directed financial schemes including maternal vouchers, user fee exemption and community based health insurance showed significant impact on maternal health service utilization with voucher schemes showing the most significant positive impact across all range of outcomes including antenatal care, skilled birth attendant, institutional delivery, complicated delivery and postnatal care. We found insufficient evidence to support or refute the use of electronic health record systems and telemedicine technology to improve maternal and newborn health specific outcomes. There is dearth of evidence on the effectiveness of district level inputs to improve maternal newborn health outcomes. Future studies should evaluate the impact of supervision and monitoring; electronic health record and tele-communication interventions in low-middle-income countries.

  14. The quality of clinical maternal and neonatal healthcare - a strategy for identifying 'routine care signal functions'.

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    Stephan Brenner

    Full Text Available A variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs, a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC, the 'EmOC signal functions', a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example.We first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal complications. We then tested this indicator set in a study assessing MNH quality of clinical care in 33 health facilities in Malawi.Our strategy identified 51 routine care processes: 23 related to initial patient risk assessment, 17 to risk monitoring, 11 to risk prevention. During the clinical performance assessment a total of 82 cases were observed. Birth attendants' adherence to clinical standards was lowest in relation to risk monitoring processes. In relation to major complications, routine care processes addressing fetal and newborn distress were performed relatively consistently, but there were major gaps in the performance of routine care processes addressing bleeding, infection, and pre-eclampsia risks.The identified set of process indicators could identify major gaps in the quality of obstetric and neonatal care provided during the intra- and immediate postpartum period. We hope our suggested indicators for essential routine care processes will contribute to streamlining

  15. The quality of clinical maternal and neonatal healthcare - a strategy for identifying 'routine care signal functions'.

    Science.gov (United States)

    Brenner, Stephan; De Allegri, Manuela; Gabrysch, Sabine; Chinkhumba, Jobiba; Sarker, Malabika; Muula, Adamson S

    2015-01-01

    A variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH) programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs), a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC), the 'EmOC signal functions', a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example. We first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal complications. We then tested this indicator set in a study assessing MNH quality of clinical care in 33 health facilities in Malawi. Our strategy identified 51 routine care processes: 23 related to initial patient risk assessment, 17 to risk monitoring, 11 to risk prevention. During the clinical performance assessment a total of 82 cases were observed. Birth attendants' adherence to clinical standards was lowest in relation to risk monitoring processes. In relation to major complications, routine care processes addressing fetal and newborn distress were performed relatively consistently, but there were major gaps in the performance of routine care processes addressing bleeding, infection, and pre-eclampsia risks. The identified set of process indicators could identify major gaps in the quality of obstetric and neonatal care provided during the intra- and immediate postpartum period. We hope our suggested indicators for essential routine care processes will contribute to streamlining MNH program

  16. Maternal Employment and Child Cognitive Outcomes in the First Three Years of Life: The NICHD Study of Early Child Care.

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    Brooks-Gunn, Jeanne; Han, Wen-Jui; Waldfogel, Jane

    2002-01-01

    Examined data on 900 European American children from the NICHD Study of Early Child Care to explore links between maternal employment during the child's first year and child cognitive outcomes. Found that maternal employment by the child's ninth month related to lower school readiness scores at 36 months, with more pronounced effects for certain…

  17. Addressing maternal healthcare through demand side financial incentives: experience of Janani Suraksha Yojana program in India

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    Gopalan Saji S

    2012-09-01

    Full Text Available Abstract Background Demand side financing (DSF is a widely employed strategy to enhance utilization of healthcare. The impact of DSF on health care seeking in general and that of maternal care in particular is already known. Yet, its effect on financial access to care, out-of-pocket spending (OOPS and provider motivations is not considerably established. Without such evidence, DSFs may not be recommendable to build up any sustainable healthcare delivery approach. This study explores the above aspects on India’s Janani Suraksha Yojana (JSY program. Methods This study employed design and was conducted in three districts of Orissa, selected through a three-stage stratified sampling. The quantitative method was used to review the Health Management Information System (HMIS. The qualitative methods included focus groups discussions with beneficiaries (n = 19 and community intermediaries (n = 9, and interviews (n = 7 with Ministry of Health officials. HMIS data enabled to review maternal healthcare utilization. Group discussions and interviews explored the perceived impact of JSY on in-facility delivery, OOPS, healthcare costs, quality of care and performance motivation of community health workers. Results The number of institutional deliveries, ante-and post-natal care visits increased after the introduction of JSY with an annual net growth of 18.1%, 3.6% and 5% respectively. The financial incentive provided partial financial risk-protection as it could cover only 25.5% of the maternal healthcare cost of the beneficiaries in rural areas and 14.3% in urban areas. The incentive induced fresh out-of-pocket spending for some mothers and it could not address maternal care requirements comprehensively. An activity-based community worker model was encouraging to augment maternal healthcare consumption. However, the existing level of financial incentives and systemic support were inadequate to motivate the volunteers optimally on their

  18. Reducing maternal morbidity and mortality in the developing world: a simple, cost-effective example

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    Browning A

    2015-02-01

    Full Text Available Andrew Browning,1,2 Birhanu Menber21Maternity Africa, Arusha, Tanzania; 2Vision Maternity Care, Barhirdar, Ethiopia Objectives: To determine the impact of volunteer obstetricians and midwife teams on obstetric services in a rural hospital in Ethiopia.Methods: The intervention was undertaken in Mota district hospital, a rural hospital in the Amhara region of Ethiopia, which is the only hospital for 1.2 million people. Before the placement of volunteer teams it had a rudimentary basic obstetric service, no blood transfusion service, and no operative delivery. The study prospectively analyzed delivery data before, during, and after the placement of volunteer obstetrician and midwife teams. The volunteers established emergency obstetric care, and trained and supervised local staff over a 3-year period. Measurable outcomes consisted of the number of women delivering, the number of referrals of pregnant women, the number of maternal deaths, and the number of referrals of obstetric fistula patients.Results: With the establishment of the service the number of women attending hospital for delivery increased by 40%. In the hospital maternal mortality decreased from 7.1% to <0.5%, and morbidity, as measured by number of obstetric fistulae, decreased from 1.5% deliveries to 0.5% over the 3-year intervention period. The improvements were sustained after handing the project back to the government.Conclusion: The placement of volunteer teams was an effective method of decreasing maternal mortality and morbidity. Keywords: emergency obstetric care, volunteers, obstetric fistula, emergency obstetric care

  19. The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi.

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    Manthalu, Gerald; Yi, Deokhee; Farrar, Shelley; Nkhoma, Dominic

    2016-11-01

    The Government of Malawi has signed contracts called service level agreements (SLAs) with mission health facilities in order to exempt their catchment populations from paying user fees. Government in turn reimburses the facilities for the services that they provide. SLAs started in 2006 with 28 out of 165 mission health facilities and increased to 74 in 2015. Most SLAs cover only maternal, neonatal and in some cases child health services due to limited resources. This study evaluated the effect of user fee exemption on the utilization of maternal health services. The difference-in-differences approach was combined with propensity score matching to evaluate the causal effect of user fee exemption. The gradual uptake of the policy provided a natural experiment with treated and control health facilities. A second control group, patients seeking non-maternal health care at CHAM health facilities with SLAs, was used to check the robustness of the results obtained using the primary control group. Health facility level panel data for 142 mission health facilities from 2003 to 2010 were used. User fee exemption led to a 15% (P fee exemption is an important policy for increasing maternal health care utilization. For certain maternal services, however, other determinants may be more important. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

  20. Use of mobile phone consultations during home visits by Community Health Workers for maternal and newborn care: community experiences from Masindi and Kiryandongo districts, Uganda.

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    Mangwi Ayiasi, Richard; Atuyambe, Lynn Muhimbuura; Kiguli, Juliet; Garimoi Orach, Christopher; Kolsteren, Patrick; Criel, Bart

    2015-06-18

    Home visits by Community Health Workers [In Uganda Community Health Workers are given the collective term of Village Health Teams (VHTs). Hereafter referred to as VHTs] is recommended to improve maternal and newborn care. We investigated perceived maternal and newborn benefits of home visits made by VHTs, combined with mobile phone consultations with professional health workers for advice. A qualitative study was conducted in Masindi and Kiryandongo districts, Uganda, in December-2013 to March-2014. Study participants were drawn from the intervention arm of a randomised community-intervention trial. In-depth interviews were conducted with 20 prenatal and 16 postnatal women who were visited by VHTs; 5 group discussions and 16 key informant interviews were held with VHTs and 10 Key Informant Interviews with professional health workers. Data were analysed using latent content analysis techniques. Majority women and VHTs contend that the intervention improved access to maternal and newborn information; reduced costs of accessing care and facilitated referral. Women, VHTs and professional health workers acknowledged that the intervention induced attitudinal change among women and VHTs towards adapting recommended maternal and newborn care practices. Mobile phone consultations between VHTs and professional health workers were considered to reinforce VHT knowledge on maternal newborn care and boosted the social status of VHTs in community. A minority of VHTs perceived the implementation of recommended maternal and newborn care practices as difficult. Some professional health workers did not approve of the transfer of promotional maternal and newborn responsibility to VHTs. For a range of reasons, a number of professional health workers were not always available on phone or at the health centre to address VHT concerns. Results suggest that home visits made by VHTs for maternal and newborn care are reasonably well accepted. Our study highlights potential benefits of

  1. Maternal near-miss in a rural hospital in Sudan

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    Adam Gamal K

    2011-06-01

    Full Text Available Abstract Background Investigation of maternal near-miss is a useful complement to the investigation of maternal mortality with the aim of meeting the United Nations' fifth Millennium Development Goal. The present study was conducted to investigate the frequency of near-miss events, to calculate the mortality index for each event and to compare the socio-demographic and obstetrical data (age, parity, gestational age, education and antenatal care of the near-miss cases with maternal deaths. Methods Near-miss cases and events (hemorrhage, infection, hypertensive disorders, anemia and dystocia, maternal deaths and their causes were retrospectively reviewed and the mortality index for each event was calculated in Kassala Hospital, eastern Sudan over a 2-year period, from January 2008 to December 2010. Disease-specific criteria were applied for these events. Results There were 9578 deliveries, 205 near-miss cases, 228 near-miss events and 40 maternal deaths. Maternal near-miss and maternal mortality ratio were 22.1/1000 live births and 432/100 000 live births, respectively. Hemorrhage accounted for the most common event (40.8%, followed by infection (21.5%, hypertensive disorders (18.0%, anemia (11.8% and dystocia (7.9%. The mortality index were 22.2%, 10.0%, 10.0%, 8.8% and 2.4% for infection, dystocia, anemia, hemorrhage and hypertensive disorders, respectively. Conclusion There is a high frequency of maternal morbidity and mortality at the level of this facility. Therefore maternal health policy needs to be concerned not only with averting the loss of life, but also with preventing or ameliorating maternal-near miss events (hemorrhage, infections, hypertension and anemia at all care levels including primary level.

  2. A mixed methods evaluation of the maternal-newborn dashboard in Ontario: dashboard attributes, contextual factors, and facilitators and barriers to use: a study protocol.

