Speaker: Wendy Foster
Facilitators: Belle Bruce and Siti Khuzaiyah
Problem: Across the globe midwives are leaving the profession. Moral distress may contribute to this attrition. While moral distress is broadly understood within health care disciplines a contextual understanding of moral distress in midwifery is limited. Current tools available to screen for moral distress are not as suitable for use in midwifery practice.
Methodology: This project is an exploratory sequential mixed methods design that occurred across four phases; concept analysis, in-depth interviews, an e-Delphi study and a pilot study. This presentation will present key findings from the first three phases.
Results: Midwives report feeling demoralised and confirmed the presence of moral distress in practice due to excessive workloads, unnecessary intervention and hierarchical medical systems. Health care organisations are identified as placing midwives in morally compromising situation that are significant factors in the development of moral distress. Negative psychological outcomes are a key feature in moral distress with midwives describing symptoms of work-related stress and anxiety, increased sick/personal leave, feelings of powerlessness and burnout. Importantly it was identified that moral distress was likely to occur across a continuum from low (moral frustration), moderate (moral distress) and severe (moral injury). A pilot tool to screen for moral distress across a continuum has been developed.
Conclusion: Moral distress is a significant issue in midwifery practice. The development of the midwifery moral distress screening tool has enhanced the conceptual understanding. This study has provided additional language for midwives to describe their experiences and may assist organisations to identify and address ethical challenges within workplaces.
Recording https://youtu.be/Czfj3EUg6g4
Speakers: Giyawati Yulilania Okinarum, Venny Vidayanti and Sri Hasta Mulyani
Facilitator: Rizka Setyani
Yogyakarta is a popular tourist destination in Indonesia, but lactation rooms in public facilities in tourist areas are currently difficult or nonexistent. The lack of lactation rooms and facilities will affect breastfeeding activities for mothers who spend their daily lives in public places. Researchers propose a solution in the form of an innovative portable public breastfeeding room. Its goal is to assess user satisfaction with the newly developed public lactation room facilities. The descriptive-analytic method is used in this study. A questionnaire is distributed to determine user satisfaction. Then proceed with the selection of participants based on the results of the questionnaire distribution. Purposive sampling of 122 respondents who were breastfeeding mothers according to the established criteria was used in this study. The color and design of the lactation room received the highest mean satisfaction score (4.92), while ventilation received the lowest (1.66). The Ruang Sehati Lactation Room is an innovation that was created in response to the needs of users, specifically tourists who are breastfeeding mothers in Yogyakarta City’s tourist area. This innovation is also a pilot that can be shown nationally, presenting an image of Jogja City as a mother- and child-friendly tourist destination.
Recording: https://youtu.be/1WLiv8AkX34
Speaker: Ponsiano Kabakyenga Nuwagaba
Facilitator: Hayat Gommaa
In low- and middle-income countries, several barriers impede utilisation of antenatal care (ANC) services by women with disabilities, yet ANC is a critical entry point for pregnant women to receive quality maternity care services. We investigated the experiences of pregnant women with physical disabilities in utilising ANC services to suggest strategies for improving the services.
Methods: A qualitative study using a multiple case study design was conducted. Twelve women with physical disabilities and six midwives from three health facilities in Sheema District in rural south-western Uganda, were selected as study participants. Women were sampled using snowball sampling. Midwives and health facilities were sampled using purposive sampling. Data was gathered through face-to-face interviews and a focus group discussion between November 2020 to January 2021. Data was transcribed, translated and thematically analysed. Ethical approval was obtained from University of Cape Town and Uganda National Council for Science and Technology. No competing interests declared.
Results: Women had mixed experiences of midwives and other health workers, noting that sometimes midwives would be supportive and other times, they would be unapproachable. Participants felt that midwives had limited knowledge on disability and were emotionally unprepared to attend to pregnant women with disabilities. There were suggestions for disability inclusion, including a dedicated ANC clinic and making connections with stakeholders, for fit-for-purpose ANC services.
Conclusion: Midwives have limited understanding of the implications of physical disability on women’s utilisation of ANC services. Respect for women with disabilities’ dignity and needs should be emphasized in midwifery education and training.
