Midwives’ perceptions of influences on their behaviour of woman-centered care: a qualitative study (original) (raw)
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Dutch midwives' views on and experiences with woman-centred care -A Q-methodology study
2018
Background: Woman-centred care is a philosophy for midwifery care management of the childbearing woman. There is no mutually recognised internalised way in midwifery to provide woman-centred care. Objective: To reveal midwives' distinct perspectives about woman-centred care. Methods: A Q-methodology study amongst 48 Dutch community-based midwives who rank-ordered 39 statements on woman-centred care, followed by semi-structured interviews to motivate their ranking. By-person factor analysis was used to derive latent views, representing midwives (factors) with similar attitudes towards woman-centred care. The qualitative data was used to aid interpretation of the factors. Results: Four distinct factors emerged: (1) the humane midwife, containing two twinning factors: (1+) The philosophical midwife, who is the woman's companion during childbearing in being an authentic individual human being; (1À) the human-rights midwife, who is the woman's advocate for achieving autonomy and self-determination regarding care during the childbearing period. (2) The quality-of-care midwife, who regards good perinatal health outcomes, responsive care and positive maternal experiences as benchmarks for the quality of woman-centred care. (3) The job-crafting midwife, who focuses on self-organisation while seeking balance between the childbearing woman, herself as a professional and an individual and as a colleague. Conclusion/Implications: Each factor represented specific perspectives feeding into woman-centred practice. Although the humane midwife seems to represent the dominant and preferable perspective of woman-centred care, awareness and exploration of and reflection on the thoughts patterns represented by the four different perspectives, should be considered in education and professional development of (student)midwives of be(com)ing a woman-centred midwife.
Woman-centered care 2.0: Bringing the concept into focus
2018
INTRODUCTION Woman-centered care has become a midwifery concept with implied meaning. In this paper we aim to provide a clear conceptual foundation of woman-centered care for midwifery science and practice. METHODS An advanced concept analysis was undertaken. At the outset, a systematic search of the literature was conducted in PubMed, OVID and EBSCO. This was followed by an assessment of maturity of the retrieved data. Principle-based evaluation was done to reveal epistemological, pragmatic, linguistic and logic principles, that attribute to the concept. Summative conclusions of each respective component and a detailed analysis of conceptual components (antecedents, attributes, outcomes, boundaries) resulted in a definition of woman-centered care. RESULTS Eight studies were selected for analyses. In midwifery, woman-centered care has both a philosophical and a pragmatic meaning. There is strong emphasis on the woman-midwife relationship during the childbearing period. The concept demonstrates a dual and equal focus on physical parameters of pregnancy and birth, and on humanistic dimensions in an interpersonal context. The concept is epistemological, dynamic and multi-dimensional. The results reveal the concept's boundaries and fluctuations regarding equity and control. The role of the unborn child is not incorporated in the concept. CONCLUSION An in-depth understanding and a broad conceptual foundation of woman-centered care has evolved. Now, the concept is ready for research and educational purposes as well as for practical utility.
Woman centred care? An exploration of professional care in midwifery practice
2008
This thesis explores what 'woman centred care' means to both women and midwives and how this care is offered by midwives and perceived by women. It is set within the context of current health care policy and the way in which this impacts on both the organisation and implementation of maternity care. A flexible qualitative design was used to explore both women's and midwives' experiences of current maternity care over the full trajectory of maternity provision. A modified grounded theory approach was used framed within a feminist perspective. The fieldwork was undertaken in two phases. In phase one and interviews were undertaken with twelve women in early pregnancy, later pregnancy and after the birth; a total of twenty-five interviews with women were completed. Nine midwives were also interviewed in phase one. Preliminary and tentative categories were identified from both sets of interviews and were used to inform phase two of the study.
The Australian Journal of Midwifery, 2001
The current movement towards woman-centred midwifery care is creating many changes for practicing midwives. In order to address these changes, midwives, particularly those working in the hospital system, need to be clear about their rote in the care of childbearing women, and how they can be part of the solution in changing the fractured maternity care currently operating under the medical system. This article examines some of the issues arising for midwives, such as autonomous practice, use of obstetric language, and education for the new generation of midwives.