    Science.gov (United States)

    Dunn, Sandra; Sprague, Ann E; Grimshaw, Jeremy M; Graham, Ian D; Taljaard, Monica; Fell, Deshayne; Peterson, Wendy E; Darling, Elizabeth; Harrold, JoAnn; Smith, Graeme N; Reszel, Jessica; Lanes, Andrea; Truskoski, Carolyn; Wilding, Jodi; Weiss, Deborah; Walker, Mark

    2016-05-04

    There are wide variations in maternal-newborn care practices and outcomes across Ontario. To help institutions and care providers learn about their own performance, the Better Outcomes Registry & Network (BORN) Ontario has implemented an audit and feedback system, the Maternal-Newborn Dashboard (MND), for all hospitals providing maternal-newborn care. The dashboard provides (1) near real-time feedback, with site-specific and peer comparison data about six key performance indicators; (2) a visual display of evidence-practice gaps related to the indicators; and (3) benchmarks to provide direction for practice change. This study aims to evaluate the effects of the dashboard, dashboard attributes, contextual factors, and facilitation/support needs that influence the use of this audit and feedback system to improve performance. The objectives of this study are to (1) evaluate the effect of implementing the dashboard across Ontario; (2) explore factors that potentially explain differences in the use of the MND among hospitals; (3) measure factors potentially associated with differential effectiveness of the MND; and (4) identify factors that predict differences in hospital performance. A mixed methods design includes (1) an interrupted time series analysis to evaluate the effect of the intervention on six indicators, (2) key informant interviews with a purposeful sample of directors/managers from up to 20 maternal-newborn care hospitals to explore factors that influence the use of the dashboard, (3) a provincial survey of obstetrical directors/managers from all maternal-newborn hospitals in the province to measure factors that influence the use of the dashboard, and (4) a multivariable generalized linear mixed effects regression analysis of the indicators at each hospital to quantitatively evaluate the change in practice following implementation of the dashboard and to identify factors most predictive of use. Study results will provide essential data to develop knowledge

  3. Unsafe Abortion- A Tragic Saga of Maternal Suffering

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    M C Regmi

    2010-03-01

    Full Text Available INTRODUCTION: Unsafe abortion is a significant cause of maternal morbidity and mortality in developing countries despite provision of adequate care and legalization of abortion. The aim of this study was to find out the contribution of unsafe abortion in maternal mortality and its other consequences. METHODS: A retrospective study was carried out in the Department of Obstetrics and Gynecology in BPKIHS between 2005 April to 2008 September analyzing all the unsafe abortion related admissions. RESULTS: There were 70 unsafe abortion patients. Majority of them (52.8% were of high grade. Most of them recovered but there were total 8maternal deaths. CONCLUSIONS: Unsafe abortion is still a significant medical and social problem even in post legalization era of this country. Keywords: abortion, legalization, maternal death, unsafe.

  4. Rise in maternal mortality in the Netherlands

    NARCIS (Netherlands)

    Schutte, J. M.; Steegers, E. A. P.; Schuitemaker, N. W. E.; Santema, J. G.; de Boer, K.; Pel, M.; Vermeulen, G.; Visser, W.; van Roosmalen, J.

    2010-01-01

    To assess causes, trends and substandard care factors in maternal mortality in the Netherlands. Design Confidential enquiry into the causes of maternal mortality. Nationwide in the Netherlands. 2,557,208 live births. Data analysis of all maternal deaths in the period 1993-2005. Maternal mortality.

  5. Maternal and Child Health Handbook use for maternal and child care: a cluster randomized controlled study in rural Java, Indonesia.

    Science.gov (United States)

    Osaki, Keiko; Hattori, Tomoko; Toda, Akemi; Mulati, Erna; Hermawan, Lukas; Pritasari, Kirana; Bardosono, Saptawati; Kosen, Soewarta

    2018-01-09

    Effectiveness of the Maternal and Child Health Handbook (MCHHB), a home-based booklet for pregnancy, delivery and postnatal/child health, was evaluated on care acquisition and home care in rural Java, a low service-coverage area. We conducted a health centre-based randomized trial, with a 2-year follow-up. Intervention included (i) MCHHB provision at antenatal care visits; (ii) records and guides by health personnel on and with the MCHHB; and (iii) sensitization of care by volunteers using the MCHHB. The follow-up rate was 70.2% (183, intervention area; 271, control area). Respondents in the intervention area received consecutive MCH services including two doses of tetanus toxoid injections and antenatal care four times or more during pregnancy, professional assistance during child delivery and vitamin A supplements administration to their children, after adjustment for confounding variables and cluster effects (OR = 2.03, 95% CI: 1.19-3.47). In the intervention area, home care (continued breastfeeding; introducing complementary feeding; proper feeding order; varied foods feeding; self-feeding training; and care for cough), perceived support by husbands, and lower underweight rates and stunting rates among children were observed. MCHHB use promoted continuous care acquisition and care at home from pregnancy to early child-rearing stages in rural Java. © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health.

  6. Family nurture intervention improves the quality of maternal caregiving in the neonatal intensive care unit: evidence from a randomized controlled trial.

    Science.gov (United States)

    Hane, Amie A; Myers, Michael M; Hofer, Myron A; Ludwig, Robert J; Halperin, Meeka S; Austin, Judy; Glickstein, Sara B; Welch, Martha G

    2015-04-01

    This study assessed the impact of Family Nurture Intervention (FNI) on the quality of maternal caregiving behavior (MCB) while in the neonatal intensive care unit (NICU). FNI is a randomized controlled trial conducted in a high-acuity NICU to facilitate an emotional connection between mothers and their premature infants. FNI begins shortly after birth, continues until discharge, and involves mother/infant calming sessions that include scent cloth exchange, vocal soothing and emotion expression, eye contact, skin-to-skin and clothed holding, and family-based support sessions. Maternal caregiving behavior was coded during a single holding and feeding session (∼30 min) in the NICU before discharge at approximately 36 weeks gestational age (GA). Sixty-five mothers and their premature infants (34 male, 31 female; 26-34 wk GA) were included in these analyses (FNI, n = 35; standard care [SC], n = 30). Relative to mothers in the SC condition, those in the FNI group showed significantly higher quality MCB, which remained significant when controlling for birth order, twin status, maternal depression, and maternal anxiety. This is the first study to demonstrate that in-unit MCB can be enhanced by a hospital-based intervention. FNI provides a new rationale for integrating nurture-based interventions into standard NICU care.

  7. Quality of maternal and paternal care predicts later stress reactivity in the cooperatively-breeding marmoset (Callithrix geoffroyi).

    Science.gov (United States)

    Birnie, Andrew K; Taylor, Jack H; Cavanaugh, Jon; French, Jeffrey A

    2013-12-01

    Variation in the early postnatal social environment can have lasting effects on hypothalamic-pituitary-adrenal (HPA) axis stress responses. Both rats and macaque monkeys subjected to low quality or abusive maternal care during the early postnatal period have more pronounced HPA responses to environmental stressors throughout development and into adulthood compared to animals reared in higher quality early maternal environments. However, little is known about the relative contributions to HPA stress response styles in developing offspring in species in which offspring care is routinely provided by group members other than the mother, such as in cooperatively breeding mammals. Marmoset monkeys exhibit cooperative offspring rearing, with fathers and older siblings providing care in addition to that provided by the mother. We evaluated the effects of early maternal, paternal, and older sibling care on HPA responses to social separation across development in captive white-faced marmoset offspring (Callithrix geoffroyi). We monitored offspring care by mothers, fathers, and older siblings in marmosets for the first 60 days of life. Later in development, each marmoset experienced three standardized social separation/novelty exposure stressors at 6, 12, and 18 months of age. During separation, we collected urine samples and analyzed them via enzyme immunoassay for cortisol levels. Infants that received higher rates of rejections from the entire family group showed higher cortisol responses to social separation. This relationship was found when mothers, fathers, and older siblings, were analyzed separately as well. No differences in cortisol responses were found between offspring that received high and low rates of carrying or high and low rates of licking and grooming by any group member. In the cooperatively breeding marmoset, early social cues from multiple classes of caregivers may influence HPA stress responses throughout the lifespan. Published by Elsevier Ltd.

  8. Learning maternity: the experiences of rural nurses.

    Science.gov (United States)

    MacKinnon, Karen

    2010-03-01

    Two research studies explored rural nurses' experience with the provision of maternity care in rural British Columbia, Canada. Frontline nurses, managers, and health-care providers were interviewed and their practices observed. One of the main challenges identified by rural nurses was ensuring that a knowledgeable/skilled maternity or perinatal nurse was always available at the local hospital. Learning how to provide safe and supportive maternity care is difficult for nurses working in small rural hospitals today due to declining birth rates, increased workloads, and a decrease in opportunities for mentoring. Decisions about the allocation of time off and resources for rural nurses' continuing professional education (CPE) were structured by discourses of personal responsibility for "continuing competence." These institutional work processes increase the burden on rural nurses, negatively affecting their opportunities for CPE and their experiences of providing maternity care, with implications for both patient safety and nurse retention.

  9. Severe Adverse Maternal Outcomes among Women in Midwife-Led versus Obstetrician-Led Care at the Onset of Labour in the Netherlands: A Nationwide Cohort Study.

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    Ank de Jonge

    Full Text Available To test the hypothesis that it is possible to select a group of low risk women who can start labour in midwife-led care without having increased rates of severe adverse maternal outcomes compared to women who start labour in secondary care.We conducted a nationwide cohort study in the Netherlands, using data from 223 739 women with a singleton pregnancy between 37 and 42 weeks gestation without a previous caesarean section, with spontaneous onset of labour and a child in cephalic presentation. Information on all cases of severe acute maternal morbidity collected by the national study into ethnic determinants of maternal morbidity in the Netherlands (LEMMoN study, 1 August 2004 to 1 August 2006, was merged with data from the Netherlands Perinatal Registry of all births occurring during the same period. Our primary outcome was severe acute maternal morbidity (SAMM, i.e. admission to an intensive care unit, uterine rupture, eclampsia or severe HELLP, major obstetric haemorrhage, and other serious events. Secondary outcomes were postpartum haemorrhage and manual removal of placenta.Nulliparous and parous women who started labour in midwife-led care had lower rates of SAMM, postpartum haemorrhage and manual removal of placenta compared to women who started labour in secondary care. For SAMM the adjusted odds ratio's and 95% confidence intervals were for nulliparous women: 0.57 (0.45 to 0.71 and for parous women 0.47 (0.36 to 0.62.Our results suggest that it is possible to identify a group of women at low risk of obstetric complications who may benefit from midwife-led care. Women can be reassured that we found no evidence that midwife-led care at the onset of labour is unsafe for women in a maternity care system with a well developed risk selection and referral system.

  10. Assessing coverage, equity and quality gaps in maternal and neonatal care in sub-saharan Africa: an integrated approach.

    Directory of Open Access Journals (Sweden)

    Calistus Wilunda

    Full Text Available Gaps in coverage, equity and quality of health services hinder the achievement of the Millennium Development Goals 4 and 5 in most countries of sub-Saharan Africa as well as in other high-burden countries, yet few studies attempt to assess all these dimensions as part of the situation analysis. We present the base-line data of a project aimed at simultaneously addressing coverage, equity and quality issues in maternal and neonatal health care in five districts belonging to three African countries.Data were collected in cross-sectional studies with three types of tools. Coverage was assessed in three hospitals and 19 health centres (HCs utilising emergency obstetric and newborn care needs assessment tools developed by the Averting Maternal Death and Disability program. Emergency obstetrics care (EmOC indicators were calculated. Equity was assessed in three hospitals and 13 HCs by means of proxy wealth indices and women delivering in health facilities were compared with those in the general population to identify inequities. Quality was assessed in three hospitals using the World Health Organization's maternal and neonatal quality of hospital care assessment tool which evaluates the whole range of aspects of obstetric and neonatal care and produces an average score for each main area of care.All the three hospitals qualified as comprehensive EmOC facilities but none of the HCs qualified for basic EmOC. None of the districts met the minimum requisites for EmOC indicators. In two out of three hospitals, there were major quality gaps which were generally greater in neonatal care, management of emergency and complicated cases and monitoring. Higher access to care was coupled by low quality and good quality by very low access. Stark inequities in utilisation of institutional delivery care were present in all districts and across all health facilities, especially at hospital level.Our findings confirm the existence of serious issues regarding coverage

  11. Addressing maternal healthcare through demand side financial incentives: experience of Janani Suraksha Yojana program in India.

