RESUMEN
BACKGROUND: Globally, midwifery-led birthing units are associated with favourable clinical outcomes and positive birth experiences. As part of our evaluation of Canada's first Alongside Midwifery Unit (AMU) at Markham Stouffville Hospital, we sought to explore and compare birth experiences and satisfaction among midwifery clients who gave birth on the AMU with midwifery clients who gave birth on the traditional obstetric unit prior to AMU implementation. METHODS: We conducted a structured, online, cross-sectional survey of midwifery clients in the six months before, and up to 18 months after, opening of the AMU at Markham Stouffville Hospital, Ontario Canada. The survey contained validated measures of satisfaction including personal capacity and participation; perceived safety, control, and security; professional support; and satisfaction. Descriptive statistics and tests of significance were completed in SPSS. RESULTS: A total of 193 responses were included in our analyses (pre-AMU n = 47, post-AMU n = 146). All participants had positive experiences in the four domains assessed. Compared to those who gave birth with midwives on the Labour unit, those who gave birth on the AMU indicated more positive experiences for some measures. Perceptions pertaining to being an active participant in care, to security and sense of control were more positive among those who gave birth on the AMU. CONCLUSION: The AMU in Ontario is associated with high levels of satisfaction during birth, particularly the perception of being actively engaged in decision making, having a sense of control and safety, and having confidence in the care provider team. Care received on the AMU does not compromise birth experiences or satisfaction and may be associated with greater autonomy and agency for the person giving birth.
Asunto(s)
Partería , Satisfacción del Paciente , Humanos , Femenino , Adulto , Embarazo , Satisfacción del Paciente/estadística & datos numéricos , Estudios Transversales , Ontario , Parto/psicología , Encuestas y Cuestionarios , Canadá , Parto Obstétrico/psicología , Adulto JovenRESUMEN
BACKGROUND: Globally, midwifery-led birthing units are associated with excellent maternal and neonatal outcomes, and positive childbirth experiences. However, little is known about what aspects of midwife-led units contribute to favorable experiences and overall satisfaction. Our aim was to explore and describe midwifery service user experiences at Canada's first Alongside Midwifery Unit (AMU). METHODS: We used a qualitative, grounded theory approach using semi-structured interviews with recipients of midwifery care at the AMU. FINDINGS: Data were collected from twenty-eight participants between September 2018 and March 2020. Our generated theory explains how birth experiences and satisfaction were influenced by how well the AMU aligned with expectations or desired experiences related to the following four themes: (1) maintaining the midwifery model of care, (2) emphasizing control and choice, (3) facilitating interprofessional relationships, and (4) appreciating the unique AMU birthing environment. CONCLUSION: Canada's first AMU met or exceeded service-user expectations, resulting in high levels of satisfaction with their birth experience. Maintaining core elements of the midwifery model of care, promoting high levels of autonomy, and facilitating positive interprofessional interactions are crucial elements contributing to childbirth satisfaction in the AMU environment.
Asunto(s)
Centros de Asistencia al Embarazo y al Parto , Partería , Embarazo , Femenino , Recién Nacido , Humanos , Partería/métodos , Motivación , Parto Obstétrico/métodos , Canadá , Investigación CualitativaRESUMEN
BACKGROUND: Canada's first alongside midwifery unit (AMU) was intentionally informed by evidence-based birth environment design principals, building on the growing evidence that the built environment can shape experiences, satisfaction, and birth outcomes. OBJECTIVES: To assess the impact of the built environment of the AMU for both service users and midwives. This study aimed to explore the meanings that individuals attribute to the built environment and how the built environment impacted people's experiences. METHODS: We conducted a mixed-methods study using a grounded theory methodology for data collection and analysis. Our research question and data collection tools were underpinned by a sociospatial conceptual approach. All midwives and all those who received midwifery care at the unit were eligible to participate. Data were collected through a structured online survey, interviews, and focus group. RESULTS: Fifty-nine participants completed the survey, and interviews or focus group were completed with 28 service users and 14 midwives. Our findings demonstrate high levels of satisfaction with the birth environment. We developed a theoretical model, where "making space" for midwifery in the hospital contributed to positive birth experiences and overall satisfaction with the built environment. The core elements of this model include creating domestic space in an institutional setting, shifting the technological approach, and shared ownership of the unit. CONCLUSIONS: Our model for creating, shifting, and sharing as a way to make space for midwifery can serve as a template for how intentional design can be used to promote favorable outcomes and user satisfaction.
Asunto(s)
Partería , Embarazo , Femenino , Humanos , Parto , Hospitales , Entorno Construido , Canadá , Investigación CualitativaRESUMEN
Most provinces in Canada now offer regulated midwifery, but the way services are delivered across the country varies. The Canadian Midwifery Regulators Consortium has identified a need to examine the different ways in which care is being organized; this is to determine what elements are essential to maintain and where flexibility is desirable, in order to promote growth of the profession and maximize the contribution of midwifery to the provision of services. In April 2012 a planning meeting (funded by Canadian Institutes of Health Research) brought together midwifery leaders, researchers, regulators, and lead clinicians of several maternity service programs across Canada. The various approaches to organizing care were discussed and three of the programs presented were selected for this descriptive review because of their unique approaches and ability to respond to the needs of communities and of care providers within those communities who strive to deliver sustainable maternity care. The programs include an interprofessional group-care approach in British Columbia, an expanded scope of practice in an underserved community in the Northwest Territories, and an interprofessional collaboration of primary maternity caregivers in Nova Scotia. Each is discussed in terms of the population served, the program itself, and the fit of that microsystem within the larger health care system. The organization of maternity care must address the needs of communities and providers alike to make the greatest contribution. Through collaborative and creative organizational approaches, midwives have an opportunity to contribute in a meaningful way and increase their impact on the provision of services.
Asunto(s)
Servicios de Salud Materna/organización & administración , Partería , Canadá , Conducta Cooperativa , Femenino , Humanos , Servicios de Salud Materna/métodos , Partería/organización & administración , EmbarazoRESUMEN
OBJECTIVES: Much has been written about the status of midwifery in developing countries, yet there is limited knowledge and analysis of the role of midwifery in the provision of maternity care in the developed world. The purpose of this study was to better understand how midwifery in Canada compares with midwifery in other developed countries with particular attention to educational preparation, scope of practice, and the contribution of midwives to the overall provision of maternity care. METHODS: Eight countries were selected on the basis of comparably low maternal mortality rates (defined as < 10/100,000 live births). Document analysis and a survey of key informants were used to develop an understanding of the role of midwifery in the various jurisdictions. We then undertook an analysis of similarities and differences among models. RESULTS: Variations in models of midwifery exist within and among the countries studied. Midwifery in Canada is most similar to midwifery in the Netherlands and New Zealand with regard to the model of practice, continuity of care, choice of birth place and degree of autonomy. CONCLUSION: Midwifery in Canada is growing, but offers a relatively small contribution to the national provision of maternity services in comparison with other countries. The growth of midwifery in Canada may play a key role in lowering intervention rates and strengthening maternity care as is evidenced in other industrialized nations where midwifery care is an integral part of maternity services.