Susanna Rance

Women's safety alerts in maternity care: is speaking up enough?

Patients’ contributions to safety include speaking up about their perceptions of being at risk. Previous studies have found that dismissive responses from staff discouraged patients from speaking up. A Care Quality Commission investigation of a maternity service where serious incidents occurred found evidence that women had routinely been ignored and left alone in labour. Women using antenatal services hesitated to raise concerns that they felt staff might consider irrelevant. The Birthplace in England programme, which investigated the quality and safety of different places of birth for ‘low-risk’ women, included a qualitative organisational case study in four NHS Trusts. The authors collected documentary, observational and interview data from March to December 2010 including interviews with 58 postnatal women. A framework approach was combined with inductive analysis using NVivo8 software. Speaking up, defined as insistent and vehement communication when faced with failure by staff to listen and respond, was an unexpected finding mentioned in half the womens interviews. Fourteen women reported raising alerts about safety issues they felt to be urgent. The presence of a partner or relative was a facilitating factor for speaking up. Several women described distress and harm that ensued from staff failing to listen. Women are speaking up, but this is not enough: organisation-focused efforts are required to improve staff response. Further research is needed in maternity services and in acute and general healthcare on the effectiveness of safety-promoting interventions, including real-time patient feedback, patient toolkits and patient-activated rapid response calls.

Value of a modified early obstetric warning system (MEOWS) in managing maternal complications in the peripartum period: an ethnographic study

Objective To explore implementation of the modified early obstetric warning system (MEOWS) in practice to further understanding about the influence of contextual factors. Methods An ethnographic study using observations (>120 h), semi-structured interviews (n=45) and documentary review was performed in the maternity services in two UK hospitals over a 7-month period. Doctors, midwives and managers participated in the study and data were analysed thematically. Results For women admitted to hospital in the antenatal and postnatal period with an established risk of morbidity, the MEOWS enabled communication about vital signs from junior to senior midwives and obstetricians. The trigger prompts helped shape shared understandings of maternal complications. However, midwifery and obstetric staff questioned the added value of an extra chart in the postnatal period given the low incidence of maternal complications and the resulting increase in workload. In an effort to prioritise workload demands and respond to the immediate needs of both women and their babies, midwives exercised professional discretion regarding its use. However, discretionary use of MEOWS meant the loss of a potential universal safety net for detection of deterioration. Conclusions Despite a decade of use in acute settings, research into the effectiveness of early warning systems still yields conflicting results. Widespread policy support for the MEOWS is based on its intuitive appeal and no validated system for use in the maternity population currently exists. Our findings suggest that, while the MEOWS has value in structuring the surveillance of hospitalised women with an established risk of morbidity, the complexities of managing risk and safety within the maternity pathway, the associated opportunity costs of MEOWS and variation in implementation currently call into question its role for routine use.

Implementação da presença de acompanhantes durante a internação para o parto: dados da pesquisa nacional nascer no Brasil

Robust evidence of the benefits of continuous support during childbirth led to the recommendation that it should be offered for all women. In Brazil, it has been guaranteed by law since 2005, but scarce data on implementation is available. We aimed to estimate the frequency and associated socio-demographic, obstetric and institutional predictors of women having companionship during childbirth in the Birth in Brazil survey. Descriptive statistical analysis was done for the characterization of companions (at different moments of hospital stay), maternal and institutional factors; associations were investigated in bivariate and multivariate models. We found that 24.5% of women had no companion at all, 18.8% had continuous companionship and 56.7% had partial companionship. Independent predictors of having no or partial companionship at birth were: lower income and education, brown color of skin, using the public sector, multiparity, and vaginal delivery. Implementation of companionship was associated with having an appropriate environment, and clear institution al rules about womens rights to companionship.As evidencias sobre os beneficios do apoio continuo durante o parto levou a recomendacao de que este apoio deve ser oferecido a todas as mulheres. No Brasil, ele e garantido por lei desde 2005, mas os dados sobre a sua implementacao sao escassos. Nosso objetivo foi estimar a frequencia e fatores sociodemograficos, obstetricos e institucionais associados a presenca de acompanhantes durante o parto na pesquisa Nascer no Brasil. Foi feita analise estatistica descritiva para a caracterizacao dos acompanhantes (em diferentes momentos do tempo da internacao), fatores maternos e institucionais; as associacoes foram investigadas em modelos bi e multivariada. Vimos que 24,5% das mulheres nao tiveram acompanhante algum, 18,8% tinham companhia continua, 56,7% tiveram acompanhamento parcial. Preditores independentes de nao ter algum, ou parcial, foram: menor renda e escolaridade, cor parda da pele, usar o setor publico, multiparidade e parto vaginal. A implementacao do acompanhante foi associada com ambiencia adequada e regras institucionais claras sobre os direitos das mulheres ao acompanhante.