    Science.gov (United States)

    Gopalan, Saji S; Durairaj, Varatharajan

    2012-09-15

    Demand side financing (DSF) is a widely employed strategy to enhance utilization of healthcare. The impact of DSF on health care seeking in general and that of maternal care in particular is already known. Yet, its effect on financial access to care, out-of-pocket spending (OOPS) and provider motivations is not considerably established. Without such evidence, DSFs may not be recommendable to build up any sustainable healthcare delivery approach. This study explores the above aspects on India's Janani Suraksha Yojana (JSY) program. This study employed design and was conducted in three districts of Orissa, selected through a three-stage stratified sampling. The quantitative method was used to review the Health Management Information System (HMIS). The qualitative methods included focus groups discussions with beneficiaries (n = 19) and community intermediaries (n = 9), and interviews (n = 7) with Ministry of Health officials. HMIS data enabled to review maternal healthcare utilization. Group discussions and interviews explored the perceived impact of JSY on in-facility delivery, OOPS, healthcare costs, quality of care and performance motivation of community health workers. The number of institutional deliveries, ante-and post-natal care visits increased after the introduction of JSY with an annual net growth of 18.1%, 3.6% and 5% respectively. The financial incentive provided partial financial risk-protection as it could cover only 25.5% of the maternal healthcare cost of the beneficiaries in rural areas and 14.3% in urban areas. The incentive induced fresh out-of-pocket spending for some mothers and it could not address maternal care requirements comprehensively. An activity-based community worker model was encouraging to augment maternal healthcare consumption. However, the existing level of financial incentives and systemic support were inadequate to motivate the volunteers optimally on their performance. Demand side financial incentive could enhance financial

  12. Care around birth, infant and mother health and maternal health investments - Evidence from a nurse strike.

    Science.gov (United States)

    Kronborg, Hanne; Sievertsen, Hans Henrik; Wüst, Miriam

    2016-02-01

    Care around birth may impact child and mother health and parental health investments. We exploit the 2008 national strike among Danish nurses to identify the effects of care around birth on infant and mother health (proxied by health care usage) and maternal investments in the health of their newborns. We use administrative data from the population register on 39,810 Danish births in the years 2007-2010 and complementary survey and municipal administrative data on 8288 births in the years 2007-2009 in a differences-in-differences framework. We show that the strike reduced the number of mothers' prenatal midwife consultations, their length of hospital stay at birth, and the number of home visits by trained nurses after hospital discharge. We find that this reduction in care around birth increased the number of child and mother general practitioner (GP) contacts in the first month. As we do not find strong effects of strike exposure on infant and mother GP contacts in the longer run, this result suggests that parents substitute one type of care for another. While we lack power to identify the effects of care around birth on hospital readmissions and diagnoses, our results for maternal health investments indicate that strike-exposed mothers-especially those who lacked postnatal early home visits-are less likely to exclusively breastfeed their child at four months. Thus reduced care around birth may have persistent effects on treated children through its impact on parental investments. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. ECLAMPSIA, A MAJOR BURDEN ON MATERNAL AND CHILD HEALTH: A RETROSPECTIVE STUDY IN TERTIARY CARE CENTRE

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    Kanchan Rani

    2017-01-01

    Full Text Available BACKGROUND Eclampsia is very common obstetric emergency and major cause of both maternal and perinatal morbidity and mortality in India. AIM The aim of study was to evaluate its incidence, clinical profile and maternal and perinatal morbidity and mortality associated with it in our hospital. MATERIALS AND METHODS A retrospective study was conducted in Government medical college, Haldwani from August 2014 to July 2015 for a period of one year. Out of 3432 deliveries a total of 53 cases of eclampsia were admitted .Cases were studied with respect to age, parity, period of gestation, blood pressure at the time of admission, severity of proteinuria ,maternal complications and mortality, mode of delivery and perinatal outcome. RESULTS Incidence of eclampsia in our study was 1.45%. Majority of patient were primigravida (62.26% It was more common in age group of 21 to 25 years (43.39% followed by age group of 26 to 30 years (26.41%.In most of patient first episode of convulsion occurred at term pregnancy with gestational age more than 37 weeks in our study (52.83%.Among 53 patients of eclampsia 48 presented with antepartum eclampsia (90.57% and 5 presented as postpartum eclampsia (9.43%. There was no case of intrapartum eclampsia in our study. Most common mode of delivery was Lower Segment Caesarean Section (62.26% in our study. Among 53 cases of eclampsia 3 patient had pulmonary oedema, 3 patient developed postpartum pyrexia and 4 patient had placental abruption. In one case postpartum haemorrhage occurred and one patient was in acute renal failure. There was one maternal mortality in our study. 6 patient had intrauterine foetal death (11.32%. 25 had preterm delivery (47.16% and 16 newborns were of low birth weight less than 2.5 Kilograms (30.19%. Most patient who developed eclampsia were unbooked or had irregular or no antenatal check-up (94.33%. CONCLUSION Improvement in antenatal care and neonatal facilities is of paramount importance in decreasing

  14. Designing, Implementing and Evaluating Preclinical Simulation Lab for Maternity Nursing Course

    Science.gov (United States)

    ALFozan, Haya; El Sayed, Yousria; Habib, Farida

    2015-01-01

    Background: The opportunity for students to deliver care safely in today's, complex health care environment is limited. Simulation allows students to practice skills in a safe environment. Purpose: to assess the students' perception, satisfaction, and learning outcomes after a simulation based maternity course. Method: a quasi experimental design…

  15. Maternal Health Care Practices among Mothers of a Selected Slum in Dhaka City

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    Mohoshina Karim

    2015-09-01

    Full Text Available Background: Bangladesh is a small South Asian country which became independent in 1971 after a bloody war. Rapid urbanisation in Bangladesh (26% of the 147.1 million inhabitants live in urban areas is fuelling a growth in urban poverty, particularly in the urban slums where the quality of life is extremely poor. The average population density in slums was reported in 2005 as 831 persons per acre or 205,415 people per square kilometre.1 Early commencement of antenatal care by pregnant women as well as regular visits has the potential to affect maternal and foetal outcome. Objective: To assess the status of ANC service used by the pregnant mothers and their socio-demographic characteristics. Materials and Methods: A community-based cross-sectional study was conducted at Moghbazar slum area in Dhaka district of Bangladesh, during January to June 2014. A total of 161 slum dwellers were enrolled in the study. Information regarding education, occupation, monthly family income, antenatal care was gathered using a pretested structured questionnnare and data were analysed. Results: The majority respondents had knowledge about antenatal care and of them 89 (55.2% completed ≥3 visits. Forty five (47.8% pregnant women received ANC from government hospitals. Nearly 72% mothers received ANC service from doctors and 16.9% received from family welfare visitors (FWV. Half of mothers were satisfied with the overall care provided to them. About 86.2% mothers said that they had to wait for more than two hours for check-ups. More than 50% received information about exercise and 36% were reassured about discussing fear and anxiety about pregnancy. Conclusion: This study reveals that antenatal care provided was not up to the mark of standard care and measures should be taken to improve it.

  16. Out-of-pocket expenditure and catastrophic health spending on maternal care in public and private health centres in India: a comparative study of pre and post national health mission period.

    Science.gov (United States)

    Mohanty, Sanjay K; Kastor, Anshul

    2017-09-18

    The National Health Mission (NHM), one of the largest publicly funded maternal health programs worldwide was initiated in 2005 to reduce maternal, neo-natal and infant mortality and out-of-pocket expenditure (OOPE) on maternal care in India. Though evidence suggests improvement in maternal and child health, little is known on the change in OOPE and catastrophic health spending (CHS) since the launch of NHM. The aim of this paper is to provide a comprehensive estimate of OOPE and CHS on maternal care by public and private health providers in pre and post NHM periods. The unit data from the 60th and 71st rounds of National Sample Survey (NSS) is used in the analyses. Descriptive statistics is used to understand the differentials in OOPE and CHS. The CHS is estimated based on capacity to pay, derived from household consumption expenditure, the subsistence expenditure (based on state specific poverty line) and household OOPE on maternal care. Data of both rounds are pooled to understand the impact of NHM on OOPE and CHS. The log-linear regression model and the logit regression models adjusted for state fixed effect, clustering and socio-economic and demographic correlates are used in the analyses. Women availing themselves of ante natal, natal and post natal care (all three maternal care services) from public health centres have increased from 11% in 2004 to 31% by 2014 while that from private health centres had increased from 12% to 20% during the same period. The mean OOPE on all three maternal care services from public health centres was US$60 in pre-NHM and US$86 in post-NHM periods while that from private health center was US$170 and US$300 during the same period. Controlling for socioeconomic and demographic correlates, the OOPE on delivery care from public health center had not shown any significant increase in post NHM period. The OOPE on delivery care in private health center had increased by 5.6 times compared to that from public health centers in pre NHM

  17. "Near-miss" obstetric events and maternal deaths in Sagamu, Nigeria: a retrospective study

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    Daniel Olusoji J

    2005-11-01

    Full Text Available Abstract Aim To determine the frequency of near-miss (severe acute maternal morbidity and the nature of near-miss events, and comparatively analysed near-miss morbidities and maternal deaths among pregnant women managed over a 3-year period in a Nigerian tertiary centre. Methods Retrospective facility-based review of cases of near-miss and maternal death which occurred between 1 January 2002 and 31 December 2004. Near-miss case definition was based on validated disease-specific criteria, comprising of five diagnostic categories: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. The near-miss morbidities were compared with maternal deaths with respect to demographic features and disease profiles. Mortality indices were determined for various disease processes to appreciate the standard of care provided for life-threatening obstetric conditions. The maternal death to near-miss ratios for the three years were compared to assess the trend in the quality of obstetric care. Results There were 1501 deliveries, 211 near-miss cases and 44 maternal deaths. The total near-miss events were 242 with a decreasing trend from 2002 to 2004. Demographic features of cases of near-miss and maternal death were comparable. Besides infectious morbidity, the categories of complications responsible for near-misses and maternal deaths followed the same order of decreasing frequency. Hypertensive disorders in pregnancy and haemorrhage were responsible for 61.1% of near-miss cases and 50.0% of maternal deaths. More women died after developing severe morbidity due to uterine rupture and infection, with mortality indices of 37.5% and 28.6%, respectively. Early pregnancy complications and antepartum haemorrhage had the lowest mortality indices. Majority of the cases of near-miss (82.5% and maternal death (88.6% were unbooked for antenatal care and delivery in this hospital. Maternal mortality ratio for the period was 2931.4 per 100

  18. Maternal Confidence for Physiologic Childbirth: A Concept Analysis.

    Science.gov (United States)

    Neerland, Carrie E

    2018-06-06

    Confidence is a term often used in research literature and consumer media in relation to birth, but maternal confidence has not been clearly defined, especially as it relates to physiologic labor and birth. The aim of this concept analysis was to define maternal confidence in the context of physiologic labor and childbirth. Rodgers' evolutionary method was used to identify attributes, antecedents, and consequences of maternal confidence for physiologic birth. Databases searched included Ovid MEDLINE, CINAHL, PsycINFO, and Sociological Abstracts from the years 1995 to 2015. A total of 505 articles were retrieved, using the search terms pregnancy, obstetric care, prenatal care, and self-efficacy and the keyword confidence. Articles were identified for in-depth review and inclusion based on whether the term confidence was used or assessed in relationship to labor and/or birth. In addition, a hand search of the reference lists of the selected articles was performed. Twenty-four articles were reviewed in this concept analysis. We define maternal confidence for physiologic birth as a woman's belief that physiologic birth can be achieved, based on her view of birth as a normal process and her belief in her body's innate ability to birth, which is supported by social support, knowledge, and information founded on a trusted relationship with a maternity care provider in an environment where the woman feels safe. This concept analysis advances the concept of maternal confidence for physiologic birth and provides new insight into how women's confidence for physiologic birth might be enhanced during the prenatal period. Further investigation of confidence for physiologic birth across different cultures is needed to identify cultural differences in constructions of the concept. © 2018 by the American College of Nurse-Midwives.

