Vicki Van Wagner - Academia.edu (original) (raw)

Papers by Vicki Van Wagner

Routledge eBooks, Aug 19, 2019

Journal of Midwifery & Women's Health, Dec 18, 2020

IntroductionIn 2014, 2 new freestanding midwifery‐led birth centers opened in Ontario, Canada. As... more IntroductionIn 2014, 2 new freestanding midwifery‐led birth centers opened in Ontario, Canada. As one part of a larger mixed‐methods evaluation of the first year of operations of the centers, our primary objective was to compare the experiences of women receiving midwifery care who intended to give birth at the new birth centers with those intending to give birth at home or in hospital.MethodsWe conducted a cross‐sectional survey of women cared for by midwives with admitting privileges at one of the 2 birth centers. Consenting women received the survey 3 to 6 weeks after their due date. We stratified the analysis by intended place of birth at the beginning of labor, regardless of where the actual birth occurred. One composite indicator was created (Composite Satisfaction Score, out of 20), and statistical significance (P < .05) was assessed using one‐way analysis of variance. Responses to the open‐ended questions were reviewed and grouped into broader categories.ResultsIn total, 382 women completed the survey (response rate 54.6%). Half intended to give birth at a birth center (n = 191). There was a significant difference on the Composite Satisfaction Scores between the birth center (19.4), home (19.5), and hospital (18.9) groups (P < .001). Among women who intended to give birth in a birth center, scores were higher in the women admitted to the birth center compared with those who were not (P = .037). Overall, women giving birth at a birth center were satisfied with the learners present at their birth, the accessibility of the centers, and the physical amenities, and they had suggestions for minor improvements.DiscussionWe found positive experiences and high satisfaction among women receiving midwifery care, regardless of intended place of birth. Women admitted to the birth centers had positive experiences with these new centers; however, future research should be planned to reassess and further understand women's experiences.

This Evidence Check review was produced using the Evidence Check methodology in response to speci... more This Evidence Check review was produced using the Evidence Check methodology in response to specific questions from the commissioning agency. It is not necessarily a comprehensive review of all literature relating to the topic area. It was current at the time of production (but not necessarily at the time of publication). It is reproduced for general information and third parties rely upon it at their own risk.

Canadian Woman Studies, Jun 1, 1985

Journal of Midwifery & Women's Health, Aug 8, 2018

Introduction: In 2014, 2 freestanding, midwifery-led birth centers opened in Ontario, Canada. The... more Introduction: In 2014, 2 freestanding, midwifery-led birth centers opened in Ontario, Canada. The purpose of this study was to qualitatively investigate the integration of the birth centers into the local, preexisting intrapartum systems from the perspective of health care providers and managerial staff. Methods: Focus groups or interviews were conducted with health care providers (paramedics, midwives, nurses, physicians) and managerial staff who had experienced urgent and/or nonurgent maternal or newborn transports from a birth center to one of 4 hospitals in Ottawa or Toronto. A descriptive qualitative approach to data analysis was undertaken. Results: Twenty-four health care providers and managerial staff participated in a focus group or interview. Participants described positive experiences transporting women and/or newborns from the birth centers to hospitals; these positive experiences were attributed to the collaborative planning, training, and communication that occurred prior to opening the birth centers. The degree of integration was dependent on hospitalspecific characteristics such as history, culture, and the presence or absence of midwifery privileging. Participants described the need for only minor improvements to administrative processes as well as the challenge of keeping large numbers of staff updated with respect to urgent transport policies. Planning and opening of the birth centers was seen as a driving force in further integrating midwifery care and improving interprofessional practice. Discussion: The collaborative approach for the planning and implementation of the birth centers was a key factor in the successful integration into the existing maternal-newborn system and contributed to improving integrated professional practice among midwives, paramedics, nurses, and physicians. This approach may be used as a template for the integration of other new independent health care facilities and programs into the existing health care system.

Midwifery, Jul 1, 2016

Abstract Objective this paper explores unexpected findings about how to "do risk talk" ... more Abstract Objective this paper explores unexpected findings about how to "do risk talk" which emerged during a broader research project on of the application and misapplication of evidence-based practice in Canada. Design the study used qualitative methods such as semi-structured interviews and thematic analysis of inter-professional maternity care conference presentations. Setting Canada Participants fifty Canadian midwives, doctors and nurses involved in maternity care were interviewed to uncover the "how and whys" of differing interpretations and uneven application of evidence. Results care providers described a "lean to technology" as an unexpected result of using evidence in their discussions with pregnant women. They perceived risk talk as undermining low intervention approaches and reassurance about the safety of birth. Across professional groups, interviewees described how they attempted to mitigate this unwanted effect. Their strategies to put risk in perspective include finding comparable everyday risks, using words and pictures to describe numbers and using absolute risk and numbers needed to treat rather than relative risk. They warned about the need to balance a culture of fear combined with maternal altruism. Time, reassurance, awareness and humility were seen as key tools. Key conclusions and implications for practice midwives and other maternity care providers can use a variety of techniques to put risk into perspective. It is important to discuss evidence and risk with an awareness that the process itself can exaggerate risk. Care providers in all professional groups were motivated to avoid contributing to a culture of fear about childbirth and increasing rates of intervention.