Implementation of the presence of companions during hospital admission for childbirth: data from the Birth in Brazil national survey

Robust evidence of the benefits of continuous support during childbirth led to the recommendation that it should be offered for all women. In Brazil, it has been guaranteed by law since 2005, but scarce data on implementation is available. We aimed to estimate the frequency and associated socio-demographic, obstetric and institutional predictors of women having companionship during childbirth in the Birth in Brazil survey. Descriptive statistical analysis was done for the characterization of companions (at different moments of hospital stay), maternal and institutional factors; associations were investigated in bivariate and multivariate models. We found that 24.5% of women had no companion at all, 18.8% had continuous companionship and 56.7% had partial companionship. Independent predictors of having no or partial companionship at birth were: lower income and education, brown color of skin, using the public sector, multiparity, and vaginal delivery. Implementation of companionship was associated with having an appropriate environment, and clear institution al rules about womens rights to companionship.As evidencias sobre os beneficios do apoio continuo durante o parto levou a recomendacao de que este apoio deve ser oferecido a todas as mulheres. No Brasil, ele e garantido por lei desde 2005, mas os dados sobre a sua implementacao sao escassos. Nosso objetivo foi estimar a frequencia e fatores sociodemograficos, obstetricos e institucionais associados a presenca de acompanhantes durante o parto na pesquisa Nascer no Brasil. Foi feita analise estatistica descritiva para a caracterizacao dos acompanhantes (em diferentes momentos do tempo da internacao), fatores maternos e institucionais; as associacoes foram investigadas em modelos bi e multivariada. Vimos que 24,5% das mulheres nao tiveram acompanhante algum, 18,8% tinham companhia continua, 56,7% tiveram acompanhamento parcial. Preditores independentes de nao ter algum, ou parcial, foram: menor renda e escolaridade, cor parda da pele, usar o setor publico, multiparidade e parto vaginal. A implementacao do acompanhante foi associada com ambiencia adequada e regras institucionais claras sobre os direitos das mulheres ao acompanhante.

Implementação da presença de acompanhantes durante a internação para o parto

Robust evidence of the benefits of continuous support during childbirth led to the recommendation that it should be offered for all women. In Brazil, it has been guaranteed by law since 2005, but scarce data on implementation is available. We aimed to estimate the frequency and associated socio-demographic, obstetric and institutional predictors of women having companionship during childbirth in the Birth in Brazil survey. Descriptive statistical analysis was done for the characterization of companions (at different moments of hospital stay), maternal and institutional factors; associations were investigated in bivariate and multivariate models. We found that 24.5% of women had no companion at all, 18.8% had continuous companionship and 56.7% had partial companionship. Independent predictors of having no or partial companionship at birth were: lower income and education, brown color of skin, using the public sector, multiparity, and vaginal delivery. Implementation of companionship was associated with having an appropriate environment, and clear institution al rules about womens rights to companionship.As evidencias sobre os beneficios do apoio continuo durante o parto levou a recomendacao de que este apoio deve ser oferecido a todas as mulheres. No Brasil, ele e garantido por lei desde 2005, mas os dados sobre a sua implementacao sao escassos. Nosso objetivo foi estimar a frequencia e fatores sociodemograficos, obstetricos e institucionais associados a presenca de acompanhantes durante o parto na pesquisa Nascer no Brasil. Foi feita analise estatistica descritiva para a caracterizacao dos acompanhantes (em diferentes momentos do tempo da internacao), fatores maternos e institucionais; as associacoes foram investigadas em modelos bi e multivariada. Vimos que 24,5% das mulheres nao tiveram acompanhante algum, 18,8% tinham companhia continua, 56,7% tiveram acompanhamento parcial. Preditores independentes de nao ter algum, ou parcial, foram: menor renda e escolaridade, cor parda da pele, usar o setor publico, multiparidade e parto vaginal. A implementacao do acompanhante foi associada com ambiencia adequada e regras institucionais claras sobre os direitos das mulheres ao acompanhante.