  19. Effect of Mobile-health on maternal health care service utilization in Eastern Ethiopia: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Gelano, Tilayie Feto; Assefa, Nega; Bacha, Yadeta Dessie; Mahamed, Afendi Abdi; Roba, Kedir Teji; Hambisa, Mitiku Teshome

    2018-02-12

    Globally, the rapid development of mobile technology has created new ways of addressing public health challenges and shifted the paradigm of health care access and delivery. The primary aim of this study is to examine the effectiveness of Mobile-health on maternal health care service utilization in Eastern Ethiopia. Through, a cluster-randomized controlled trial, 640 participants will be selected based on their districts and respective health centers as the unit of randomization. All pregnant mothers who fulfill the inclusion criteria will be allocated to a mobile-phone-based intervention and existing standard of care or control with a 1:1 allocation ratio. The intervention consists of a series of 24 voice messages which will be sent every 2 weeks from the date of enrollment until the close-out time. The control group will receive existing standard of care without voice messages. Data related to outcome variables will be assessed at three phases of the data collection periods. The primary outcome measures will be the proportion of antenatal care visits and institutional delivery, whereas the secondary outcome measures will consist of the proportion of postnatal care visits and pregnancy outcomes. Risk ratios will be used to a measure the effect of intervention on the outcomes which will be estimated with 95% confidence interval and all the analyses will be done with consideration of clustering effect. This study should generate evidence on the effectiveness of mobile-phone-based voice messages for the early initiation of maternal health care service use and its uptake. It has been carefully designed with the assumption of obtaining higher levels of maternal health care service use among the treatment group as compared to the control. Pan African Clinical Trial Registry, www.panctr.org , ID: PACTR201704002216259 . Registered on 28 April 2017.

  20. Task shifting in maternal and newborn care: a non-inferiority study examining delegation of antenatal counseling to lay nurse aides supported by job aids in Benin

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    Affo Jean

    2011-01-01

    Full Text Available Abstract Background Shifting the role of counseling to less skilled workers may improve efficiency and coverage of health services, but evidence is needed on the impact of substitution on quality of care. This research explored the influence of delegating maternal and newborn counseling responsibilities to clinic-based lay nurse aides on the quality of counseling provided as part of a task shifting initiative to expand their role. Methods Nurse-midwives and lay nurse aides in seven public maternities were trained to use job aids to improve counseling in maternal and newborn care. Quality of counseling and maternal knowledge were assessed using direct observation of antenatal consultations and patient exit interviews. Both provider types were interviewed to examine perceptions regarding the task shift. To compare provider performance levels, non-inferiority analyses were conducted where non-inferiority was demonstrated if the lower confidence limit of the performance difference did not exceed a margin of 10 percentage points. Results Mean percent of recommended messages provided by lay nurse aides was non-inferior to counseling by nurse-midwives in adjusted analyses for birth preparedness (β = -0.0, 95% CI: -9.0, 9.1, danger sign recognition (β = 4.7, 95% CI: -5.1, 14.6, and clean delivery (β = 1.4, 95% CI: -9.4, 12.3. Lay nurse aides demonstrated superior performance for communication on general prenatal care (β = 15.7, 95% CI: 7.0, 24.4, although non-inferiority was not achieved for newborn care counseling (β = -7.3, 95% CI: -23.1, 8.4. The proportion of women with correct knowledge was significantly higher among those counseled by lay nurse aides as compared to nurse-midwives in general prenatal care (β = 23.8, 95% CI: 15.7, 32.0, birth preparedness (β = 12.7, 95% CI: 5.2, 20.1, and danger sign recognition (β = 8.6, 95% CI: 3.3, 13.9. Both cadres had positive opinions regarding task shifting, although several preferred 'task sharing

  1. Prenatal care in combination with maternal educational level has a synergetic effect on the risk of neonatal low birth weight: new findings in a retrospective cohort study in Kunshan City, China.

    Directory of Open Access Journals (Sweden)

    Lin-Lin Dai

    Full Text Available OBJECTIVES: To investigate the dose-response relationship and synergetic effect of the maternal educational level and two measures of prenatal care on neonatal low birth weight (LBW risk. METHODS: Data were derived from the Perinatal Health Care Surveillance System (PHCSS from January 2001 to September 2009 in Kunshan City, Jiangsu province, eastern China, which included data on 31412 women with a normal birth weight delivery and 640 women with a LBW delivery. Logistic modelling was performed to estimate the association including the joint effects with odds ratio (OR and 95% confidence interval (CI between the prenatal care measures and LBW risk after adjusting for the potential confounders. The dose-response relationship between the number of prenatal care visits and the risk of LBW was investigated by modeling the quantitative exposure with restricted cubic splines (RCS. RESULTS: There was a significant synergetic effect on the LBW risk between maternal educational attainment and the number of prenatal care visits (χ(2 = 4.98, P = 0.0257, whereas no significant maternal educational attainment interaction was found with the week of initiation of prenatal care after adjusting for relevant confounding factors (χ(2 = 2.04, P = 0.1530, and the LBW risk displayed a 'U-shape' curve tendency among the different number of prenatal care visits (P for nonlinearity = 0.0002 using RCS. In particular, the ORs were approaching the curve's bottom when the women had 9 or 10 prenatal care visits. Comparing with 5 prenatal care visits, the ORs and 95%CI of LBW risk for 7, 9, 11 and ≥ 13 visits were 0.92 (0.82-1.03, 0.50 (0.38-0.66, 0.62 (0.47-0.82, and 0.99 (0.61-1.60, respectively. CONCLUSIONS: Our findings suggest that appropriate prenatal care, in combination with a higher maternal educational level, can produce a protective interaction effect on LBW risk. Reasonable health resource assignment for different social statuses should be taken into account by

  2. User fees and maternity services in Ethiopia.

    Science.gov (United States)

    Pearson, Luwei; Gandhi, Meena; Admasu, Keseteberhan; Keyes, Emily B

    2011-12-01

    To examine user fees for maternity services and how they relate to provision, quality, and use of maternity services in Ethiopia. The national assessment of emergency obstetric and newborn care (EmONC) examined user fees for maternity services in 751 health facilities that provided childbirth services in 2008. Overall, only about 6.6% of women gave birth in health facilities. Among facilities that provided delivery care, 68% charged a fee in cash or kind for normal delivery. Health centers should be providing maternity services free of charge (the healthcare financing proclamation), yet 65% still charge for some aspect of care, including drugs and supplies. The average cost for normal and cesarean delivery was US $7.70 and US $51.80, respectively. Nineteen percent of these facilities required payment in advance for treatment of an obstetric emergency. The health facilities that charged user fees had, on average, more delivery beds, deliveries (normal and cesarean), direct obstetric complications treated, and a higher ratio of skilled birth attendants per 1000 deliveries than those that did not charge. The case fatality rate was 3.8% and 7.1% in hospitals that did and did not charge user fees, respectively. Utilization of maternal health services is extremely low in Ethiopia and, although there is a government decree against charging for maternity service, 65% of health centers do charge for some aspects of maternal care. As health facilities are not reimbursed by the government for the costs of maternity services, this loss of revenue may account for the more and better services offered in facilities that continue to charge user fees. User fees are not the only factor that determines utilization in settings where the coverage of maternity services is extremely low. Additional factors include other out-of-pocket payments such as cost of transport and food and lodging for accompanying relatives. It is important to keep quality of care in mind when user fees are under

  3. Access and quality of maternity care for disabled women during pregnancy, birth and the postnatal period in England: data from a national survey.

    Science.gov (United States)

    Malouf, Reem; Henderson, Jane; Redshaw, Maggie

    2017-07-20

    More disabled women are becoming mothers, and yet, their care is rarely the focus of quantitative research. This study aimed to investigate access and quality of maternity care for women with differing disabilities. Secondary analysis was conducted on data from a 2015 national survey of women's experience of maternity care. Descriptive and adjusted analyses were undertaken for five disability groups: physical disability, sensory impairment, mental health disability, learning disability and multiple disability, and comparisons were made with the responses of non-disabled women. Survey data were collected on women's experience of primary and secondary care in all trusts providing maternity care in England. Women who had given birth 3 months previously, among whom were groups self-identifying with different types of disability. Exclusions were limited to women whose baby had died and those who were younger than 16 years at the time of the recent birth. Overall, 20 094 women completed and returned the survey; 1958 women (9.5%) self-identified as having a disability. The findings indicate some gaps in maternity care provision for these women relating to interpersonal aspects of care: communication, feeling listened to and supported, involvement in decision making, having a trusted and respected relationship with clinical staff. Women from all disability groups wanted more postnatal contacts and help with infant feeding. While access to care was generally satisfactory for disabled women, women's emotional well-being and support during pregnancy and beyond is an area that is in need of improvement. Specific areas identified included disseminating information effectively, ensuring appropriate communication and understanding, and supporting women's sense of control to build trusting relationships with healthcare providers. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted

  4. [Pre-pregnancy nutritional status, maternal weight gain, prenatal care, and adverse perinatal outcomes among adolescent mothers].

    Science.gov (United States)

    Santos, Marta Maria Antonieta de Souza; Baião, Mirian Ribeiro; de Barros, Denise Cavalcante; Pinto, Alessandra de Almeida; Pedrosa, Priscila La Marca; Saunders, Claudia

    2012-03-01

    To identify the association between pre-gestational nutritional status, maternal weight gain, and prenatal care with low birth weight (LBW) and prematurity outcomes in infants of adolescent mothers. Cross-sectional study with 542 pairs of adolescent mothers and their children attending a public maternity hospital in Rio de Janeiro. Data were collected from medical records. To determine the association between independent variables and the outcomes studied, odds ratio (OR) and a 95% confidence interval (CI) were estimated With respect to pre-pregnancy nutritional status of adolescents, 87% had normal weight, 1% were underweight, 10% were overweight, and 2% obese. Inadequate total gestational weight gain (72%) exceeded adequacy (28%). Birth weight was favored with greater gestational weight gain, and reduced with late onset of prenatal care. The comparison between the low birth weight and normal birth weight groups revealed significant differences between variable means: interval between the past pregnancy and current pregnancy (p = 0.022), pre-gestational weight (p = 0.018); pre-gestational body mass index (p pregnancy weight and body mass index before pregnancy. The minimum frequency of six prenatal care visits was a protective factor against LBW and prematurity.

  5. Utilization of maternal health care services in the department of Matagalpa, Nicaragua Utilización de los servicios de salud materna en el departamento de Matagalpa, Nicaragua

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    Lindsey Ann Lubbock

    2008-08-01

    Full Text Available OBJECTIVES: To better understand the individual and community factors and perceptions that influence women's health care-seeking behaviors during pregnancy in order to increase women's utilization of maternal health services. METHODS: This study investigates the logistical and sociocultural barriers influencing women's utilization of maternal health services through 37 semi-structured in-depth interviews with women from the department of Matagalpa, Nicaragua. RESULTS: Results reveal that delays in seeking health care during pregnancy are influenced not only by poor access to care and economic barriers but also by individual and community knowledge and acceptance of maternal health services. Partner support, previous maternal health care experiences, and the degree of communication with other women and health workers affect women's decisions to seek care. CONLUSIONS: Evidence suggests that in order to improve maternal health outcomes in this region, interventions must be targeted at a hierarchy of levels: individual, household, and community.OBJETIVOS: Mejorar el conocimiento sobre las percepciones y los factores personales y comunitarios que influyen en la búsqueda de atención médica durante el embarazo, con vistas a aumentar la utilización de los servicios de salud materna. MÉTODOS: Mediante 37 entrevistas semiestructuradas en profundidad aplicadas a mujeres del departamento de Matagalpa, Nicaragua, se investigaron las barreras logísticas y socioculturales que influyen en la utilización de los servicios de salud materna. RESULTADOS: Los resultados muestran que sobre la demora en la búsqueda de atención sanitaria durante el embarazo influyeron no solo el escaso acceso y las barreas económicas, sino también el conocimiento individual y comunitario sobre los servicios de salud materna y su grado de aceptación. El apoyo de la pareja, el haber recibido atención médica durante embarazos previos y el grado de comunicación con otras

  6. Maternal-child health fellowship: maintaining the rigor of family medicine obstetrics.

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    Magee, Susanna R; Radlinski, Heidi; Nothnagle, Melissa

    2015-01-01

    The United States has a growing shortage of maternity care providers. Family medicine maternity care fellowships can address this growing problem by training family physicians to manage high-risk pregnancies and perform cesarean deliveries. This paper describes the impact of one such program-the Maternal Child Health (MCH) Fellowship through the Department of Family Medicine at Brown University and the careers of its graduates over 20 years (1991--2011). Fellowship graduates were mailed a survey regarding their training, current practice and teaching roles, and career satisfaction. Seventeen of 23 fellows (74%) responded to the survey. The majority of our fellowship graduates provide maternity care. Half of our respondents are primary surgeons in cesarean sections, and the majority of these work in community hospitals. Nearly all of our graduates maintain academic appointments and teach actively in their respective departments of family medicine. Our maternal child health fellowship provides family physicians with the opportunity to develop advanced skills needed to provide maternity care for underserved communities and teaching skills to train the next generation of maternal child health care providers.