Recording: youtube.com/watch?v=ihQOrbHdI2M
Speaker: Amy Goh, Dia Kapoor, and Anna Nguyen
Facilitator: Olajumoke Ojeleye
Asians and Asian Americans (Asians) have the second highest rate of caesarean birth in the U.S. Asians have the lowest rate of out-of-hospital birth and are low utilizers of midwifery care. This presentation examines cesarean birth amongst Asians who have birthed at U.S. institutions participating in the AABC’s Perinatal Data Registry (PDR).
Methods: Data from the PDR from 2007-2020 was utilized. Logistical regression was completed to determine the odds of cesarean birth for nulliparous and multiparous Asians in medically low-risk and elective hospitals categories.
Results: 2,983 Asian birthing people were sampled. Multiparous birthing people had 1.5 greater odds of caesarean birth compared to nulliparous birthing people (OR = 1.54; 95% CI, 1.19 – 2.03; p .01). The elective hospitalization group had higher adjusted odds of caesarean births compared to the low-risk and total population (OR = 1.54; 95% CI, 1.23 -1.93; p; .01). Nulliparous people in the elective hospitalization category had a rate of caesarean birth 1.5 times higher than the total (OR = 1.26; 95% CI, 1.09 -1.46; p .01) and 1.36 times higher than the low-risk sample (OR = 1.36; 95% CI, 1.13 -1.63; p .01).
Conclusion: This study highlights inequities in multiparous and nulliparous cesarean birth among medically low-risk Asians. Further research is needed in disaggregation of perinatal outcomes and on reasons for low utilization of midwifery care and out-of-hospital births amongst U.S. Asians.
Recording: https://youtu.be/jc1ZxhkUvrc
Speaker: Isabella Garti
Facilitator: Caitlin Goodwin
Abstract:
Midwifery holds relevance across diverse settings, as the proficiency of midwives plays a crucial role in the provision of care for women facing complications. In Low- and Middle-Income Countries (LMICs), such as Ghana, a significant number of maternal and neonatal deaths result from insufficient or delayed handling of preventable complications, notably pre-eclampsia. Continuous training is particularly essential for midwives in LMICs, to effectively respond to the increasing demand for specialised care in pre-eclampsia. As part of a mixed method evaluation of multi-level factors influencing midwives’ management of pre-eclampsia in Ghana, we conducted a hospital-based quantitative cross-sectional study in 2021 to determine the pre-eclampsia specific training needs of midwives. Midwives completed an adapted version of the WHO Hennessy-Hicks Training Needs Analysis questionnaire. Midwives required training in 14 priority areas mainly in the research and clinical domains. Training courses were identified as the preferred approach to address training needs and improve overall proficiency. Midwifery is an essential sustainable resource for improved pre-eclampsia outcomes in LMICs. The implementation of context-specific training, integrating innovative and contemporary approaches, holds paramount significance in this regard.
Recording – not available
Speaker: Ang Broadbridge and Rachel McDonald
Facilitator: Raissa Manika Purwaningtias
Abstract:
Abstract summary: Sharing learning from four prototypes in the North East of England where we have developed new maternal mental health supports through collaboration and co-production across sectors, with key indicators of building sustainability Background – Project demonstrates improved maternal mental health through integrating third sector support into the pathway to reduce health inequalities and increase sustainability supporting the best start in life agenda with benefits for women, partners, their babies and the whole family unit in the perinatal period. The MMHS social prescribing link worker model aims to provide evidence based maternal mental health support based in the third sector: • The perinatal period is a time when women have regular contact with services, when there is a crucial window of opportunity to support a best start. • Building and integrating flexible third sector provision with referrals from midwifery, health visiting, mental health and community teams to overcome workforce capacity and waiting list pressures and threshold barriers complementing statutory offers through specialist, personalised non-clinical support Discussion • Project addresses health inequalities, issues for ethically minoritised communities and social determinants of health including sustainability and accessibility in rural and remote communities • Evidences benefits for mum and infant as well as wider family unit • Indicators of sustainability – developing sustainable community support networks, reducing duplication, developing eco-friendly accessible digital resources and supports and increasing digital inclusion Conclusion – Innovative and flexible approaches developed through cross-sector collaboration leading to sustainable practice and initiatives
Recording: https://youtu.be/ZwyvGbl7eNw
