Strategies to improve the quality of midwifery care and developing midwife-centered care in Iran: analyzing the attitudes of midwifery experts

Background In recent years, extensive studies have been designed and performed in the context of providing midwifery care in developed countries, which has been unfortunately neglected in some low resources and upper middle-income countries such as Iran. This study was conducted to identify the best strategies for improving the quality of midwifery care and developing midwife-centered care in Iran. Methods This was a qualitative study using focus group discussion and content analysis method. Data were collected from 121 participants including midwifery board members, gynecologists, heads of midwifery departments, midwifery students, in charge midwives in hospitals, and midwives in the private sector. Focused-group discussions were used for data collection, and data were analyzed using content analysis method. Results The main themes extracted from the participants’ statements regarding improving the quality of midwifery care were as follows: Promotion and development of education, Manpower management, Rules, and regulations and standards for midwifery services, and Policy making. Conclusion This study showed that to improve midwifery care, health policy makers should take into account both the quality and quantity of midwifery education, and promote midwifery human resources through employment. Furthermore, insurance support, encouragement, supporting and motivating midwives, enhancing and improving the facilities, providing hospitals and maternity wards with cutting-edge equipment, promoting and reinforcing the position of midwives in the family doctor program, and using a referral system were the strategies proposed by participants for improving midwifery care. Finally, establishing an efficient and powerful monitoring system to control the practice of gynecologists and midwives, promoting the collaborative practice of midwives and gynecologists, and encouraging team-work with respect to midwifery care were other strategies to improve the midwifery services in Iran. Authorities and policymakers may set the stage for developing high quality and affordable midwifery care by relying on the strategies presented in this study.

Asuhan Kebidanan Komprehensif Covid- 19 Pada Ny. R Di Desa Gegjlik Wilayah Kerja Puskesmas Kajen I Kabupaten Pekalongan Tahun 2021

Comprehensive midwifery care is care which is a function and activity that provides services for clients who have problems or needs in health including the period of pregnancy in Ny. R with High Risk Maternal Age 37 years and Pregnancy Distance 11 Years, ovarian cysts, and Reactive Covid-19, delivery of sectio caesarea covid-19, postpartum, and normal newborns. The purpose of writing is to be able to provide comprehensive midwifery care for Ny. R In Gegjlik Village, the Work Area of the Kajen I Health Center, Pekalongan Regency in 2021 in accordance with standards, competencies, authorities, and properly documented The data collection method used by the author during the pandemic is in accordance with the Covid-19 Prevention and Control Guidelines of the Ministry of Health of the Republic of Indonesia : washing hands, wearing masks, maintaining distance, avoiding crowds, and reducing mobility.Keywords: Comprehensive midwifery care; Pregnancy; Ovarian cysts; Reactive Covid-19; Sectio Caesarea covid-19; Postpartum; Normal newborns. AbstrakAsuhan kebidanan Komperhensif adalah asuhan yang merupakan fungsi dan kegiatan yang memberikan pelayanan klien yang mempunyai masalah atau kebutuhan dalam kesehatan meliputi masa kehamilan pada Ny. R dengan Risiko Tinggi yaitu Usia Ibu 37 tahun dan Jarak Kehamilan 11 Tahun ,kista ovarium, dan Reaktif Covid-19, persalinan sectio caesarea covid-19, nifas , dan bayi baru lahir nonatus normal. Tujuan penulisan yaitu Dapat memberikan Asuhan Kebidanan Komprehensif Pada Ny. R Di Desa Gegjlik Wilayah Kerja Puskesmas Kajen I Kabupaten Pekalongan Tahun 2021 sesuai dengan standar, kompetensi, kewenangan, dan di dokumentasikan dengan benar Metode pengumpulan data yang digunakan penulis pada masa pandemi sudah sesuai dengan Pedoman Pencegahan dan Pengendalian Covid-19 Kementerian Kesehatan Republik Indonesia : mencuci tangan, memakai masker, menjaga jarak, menghindari kerumunan, dan mengurangi mobilitas.Kata kunci: Asuhan kebidanan Komperhensif; Kehamilan; Kista ovarium; Reaktif Covid-19; Sectio caesarea covid-19; Nifas; Bayi baru lahir nonatus normal