The Canadian Journal of Program Evaluation, 2020

A group of Indigenous health and social service evaluators called the "Three Ribbon" panel came t... more A group of Indigenous health and social service evaluators called the "Three Ribbon" panel came together in Toronto in 2015/16 with the goal of informing a set of evidence-based guidelines for urban Indigenous health and social service and program evaluation. The collective knowledge and experiences of the Th ree Ribbon panel was gathered through discussion circles and synthesized around the follow ing areas: barriers to conducting Indigenous health and social service evaluation; decolonizing principles and protocols that support community self-determination and centralize Indigenous culture and worldviews; and guidelines to inform health and social service evaluation moving forward. The wisdom and contributions of the Three Ribbon Panel creates space for Indigenous worldviews, values, and beliefs within program evaluation practice and has important implications for evaluation research and application.

Midwives in birth centres are able to provide safe care in remote communities. Local midwives in ... more Midwives in birth centres are able to provide safe care in remote communities. Local midwives in the Nunavik region were able to provide culturally competent care for pregnant women and help women give birth safely.

Evidence-based practice (EBP) has been widely adopted as a scientific and objective approach to h... more Evidence-based practice (EBP) has been widely adopted as a scientific and objective approach to health care. Enthusiastic acceptance of EBP within maternity care appears to have had unexpected effects on the care of childbearing women. This qualitative study of an interprofessional group of maternity care providers explores EBP from a critical science studies perspective to understand the social inside the science. A literature review and interviews with family physicians, midwives, nurses and obstetricians were analyzed for themes. Initial hopes for EBP were high and often contradictory. Although many had hoped EBP would help limit rising rates of intervention in childbirth, informants noted that interventions, such as induction of labour and caesarean section, have continued to increase. Informants described patterns of uneven application and misapplication of evidence. They described how some evidence is applied quickly while other evidence is resisted. The rapid uptake of the findings of a single trial about breech birth was frequently contrasted with reluctance to implement evidence in favour of auscultation rather than electronic fetal heart monitoring. My findings reveal patterns of over application, for example, when research about post-term pregnancy is used as a rationale for induction of labour earlier than the findings justify. Informants described under interpretation when multiple or ambiguous interpretations are ignored and over interpretation when evidence is generalised to populations beyond its relevance. Informant interviews reveal underlying reasons that evidence is oversimplified and unevenly applied. Care providers are influenced by belief systems, powerful cultural trends to technologic solutions, discomfort with uncertainty, a focus on risk avoidance, and structural issues including payment systems and limited resources. Many informants expressed concern that the adoption of EBP has unexpectedly undermined support for physiologic birth. They described a profound sense of loss, including loss of skills, access to care and choices for women. Informants advocated reconsideration of EBP, calling for a conscious and reflective approach which acknowledges that scientific evidence alone cannot set goals and objectives of care. My findings are evidence of interprofessional interest in open dialogue about interpretations of evidence and revisions of EBP in the care of childbearing women