  7. Effects of maternal gate-keeping behavior on father involvement in care of a pre-school child

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    Mihić Ivana

    2010-01-01

    Full Text Available The research so far indicates that the context in which the father’s role takes place significantly influences the form and level of father involvement in taking care of the child. The primary goal of this research was to describe the forms and effects of maternal gate-keeping behavior as a characteristic form of interaction between parents which is, as part of the context, considered a significant factor in father involvement in care of the child. Research participants were 247 parental couples from complete families whose oldest child attended a pre-school institution. Fathers provided assessments of their own involvement via the Father Involvement Inventory, as well as assessments of prominence of gate-keeping behavior in their wives via the checklist of maternal gate-keeping behavior. Mothers reported on their beliefs about the importance and possibilities of father involvement in care of the child, as well as on their personal satisfaction with the current involvement of their husband in the joint care of the child. The results point out to the particular forms of mothers’ ambivalence when it comes to the joint care of the child, which is a form of gate-keeping behavior. The frequency of gate-keeping behavior, assessed by the checklist, significantly changes the possibilities of father involvement in taking care of the child in the developmental phase of the family, having in mind that the task of this phase is precisely the definition of parental roles and formation of parent cooperative principle.

  8. Use of antenatal care, maternity services, intermittent presumptive treatment and insecticide treated bed nets by pregnant women in Luwero district, Uganda

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    Mufubenga Patrobas

    2008-03-01

    Full Text Available Abstract Background To reduce the intolerable burden of malaria in pregnancy, the Ministry of Health in Uganda improved the antenatal care package by including a strong commitment to increase distribution of insecticide-treated nets (ITNs and introduction of intermittent preventive treatment with sulphadoxine-pyrimethamine for pregnant women (IPTp-SP as a national policy in 2000. This study assessed uptake of both ITNs and IPTp-SP by pregnant women as well as antenatal and maternity care use with the aim of optimizing their delivery. Methods 769 post-partum women were recruited from a rural area of central Uganda with perennial malaria transmission through a cross-sectional, community-based household survey in May 2005. Results Of the 769 women interviewed, antenatal clinic (ANC attendance was high (94.4%; 417 (57.7% visiting initially during the 2nd trimester, 242 (33.5% during the 3rd trimester and 266 (37.1% reporting ≥ 4 ANC visits. About 537 (71% and 272 (35.8% received one or ≥ 2 IPTp-SP doses respectively. Only 85 (15.8% received the first dose of IPTp-SP in the 3rd trimester. ITNs were used by 239 (31.3% of women during pregnancy and 314 (40.8% delivered their most recent pregnancy outside a health facility. Post-partum women who lacked post-primary education were more likely not to have attended four or more ANC visits (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.2–9.3. Conclusion These findings illustrate the need to strengthen capacity of the district to further improve antenatal care and maternity services utilization and IPTp-SP uptake. More specific and effective community health strategies to improve effective ANC, maternity services utilization and IPTp-SP uptake in rural communities should be undertaken.

  9. Evaluation of Maternal Health Service Indicators in Urban Slum of Bangladesh.

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    Jolly, Saira Parveen; Rahman, Mahfuzar; Afsana, Kaosar; Yunus, Fakir Md; Chowdhury, Ahmed M R

    2016-01-01

    A continuous influx of poor people to urban slums poses a challenge to Bangladesh's health system as it has failed to tackle maternal morbidity and mortality. BRAC is the largest non-governmental organisation in Bangladesh. BRAC has been working to reduce maternal, neonatal and under-five children morbidity and mortality of slum dwellers in cities. BRAC has been doing this work for a decade through a programme called MANOSHI. This programme provides door-to-door services to its beneficiaries through community health workers (CHWs) and normal delivery service through its delivery and maternity centres. BRAC started the 'MANOSHI' programme in Narayanganj City Corporation during 2011 to address maternal, neonatal and child health problems facing slum dwellers. We investigated the existing maternal health-service indicators in the slums of Narayanganj City Corporation and compared the findings with a non-intervention area. This cross-sectional study was conducted during 2012, in 47 slums of Narayanganj City Corporation as intervention and 10 slums of Narsingdi Sadar Municipality as comparison area. A total of 1206 married women, aged 15-49 years, with a pregnancy outcome in the previous year were included for interview. Data on socio-demographic characteristics, reproductive and maternal health-care practices like use of contraceptive methods, antenatal care (ANC), delivery care, postnatal care (PNC) were collected through a structured questionnaire. The chi-square test, Student t test, Mann Whitney U-test, factor analysis and log-binominal test were performed by using STATA statistical software for analysing data. The activities of BRAC CHWs significantly improved four or more ANC (47% vs. 21%; pslums compared to comparison slums. Still, about half of the deliveries in both areas were attended at home by unskilled birth attendants, of which a very few received PNC within 48 hours after delivery. The poorest and illiterate women received fewer maternal health services

  10. Maternal and perinatal outcome in gestational diabetes mellitus in a Tertiary Care Hospital in Delhi

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    Rajesh Kumari

    2018-01-01

    Full Text Available Background: Gestational diabetes mellitus (GDM is defined as a carbohydrate intolerance first diagnosed in pregnancy and may be associated with adverse maternal and perinatal outcome. Aim: The aim of the study was to determine the maternal and perinatal outcome in GDM during pregnancy. Materials and Methods: It is a retrospective analysis of women diagnosed with GDM who got antenatal care and delivered in our hospital in previous 5 years. Another 191 women with normal pregnancy without GDM and other medical conditions were taken as control. The baseline characteristics (age, body mass index, religion, and socioeconomic status were noted in all cases. Diagnosis of GDM was made using oral glucose tolerance test with 75 g glucose. GDM patients were started on diet following which insulin or oral hypoglycemic agents were given if required. Maternal and perinatal outcome was noted in all women.Results: The prevalence of GDM was 5.72% (170/2970. Most patients (79.41% could be controlled on diet alone. However, 21 (12.35% needed insulin and 14 (8.23% needed oral hypoglycemic agents. Middle socioeconomic status was more common in GDM than control and pregnancy-induced hypertension was more common in GDM (13.5% than in control (6.3% (P = 0.019. Mode of delivery was not different in two groups. Instrumental deliveries and postpartum hemorrhage were also similar. However, mean birth weight was significantly higher in GDM (2848 ± 539 g than in control (2707 ± 641 g (P = 0.004. Incidence of large-for-date babies was also higher (28.2% in GDM than control (19.4% (P = 0.005. In neonatal complication, hypoglycemia was significantly higher in GDM (20.6% than in control (5.2% (P = 0.001. However, the incidence of hyperbilirubinemia and congenital malformations was not significantly different in two groups. Conclusion: The prevalence of GDM was 5.72% in this study. Adequate treatment of GDM on diet, oral hypoglycemic agents, or insulin to achieve euglycemia can

  11. Exploring Maternal Perceptions of Infant Sleep and Feeding Method Among Mothers in the United Kingdom: A Qualitative Focus Group Study.

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    Rudzik, Alanna E F; Ball, Helen L

    2016-01-01

    In a context with strong rhetorical support for breastfeeding in the health system, yet extremely low rates of breastfeeding after hospital discharge, U.K. women's decisions about infant feeding reflect the reality of competing priorities in their lives, including obtaining adequate sleep. Popular wisdom in the U.K. tightly links breastfeeding and inadequate night-time sleep. Mothers are advised by peers and family to introduce formula or solid foods to infants to promote longer sleep. The first objective of this study was to investigate women's understandings of the nature of infant sleep and their perceptions of links between infant feeding method and sleep. The second was to explore how these perceptions influence infant feeding and sleep practices. Underpinning our work is the understanding that infant care choices result from trade-offs by which mothers strive to balance infant- and self-care. We conducted seven focus groups with mothers of infants in two regions of the U.K. Verbatim transcripts were thematically coded and emergent themes were identified. We found clearly diverging narratives between breastfeeding and formula-feeding mothers. Breastfeeding mothers viewed the fragmentary nature of infant sleep as natural, while mothers who were formula feeding felt this was a problem to be fixed. The strategies used to promote infant and maternal sleep in each group were aligned with their underlying perception of how infant sleep works. Maternal perceptions of the nature of infant sleep and its relation to infant feeding method impact infant care practices in the first year of life.

  12. Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation.

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    Basinga, Paulin; Gertler, Paul J; Binagwaho, Agnes; Soucat, Agnes L B; Sturdy, Jennifer; Vermeersch, Christel M J

    2011-04-23

    Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics. Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026-0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines. The P4P scheme in Rwanda had

  13. A Qualitative Study of the Maternity Care Experiences of Women with Obesity: "More than Just a Number on the Scale".

    Science.gov (United States)

    DeJoy, Sharon Bernecki; Bittner, Krystle; Mandel, Deborah

    2016-01-01

    The prevalence of obesity among pregnant women in the United States is high. Obesity can have long-term health consequences for both women and their offspring, so high-quality perinatal care for women with obesity is essential. However, stigmatizing encounters with health care professionals can decrease quality and promote avoidance of care. The purpose of this study was to explore the experiences of women with obesity in the maternity care system in the United States. In-depth telephone interviews were conducted with 16 women with a body mass index of 30 or greater. The authors used an inductive analytical process to translate women's experiences into themes. Women with obesity reported diverse maternity care experiences, with some reporting appropriate and satisfactory care, while most reported at least one negative encounter over the course of perinatal care. Three major themes emerged from the analysis: personalized care, depersonalized care, and setting the tone. Interactions with providers during pregnancy had psychological and emotional effects on women with obesity and influenced the content and perceived quality of their care. Further research is required to explore this phenomenon and its implications for care of women during pregnancy and birth outcomes. In the meantime, providers may wish to consider greater sensitivity to the needs of women with obesity during the perinatal period. © 2016 by the American College of Nurse-Midwives.

  14. Increased use of recommended maternal health care as a determinant of immunization and appropriate care for fever and diarrhoea in Ghana: an analysis pooling three demographic and health surveys.

