Fragmented Care

Advances in Family Practice Nursing, Год журнала: 2025, Номер unknown

Опубликована: Март 1, 2025

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Ninety-one years of midwifery continuity of care in low and middle-income countries: a scoping review

BMC Health Services Research, Год журнала: 2025, Номер 25(1)

Опубликована: Март 28, 2025

Midwifery continuity of care during pregnancy, childbirth, and postpartum is essential for improving maternal neonatal health outcomes. In low- middle-income countries (LMICs), however, challenges such as healthcare worker shortages, limited infrastructure, poor access, cultural barriers often hinder the effective provision midwifery services. These issues contribute to unsustainable inadequate care, adversely affecting newborn health. This study examines impact these on its subsequent effect A scoping review was conducted following Arksey O'Malley's framework. We analyzed 43 articles published between 1932 2023 across four databases. Included studies were in LMICs, focused continuous models, English. The aimed capture varied impacts found that LMICs significantly improves by reducing medical interventions, increasing physiological births, enhancing satisfaction breastfeeding rates. approach also lowers mortality morbidity. Success factors include community acceptance, midwives' competence, collaboration with traditional birth attendants. Barriers insufficient funding resistance change persist. Midwife-led (MLCC) associated a 16% reduction loss 24% pre-term births. Also, MLCC decreases 10-20% increases rates up 30%. Effective implementation requires integrating services into existing systems, securing funding, expanding training, strengthening partnerships. enhances minimizing unnecessary interventions However, socioeconomic influence acceptance. Further research needed integrate attendants formal overcome change, develop strategies professional providers.

Язык: Английский

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The Cost and Cost-Effectiveness of Childbirth Settings: A Systematic Review

Applied Health Economics and Health Policy, Год журнала: 2025, Номер unknown

Опубликована: Апрель 2, 2025

To sustain positive progress toward sustainable development goals as envisioned in goal 3 and beyond, safe affordable care during pregnancy birth for women, their families, health facilities professionals is essential. In this systematic review, we report the best available evidence regarding cost cost-effectiveness of various settings, including hospitals, centres, homes women at low risk complications from high-, middle-, low-income countries. We conducted a review economic evaluation papers, following comprehensive search online databases, Medline, CINAHL, Embase, Scopus, Google Scholar, grey literature, using predetermined strategies. Both partial full studies were included, appraised them Joanna Briggs Institute's (JBI's) critical appraisal checklists studies. Although attempted to pool total incremental net benefit, results synthesised narratively without meta-analysis due high heterogeneity between primary From 2307 identified studies, 11 (13 country level records countries) included. direct indirect costs childbirth home, midwife-led units (MLBUs), hospitals reported. Ten showed that births MLBUs less costly than hospital births, while home also reported be seven Regarding cost-effectiveness, Bangladesh, generally better outcomes lower one site had higher costs. Pakistan Uganda, displayed mixed results, with some being cost-effective others more poorer outcomes. Netherlands, but outcomes, whereas effective. Belgium, effective reducing caesarean instrumental though they did reduce epidural analgesia use cost-effectively. Most found hospital. There potential these settings provide option through reduced intervention rates favourable high-income countries could offer birthing options low- middle-income includes by skilled maternity practitioners potentially settings.

Язык: Английский

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“This Should Be the Answer!”: The Evolution of Relational Dynamic Capabilities in the Co-Production of Maternity Care Services to Vulnerable Women

Qualitative Health Research, Год журнала: 2025, Номер unknown

Опубликована: Апрель 12, 2025

Established models of maternity care delivery in high-income countries have increasingly proved inadequate to address the highly idiosyncratic and heterogenous needs vulnerable pregnant women, such as ethnic minorities, migrants, asylum seekers, who still disproportionately suffer from high maternal morbidity mortality. Intersectionality theory has been salient represent women's lived, subjective experience inequity healthcare access; however, it less effective informing organizational systemic change able redress intersectional disadvantage affecting populations. To these theoretical empirical gaps, this article develops an in-depth single case study around HAAMLA team, a specialized community midwifery group active at Leeds Teaching Hospital NHS Trust England (UK), which specifically evolved over time cater women. We conducted semi-structured interviews with midwives team leadership triangulated our data archival material participant feedback. Building abductively on novel intersectional, socio-ecological framework, findings highlight how developed radically different model that conceptualizes vulnerability socially constructed category co-produces holistic, bespoke services together women external network partner agencies. In doing so, leveraged two key relational dynamic capabilities: adaptive activation trust-based relationship building. The discusses contributions theory, policy, practice, while providing fresh insight into strongly innovative potentially replicable groups.

Язык: Английский

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‘Great in theory’: Women’s care experiences in relation to Australia’s national maternity Strategy—Qualitative survey responses

PLoS ONE, Год журнала: 2025, Номер 20(4), С. e0319249 - e0319249

Опубликована: Апрель 15, 2025

Background The provision of woman-centred maternity care in Australia is guided by a national Strategy released November 2019 titled Woman-centred care: Strategic directions for Australian services (the Strategy). upholds four values (safety, respect, choice, and access) that underpin twelve principles care. Aim To examine the experiences women explore how these align with stated Strategy. Methods A online survey was undertaken between February June 2023. Women who received all their since 1 January 2020 were invited to participate. consisted predominantly closed questions; however, six open-text questions included give participants opportunity provide in-depth responses about its values. This paper presents qualitative content analysis free-text responses. Findings completed submitted 1750 eligible participants, whom 1667 provided 3562 this analysis. These showed while definition safety favours physically safe care, preferred more holistic, providing emotional psychological safety. Participants expressed need respectful relationships providers where they felt listened heard. They wanted be made aware choices have decisions supported without coercion. also desired access continuity particularly midwives, greater mental health support across episode. Conclusion intent has not yet been fully realised. nationally coordinated response required if move from policy practice, ensuring receive true as intended.

Язык: Английский

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