Women’s vulnerability within the childbearing continuum: A scoping review (original) (raw)
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Defining vulnerability in European pregnant women, a Delphi study
Midwifery, 2020
Objective: Vulnerability among pregnant women is an important and complex theme in the everyday practice of midwives. Exchanging knowledge and best practices about vulnerability between midwives in Europe can contribute to improving the knowledge and skills of midwives and as a result improve the care for vulnerable pregnant women. We therefore start a consortium with midwives, midwifery teachers, researchers and students from organizations of seven European cities with the aim to exchange knowledge and best practices concerning vulnerable pregnant women between midwives. To be able to effectively exchange knowledge and best practices, our consortium started with this study focuses on establishing a mutual definition of vulnerable pregnant women. Therefore, the aim of this study is to develop a mutual definition of vulnerable pregnant women and to identify aspects related to vulnerability. Design: Delphi study with four rounds: (1) gathering existing knowledge from literature and definitions used by partners of the consortium, (2) and (3) two survey rounds and (4) an in-person consensus meeting. Setting: Consortium of midwives, midwifery teachers, researchers and students from Antwerp (Belgium), Ghent (Belgium), Turku (Finland), Milan (Italy), Piła (Poland), Lisbon (Portugal) and Rotterdam (The Netherlands) Participants: We included all consortium members in the Delphi study. Findings: Various aspects related to vulnerability and appropriate definitions were identified during the Delphi rounds. Consensus about the aspects related to vulnerability and the definition of vulnerable pregnant women was reached during the final consensus meeting. A vulnerable pregnant woman was defined as a woman who is threatened by physical, psychological, cognitive and/or social risk factors in combination with lack of adequate support and/or adequate coping skills. Key conclusion: We reached consensus about a mutual definition of vulnerable pregnant women and aspects related to vulnerability within this consortium. The Delphi approach led to interesting discussions and was a valuable method to define the concept of vulnerable pregnant women within our project .
Development of a Blueprint for Integrated Care for Vulnerable Pregnant Women
Maternal and Child Health Journal, 2022
Purpose There has been increasing awareness of perinatal health and organisation of maternal and child health care in the Netherlands as a result of poor perinatal outcomes. Vulnerable women have a higher risk of these poor perinatal outcomes and also have a higher chance of receiving less adequate care. Therefore, within a consortium, embracing 100 organisations among professionals, educators, researchers, and policymakers, a joint aim was defined to support maternal and child health care professionals and social care professionals in providing adequate, integrated care for vulnerable pregnant women. Description Within the consortium, vulnerability is defined as the presence of psychopathology, psychosocial problems, and/or substance use, combined with a lack of individual and/or social resources. Three studies focussing on population characteristics, organisation of care and knowledge, skills, and attitudes of professionals regarding vulnerable pregnant women, were carried out. Ou...