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    McGlynn, Natalie; Wilk, Piotr; Luginaah, Isaac; Ryan, Bridget L; Thind, Amardeep

    2015-09-01

    Enhancing maternal and child health are key Millennium Development Goals (MDGs). This study examined whether increased utilization of recommended maternal health care (MHC), is associated with factors that improve children's health; specifically, complete immunization and appropriate care for fever and diarrhoea in Ghana. Data from the 1998, 2003, and 2008 Ghana Demographic and Health Surveys were pooled for a nationally representative sample of 6786 women aged 15-49 years who had a child in the previous 5 years. Children aged 12-23 months were considered fully immunized if they received all eight basic immunizations. Appropriate care for children under-five was receipt of medical treatment for fever or oral rehydration therapy for diarrhoea. The effect of recommended MHC utilization (characterized as poor, intermediate or best use) on immunization and appropriate care for fever and diarrhoea was determined through logistic regression with Andersen's Behavioural Model guiding co-variate selection. Increased MHC utilization (reference: intermediate MHC use) increased the odds of immunization [poor use: odds ratio (OR) = 0.54, 95% confidence interval (CI): 0.42-0.69; best use: OR = 1.29, 95% CI: 1.01-1.67], as well as appropriate care for fever (poor use: OR = 0.55, 95% CI: 0.35-0.88; best use: OR = 1.72, 95% CI: 1.17-2.52) and diarrhoea (poor use: OR = 0.63, 95% CI: 0.43-0.93). Survey year and region also predicted each outcome. Other determinants of immunization were maternal education, ethnicity, religion, media exposure, wealth and birth weight. Determinants of appropriate care for fever included paternal education, media exposure and wealth, and for diarrhoea, child's age and birth weight. This study proposes a linkage between MDGs; initiatives to improve maternal health through promoting increased use of recommended MHC may enhance children's health-related care. This could be useful for countries with limited resources in achieving MDGs, especially in sub

  15. Caring for children with learning disabilities who present problem behaviours: a maternal perspective.

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    Johnson, Robert F; O'Reilly, Michelle; Vostanis, Panos

    2006-09-01

    The theoretical cognitive model of stress and coping provides a structure to obtain and analyse maternal perceptions of caring for children with learning disabilities who present severe problem behaviours. The Family Fund database identified 18 families who met the sample criteria of children aged five years to 15 years with severe to moderate learning disability presenting severe problem behaviour. Physical aggression was reported to be the primary behavioural problem for 13 of the children. Interviews undertaken with the main carer of the child at their home were taped and transcribed. The data were analysed using grounded theory techniques which identified 'secondary stressors' for the parent. These were social isolation, conflict, limitation of lifestyle and self-blame. It is proposed that the amalgamated impact of these can weaken parents' coping resources and, therefore, may prove to be as significant to the negative association with maternal wellbeing as the problem behaviour.

  16. Third delay of maternal mortality in a tertiary hospital

    International Nuclear Information System (INIS)

    Shah, N.; Khan, N.H.

    2007-01-01

    To assess the magnitude, causes and substandard care factors responsible for the third delay of maternal mortality seen in our unit III, Department of Obstetrics and Gynecology, Civil Hospital, Karachi. This Cross-sectional, retrospective study was carried out on 152 mothers who died over a period of eight years from 1997 to 2004 at Civil Hospital Karachi. Death summaries of all maternal deaths were reviewed from death registers and were studied for substandard care factors which could have been responsible for the third delay of maternal mortality. The frequency of maternal mortality was 1.3 per 100 deliveries. The mean age was 29+-6.49 years and mean parity was 3.24+-3.25. The main causes of death were hypertensive disorders in 52/152 (34.21%), hemorrhage in 40/152 (26.31%), unsafe abortion in 16/152 (10.52%), puerperal sepsis in 14/152 (9.21%) and obstructed labor in 11/152 (7.2%) cases. Substandard care factors were present in 76.7% of patients, which included inappropriate management of pulmonary edema, delay in arranging blood for hemorrhaging patients and delay in surgical intervention. Substandard care factors were present in majority of cases of maternal deaths. Improvement of maternity care services in Civil Hospital Karachi is needed on an urgent basis. (author)

  17. Maternal mortality in Henan Province, China: changes between 1996 and 2009.

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    Fengzhi You

    Full Text Available BACKGROUND: Maternal deaths occur mostly in developing countries and the majority of them are preventable. This study analyzes changes in maternal mortality and related causes in Henan Province, China, between 1996 and 2009, in an attempt to provide a reliable basis for introducing effective interventions to reduce the maternal mortality ratio (MMR, part of the fifth Millennium Development Goal. METHODS AND FINDINGS: This population-based maternal mortality survey in Henan Province was carried out from 1996 to 2009. Basic information was obtained from the health care network for women and children and the vital statistics system, from specially trained monitoring personnel in 25 selected monitoring sites and by household survey in each case of maternal death. This data was subsequently reported to the Henan Provincial Maternal and Child Healthcare Hospital. The total MMR in Henan Province declined by 78.4%, from 80.1 per 100 000 live births in 1996 to 17.3 per 100 000 live births in 2009. The decline was more pronounced in rural than in urban areas. The most common causes of maternal death during this period were obstetric hemorrhage (43.8%, pregnancy-induced hypertension (15.8%, amniotic fluid embolism (13.9% and heart disease (8.0%. The MMR was higher in rural areas with lower income, less education and poorer health care. CONCLUSION: There was a remarkable decrease in the MMR in Henan Province between 1996 and 2009 mainly in the rural areas and MMR due to direct obstetric causes such as obstetric hemorrhage. This study indicates that improving the health care network for women, training of obstetric staff at basic-level units, promoting maternal education, and increasing household income are important interventional strategies to reduce the MMR further.

  18. Inequalities in maternity care and newborn outcomes: one-year surveillance of births in vulnerable slum communities in Mumbai

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    More, Neena Shah; Bapat, Ujwala; Das, Sushmita; Barnett, Sarah; Costello, Anthony; Fernandez, Armida; Osrin, David

    2009-01-01

    Background Aggregate urban health statistics mask inequalities. We described maternity care in vulnerable slum communities in Mumbai, and examined differences in care and outcomes between more and less deprived groups. Methods We collected information through a birth surveillance system covering a population of over 280 000 in 48 vulnerable slum localities. Resident women identified births in their own localities and mothers and families were interviewed at 6 weeks after delivery. We analysed data on 5687 births over one year to September 2006. Socioeconomic status was classified using quartiles of standardized asset scores. Results Women in higher socioeconomic quartile groups were less likely to have married and conceived in their teens (Odds ratio 0.74, 95% confidence interval 0.69–0.79, and 0.82, 0.78–0.87, respectively). There was a socioeconomic gradient away from public sector maternity care with increasing socioeconomic status (0.75, 0.70–0.79 for antenatal care and 0.66, 0.61–0.71 for institutional delivery). Women in the least poor group were five times less likely to deliver at home (0.17, 0.10–0.27) as women in the poorest group and about four times less likely to deliver in the public sector (0.27, 0.21–0.35). Rising socioeconomic status was associated with a lower prevalence of low birth weight (0.91, 0.85–0.97). Stillbirth rates did not vary, but neonatal mortality rates fell non-significantly as socioeconomic status increased (0.88, 0.71–1.08). Conclusion Analyses of this type have usually been applied across the population spectrum from richest to poorest, and we were struck by the regularly stepped picture of inequalities within the urban poor, a group that might inadvertently be considered relatively homogeneous. The poorest slum residents are more dependent upon public sector health care, but the regular progression towards the private sector raises questions about its quality and regulation. It also underlines the need for

  19. Assessing the Continuum of Care Pathway for Maternal Health in South Asia and Sub-Saharan Africa.

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    Singh, Kavita; Story, William T; Moran, Allisyn C

    2016-02-01

    We assess how countries in regions of the world where maternal mortality is highest-South Asia and Sub-Saharan Africa-are performing with regards to providing women with vital elements of the continuum of care. Using recent Demographic and Health Survey data from nine countries including 18,036 women, descriptive and multilevel regression analyses were conducted on four key elements of the continuum of care-at least one antenatal care visit, four or more antenatal care visits, delivery with a skilled birth attendant and postnatal checks for the mother within the first 24 h since birth. Family planning counseling within a year of birth was also included in the descriptive analyses. Results indicated that a major drop-out (>50 %) occurs early on in the continuum of care between the first antenatal care visit and four or more antenatal care visits. Few women (health.

  20. Effects of community participation on improving uptake of skilled care for maternal and newborn health: a systematic review.

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    Cicely Marston

    Full Text Available Despite a broad consensus that communities should be actively involved in improving their own health, evidence for the effect of community participation on specific health outcomes is limited. We examine the effectiveness of community participation interventions in maternal and newborn health, asking: did participation improve outcomes? We also look at how the impact of community participation has been assessed, particularly through randomised controlled trials, and make recommendations for future research. We highlight the importance of qualitative investigation, suggesting key areas for qualitative data reporting alongside quantitative work.Systematic review of published and 'grey' literature from 1990. We searched 11 databases, and followed up secondary references. Main outcome measures were the use of skilled care before/during/after birth and maternal/newborn mortality/morbidity. We included qualitative and quantitative studies from any country, and used a community participation theoretical framework to analyse the data. We found 10 interventions. Community participation had largely positive impacts on maternal/newborn health as part of a package of interventions, although not necessarily on uptake of skilled care. Interventions improving mortality or use of skilled care raised awareness, encouraged dialogue and involved communities in designing solutions-but so did those showing no effect.There are few high-quality, quantitative studies. We also lack information about why participation interventions do/do not succeed - an area of obvious interest for programme designers. Qualitative investigation can help fill this information gap and should be at the heart of future quantitative research examining participation interventions - in maternal/newborn health, and more widely. This review illustrates the need for qualitative investigation alongside RCTs and other quantitative studies to understand complex interventions in context, describe

  1. Sex-dependent effects of an early life treatment in rats that increases maternal care: vulnerability or resilience?

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    Fuentes, Sílvia; Daviu, Núria; Gagliano, Humberto; Garrido, Pedro; Zelena, Dóra; Monasterio, Nela; Armario, Antonio; Nadal, Roser

    2014-01-01

    Early life stress (ELS) in rodents has profound long-term effects that are partially mediated by changes in maternal care. ELS not only induces "detrimental" effects in adulthood, increasing psychopathology, but also promotes resilience to further stressors. In Long-Evans rats, we evaluated a combination of two procedures as a model of ELS: restriction of bedding during the first post-natal days and exposure to a "substitute" mother. The maternal care of biological and "substitute" mothers was measured. The male and female offspring were evaluated during adulthood in several contexts. Anxiety was measured by the elevated plus-maze (EPM), acoustic startle response (ASR) and forced swim test (FST). In other group of animals, novelty-seeking was measured (activity in an inescapable novel environment, preference for novel environments and exploration of novel objects). Plasmatic ACTH and corticosterone in basal conditions and in response to stress were also measured. Cognitive impulsivity was assessed by a delay-discounting paradigm, and impulsive action, attention and compulsive-like behavior by a five choice serial reaction time task (5CSRTT). ELS decreased pup body weight and increased the care of the biological mother; however, the "substitute" mother did not exhibit overt maltreatment. A mixture of "detrimental" and "beneficial" effects was shown. In the 5CSRTT, attention was impaired in both genders, and in females, ELS increased compulsive-like behavior. Novel object exploration was only increased by ELS in males, but the preference for novel spaces decreased in both genders. Baseline anxiety (EPM and ASR) and recognition memory were not affected. Unexpectedly, ELS decreased the ACTH response to novelty and swim stress and increased active coping in the FST in both genders. Cognitive impulsivity was decreased only in females, but impulsive action was not affected. The enhancement in maternal care may "buffer" the effects of ELS in a context-dependent manner.

  2. Sex-dependent effects of an early life treatment in rats that increases maternal care: vulnerability or resilience?

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    Silvia eFuentes

    2014-02-01

    Full Text Available Early life stress (ELS in rodents has profound long-term effects that are partially mediated by changes in maternal care. ELS not only induces detrimental effects in adulthood, increasing psychopathology, but also promotes resilience to further stressors. In Long-Evans rats, we evaluated a combination of two procedures as a model of ELS: restriction of bedding during the first postnatal days and exposure to a substitute mother. The maternal care of biological and substitute mothers was measured. The male and female offspring were evaluated during adulthood in several contexts. Anxiety was measured by the elevated plus-maze (EPM, acoustic startle response (ASR and forced swim test (FST. In other group of animals, novelty-seeking was measured (activity in an inescapable novel environment, preference for novel environments and exploration of novel objects. Plasmatic ACTH and corticosterone in basal conditions and in response to stress were also measured. Cognitive impulsivity was assessed by a delay-discounting paradigm, and impulsive action, attention and compulsive-like behaviour by a five choice serial reaction time task (5CSRTT. ELS decreased pup body weight and increased the care of the biological mother; however, the substitute mother did not exhibit overt maltreatment. A mixture of detrimental and beneficial effects was shown. In the 5CSRTT, attention was impaired in both genders, and in females, ELS increased compulsive-like behaviour. Novel object exploration was only increased by ELS in males, but the preference for novel spaces decreased in both genders. Baseline anxiety (EPM and ASR and recognition memory were not affected. Unexpectedly, ELS decreased the ACTH response to novelty and swim stress and increased active coping in the FST in both genders. Cognitive impulsivity was decreased only in females, but impulsive action was not affected. The enhancement in maternal care may buffer the effects of ELS in a context-dependent manner.

