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The quality of maternity care services as experienced by women in the Netherlands
Therese A Wiegers
BMC Pregnancy and Childbirth , 2009, DOI: 10.1186/1471-2393-9-18
Abstract: In the Netherlands a new tool is being developed to evaluate the quality of care from the perspective of clients. The tool is called: 'Consumer Quality Index' or CQI and is, within a standardized and systematic framework, tailored to specific health care issues.Within the framework of developing a CQI Maternity Care, data were gathered about the care women in the Netherlands received during pregnancy, childbirth, and the postpartum period. In this paper the quality of maternity care in the Netherlands is presented, as experienced by women at different stages of their care path.A sample of 1,248 pregnant clients of four insurance companies, with their due date in early April 2007, received a postal survey in the third trimester of pregnancy (response 793). Responders to the first questionnaire received a second questionnaire twelve weeks later, on average four weeks after delivery (response 632). Based on care provider and place of birth the 'care path' of the women is described. With factor analysis and reliability analysis five composite measures indicating the quality of treatment by the care provider at different stages of the care path have been constructed. Overall ratings relate to eight different aspects of care, varying from antenatal care by a midwife or GP to care related to neonatal screening.41.5 percent of respondents remained in primary care throughout pregnancy, labor, birth and the postpartum period, receiving care from a midwife or general practitioner, 31.3% of respondents gave birth at home. The majority of women (58.5%) experienced referral from one care provider to another, i.e. from primary to secondary care or reverse, at least once. All but two percent of women had one or more ultrasound scans during pregnancy. The composite measures for the quality of treatment in different settings and by different care providers showed that women, regardless of parity, were very positive about the quality of the maternity care they received. Quality-of-tre
Huge poor-rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries
Houweling,Tanja AJ; Ronsmans,Carine; Campbell,Oona MR; Kunst,Anton E;
Bulletin of the World Health Organization , 2007, DOI: 10.1590/S0042-96862007001000010
Abstract: objective: progress towards the millennium development goals for maternal health has been slow, and accelerated progress in scaling up professional delivery care is needed. this paper describes poor-rich inequalities in the use of maternity care and seeks to understand these inequalities through comparisons with other types of health care. methods: demographic and health survey (dhs) data from 45 developing countries were used to describe poor-rich inequalities by wealth quintiles in maternity care (professional delivery care and antenatal care), full childhood immunization coverage and medical treatment for diarrhoea and acute respiratory infections (ari). findings: poor-rich inequalities in maternity care in general, and professional delivery care in particular, are much greater than those in immunization coverage or treatment for childhood illnesses. public-sector inequalities make up a major part of the poor-rich inequalities in professional delivery attendance. even delivery care provided by nurses and midwives favours the rich in most countries. although poor-rich inequalities within both rural and urban areas are large, most births without professional delivery care occur among the rural poor. conclusion: poor-rich inequalities in professional delivery care are much larger than those in the other forms of care. reducing poor-rich inequalities in professional delivery care is essential to achieving the mdgs for maternal health. the greatest improvements in professional delivery care can be made by increasing coverage among the rural poor. problems with availability, accessibility and affordability, as well as the nature of the services and demand factors, appear to contribute to the larger poor-rich inequalities in delivery care. a concerted effort of equity-oriented policy and research is needed to address the huge poor-rich inequalities in maternity care.
Weight stigma in maternity care: women’s experiences and care providers’ attitudes
Kate Mulherin, Yvette D Miller, Fiona Kate Barlow, Phillippa C Diedrichs, Rachel Thompson
BMC Pregnancy and Childbirth , 2013, DOI: 10.1186/1471-2393-13-19
Abstract: Study One investigated associations between pre-pregnancy body mass index (BMI) and experiences of maternity care from a state-wide, self-reported survey of 627 Australian women who gave birth in 2009. Study Two involved administration of an online survey to 248 Australian pre-service medical and maternity care providers, to investigate their perceptions of, and attitudes towards, providing care for pregnant patients of differing body sizes. Both studies used linear regression analyses.Women with a higher BMI were more likely to report negative experiences of care during pregnancy and after birth, compared to lower weight women. Pre-service maternity care providers perceived overweight and obese women as having poorer self-management behaviours, and reported less positive attitudes towards caring for overweight or obese pregnant women, than normal-weight pregnant women. Even care providers who reported few weight stigmatising attitudes responded less positively to overweight and obese pregnant women.Overall, these results provide preliminary evidence that weight stigma is present in maternity care settings in Australia. They suggest a need for further research into the nature and consequences of weight stigma in maternity care, and for the inclusion of strategies to recognise and combat weight stigma in maternity care professionals’ training.Weight stigma is the exhibition of prejudiced attitudes (e.g., attribution of negative labels such as lazy, unclean, and unintelligent) and discriminatory actions (e.g., teasing, providing inferior quality education, health or other services) towards an individual based upon their weight and body size alone (see [1] for a review). Weight stigma is the fourth most common form of discrimination in the United States, and studies from Australia, Europe and North America document its presence across a range of professional settings [2]. Weight stigma has serious negative consequences for targeted individuals’ psychological and physic
Risk adjustment in maternity care: the use of indirect standardization
James M Nicholson
International Journal of Women's Health , 2010, DOI: http://dx.doi.org/10.2147/IJWH.S9494