Psychosocial risk assessment by midwives during antenatal care: a focus on psychosocial support
2013
The rationale of any national screening programme is to recognize the benefits for public health, to test a predominantly healthy population including low risk pregnant women, and to detect risk factors for morbidity in order to provide timely care interventions. The South African health care system faces many challenges that undoubtedly impact on maternal health, resulting in poor quality of care and indirectly causing maternal deaths. The government has embarked on a number of initiatives that address women's psychosocial wellbeing during pregnancy, for example free maternity care, legalizing abortion, expanding on provider-initiated HIV counseling and testing for antenatal patients. These initiatives imply a re-look at antenatal care screening, in order to identify wider determinants of health that may have an impact on a woman's psychosocial wellbeing. This includes amongst others, poor socioeconomic conditions such as poverty, lack of social support, general health inequalities, domestic violence and a history of either personal or familial mental illness, all of which have the capacity to influence a pregnant woman's decision to utilize health care services. The intention of this study was therefore to establish the extent of psychosocial risk assessment for pregnant women during antenatal care, with a focus on the psychosocial support.Ethical clearance was obtained from the University of the Witwatersrand Human Research Ethics Committee (Protocol no. M081013). A mixed-method approach was applied through combining quantitative and qualitative research techniques, methods and approaches to address psychosocial risk assessment and psychosocial support by midwives during antenatal care. An explanatory sequential design was used. The methodology was aimed at accommodating the diverse population involved in the study, the nature of data being sought and the number of investigations conducted. A fully mixed research approach was implemented interactively through all the stages of the study. The study took place in six phases to meet the purpose of this research. Phase 1 entailed quantitative data collection and analysis; phase 2 qualitative data collection and analysis; phase 3 report writing; phase 4 formulation of guidelines; phase 5 pilot test; phase 6 integration of results and findings, and writing of final report. v The philosophical basis of the study is based on the researcher's values and belief of holism and comprehensive assessment. Much as values are part of the study, the researcher strove to keep values as separate from the research as possible, to minimise researcher bias. The feminist standpoint theory provided the guiding epistemological framework to address the qualitative research questions for this study as the issues regarding reproduction are of central feminist concern. Pragmatism, which is considered a best philosophical basis for mixed-methods as it values both objective and subjective knowledge, was applied in this study. The methodological goal of the study was guided by two paradigms, "constructivist", which is the basis of qualitative research and "contemporary empiricist" paradigms, which is the basis of empirical analytic research as the study used a mixed-method approach. Although the empiricist lens is the most appropriate for a sequential explanatory design, both paradigms are acknowledged in this study. A quantitative-qualitative data collection and analysis sequence was followed. The sequential explanatory approach was maintained through, for example, collecting and analyzing quantitative data first, followed by obtaining information from midwives through a questionnaire and focus group discussions, and from pregnant women through a questionnaire and focus group discussions, using the same populations. Non-probability purposive sampling was done for all data sources. All data were collected by the researcher.Qualitative data analysis consisted of the identification of themes and relationships through constant comparison of data, which enabled the researcher to establish group and across-group saturation in focus group discussions. Quantitative data was collected through the review of midwifery education regulations, documents and records. Midwives' questionnaires with a response rate of 46%, questionnaires administered to pregnant women and the review of antenatal cards with a 94% response rate. The data sets provided multiple data sources, a characteristic of the mixed methods approach. Data were analyzed using the Stata Release 10 statistical software package. Data analysis included summary statistics i.e. mean and standard deviation for continuous variables, frequencies and percentages for discrete variables, and Chronbach's alpha for internal consistency. Confidence intervals of 95% were used to report on discrete variables. Quantitative and qualitative data were initially analyzed separately to develop an understanding of the two data bases before merging the findings and results. The process provided separate and vi independent results that could be compared for the purposes of corroboration, complementarity and discussion. The results were compared for specific content areas, for example major themes. A tool for psychosocial risk assessment and care was developed in response to the findings from the midwives' focus group discussions at the three clinics, the expert interviews findings, the crosssectional survey results from midwives, the self-administered questionnaires for pregnant women, and review of the antenatal cards carried by women during antenatal care. The tool was piloted in the three clinics where data were initially obtained. The general results of the study suggest that depressive and anxiety disorders are common in pregnancy and may be associated with negative experiences during antenatal care. Adequate screening of women and recognition of emotional responses with appropriate interventions are essential to promote a woman's healthy adjustment to pregnancy. Attempts to minimise high levels of uncertainty, anxiety and depression should be incorporated within routine antenatal care.Midwives should strive to empower women physically and psychosocially in order for women to be able to overcome any barriers to safe motherhood, with emphasis on providing information, in order for them to make informed choices.The findings from the pilot study confirmed that pregnant women experience psychosocial problems which can be identified by the use of a screening tool, howeverthere remains a need to test the tool on a larger sample which might elicit more factors that could hinder or help its implementation. The implication of the findings appears to be that midwives are willing to incorporate the psychosocial assessment tool into routine antenatal care. The findings might be used to advocate for the incorporation of the tool into routine antenatal care. While the use of this antenatal psychosocial pilot tool may increase the midwives' awareness of psychosocial risks and form a basis for further studies, a bigger sample size and statistical power are required to provide evidence that routine antenatal psychosocial assessment would also lead to improved outcomes for mother and/or child. The final stage of the study, based on research findings, led to the development of guidelines and recommendations for psychosocial care at the midwifery regulation level, midwifery education, clinical practice level and research.