  3. Age, pathogen exposure, but not maternal care shape offspring immunity in an insect with facultative family life.

    Science.gov (United States)

    Vogelweith, Fanny; Körner, Maximilian; Foitzik, Susanne; Meunier, Joël

    2017-03-07

    To optimize their resistance against pathogen infection, individuals are expected to find the right balance between investing into the immune system and other life history traits. In vertebrates, several factors were shown to critically affect the direction of this balance, such as the developmental stage of an individual, its current risk of infection and/or its access to external help such as parental care. However, the independent and/or interactive effects of these factors on immunity remain poorly studied in insects. Here, we manipulated maternal presence and pathogen exposure in families of the European earwig Forficula auricularia to measure whether and how the survival rate and investment into two key immune parameters changed during offspring development. The pathogen was the entomopathogenic fungus Metarhizium brunneum and the immune parameters were hemocyte concentration and phenol/pro-phenoloxidase enzyme activity (total-PO). Our results surprisingly showed that maternal presence had no effect on offspring immunity, but reduced offspring survival. Pathogen exposure also lowered the survival of offspring during their early development. The concentration of hemocytes and the total-PO activity increased during development, to be eventually higher in adult females compared to adult males. Finally, pathogen exposure overall increased the concentration of hemocytes-but not the total-PO activity-in adults, while it had no effect on these measures in offspring. Our results show that, independent of their infection risk and developmental stage, maternal presence does not shape immune defense in young earwigs. This reveals that pathogen pressure is not a universal evolutionary driver of the emergence and maintenance of post-hatching maternal care in insects.

  4. Meeting community health worker needs for maternal health care service delivery using appropriate mobile technologies in Ethiopia.

    Directory of Open Access Journals (Sweden)

    Alex Little

    Full Text Available BACKGROUND: Mobile health applications are complex interventions that essentially require changes to the behavior of health care professionals who will use them and changes to systems or processes in delivery of care. Our aim has been to meet the technical needs of Health Extension Workers (HEWs and midwives for maternal health using appropriate mobile technologies tools. METHODS: We have developed and evaluated a set of appropriate smartphone health applications using open source components, including a local language adapted data collection tool, health worker and manager user-friendly dashboard analytics and maternal-newborn protocols. This is an eighteen month follow-up of an ongoing observational research study in the northern of Ethiopia involving two districts, twenty HEWs, and twelve midwives. RESULTS: Most health workers rapidly learned how to use and became comfortable with the touch screen devices so only limited technical support was needed. Unrestricted use of smartphones generated a strong sense of ownership and empowerment among the health workers. Ownership of the phones was a strong motivator for the health workers, who recognised the value and usefulness of the devices, so took care to look after them. A low level of smartphones breakage (8.3%,3 from 36 and loss (2.7% were reported. Each health worker made an average of 160 mins of voice calls and downloaded 27Mb of data per month, however, we found very low usage of short message service (less than 3 per month. CONCLUSIONS: Although it is too early to show a direct link between mobile technologies and health outcomes, mobile technologies allow health managers to more quickly and reliably have access to data which can help identify where there issues in the service delivery. Achieving a strong sense of ownership and empowerment among health workers is a prerequisite for a successful introduction of any mobile health program.

  5. Ghana's National Health insurance scheme and maternal and child health: a mixed methods study.

    Science.gov (United States)

    Singh, Kavita; Osei-Akoto, Isaac; Otchere, Frank; Sodzi-Tettey, Sodzi; Barrington, Clare; Huang, Carolyn; Fordham, Corinne; Speizer, Ilene

    2015-03-17

    Ghana is attracting global attention for efforts to provide health insurance to all citizens through the National Health Insurance Scheme (NHIS). With the program's strong emphasis on maternal and child health, an expectation of the program is that members will have increased use of relevant services. This paper uses qualitative and quantitative data from a baseline assessment for the Maternal and Newborn errals Evaluation from the Northern and Central Regions to describe women's experiences with the NHIS and to study associations between insurance and skilled facility delivery, antenatal care and early care-seeking for sick children. The assessment included a quantitative household survey (n = 1267 women), a quantitative community leader survey (n = 62), qualitative birth narratives with mothers (n = 20) and fathers (n = 18), key informant interviews with health care workers (n = 5) and focus groups (n = 3) with community leaders and stakeholders. The key independent variables for the quantitative analyses were health insurance coverage during the past three years (categorized as all three years, 1-2 years or no coverage) and health insurance during the exact time of pregnancy. Quantitative findings indicate that insurance coverage during the past three years and insurance during pregnancy were associated with greater use of facility delivery but not ANC. Respondents with insurance were also significantly more likely to indicate that an illness need not be severe for them to take a sick child for care. The NHIS does appear to enable pregnant women to access services and allow caregivers to seek care early for sick children, but both the quantitative and qualitative assessments also indicated that the poor and least educated were less likely to have insurance than their wealthier and more educated counterparts. Findings from the qualitative interviews uncovered specific challenges women faced regarding registration for the NHIS and other

  6. The operations of the free maternal care policy and out of pocket payments during childbirth in rural Northern Ghana

    OpenAIRE

    Dalinjong, Philip Ayizem; Wang, Alex Y.; Homer, Caroline S. E.

    2017-01-01

    Background To promote skilled attendance at births and reduce maternal deaths, the government of Ghana introduced the free maternal care policy under the National Health Insurance Scheme (NHIS) in 2008. The objective is to eliminate financial barriers associated with the use of services. But studies elsewhere showed that out of pocket (OOP) payments still exist in the midst of fee exemptions. The aim of this study was to estimate OOP payments and the financial impact on women during childbirt...

  7. Maternal perceptions of family-centred support and their associations with the mother-nurse relationship in the neonatal intensive care unit.

    Science.gov (United States)

    Shimizu, Aya; Mori, Akiko

    2018-04-01

    To evaluate maternal perceptions of family-centred support with hospitalised preterm infants and their relationship between mothers and nurses in the neonatal intensive care unit (NICU). Mothers who gave birth to preterm infants tend to suffer more stress and need individual support based on family-centred care. However, there may be a shortage of support for mothers to obtain parent-crafting skills before bringing their infants home. This cross-sectional study used path analysis and multiple group analysis to evaluate a structural equation model of the relationship between maternal perception based on family-centred support in parent-crafting training and the mothers-nurses collaboration. We analysed data from 98 mothers (valid response proportion, 41.0%) whose infants were hospitalised in the NICU of two types of perinatal centres in Japan. We used three revised standardised questionnaires in Japanese: Measure of Process of Care in the NICU (Neo-MPOC 20), Enabling Practice Scale in the NICU (Neo-EPS) and the author-developed Mother and Infant Questionnaire. Path analysis revealed that the relationship between mothers and nurses was linked to three factors related to the perinatal centres' support: consideration of parents' feelings, ability to deal with specific needs and coordination in dealing with situations that interact with provision of parent-friendly visual information. Separate path analyses for each perinatal centre showed the same pattern, although the standard coefficients were different. Maternal perceptions of family-centred support with hospitalised preterm infants promoted better collaboration between mothers and nurses to obtain parent-crafting skills at two types of perinatal units in Japan. Clear visual information materials might promote better maternal understanding of their infants, help in acquisition of parent-crafting skills and improve mother-nurse collaboration, with the result that mothers are better able to care for their infants

  8. Trends in Maternity Care Practice Skin-to-Skin Contact Indicators: United States, 2007-2015.

    Science.gov (United States)

    Boundy, Ellen O; Perrine, Cria G; Barrera, Chloe M; Li, Ruowei; Hamner, Heather C

    2018-05-21

    Mother-infant skin-to-skin contact (SSC) immediately after birth helps transition infants to the post-uterine environment and increases the likelihood of breastfeeding initiation and duration. This study examines trends in U.S. maternity practices related to SSC, and variations by facility demographics. Data were from the Maternity Practices in Infant Nutrition and Care (mPINC) surveys (2007-2015), a biennial assessment of all U.S. maternity facilities. Facilities reported how often patients were encouraged to practice mother-infant SSC for ≥30 minutes within 1 hour of uncomplicated vaginal birth and 2 hours of uncomplicated cesarean birth, and how often routine infant procedures are performed while in SSC. We calculated the percentage of maternity facilities reporting these indicators for ≥90% of patients across the United States for each survey year. Estimates by facility characteristics (size, type, and state) were calculated for 2015 only. The percentage of facilities reporting "Most (≥90%)" women, which were encouraged to practice early SSC, increased from 2007 to 2015 following both vaginal (40.4% to 83.0%) and cesarean (29.3% to 69.9%) births. The percentage of facilities reporting routine infant procedures were performed "Almost always (≥90%)," while mother and infant were SSC increased from 16.6% to 49.5% (2007 to 2015) for vaginal births and from 2.2% to 10.7% (2009 to 2015) for cesarean births. Variations in SSC practice by facility type, size, and state were noted. Significant progress has been made in increasing hospital encouragement of early SSC for both vaginal and cesarean births. Continued efforts to support evidence-based maternity practices are needed.

  9. The effect of relational continuity of care in maternity and child health clinics on parenting self-efficacy of mothers and fathers with loneliness and depressive symptoms.

    Science.gov (United States)

    Tuominen, Miia; Junttila, Niina; Ahonen, Pia; Rautava, Päivi

    2016-06-01

    This study explored the parenting self-efficacy of the parents of 18-month-old children in the context of Finnish maternity and child health clinics. This parenting self-efficacy was observed in relation with the relational continuity of care and parents' experienced loneliness and depressive symptoms. The relational continuity of care was provided by a public health nurse in maternity and child health clinics. The participating parents were drawn from the STEPS study that is being carried out by the Institute for Child and Youth Research at the University of Turku. The results showed that relational continuity of care provided by the same public health nurse in the maternity and child health clinics was associated with mothers' higher emotional loneliness and with lower scores on three dimensions of parents' parenting self-efficacy. Loneliness and depressive symptoms negatively influenced parents' parenting self-efficacy - however, in the case where the family had experienced relational continuity of care, the parents' higher levels of depressive symptoms had not weakened their parenting self-efficacy beliefs. These results are discussed in terms of organizing maternity and child health clinic services. © 2016 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

  10. "So Either You Have a Foetal Monitor or You Have Your Waters Broken, Basically Is It?": Articulating Maternity Care Policy at a Midwives' Ante-Natal Clinic

    Science.gov (United States)

    O'Malley, Mary-Pat

    2010-01-01

    Maternity care in Ireland has been described as a "testament to the strength and influence of the medical profession" (Mc Kee 1986: 192). A review of maternity and gynaecology services in the Dublin area in 2004 revealed that "no participant...thought that the maternity services were women centred at the time" (Women's Health…

  11. [Maternal death: unequal risks].