Abstract: k adjustment in maternity care: the use of indirect standardization Methodology (3055) Total Article Views Authors: James M Nicholson Published Date August 2010 Volume 2010:2 Pages 255 - 262 DOI: http://dx.doi.org/10.2147/IJWH.S9494 James M Nicholson Department of Family Practice and Community Medicine, University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, PA, USA Purpose: Annual US national rates of family physicians providing maternity care are -decreasing and rates of cesarean delivery are increasing. Family physicians tend to have lower cesarean delivery rates than obstetrician specialists, but this association is usually explained by an assumed lower pre-delivery risk for cesarean delivery. This study was developed to compare the estimated risk of cesarean delivery in patients of the two specialties. Methods: A retrospective cohort study within an urban teaching hospital compared 100 -family-physician treated subjects to 300 subjects treated by obstetrician-specialists. Risk factors for cesarean delivery were identified, and an indirect standardization procedure was used to compare the pre-38 week of gestation risk of cesarean delivery in the two groups. Results: The patients treated by family physicians had a projected pre-38 week of gestation risk of cesarean delivery (17.4%) that was similar to the actual rate of cesarean delivery in the obstetrician-specialist group (16.7%). The Standardized Cesarean Delivery Ratio was 1.04. Conclusion: Lower cesarean delivery rates provided by family physicians may not be simply due to case-mix issues. Additional studies comparing the pre-delivery estimation of cesarean delivery risk would be helpful in measuring the relative levels of obstetric risk of patients treated by different maternity-care provider types.
Less hypoglycaemias in single room maternity care  [PDF]
Peter Gerrits, Maartje de Hosson, Ben Semmekrot, Jan Sporken
Open Journal of Pediatrics (OJPed) , 2013, DOI: 10.4236/ojped.2013.33031
Abstract: In January 2006, the Canisius-Wilhelmina Hospital introduced the concept of Single Room Maternity Care (SMRC) by realizing 13 labour rooms for mother, infant and partner. Benefits of this new care concept not only include maternal satisfaction and increased staff satisfaction, but also significant health benefits for the neonate. Since the introduction of the concept, we registered a sharp decrease in the number of hypoglycaemias (from 15.6% in 2005 to 2.5% in 2009). Varying causes, such as successful breastfeeding and/or improved attachment between mother and infant may contribute to the decrease of hypoglycaemias.
Risk adjustment in maternity care: the use of indirect standardization  [cached]
James M Nicholson
International Journal of Women's Health , 2010,
Abstract: James M NicholsonDepartment of Family Practice and Community Medicine, University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, PA, USAPurpose: Annual US national rates of family physicians providing maternity care are -decreasing and rates of cesarean delivery are increasing. Family physicians tend to have lower cesarean delivery rates than obstetrician specialists, but this association is usually explained by an assumed lower pre-delivery risk for cesarean delivery. This study was developed to compare the estimated risk of cesarean delivery in patients of the two specialties.Methods: A retrospective cohort study within an urban teaching hospital compared 100 -family-physician treated subjects to 300 subjects treated by obstetrician-specialists. Risk factors for cesarean delivery were identified, and an indirect standardization procedure was used to compare the pre-38 week of gestation risk of cesarean delivery in the two groups.Results: The patients treated by family physicians had a projected pre-38 week of gestation risk of cesarean delivery (17.4%) that was similar to the actual rate of cesarean delivery in the obstetrician-specialist group (16.7%). The Standardized Cesarean Delivery Ratio was 1.04.Conclusion: Lower cesarean delivery rates provided by family physicians may not be simply due to case-mix issues. Additional studies comparing the pre-delivery estimation of cesarean delivery risk would be helpful in measuring the relative levels of obstetric risk of patients treated by different maternity-care provider types.Keywords: family medicine obstetrics, cesarean delivery
Socioeconomic Disparities in Maternity Care among Indian Adolescents, 1990–2006  [PDF]
Chandan Kumar, Rajesh Kumar Rai, Prashant Kumar Singh, Lucky Singh
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0069094
Abstract: Background India, with a population of more than 1.21 billion, has the highest maternal mortality in the world (estimated to be 56000 in 2010); and adolescent (aged 15–19) mortality shares 9% of total maternal deaths. Addressing the maternity care needs of adolescents may have considerable ramifications for achieving the Millennium Development Goal (MDG)–5. This paper assesses the socioeconomic differentials in accessing full antenatal care and professional attendance at delivery by adolescent mothers (aged 15–19) in India during 1990–2006. Methods and Findings Data from three rounds of the National Family Health Survey of India conducted during 1992–93, 1998–99, and 2005–06 were analyzed. The Cochran-Armitage and Chi-squared test for linear and non-linear time trends were applied, respectively, to understand the trend in the proportion of adolescent mothers utilizing select maternity care services during 1990–2006. Using pooled multivariate logistic regression models, the probability of select maternal healthcare utilization among women by key socioeconomic characteristics was appraised. After adjusting for potential socio-demographic and economic characteristics, the likelihood of adolescents accessing full antenatal care increased by only 4% from 1990 to 2006. However, the probability of adolescent women availing themselves of professional attendance at delivery increased by 79% during the same period. The study also highlights the desolate disparities in maternity care services among adolescents across the most and the least favoured groups. Conclusion Maternal care interventions in India need focused programs for rural, uneducated, poor adolescent women so that they can avail themselves of measures to delay child bearing, and for better antenatal consultation and delivery care in case of pregnancy. This study strongly advocates the promotion of a comprehensive ‘adolescent scheme’ along the lines of ‘Continuum of Maternal, Newborn and Child health Care’ to address the unmet need of reproductive and maternal healthcare services among adolescent women in India.
