RESUMEN
OBJECTIVE: the aim of the study was to ascertain the attitudes of Swedish midwives towards management of very preterm labour and birth and to compare the attitudes of midwives at university hospitals with those at general hospitals. DESIGN: this cross-sectional descriptive and comparative study used an anonymous self-administrated questionnaire for data collection. Descriptive and analytic statistics were carried out for analysis. PARTICIPANTS: the answers from midwives (n=259) were collected in a prospective SWEMID study. SETTING: the midwives had experience of working on delivery wards in maternity units with neonatal intensive care units (NICU) in Sweden. FINDINGS: in the management of very preterm labour and birth, midwives agreed to initiate interventions concerning steroid prophylaxis at 23 gestational weeks (GW), caesarean section for preterm labour only at 25 GW, when to give information to the neonatologist before birth at 23 GW, and when to suggest transfer to NICU at 23 GW. Midwives at university hospitals were prone to start interventions at an earlier gestational age than the midwives at general hospitals. Midwives at university hospitals seemed to be more willing to disclose information to the parents. KEY CONCLUSIONS: midwives with experience of handling very preterm births at 21-28 GW develop a positive attitude to interventions at an earlier gestational age as compared to midwives without such experience. IMPLICATIONS FOR PRACTICE: based on these results we suggest more communication and transfer of information about the advances in perinatal care and exchange of knowledge between the staff at general and university hospitals. Establishment of platforms for inter-professional discussions about ethically difficult situations in perinatal care, might benefit the management of very preterm labour and birth.
Asunto(s)
Recien Nacido Extremadamente Prematuro , Partería/métodos , Rol de la Enfermera , Atención Posnatal/métodos , Nacimiento Prematuro/enfermería , Adulto , Femenino , Humanos , Recién Nacido , Cuidado Intensivo Neonatal/métodos , Relaciones Interprofesionales , Relaciones Enfermero-Paciente , Investigación Metodológica en Enfermería , Embarazo , Embarazo de Alto Riesgo , Encuestas y Cuestionarios , Suecia , Adulto JovenRESUMEN
BACKGROUND: A woman's refusal or request for a cesarean section can be a problem for midwives and obstetricians working in maternity units. The objective of this study was to describe the attitudes of midwives in Sweden toward the obstetrician's decision making in relation to a woman's refusal of an emergency cesarean section and to a woman's request for a cesarean section without a medical indication. METHODS: The study has a cross-sectional multicenter design and used an anonymous, structured, and standardized questionnaire for data collection. The study group comprised midwives who had experience working at a delivery ward at 13 maternity units with neonatal intensive care units in Sweden (n = 259). RESULTS: In the case of a woman's refusal to undergo an emergency cesarean section for fetal reasons, most midwives (89%) thought that the obstetrician should try to persuade the woman to agree. Concerning a woman's request for a cesarean section without any medical indications, most midwives thought that the obstetrician should agree if the woman had previous maternal or fetal complications. The reason was to support the woman's decision out of respect for her autonomy; the midwives at six university hospitals were less willing to accept the woman's autonomy in this situation. If the only reason was "her own choice," 77 percent of the midwives responded that the obstetrician should not comply. CONCLUSIONS: The main focus of midwives seems to be the baby's health, and therefore they do not always agree with respect to a woman's refusal or request for a cesarean section. The midwives prefer to continue to explain the situation and persuade the woman to agree with the recommendation of the obstetrician.
Asunto(s)
Cesárea/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Partería/métodos , Rol de la Enfermera/psicología , Negativa del Paciente al Tratamiento/estadística & datos numéricos , Adulto , Actitud del Personal de Salud , Cesárea/psicología , Estudios Transversales , Toma de Decisiones , Urgencias Médicas , Femenino , Humanos , Relaciones Enfermero-Paciente , Embarazo , Resultado del Embarazo/epidemiología , Encuestas y Cuestionarios , Suecia/epidemiología , Negativa del Paciente al Tratamiento/psicología , Adulto JovenRESUMEN
OBJECTIVE: to gain a deeper understanding of both parents' experiences during the mother's stay in hospital for threat of an early delivery and eventual preterm birth. DESIGN: explanatory design with separate interviews for mothers and fathers using the grounded theory method. SETTING: University Hospital in southern Sweden. PARTICIPANTS: 17 mothers and six fathers, who had experienced a threat of early delivery and eventual preterm birth, while the mother was in hospital. FINDINGS: the core category 'inter-adapting' and the following three categories and six subcategories emerged: interacting (communicating with the professional caregivers; keeping the family together through a stressful situation; seeking empowerment during labour and birth); reorganising (arranging for a new family situation); and caring (accepting the restrictions for the health of the fetus; reaching out to the baby and taking part in the care). KEY CONCLUSIONS: during the mothers' stay in hospital, the most stressful issues experienced were the parents' concern for the baby and the separation from the family. Parents are able to manage the situation by mutually adapting to each other, family members, significant others and caregivers. A new concept 'inter-adapting' therefore emerged. IMPLICATIONS FOR PRACTICE: for perinatal care, feelings of separation can be reduced and family bonds strengthened through integrating the different wards involved.
Asunto(s)
Recien Nacido Prematuro/psicología , Rol de la Enfermera , Apego a Objetos , Padres/psicología , Resultado del Embarazo/psicología , Nacimiento Prematuro/psicología , Adulto , Anécdotas como Asunto , Ansiedad/prevención & control , Padre/psicología , Femenino , Humanos , Recién Nacido , Masculino , Madres/psicología , Relaciones Enfermero-Paciente , Embarazo , Relaciones Profesional-Familia , Apoyo Social , SueciaRESUMEN
BACKGROUND: Ethical issues arise in many obstetric situations and demand constant consideration by obstetricians. The aim of this study was to highlight the meaning of being in an ethically difficult situation as narrated by obstetricians. METHODS: A descriptive design with a qualitative approach using a hermeneutic phenomenological method for analysis. Interviews were performed with 14 obstetricians working in a Swedish hospital setting. RESULTS: The overriding theme was Sympathetic responsibility in the decisions of critical importance for the mother and her infant. Five related themes were to: (i) proceed with a moral reasoning that leads to the choice of a possible solution; (ii) balance one's own medical knowledge and moral insight with the needs and requests of the parents; (iii) be aware of one's medical and moral responsibility in relation to the decision made; (iv) experience the ability to take action and to make and carry out difficult and important decisions relating to the health of the mother and infant; and (v) reflect on a given situation in a manner leading to a rational acceptance of one's own conduct. CONCLUSIONS: Sympathetic responsibility is the structure of the meaning of the obstetricians' lived experience, which means that the obstetricians with the help of their medical knowledge and their desire to support the mother's autonomy do what is best for the mother and her infant. Implications include that an exchange of ethical thoughts and moral reasoning should lead to a higher degree of mutual understanding between colleagues and between the different professionals. Co-operation is important to achieve the best outcome for the mother and her infant.