ABSTRACTAcross Canada, researchers and maternity care leaders have identified a crisis in materni... more ABSTRACTAcross Canada, researchers and maternity care leaders have identified a crisis in maternity care due to a shortageof skilled providers (obstetricians, family physicians, midwives). For the remote Inuit communities of Nunavutthis crisis is about a lack of local maternity care and childbirth brought about by the erosion of local capacity andparticipation in planning and provision. These communities face difficulties recruiting, training and retainingskilled providers. They also experience a lack of consistency in providers and services within and acrossAboriginal communities in Canada, and system dependence on the evacuation of women in remote communitiesfor childbirth.System dependence on evacuation for childbirth has effectively removed childbirth from Nunavut families andcommunities. Across Nunavut, efforts to return childbirth to communities have been challenged by a lack ofmobilization of providers and communities, concerns about safety, and relationships between communities,providers, decision-makers, and various levels of government.From November 2002 to December 2004, through a qualitative consultative methodology we examined currentmaternity care across ten Nunavut communities and their visions for change. We found that a return of childbirthto communities is thus, not simply about hiring more providers and developing local training. This return willrequire a rethinking of relationships between and collaboration among communities, providers, and levels ofgovernment to determine, plan and implement sustainable maternity care for remote, Inuit communities.While collaboration is crucial to providing sustainable maternity care in remote, Inuit settings, we argue thatmultidisciplinary collaboration needs to be reframed to include the community. Moreover, we find thatcollaboration becomes all the more complex in the context of community ownership and historical relationshipsbetween traditional and non-traditional providers.RESUMELes chercheurs et chefs de file en soins de maternite affirment qu'il y a presentement une crise en soins dematernite a cause d'une penurie de fournisseurs competents (obstetriciens, medecins de famille, sages-femmes)et ce, dans tous le pays. Dans les communautes Inuits du Nunavut, cette crise se traduit par une penurie en soinsde maternite et en parturition due a l'erosion a l'echelle locale de la capacite et de la participation a laplanification et a l'offre. Ces communautes ont de serieux problemes a recruter et conserver des fournisseurs desoins competents. Elles font aussi face a une penurie de fournisseurs autochtones et la formation des Inuits estinadequate. De plus, il n'y a pas de consistance en ce qui a trait aux soins et services offerts par les fournisseursdans les communautes autochtones du Canada. Il est aussi tres difficile de proceder a l'evacuation des femmes entravail des communautes eloignees du a la dependance envers le systeme.La dependance du systeme par rapport a l'evacuation pour l'accouchement a vraiment elimine l'accouchementdes familles et communautes du Nunavut. Les efforts a ramener les accouchements dans la communautenunavutmiuk sont mis au defi par le manque de mobilisation des fournisseurs et des communautes, lespreoccupations en matiere de securite, ainsi que les relations entre les communautes, fournisseurs, preneurs dedecision et differents paliers de gouvernement.Une etude methodologique qualificative en consultation qui s'est deroulee de novembre 2002 a decembre 2004nous a permis d'etudier les soins de maternite de dix communautes du Nunavut, ainsi que de connaitre la visionde ces dernieres en ce qui a trait aux changements a apporter. Nous constatons que de ramener lesaccouchements dans la communaute ne consiste pas qu'a embaucher plus de fournisseurs et a developper laformation a l'echelle locale. Ce retour demandera une reflexion quant aux relations et a la collaboration entre lescommunautes et les fournisseurs et differents paliers de gouvernements en vue de determiner, planifier et mettresur pied des soins de maternite viables pour les communautes Inuits eloignees.Il ne va pas sans dire que la collaboration est essentielle si on veut fournir des soins de maternite viables enregions Inuits. Nous croyons fermement que la collaboration multidisciplinaire doit etre recadree pour y inclurela communaute. En outre, nous croyons que cette collaboration est encore plus complexe dans le contexte de lapropriete collective et des relations historiques entre les fournisseurs traditionnels et non traditionnels.

Journal of Midwifery & Women's Health, Jul 8, 2007

This article describes the Inuulitsivik midwifery service and education program, an international... more This article describes the Inuulitsivik midwifery service and education program, an internationally recognized approach to returning childbirth to the remote Hudson coast communities of Nunavik, the Inuit region of Quebec, Canada. The service is seen as a model of community-based education of Aboriginal midwives, integrating both traditional and modern approaches to care and education. Developed in response to criticisms of the policy of evacuating women from the region in order to give birth in hospitals in southern Canada, the midwifery service is integrally linked to community development, cultural revival, and healing from the impacts of colonization. The midwifery-led collaborative model of care involves effective teamwork between midwives, physicians, and nurses working in the remote villages and at the regional and tertiary referral centers. Evaluative research has shown improved outcomes for this approach to returning birth to remote communities, and this article reports on recent data. Despite regional recognition and wide acknowledgement of their success in developing and sustaining a model for remote maternity care and aboriginal education for the past 20 years, the Nunavik midwives have not achieved formal recognition of their graduates under the Quebec Midwifery Act.

Birth-issues in Perinatal Care, Jun 29, 2012

BackgroundThe Inuulitsivik midwifery service is a community‐based, Inuit‐led initiative serving t... more BackgroundThe Inuulitsivik midwifery service is a community‐based, Inuit‐led initiative serving the Hudson coast of the Nunavik region of northern Québec. This study of outcomes for the Inuulitsivik birth centers, aims to improve understanding of maternity services in remote communities.MethodsWe used a retrospective review of perinatal outcome data collected at each birth at the Inuulitsivik birth centers to examine outcomes for 1,372 labors and 1,382 babies from 2000 to 2007. Data were incomplete for some indicators, particularly for transfers to Montreal.ResultsFindings revealed low rates of intervention with safe outcomes in this young, largely multiparous “all risk” Inuit population. Ninety‐seven percent of births were documented as spontaneous vaginal deliveries, and 85 percent of births were attended by midwives. Eighty‐six percent of the labors occurred in Nunavik, whereas 13.7 percent occurred outside Nunavik. The preterm birth rate was found to be 10.6 percent. Postpartum hemorrhage was documented in 15.4 percent of women; of these cases, 6.9 percent had blood loss greater than 1,000 mL. Four fetal deaths (2.9 per 1,000) and five neonatal deaths (< 3.6 per 1,000) were documented. Nine percent (9%) of births involved urgent transfers of mother or baby. The most common reasons for medical evacuation were preterm labor and preeclampsia, and preterm birth was the most common reason for urgent neonatal transfer.ConclusionsThe success of the Innulitsivik midwifery service rests on the knowledge and skills of the Inuit midwives, and support of an interprofessional health team. Our study points to the potential for safe, culturally competent local care in remote communities without cesarean section capacity. Our findings support recommendations for integration of midwifery services and Aboriginal midwifery education programs in remote communities. (BIRTH 39:3 September 2012)

Canadian Journal of Program Evaluation, 2020