BMC Public Health
Background Living in socially disadvantaged circumstances has a widespread impact on one’s physical and mental health. That is why individuals living in this situation are often considered vulnerable. When pregnant, not only the woman’s health is affected, but also that of her (unborn) child. It is well accepted that vulnerable populations experience worse (perinatal) health, however, little is known about the lived adversities and health of these vulnerable individuals. Objectives With this article, insights into this group of highly vulnerable pregnant women are provided by describing the adversities these women face and their experienced well-being. Methods Highly vulnerable women were recruited when referred to tailored social care during pregnancy. Being highly vulnerable was defined as facing at least three different adversities divided over two or more life-domains. The heat map method was used to assess the interplay between adversities from the different life domains. Demog...
Birth, 2006
Background: When antenatal care is provided, identification and management of challenging problems, such as depression, domestic violence, child abuse, and substance abuse, are absent from traditional midwifery and medical training. The main objective of this project was to provide an alternative to psychosocial risk screening in pregnancy by offering a training program (ANEW) in advanced communication skills and common psychosocial issues to midwives and doctors, with the aim of improving identification and support of women with psychosocial issues in pregnancy. Methods: ANEW used a before-and-after survey design to evaluate the effects of a 6-month educational intervention for health professionals. The setting for the project was the Mercy Hospital for Women in Melbourne, Australia. Surveys covered issues, such as perceived competency and comfort in dealing with specific psychosocial issues, self-rated communication skills, and open-ended questions about participants' experience of the educational program. Results: Educational program participants (n = 22/27) completed both surveys. After the educational intervention, participants were more likely to ask directly about domestic violence (p = 0.05), past sexual abuse (p = 0.05), and concerns about caring for the baby (p = 0.03). They were less likely to report that psychosocial issues made them feel overwhelmed (p = 0.01), and they reported significant gains in knowledge of psychosocial issues, and competence in dealing with them. Participants were highly positive about the experience of participating in the program. Conclusions: The program increased the selfreported comfort and competency of health professionals to identify and care for women with psychosocial issues. (BIRTH 33:1 March 2006) Health professionals providing maternity care need the skills to identify and manage a wide range of challenging psychosocial problems, such as depression, domestic violence, child and substance abuse, homelessness, intellectual disability, extreme social isolation, lack of capacity to care for a baby, lack of social and interpersonal support, and serious mental illness, yet traditional midwifery and medical training has not equipped them well for this role. In addition, women who experience these issues often find it difficult to talk about them (1), and health professionals can be reluctant to ask directly about them.
BMC Pregnancy and Childbirth
Background Tailoring an intervention to the needs and wishes of pregnant women in vulnerable situations (e.g., socioeconomic disadvantages) can reduce the risk of adverse outcomes and empower these women. A relatively high percentage of pregnant women in the North of the Netherlands are considered vulnerable to adverse pregnancy outcomes because of their low socioeconomic status and the intergenerational transmission of poverty. In order to improve perinatal and maternal health, next to standard prenatal care, various interventions for pregnant women in vulnerable situations have been developed. We do not know to what extent these additional interventions suit the needs of (pregnant) women. Therefore, the aim of this study is to gain insight into the experiences and needs of women in vulnerable situations who receive additional maternity care interventions in the Northern Netherlands. Methods Qualitative research was performed. We used a phenomenological framework, which is geared t...