Development of a Concourse for a Q-Method Study about Midwives’ 2perspectives of Woman-Centered Care
Health Education and Care, 2016
Objective: To transparently describe the development of a Q-set for a Q-method study about midwives' perspectives of woman-centered care. Research design: Q-methodology is a relevant study approach to identify key viewpoints that are relevant for practitioners and for educational purposes. The development of a set of statements (Q-sample) is the first phase of this study's methodology, forming the research instrument-and being the focus of this paper. Methods: Q-set development and construction included four steps: (1) Collections of items, (2) Q sample selection, (3) Formulating the Q statements, (4) Validation of the Q sample. Methods to collect items included a systematic review, a scoping review and personal narratives. Results: We used scientific literature, Dutch midwifery journals, international governmental and healthcare professional reports and guidelines, practising midwives, midwifery lecturers, media, fiction and art as sources to collect items. A collection of 45 Q-statements was formulated according the Attitude, Social influence & self-Efficacy (ASE) model. The statements were pre-tested among student midwives and pilot-tested by midwifery Master students and two individual midwives, resulting in a final Q-set of 39 statements. Conclusion: We systematically, thoroughly and transparently developed a valid and robust Q-set. Albeit a time consuming process and granting that the Q-statements might not represent thoughts of midwives in other countries than the Netherlands, we have constructed a concourse based on rich and detailed information that is appropriate for a Q-method study among Dutch midwives about their perspectives of woman-centered care.
‘ISeeYou’: A woman-centred care education and research project in Dutch bachelor midwifery education
Health Education Journal, 2018
Objective: To examine how student midwives in higher education learn to become competent and confident woman-centred practitioners. Design: Participant observation study using a ‘buddy’ approach. Setting: Bachelor of Midwifery students in one higher education institution in the Netherlands Methods: First-year student midwives followed one woman throughout the continuum of childbirth. The students attended a minimum of five of the woman’s antenatal care encounters and a minimum of one postnatal care encounter. In addition, students explored the woman’s professional care network. Student midwives used participant observation, structured interview techniques and reflective practice to focus on (1) the woman and to gain insight into her wishes and experiences of care throughout the continuum of pregnancy, birth and postpartum period; (2) the impact of the caregiver on the woman; and (3) the woman’s experience of the partnership. Lectures, peer-debriefing, competency assessments, research activities and a logbook supported students’ learning. Results: Learning was achieved through the student’s relational continuity and active engagement with the individual woman. Students gained insight into the experiences of individual pregnant and postpartum women, the individual practice of healthcare practitioners and the interaction between the woman and the healthcare practitioner. Students’ development of critical thinking and reflective practice was enhanced to begin to form a vision of woman-centred care. Conclusion: The project was successful in equipping Bachelor of Midwifery students with competencies to support them in their learning of providing woman-centred care and offered them unique and in-depth experiences supporting and augmenting their personal, professional and academic development.
A hermeneutic phenomenological study of Belgian midwives' views on ideal and actual maternity care
Midwifery, 2013
Objective: to explore midwives' views on ideal and actual maternity care. Design: a qualitative hermeneutic phenomenological study based on the method of van Manen (1997) using individual in-depth interviews to gather data. Setting: Flanders, Belgium. Participants: 12 purposively sampled midwives, of whom nine from three different non-university hospitals and three independent midwives conducting home births. Findings: five major themes were identified: 'woman-centred care', 'cultural change', 'support', 'midwife and obstetrician as equal partners' and 'inter-collegial harmony'. In this paper 'woman-centred care', 'cultural change' and 'support' are discussed along with their subthemes. Midwives thought ideal maternity care should be woman-centred in which there were no unnecessary interventions, women were able to make an informed choice and there was continuity of care. Furthermore, ideal maternity care should be supported by midwifery education and an adequate staffing level. Also, a cultural change was wanted as actual maternity care was perceived to be highly medicalised. Barriers to achieving woman-centred care and possible strategies to overcome these were described. Conclusions: findings from this study were consistent with those of other studies on midwives' experience with obstetric-led care. Despite the medicalised care, midwives still held a woman-centred ideology. In order to be able to work according to their ideology, different barriers need to be addressed. Although midwives suggested strategies to overcome these barriers, some were considered to be very difficult to overcome.