Studi Kasus Pada Ibu Hamil Ny K Dengan Jarak Kehamilan Dekat Dan Anemia

Anemia is defined as a condition with Hb levels in the blood below the normal 11gr/dL, anemia in Indonesia that often occurs is iron deficiency anemia. According to WHO that pregnant women who experience iron deficiency are around 35-37% and will increase with gestational age, iron deficiency anemia in pregnant women has a bad impact on both the mother and the fetus. Pregnant women with severe anemia are more likely to have premature labor and have low birth weight (LBW) babies and increase perinatal mortality. The design method used in this case describes midwifery care in pregnant women with anemia. Data was collected by anamnesis physical examination method, through inspection, palpation, auscultation, percussion. For this reason, midwives are expected to provide care to overcome anemia in pregnancy so that it does not cause ongoing problemsKeywords: Anemia; Pregnancy AbstrakAnemia didefinisikan sebagai kondisi dengan kadar Hb dalam darah di bawah normal 11gr/dL, anemia di indonesia yang sering terjadi adalah anemia defisiensi zat besi. Menurut WHO bahwa ibu hamil yang mengalami defisiensi besi sekitar 35-37% dan akan semakin meningkat seiring dengan usia kehamilan, anemia defisiensi zat besi pada ibu hamil mempunyai dampak buruk baik pada ibunya maupun pada janin yang dikandungnya. ibu hamil dengan anemia berat lebih memungkinkan terjadinya partus premature dan memiliki bayi berat badan lahir rendah (BBLR) serta meningkatkan kematian perinatal. Rancangan metode yang dilakukan pada kasus ini menggambarkan asuhan kebidanan pada kehamilan dengan anemia. Pengumpulan data dilakukan dengan metode anamnesa pemeriksaan fisik, melalui inspeksi, palpasi, auskltasi, perkusi. Untuk itu bidan di harapkan dapat memberikan asuhan untuk mengatasi anemia pada kehamilan sehingga tidak menimbulkan masalah yang berkelanjutanKata kunci: Anemia;Kehamilan

Studi Kasus Kehamilan Dengan Risiko Tinggi

Maternal mortality rate (MMR) and infant mortality rate (IMR) are determinants and benchmarks for the success of health service delivery. In 2019 Indonesia's Maternal Mortality Rate (MMR) is still high, at 305 per 100,000 live births. The purpose of this case study is to provide midwifery care during pregnancy to high-risk mothers aged over 35 years and mild anemia to minimize complications that will occur. The method of this case study is to provide midwifery care to pregnant women with high risk in the form of exposure to the subject of one client who experiences a high risk of pregnancy who will be given care during pregnancy. The results of this case study are given care to reduce the complaints felt by the client and carry out early detection to reduce the occurrence of complications. The conclusion of this case study is midwifery care for Ny. N during pregnancy in Pekalongan has been carried out on high-risk patients aged more than 35 years and mild anemia according to the needs and authority of the midwife so that it does not cause any complications. For this reason, midwives need to provide care as a form of early detection to reduce the incidence of complicationsKey Word: Maternity care, pregnant, high risk AbstrakAngka kematian ibu (AKI) dan angka kematian bayi (AKB) menjadi penentu dan tolak ukur keberhasilan penyelenggaraan pelayanan kesehatan. Pada tahun 2019 Angka Kematian Ibu (AKI) Indonesia masih tetap tinggi, yaitu 305 per 100.000 kelahiran hidup. Tujuan dari studi kasus ini adalah memberikan asuhan kebidanan selama masa kehamilan pada ibu dengan risiko tinggi usia diatas 35 tahun dan anemia ringan untuk meminimalkan komplikasi yang akan terjadi. Metode studi kasus ini adalah dengan pemberian asuhan kebidanan pada ibu hamil dengan risiko tinggi berupa pemaparan dengan subyek satu klien yang mengalami risiko tinggi dalam kehamilanya yang akan diberikan asuhan selama masa kehamilan. Hasil studi kasus ini diberikan asuhan untuk mengurangi keluhan yang dirasakan klien serta melakukan deteksi dini untuk mengurangi terjadinya komplikasi. Simpulan studi kasus ini adalah asuhan kebidanan pada Ny. N selama masa kehamilan Pekalongan sudah dilakukan pada pasien yang mengalami risiko tinggi usia lebih dari 35 tahun dan anemia ringan sesuai kebutuhan dan kewenangan bidan sehingga tidak menimbulkan komplikasi apapun. Untuk itu bidan perlu melakukan asuhan sebagai bentuk deteksi dini untuk mengurangi timbulnya komplikasiKata kunci: asuhan kebidanan, ibu hamil, risiko tinggi

