RESUMEN
BACKGROUND: Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportunity to identify systematically the characteristics of care delivery that may be generalizable across contexts, thereby enhancing implementation. Our objective was to map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to a new evidence-based framework for quality maternal and newborn care; thus facilitating the identification of characteristics of effective care. METHODS: A systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of these models' characteristics to the QMNC framework using data extraction and scoring forms derived from the five framework components. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria. RESULTS: From 13,050 citations initially retrieved we identified 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each). QMNC framework scores ranged from 9 to 25 (possible range 0-32), with most models reporting fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was lacking in many studies, but was better reported for the intervention arms. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported. CONCLUSIONS: The QMNC framework facilitates assessment of the characteristics of antenatal care models. It is vital to understand all the characteristics of multi-faceted interventions such as care models; not only what is done but why it is done, by whom, and how this differed from the standard care package. By applying the QMNC framework we have established a foundation for future reports of intervention studies so that the characteristics of individual models can be evaluated, and the impact of any differences appraised.
Asunto(s)
Servicios de Salud Materno-Infantil/normas , Partería/métodos , Modelos Teóricos , Atención Prenatal/métodos , Garantía de la Calidad de Atención de Salud/métodos , Australia , Canadá , China , Femenino , Humanos , Recién Nacido , Irlanda , México , Partería/normas , Embarazo , Atención Prenatal/normas , Ensayos Clínicos Controlados Aleatorios como Asunto , Suecia , Reino UnidoRESUMEN
In this first paper in a series of four papers on midwifery, we aimed to examine, comprehensively and systematically, the contribution midwifery can make to the quality of care of women and infants globally, and the role of midwives and others in providing midwifery care. Drawing on international definitions and current practice, we mapped the scope of midwifery. We then developed a framework for quality maternal and newborn care using a mixed-methods approach including synthesis of findings from systematic reviews of women's views and experiences, effective practices, and maternal and newborn care providers. The framework differentiates between what care is provided and how and by whom it is provided, and describes the care and services that childbearing women and newborn infants need in all settings. We identified more than 50 short-term, medium-term, and long-term outcomes that could be improved by care within the scope of midwifery; reduced maternal and neonatal mortality and morbidity, reduced stillbirth and preterm birth, decreased number of unnecessary interventions, and improved psychosocial and public health outcomes. Midwifery was associated with more efficient use of resources and improved outcomes when provided by midwives who were educated, trained, licensed, and regulated. Our findings support a system-level shift from maternal and newborn care focused on identification and treatment of pathology for the minority to skilled care for all. This change includes preventive and supportive care that works to strengthen women's capabilities in the context of respectful relationships, is tailored to their needs, focuses on promotion of normal reproductive processes, and in which first-line management of complications and accessible emergency treatment are provided when needed. Midwifery is pivotal to this approach, which requires effective interdisciplinary teamwork and integration across facility and community settings. Future planning for maternal and newborn care systems can benefit from using the quality framework in planning workforce development and resource allocation.
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Partería/normas , Atención Perinatal/normas , Atención Prenatal/normas , Brasil , China , Competencia Clínica/normas , Atención a la Salud/normas , Femenino , Promoción de la Salud/organización & administración , Promoción de la Salud/normas , Humanos , India , Recién Nacido , Partería/organización & administración , Satisfacción del Paciente , Atención Perinatal/organización & administración , Embarazo , Resultado del Embarazo , Mujeres Embarazadas/psicología , Atención Prenatal/organización & administración , Calidad de la Atención de Salud/normasRESUMEN
BACKGROUND: Despite the widely documented health advantages of breastfeeding over formula feeding, initiation rates remain relatively low in many high-income countries, particularly among women in lower income groups. OBJECTIVE : To evaluate the effectiveness of interventions which aim to encourage women to breastfeed in terms of changes in the number of women who start to breastfeed. METHODS : Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2007), handsearched the Journal of Human Lactation, Health Promotion International and Health Education Quarterly from inception to 15 August 2007, and scanned reference lists of all articles obtained. Selection criteria: Randomized controlled trials, with or without blinding, of any breastfeeding promotion intervention in any population group except women and infants with a specific health problem. Data collection and analysis: One review author independently extracted data and assessed trial quality, checked by a second author. We contacted investigators to obtain missing information. MAIN RESULTS: Main results: Eleven trials were included. Statistical analyses were conducted on data from eight trials (1553 women). Five studies (582 women) on low incomes in the USA with typically low breastfeeding rates showed breastfeeding education had a significant effect on increasing initiation rates compared to standard care (risk ratio (RR) 1.57, 95% confidence interval (CI) 1.15 to 2.15, P = 0.005). Subgroup analyses showed that one-to-one, needs-based, informal repeat education sessions and generic, formal antenatal education sessions are effective in terms of an increase in breastfeeding rates among women on low incomes regardless of ethnicity and feeding intention. Needs-based, informal peer support in the antenatal and postnatal periods was also shown to be effective in one study conducted among Latina women who were considering breastfeeding ...
Asunto(s)
Femenino , Humanos , Lactancia Materna/psicología , Educación en SaludRESUMEN
OBJECTIVE: To assess the association between breastfeeding and child cognitive development in term and preterm children. STUDY DESIGN: We analyzed data on white singleton children from the United Kingdom Millennium Cohort Study. Children were grouped according to breastfeeding duration. Results were stratified by gestational age at birth: 37 to 42 weeks (term, n = 11,101), and 28 to 36 weeks (preterm, n = 778). British Ability Scales tests were administered at age 5 years (naming vocabulary, pattern construction, and picture similarities subscales). RESULTS: The mean scores for all subscales increased with breastfeeding duration. After adjusting for confounders, there was a significant difference in mean score between children who were breastfed and children who were never breastfed: in term children, a two-point increase in score for picture similarities (when breastfed ≥ 4 months) and naming vocabulary (when breastfed ≥ 6 months); in preterm children, a 4-point increase for naming vocabulary (when breastfed ≥ 4 months) and picture similarities (when breastfed ≥ 2 months) and a 6-point increase for pattern construction (when breastfed ≥ 2 months). These differences suggest that breastfed children will be 1 to 6 months ahead of children who were never breastfed. CONCLUSIONS: In white, singleton children in the United Kingdom, breastfeeding is associated with improved cognitive development, particularly in children born preterm.