Quality of Maternity Care at Health Facilities in Eritrea in 2008
M Ghebrehiwe, M Sharan, K Rogo, O Gebreamlak, B Haile, M Gaim, Z Andemariam, S Gebreselasie
Journal of the Eritrean Medical Association , 2009,
Abstract: Objective: To examine the quality of maternal health services at health facilities in Eritrea. Methods: The study was a cross-sectional survey of all hospitals and health centers and a random sample of a third of health stations. Extensive interviews with health providers and facility managers were undertaken using structured questionaires. Findings: The key findings of the study include: All hospitals and all health centers provided Basic Obstetric Emergency Care. However, only 11 of the 18 hospitals provided Comprehensive Obstetric Emergency Care including caesarian section. The national referral hospital treated 54 percent of obstetric complications, while health centers and health stations are not proportionally sharing the burden of work. Recommendations: Eritrean health system which was performing well with the current demand for services can improve its outputs. Upgrading of the function of existing facilities by strengthening the human resource capacity is needed to increase availability of emergency obstetric care by more than one third, using the existing physical structure of health facilities.
“Business Orphans”: Maternity Rights and Child Care in the Philippines  [cached]
Roselle Leah K. Rivera
Kasarinlan : Philippine Journal of Third World Studies , 2001,
Abstract: The unaddressed problem of national poverty is rearing a generation of Filipino "business orphans," children who do not receive adequate care from parents, particularly mothers who must work to make ends meet. In making ends meet, the mothers leave the children in the care of relatives or domestic helpers. Often income does not satisfy basic needs and mothers cannot make up for lost time. Also, some men perceive child care,like employment and housekeeping, the sole responsibility of the mother. Making parenting nnore difficult are insensitive and often unenforced matemity laws despite the Constitution's proclamations on the women's matemal and economic roles. For example, patemity leave and requiring employers of more than 15 women to establish workplace nurseries with trained personnel are routinely flaunted. Breastfeeding, the healthier and by far the more economic alternative to bottle feeding is not fully endorsed by government, giving infant formula manufacturers II free hand in conditioning mothers into believing the opposite. Consequently, the cost of bottle feeding eats up a substantial portion of the family income. This, along with unsympathetic matemity rights laws makes life very difficult for the business orphan and the working mother alike.
Physical activity counseling in maternity and child health care – a controlled trial
Minna Aittasalo, Matti Pasanen, Mikael Fogelholm, Tarja I Kinnunen, Katriina Ojala, Riitta Luoto
BMC Women's Health , 2008, DOI: 10.1186/1472-6874-8-14
Abstract: Three clinics including both maternity and child health care signed up for the experimental (EXP) and three for the control group (CON). The participants were 132 pregnant and 92 postpartum primiparas. The nurses in EXP integrated a primary and four booster PA counseling sessions into routine visits. An option for supervised group exercise was offered. In CON former practices, usually including brief PA advice, were continued. Leisure-time PA (LTPA) prior to pregnancy was elicited by questionnaire and followed 16–18 and 36–37 weeks' gestation in maternity clinics and 5 and 10 months postpartum in child health clinics. Feasibility included safety, participant responsiveness, realization of counseling and applicability.According to analysis of covariance adjusted for baseline LTPA and possible confounders, no relative between-group differences in LTPA were found at the first follow-up in either maternity or child health clinics. At the last follow-up in maternity clinics the weekly number of at least moderate-intensity LTPA days was 43% (95% CI: 9, 87) higher and the weekly duration of at least moderate-intensity LTPA 154% (95% CI: 16, 455) higher in EXP compared with CON. Counseling proved feasible in both maternity and child health clinics.Counseling encouraged pregnant women to sustain their moderate-intensity LTPA and was feasible in routine practices. No effects were observed if counseling was initiated postpartum.Current Controlled Trials ISRCTN21512277The health benefits of physical activity (PA) among general population are well documented [1,2]. Nevertheless, only less than half of the population in the developed countries is sufficiently physically active [2,3]. Women, in general, seem to be more inactive than men, especially in moderate-to-vigorous-intensity PA [4].Women's PA may decrease further during pregnancy [5-7] due, for example, to physical limitations [6] or due to fear of harming the fetus [6,8]. Similar unfavorable changes in PA have also been di
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