Improving intrapartum care

Personal Values Required for Ethical Best Practice during Intrapartum Care

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/4398 ◽

2018 ◽

Vol 20 (2) ◽

Author(s):

Jacobeth Mmabyala Louisa Malesela

Keyword(s):

Nursing Education ◽

Best Practice ◽

Personal Values ◽

Self Control ◽

Intrapartum Care ◽

Performance Reviews ◽

Qualitative Research Design ◽

Selection Processes ◽

The Individual ◽

Recruitment And Selection

Women bring into the birthing unit values which include preferences, concerns and expectations that are involved in decision-making during intrapartum care. When midwives fail to meet the women’s values, they experience such care as being inhumane and degrading, thus affecting the childbirth outcomes. The inhumane and degrading care includes a lack of sympathy and empathy, as well as a lack of attention to privacy and confidentiality. Midwives’ possession of the required personal values and the ability to integrate women’s values are vital to enhance ethical best practice during intrapartum care. The aim of the study was to explore and to describe the midwives’ personal values that are required for ethical best practice during intrapartum care. The birthing unit at a public hospital in the Gauteng province of South Africa formed the context of the study. A qualitative research design that was explorative, descriptive and contextual in nature was used. The following personal values emerged: (1) respect, trust and dignity; (2) justice, equality and fairness; (3) freedom of choice and autonomy; (4) integrity, honesty and consistency; (5) good character and personality; (6) self-control and rapport; and (7) open-mindedness and flexibility. The midwives’ personal values form a strong precursor that is crucial for ethical best practice during intrapartum care. The individual midwives, nursing education institutions and health facilities can use the study findings in areas such as reflective midwifery practice, the midwifery curriculum, recruitment and selection processes, and as part of key performance areas and indicators in performance reviews.

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Resilience to maintain quality of intrapartum care in war torn Yemen: a retrospective pre-post study evaluating effects of changing birth volumes in a congested frontline hospital

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03507-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Josephine Obel ◽

Antonio Isidro Carrion Martin ◽

Abdul Wasay Mullahzada ◽

Ronald Kremer ◽

Nanna Maaløe

Keyword(s):

Quality Of Care ◽

Birth Outcomes ◽

Birth Outcome ◽

High Volume ◽

Maternal Health Service ◽

Service Access ◽

Intrapartum Care ◽

Health Service Access ◽

Low Volume

Abstract Background Fragile and conflict-affected states contribute with more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access and quality and adaptive responses during armed conflict. Taiz Houbane Maternal and Child Health Hospital in Yemen was established during the war as such adaptive response. However, as number of births vastly exceeded the facility’s pre-dimensioned capacity, a policy was implemented to restrict admissions. We here assess the restriction’s effects on the quality of intrapartum care and birth outcomes. Methods A retrospective before and after study was conducted of all women giving birth in a high-volume month pre-restriction (August 2017; n = 1034) and a low-volume month post-restriction (November 2017; n = 436). Birth outcomes were assessed for all births (mode of birth, stillbirths, intra-facility neonatal deaths, and Apgar score < 7). Quality of intrapartum care was assessed by a criterion-based audit of all caesarean sections (n = 108 and n = 82) and of 250 randomly selected vaginal births in each month. Results Background characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71)). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume. Conclusions Assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes; to enable safe care during birth for as many women as possible.

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Assessment of the quality, content and perceived utility of local maternity guidelines in hospitals in England implementing the saving babies’ lives care bundle to reduce stillbirth

BMJ Open Quality ◽

10.1136/bmjoq-2019-000756 ◽

2020 ◽

Vol 9 (2) ◽

pp. e000756

Author(s):

Yu Zhen Lau ◽

Kate Widdows ◽

Stephen A Roberts ◽

Sheher Khizar ◽

Gillian L Stephen ◽

...

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Stakeholder Involvement ◽

Care Bundle ◽

Intrapartum Care ◽

National Guidelines ◽

Department Of Health ◽

The Uk

IntroductionThe UK Department of Health have targeted a reduction in stillbirth by 50% by 2025; to achieve this, the first version of the Saving Babies’ Lives Care Bundle (SBLCB) was developed by NHS England in 2016 to improve four key areas of antenatal and intrapartum care. Clinical practice guidelines are a key means by which quality improvement initiatives are disseminated to front-line staff.MethodsSeventy-five clinical practice guidelines covering the four areas of antenatal and intrapartum care in the first version of SBLCB were obtained from 19 maternity providers. The content and quality of guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Maternity health professionals in participating organisations were invited to participate in an anonymous survey to determine perceptions toward and experiences of the use of clinical practice guidelines using a series of Likert scales.ResultsUnit guidelines showed considerable variation in quality with median scores of 50%–58%. Only 4 (5.6%) guidelines were recommended for use in clinical practice without modifications, 54 (75.0%) were recommended for use subject to modifications and 12 (16.7%) were not recommended for use. The lowest scoring domains were ‘rigour of development’, ‘stakeholder involvement’ and ‘applicability’. A significant minority of unit guidelines omitted recommendations from national guidelines. The majority of staff believed that clinical practice guidelines standardised and improved the quality of care but over 30% had insufficient time to use them and 24% stated they were unable to implement recommendations.ConclusionTo successfully implement initiatives such as the SBLCB change is needed to local clinical practice guidelines to reduce variation in quality and to ensure they are consistent with national recommendations . In addition, to improve clinical practice, adequate time and resources need to be in place to deliver and evaluate care recommended in the SBLCB.

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