    Science.gov (United States)

    Defossez, A C; Fassin, D

    1989-01-01

    Nearly 99% of maternal deaths in the world each year occur in developing countries. New efforts have recently been undertaken to combat maternal mortality through research and action. The medical causes of such deaths are coming to be better understood, but the social mechanisms remain poorly grasped. Maternal mortality rates in developing countries are difficult to interpret because they tend to exclude all deaths not occurring in health care facilities. The countries of Europe and North America have an average maternal mortality rate of 30/100,000 live births, representing about 6000 deaths each year. The developing countries of Asia, Africa, and Latin America have rates of 270-640/100,000, representing some 492,000 deaths annually. For a true comparison of the risks of maternal mortality in different countries, the risk itself and the average number of children per woman must both be considered. A Nigerian woman has 375 times greater risk of maternal death than a Swedish woman, but since she has about 4 times more children, her lifetime risk of maternal death is over 1500 times greater than that of the Swedish woman. The principal medical causes of maternal death are known: hemorrhages due to placenta previa or retroplacental hematoma, mechanical dystocias responsible for uterine rupture, toxemia with eclampsia, septicemia, and malaria. The exact weight of abortion in maternal mortality is not known but is probably large. The possible measures for improving such rates are of 3 types: control of fertility to avoid early, late, or closely spaced pregnancies; effective medical surveillance of the pregnancy to reduce the risk of malaria, toxemia, and hemorrhage, and delivery in an obstetrical facility, especially for high-risk pregnancies. Differential access to high quality health care explains much of the difference between mortality rates in urban and rural, wealthy and impoverished areas of the same country. The social determinants of high maternal mortality

  12. Putting women at the center: a review of Indian policy to address person-centered care in maternal and newborn health, family planning and abortion

    Directory of Open Access Journals (Sweden)

    Aradhana Srivastava

    2017-07-01

    Full Text Available Abstract Background Person-centered care is a critical component of quality care, essential to enable treatment adherence, and maximize health outcomes. Improving the quality of health services is a key strategy to achieve the new global target of zero preventable maternal deaths by 2030. Recognizing this, the Government of India has in the last decade initiated a number of strategies to address quality of care in health and family welfare services. Methods We conducted a policy review of quality improvement strategies in India from 2005 to 15, covering three critical areas– maternal and newborn health, family planning, and abortion (MNHFP + A. Based on Walt and Gilson’s policy triangle framework, we analyzed the extent to which policies incorporated person-centered care, while identifying unaddressed issues. Data was sourced from Government of India websites, scientific and grey literature databases. Results Twenty-two national policy documents, comprising two policy statements and 20 implementation guidelines of specific schemes were included in the review. Quality improvement strategies span infrastructure, commodities, human resources, competencies, and accountability that are driving quality assurance in MNHFP + A services. However, several implementation challenges have affected compliance with person-centered care, thereby affecting utilization and outcomes. Conclusion Focus on person-centered care in Indian MNHFP + A policy has increased in recent years. Nevertheless, some aspects must still be strengthened, such as positive interpersonal behavior, information sharing and promptness of care. Implementation can be improved through better provider training, patient feedback and monitoring mechanisms. Moreover, unless persisting structural challenges are addressed implementation of person-centered care in facilities will not be effective.

  13. Addressing maternal and child health in fragile contexts | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2018-01-18

    Jan 18, 2018 ... ... improving maternal and child care, even in difficult contexts such as South ... the Innovating for Maternal and Child Health in Africa (IMCHA) initiative ... of Health and National Primary Health Care Development Agency, and ...

  14. The influence of intrafamilial power on maternal health care in Mali: perspectives of women, men and mothers-in-law.

    Science.gov (United States)

    White, Darcy; Dynes, Michelle; Rubardt, Marcie; Sissoko, Koman; Stephenson, Rob

    2013-06-01

    Evidence from diverse settings suggests that women often have limited control over their own reproductive health decisions. To increase uptake of preventive services and behaviors, it is important to understand how intrafamilial power dynamics and the attitudes of women, their husband and their mother-in-law are associated with maternal health practices. In 317 households in two rural districts of central Mali, women who had given birth in the previous year, their husband and their mother-in-law each completed a survey gauging their attitudes toward constructs of gender, power and health. Bivariate and multivariable logistic regression analyses were conducted to identify associations with four maternal health outcomes: antenatal care frequency, antenatal care timing, institutional delivery and postnatal care. In multivariable analyses, the preferences and opinions of mothers-in-law were associated with the maternal health behaviors of their daughters-in-law. Women's own perceptions of their self-efficacy, the value of women in society and the quality of services at the local health facility were also independently associated with their preventive and health-seeking practices. Husbands' preferences and opinions were not associated with any outcome. Interventions focusing on women or couples may be insufficient to advance women's reproductive health in patriarchal societies such as Mali. Future research and programmatic efforts need to address gender norms and consider the influence of other family members, such as mothers-in-law.

  15. [Family planning can reduce maternal mortality].

    Science.gov (United States)

    Potts, M

    1987-01-01

    Although the maternal mortality rate receives no newspaper headlines, the number of mothers dying throughout the world is equivalent to a full jumbo jet crashing every 5 hours. Population surveys carried out between 1981-83 by Family Health International indicated maternal mortality rates of 1.9/1000 live births in Menoufia, Egypt, and 7.2/1000 in Bali, Indonesia. 20-25% of all deaths in women aged 15-49 were directly related to pregnancy and delivery, compared to 1% in western countries where there is better prenatal care, medical assistance in almost all deliveries, and elimination of most high risk pregnancies through voluntary fertility control. Maternal mortality could be controlled by teaching traditional midwives to identify high risk patients at the beginning of their pregnancies and to refer them to appropriate health services. Maternal survival would also be improved if all women were in good health at the beginning of pregnancy. Families should be taught to seek medical care for the mother in cases of prolonged labor; many women arrive at hospitals beyond hope of recovery after hours or days of futile labor. Health policy makers should set new priorities. Sri Lanka, for example, has a lower per capita income than Pakistan, but also a lower maternal mortality rate because of better use of family planning services, more emphasis on prenatal care, and a tradition of care and attention on the part of the public health services.

  16. Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries: a systematic review.

    Science.gov (United States)

    Das, Ashis; Gopalan, Saji S; Chandramohan, Daniel

    2016-04-14

    Pay for Performance (P4P) mechanisms to health facilities and providers are currently being tested in several low- and middle-income countries (LMIC) to improve maternal and child health (MCH). This paper reviews the existing evidence on the effect of P4P program on quality of MCH care in LMICs. A systematic review of literature was conducted according to a registered protocol. MEDLINE, Web of Science, and Embase were searched using the key words maternal care, quality of care, ante natal care, emergency obstetric and neonatal care (EmONC) and child care. Of 4535 records retrieved, only eight papers met the inclusion criteria. Primary outcome of interest was quality of MCH disaggregated into structural quality, process quality and outcomes. Risk of bias across studies was assessed through a customized quality checklist. There were four controlled before after intervention studies, three cluster randomized controlled trials and one case control with post-intervention comparison of P4P programs for MCH care in Burundi, Democratic Republic of Congo, Egypt, the Philippines, and Rwanda. There is some evidence of positive effect of P4P only on process quality of MCH. The effect of P4P on delivery, EmONC, post natal care and under-five child care were not evaluated in these studies. There is weak evidence for P4P's positive effect on maternal and neonatal health outcomes and out-of-pocket expenses. P4P program had a few negative effects on structural quality. P4P is effective to improve process quality of ante natal care. However, further research is needed to understand P4P's impact on MCH and their causal pathways in LMICs. PROSPERO registration number CRD42014013077 .

  17. Approaches to improve the quality of maternal and newborn health care: an overview of the evidence

    OpenAIRE

    Austin, Anne; Langer, Ana; Salam, Rehana A; Lassi, Zohra S; Das, Jai K; Bhutta, Zulfiqar A

    2014-01-01

    Despite progress in recent years, an estimated 273,500 women died as a result of maternal causes in 2010. The burden of these deaths is disproportionately bourne by women who reside in low income countries or belong to the poorest sectors of the population of middle or high income ones, and it is particularly acute in regions where access to and utilization of facility-based services for childbirth and newborn care is lowest. Evidence has shown that poor quality of facility-based care for the...

  18. Trends in adverse maternal outcomes during childbirth: a population-based study of severe maternal morbidity

    Directory of Open Access Journals (Sweden)

    Algert Charles S

    2009-02-01

    Full Text Available Abstract Background Maternal mortality is too rare in high income countries to be used as a marker of the quality of maternity care. Consequently severe maternal morbidity has been suggested as a better indicator. Using the maternal morbidity outcome indicator (MMOI developed and validated for use in routinely collected population health data, we aimed to determine trends in severe adverse maternal outcomes during the birth admission and in particular to examine the contribution of postpartum haemorrhage (PPH. Methods We applied the MMOI to the linked birth-hospital discharge records for all women who gave birth in New South Wales, Australia from 1999 to 2004 and determined rates of severe adverse maternal outcomes. We used frequency distributions and contingency table analyses to examine the association between adverse outcomes and maternal, pregnancy and birth characteristics, among all women and among only those with PPH. Using logistic regression, we modelled the effects of these characteristics on adverse maternal outcomes. The impact of adverse outcomes on duration of hospital admission was also examined. Results Of 500,603 women with linked birth and hospital records, 6242 (12.5 per 1,000 suffered an adverse outcome, including 22 who died. The rate of adverse maternal outcomes increased from 11.5 in 1999 to 13.8 per 1000 deliveries in 2004, an annual increase of 3.8% (95%CI 2.3–5.3%. This increase occurred almost entirely among women with a PPH. Changes in pregnancy and birth factors during the study period did not account for increases in adverse outcomes either overall, or among the subgroup of women with PPH. Among women with severe adverse outcomes there was a 12% decrease in hospital days over the study period, whereas women with no severe adverse outcome occupied 23% fewer hospital days in 2004 than in 1999. Conclusion Severe adverse maternal outcomes associated with childbirth have increased in Australia and the increase was

  19. Maternal behavior of the mouse dam toward pups: implications for maternal separation model of early life stress.

    Science.gov (United States)

    Orso, Rodrigo; Wearick-Silva, Luis Eduardo; Creutzberg, Kerstin Camile; Centeno-Silva, Anderson; Glusman Roithmann, Laura; Pazzin, Rafaelly; Tractenberg, Saulo Gantes; Benetti, Fernando; Grassi-Oliveira, Rodrigo

    2018-01-01

    Maternal care is essential for an adequate pup development, as well as for the health of the dam. Exposure to stress in early stages of life can disrupt this dam-pup relationship promoting altered neurobiological and behavioral phenotypes. However, there is a lack of consensus regarding the effects of daily maternal separation (MS) on the pattern of maternal behavior. The aim of this study is to compare the patterns of maternal behavior between mice exposed to MS and controls. BALB/c mice were subjected to MS for a period of 180 min/day from postnatal day 2-7 (n = 17) or designated to be standard animal facility reared (AFR) controls (n = 19). Maternal behaviors were computed as frequency of nursing, licking pups and contact with pups, and nonmaternal behaviors were computed as frequency of actions without interaction with pups and eating/drinking. A total of 18 daily observations of maternal behavior were conducted during these six days, and considering the proportion of maternal and nonmaternal behaviors, an index was calculated. There was no difference when comparing the global index of maternal behavior between the AFR and MS animals by the end of the observed period. However, the pattern of maternal behavior between groups was significantly different. While MS dams presented low frequency of maternal behavior within the first couple days of the stress protocol, but increasing over time, AFR dams showed higher maternal behavior at the beginning, reducing over time. Together, our results indicate that MS alters the maternal behavior of the dams toward pups throughout the first week of the stress protocol and provoked some anxiety-related traits in the dams. The inversion of maternal behavior pattern could possibly be an attempt to compensate the low levels of maternal care observed in the first days of MS.

  20. Understanding the meaning and role of gifts given to Ugandan mothers in maternity care settings: 'The help they give when they've seen how different you are'.

    Science.gov (United States)

    Rudrum, Sarah; Brown, Helen; Oliffe, John L

    2016-11-01

    The provision of gifts to new mothers in Uganda is laden with significance that varies by the social location of the giver and receiver and the context and conditions under which the gift is made available. Here, we examine the act of gift giving and receiving within a Ugandan maternity care setting, describing the connections between these material objects and social relations. A study investigating the social organisation of maternity care in post-conflict northern Uganda found that gift-giving to new mothers functioned to create a material and discursive context wherein women's desire to access these goods was leveraged to create an incentive to attend formal maternity care during pregnancy and for delivery. In this article we describe the material and discursive processes surrounding gift-giving to new mothers in this global South health care setting. This article contributes critical analyses of the function of gifts in healthcare settings as constructing shared identities, social differences and normative values about health citizenship, and an incentive politic that affects equitable access to maternity care. Drawing on intersectional theory and analysis of how specific practices function ideologically to reward or incentivise pregnant women, we integrate material culture studies into the sociology of women's reproductive health. © 2016 Foundation for the Sociology of Health & Illness.