International journal of Childbirth, 2019
AIMS: To examine the woman-centeredness of maternity care providers from the woman’s perspective. To investigate the validity and reliability of the Client Centered Care Questionnaire among a childbearing population. DESIGN: A cross-sectional study. METHODS: The self-report Client Centered Care Questionnaire was administered to evaluate women’s one-on-one antenatal and postnatal care appointments with various Dutch care providers: community and hospital-based midwives, General Practitioners, (registrar) obstetricians, sonographers, and maternity care nurses. RESULTS: Eight-hundred and fifteen completed questionnaires were received. Exploratory and confirmatory factor analyses provided support for a two-factor model, with an acceptable model fit. Woman-centeredness of all maternity care providers showed scores above baseline for the neutral value. Welch ANOVA showed a statistical significant effect of the type of maternity care practitioner in providing woman-centered care during antenatal and postnatal visits (F(5.8) = 7.79). The Bonferroni post hoc test showed that women assigned significantly higher woman-centered care scores to community-based midwives compared with hospital-based midwives (p .011) and compared with registrars/obstetricians (p < .001). CONCLUSION: Although overall scores of perceived woman-centeredness indicated a good to excellent performance of woman-centered care, with significantly higher scores for community-based midwives, it cannot be assumed that current woman-centered care completely meets the needs of Dutch childbearing women. The Client Centered Care Questionnaire (CCCQ) is an adequate instrument to measure woman-centered care in antenatal and postnatal maternity services. Further research regarding measuring woman-centered care is needed.
Development of a Q-set for a Q-Method Study about Midwives’ perspectives of Woman-Centered Care
Health Education and Care, 2016
Objective: To transparently describe the development of a Q-set for a Q-method study about midwives' perspectives of woman-centered care. Research design: Q-methodology is a relevant study approach to identify key viewpoints that are relevant for practitioners and for educational purposes. The development of a set of statements (Q-sample) is the first phase of this study's methodology, forming the research instrument-and being the focus of this paper. Methods: Q-set development and construction included four steps: (1) Collections of items, (2) Q sample selection, (3) Formulating the Q statements, (4) Validation of the Q sample. Methods to collect items included a systematic review, a scoping review and personal narratives. Results: We used scientific literature, Dutch midwifery journals, international governmental and healthcare professional reports and guidelines, practising midwives, midwifery lecturers, media, fiction and art as sources to collect items. A collection of 45 Q-statements was formulated according the Attitude, Social influence & self-Efficacy (ASE) model. The statements were pre-tested among student midwives and pilot-tested by midwifery Master students and two individual midwives, resulting in a final Q-set of 39 statements. Conclusion: We systematically, thoroughly and transparently developed a valid and robust Q-set. Albeit a time consuming process and granting that the Q-statements might not represent thoughts of midwives in other countries than the Netherlands, we have constructed a concourse based on rich and detailed information that is appropriate for a Q-method study among Dutch midwives about their perspectives of woman-centered care.
Woman-centred care in childbirth: A concept analysis (Part 1)
Curationis, 2013
Woman-centred care' in childbirth is a process in which a woman makes choices and is involved in and has control over her care and relationship with her midwife. The aim of this paper is to study the concept of woman-centred care through analysis in the context of childbirth. The attributes, antecedents and consequences of this concept are identified, and a model case, a borderline case and a contrary case constructed to achieve conceptual clarity. A concept analysis was undertaken as described by Walker and Avant (2011), with an extensive exploration of domain-specific literature and evidence from various disciplines. It was established from the concept analysis that 'woman-centred care' was complex and experienced individualistically. The analysis indicated that mothers' participation is supposed to be based on a more collaborative relationship and partnership. Participation is exhibited by open communication and the mother's involvement in decision-making, consultation and collaboration with the attending midwife, further characterised by mutual respect and the midwife listening to the mother's views. There is also an exchange of complete and unbiased information, recognition and honouring of cultural diversity and making of informed choices. Through an inductive discovery approach and drawing on inferences, attributes were clustered in an attempt to identify the apparent essence of the concept. From the results of the concept analysis described in this study, the researchers recommend the formulation of criteria that could facilitate implementation and evaluation of womancentred care and its empirical referents in the context of the Batho Pele principles (Part 2).