Birth Companions Research Project: Experiences and Birth Outcomes of Vulnerable Women
2016
The VABM midwives, as well as other maternity professionals refer women into Birth Companions. While there are no formal criteria for referral, women are more likely to be referred if they are isolated and/or unsupported. C. Methodology Design A mixed-methods study was undertaken using quantitative (socio-demographic and birth related/outcome) data and qualitative interviews. Participants/Data Collection Routinely collected socio-demographic and birth related/outcome data were recorded for all women who birthed at the Whittington Hospital over a 12 month period (1 st July, 2014-30 th June, 2015). Semi-structured interviews were undertaken with a purposive and stratified sample of women. Data analysis Descriptive and inferential statistics of the socio-demographic and birth related/outcome data were undertaken using SPSS v. 22. Analysis of the interview data was undertaken using Braun & Clark's (2005) thematic framework, supported by MAXQDA qualitative data analysis software. Ethics Ethics and governance approval was sought via a National Research Ethics Service committee, the Research & Development unit at the Whittington Hospital and via one of the ethics subcommittees at UCLan. D. Findings Socio-demographic and birth related/outcome data A total of 3,511 women birthed at the Whittington Hospital during 1 st July, 2014-30 th June, 2015. Three hundred and fifteen (8.9%) women were identified as 'vulnerable' of which 24 (7.6%) received additional support either through Birth Companions (n=5, 1.6%), the VABM team (n=14, 4.4%) or both Birth Companions and the VABM service (n=5, 1.6%). Analyses of socio-demographic and birth related/outcome data were undertaken between the following groups: a) Vulnerable versus non-vulnerable: Comparisons between vulnerable (n=315) and non-vulnerable (n=3,196) women. b) Vulnerable only (n=315): Comparisons between women who were: a) case-loaded by Birth Companions (n=10) (including those who received support from Birth Companions and the VABM team (n=5)); b) case-loaded by VABM service (n=14) and c) referred into the VABM service only (n=291). Comparisons between vulnerable versus non-vulnerable population Vulnerable women were significantly: More likely to be of a younger age (p=0.001, t-test) More likely to be from a black or minority ethnic group (p<0.001, chi-square test) More likely to attend a booking appointment at a later time period (p=0.001, t-test) More likely to be a current/previous smoker (p<0.001 chi-square test) Less likely to experience a perineal tear (p=0.007, chi-square test) More likely to stay on the postnatal ward for a longer period of time (p<0.001, t-test)
Perception of vulnerability among mothers of healthy infants in a middle‐income country
Child: Care, Health …, 2009
Background Although four decades have passed since the concept of 'vulnerable children' has been introduced into paediatric literature, research on vulnerability is limited to high-income, Western countries. To adapt and adopt practices that have been advised for paediatricians to prevent 'the vulnerable child syndrome' , information is needed also on the prevalence and correlates of perceived vulnerability in children in low-and middle-income (LAMI) countries. Objective To determine the rate and correlates of the perception of vulnerability among healthy young children in a healthy population of children in Ankara, Turkey. Methods In this cross-sectional observational study, participants comprised of a 'prescriptive sample' of healthy, thriving children with no known health risk for vulnerability. Maternal perception of child vulnerability was assessed using the Child Vulnerability Scale (CVS). Potential risks factors for vulnerability including history of threatened abortion during pregnancy, child gender, birth order, maternal and paternal age and education were collected using a structured questionnaire. Results A total of 519 children-264 boys (50.9%) and 255 girls (49.1%)-comprised the sample. The internal consistency of the CVS was 0.71. Item-total scale corrrelations were 0.30 or above for all of the eight items. The median CVS score of the sample was 2.0 and 30 mothers (5.8%) were found to perceive their children as vulnerable. None of the socio-demographic variables that were investigated were found to be associated with high vulnerability scores. Conclusion This study is the first to examine maternal perceived vulnerability of healthy children in a middle-income country. The findings imply that a high proportion of healthy children are perceived as vulnerable by their mothers and that previously studied socio-demographic factors do not explain perceived vulnerability. The results of this study may provide a comparison point for studies on childhood vulnerability in LAMI countries.