Continuity of Midwifery Care in Complexity

<p>Continuity of midwifery care has demonstrated some beneficial outcomes for mothers and their babies with no evidence of poorer outcomes. Much of the evidence to support this claim is sourced from research conducted with women described as ‘low risk’. The model of midwifery in New Zealand, which is based on continuity of midwifery carer, has the potential for midwives to continue care even when significant risk has been identified. This care would be provided in collaboration with and support from medical personnel and hospital-based midwives. There is no research that has specifically examined the outcomes for women with complex needs, also called ‘high risk’, who have been provided continuity of midwifery carer. Given the increased incidence of morbidity in the childbearing population it is important to examine this issue in some depth. This small piece of research begins this, by looking at how women with complex needs and who have had continuity of midwifery care have experienced this care. The aim of this research therefore is to provide a comprehensive description of how women with complexities experience continuity of midwifery care across the maternity episode. A qualitative descriptive study was conducted in one part of New Zealand. Three women, all with varying types of complexity were interviewed. The interviews were transcribed, and the transcripts were analysed thematically. There were four themes: the relationship was everything; knowing what was happening was important; power was managed and balanced; and extra care was needed. The three women had the same needs and experiences of continuity as did low risk women described in the literature. However, another aspect, not previously reported, was that the women thought that the midwives spent a lot more time with them than they otherwise would have needed to. They were grateful for this.</p>

Continuity of Midwifery Care in Complexity

<p>Continuity of midwifery care has demonstrated some beneficial outcomes for mothers and their babies with no evidence of poorer outcomes. Much of the evidence to support this claim is sourced from research conducted with women described as ‘low risk’. The model of midwifery in New Zealand, which is based on continuity of midwifery carer, has the potential for midwives to continue care even when significant risk has been identified. This care would be provided in collaboration with and support from medical personnel and hospital-based midwives. There is no research that has specifically examined the outcomes for women with complex needs, also called ‘high risk’, who have been provided continuity of midwifery carer. Given the increased incidence of morbidity in the childbearing population it is important to examine this issue in some depth. This small piece of research begins this, by looking at how women with complex needs and who have had continuity of midwifery care have experienced this care. The aim of this research therefore is to provide a comprehensive description of how women with complexities experience continuity of midwifery care across the maternity episode. A qualitative descriptive study was conducted in one part of New Zealand. Three women, all with varying types of complexity were interviewed. The interviews were transcribed, and the transcripts were analysed thematically. There were four themes: the relationship was everything; knowing what was happening was important; power was managed and balanced; and extra care was needed. The three women had the same needs and experiences of continuity as did low risk women described in the literature. However, another aspect, not previously reported, was that the women thought that the midwives spent a lot more time with them than they otherwise would have needed to. They were grateful for this.</p>

Changes in care in the fourth trimester in Ireland: 2010–2020

Background There has been a shift in maternity care over the past decade. The changes encountered by postnatal ward staff and the impact of these changes on women postnatally requires exploration. This study aimed to ascertain midwives' and healthcare assistants' perspectives of the changes in postnatal care and challenges to providing care in the current context. Methods This was a qualitative study involving two focus groups of 15 midwives and healthcare assistants from an Irish urban maternity hospital. The participants' responses were analysed thematically. Results Changes in women's clinical characteristics, including increased comorbidities and caesarean section rates, were highlighted as creating additional care needs. Furthermore, additional midwifery tasks and clinical protocols as well as shorter hospital stays leave little time for high-quality, woman-centred care. Participants highlighted a negative impact on maternal health from limited follow-up midwifery care in the community. Conclusions With additional midwifery duties and a reduction in time to complete them, additional community midwifery care is key to providing high-quality follow-on care after postnatal discharge from hospital.