Implementation of the presence of companions during hospital admission for childbirth

Robust evidence of the benefits of continuous support during childbirth led to the recommendation that it should be offered for all women. In Brazil, it has been guaranteed by law since 2005, but scarce data on implementation is available. We aimed to estimate the frequency and associated socio-demographic, obstetric and institutional predictors of women having companionship during childbirth in the Birth in Brazil survey. Descriptive statistical analysis was done for the characterization of companions (at different moments of hospital stay), maternal and institutional factors; associations were investigated in bivariate and multivariate models. We found that 24.5% of women had no companion at all, 18.8% had continuous companionship and 56.7% had partial companionship. Independent predictors of having no or partial companionship at birth were: lower income and education, brown color of skin, using the public sector, multiparity, and vaginal delivery. Implementation of companionship was associated with having an appropriate environment, and clear institution al rules about womens rights to companionship.As evidencias sobre os beneficios do apoio continuo durante o parto levou a recomendacao de que este apoio deve ser oferecido a todas as mulheres. No Brasil, ele e garantido por lei desde 2005, mas os dados sobre a sua implementacao sao escassos. Nosso objetivo foi estimar a frequencia e fatores sociodemograficos, obstetricos e institucionais associados a presenca de acompanhantes durante o parto na pesquisa Nascer no Brasil. Foi feita analise estatistica descritiva para a caracterizacao dos acompanhantes (em diferentes momentos do tempo da internacao), fatores maternos e institucionais; as associacoes foram investigadas em modelos bi e multivariada. Vimos que 24,5% das mulheres nao tiveram acompanhante algum, 18,8% tinham companhia continua, 56,7% tiveram acompanhamento parcial. Preditores independentes de nao ter algum, ou parcial, foram: menor renda e escolaridade, cor parda da pele, usar o setor publico, multiparidade e parto vaginal. A implementacao do acompanhante foi associada com ambiencia adequada e regras institucionais claras sobre os direitos das mulheres ao acompanhante.

Implementación de la presencia de acompañantes durante el internamiento para el parto: datos de la encuesta nacional Nacer en Brasil

Robust evidence of the benefits of continuous support during childbirth led to the recommendation that it should be offered for all women. In Brazil, it has been guaranteed by law since 2005, but scarce data on implementation is available. We aimed to estimate the frequency and associated socio-demographic, obstetric and institutional predictors of women having companionship during childbirth in the Birth in Brazil survey. Descriptive statistical analysis was done for the characterization of companions (at different moments of hospital stay), maternal and institutional factors; associations were investigated in bivariate and multivariate models. We found that 24.5% of women had no companion at all, 18.8% had continuous companionship and 56.7% had partial companionship. Independent predictors of having no or partial companionship at birth were: lower income and education, brown color of skin, using the public sector, multiparity, and vaginal delivery. Implementation of companionship was associated with having an appropriate environment, and clear institution al rules about womens rights to companionship.As evidencias sobre os beneficios do apoio continuo durante o parto levou a recomendacao de que este apoio deve ser oferecido a todas as mulheres. No Brasil, ele e garantido por lei desde 2005, mas os dados sobre a sua implementacao sao escassos. Nosso objetivo foi estimar a frequencia e fatores sociodemograficos, obstetricos e institucionais associados a presenca de acompanhantes durante o parto na pesquisa Nascer no Brasil. Foi feita analise estatistica descritiva para a caracterizacao dos acompanhantes (em diferentes momentos do tempo da internacao), fatores maternos e institucionais; as associacoes foram investigadas em modelos bi e multivariada. Vimos que 24,5% das mulheres nao tiveram acompanhante algum, 18,8% tinham companhia continua, 56,7% tiveram acompanhamento parcial. Preditores independentes de nao ter algum, ou parcial, foram: menor renda e escolaridade, cor parda da pele, usar o setor publico, multiparidade e parto vaginal. A implementacao do acompanhante foi associada com ambiencia adequada e regras institucionais claras sobre os direitos das mulheres ao acompanhante.

PL.13 Experiences of Women and Families in Alongside Midwifery Units; Tackling the Bottlenecks and Critical Touchpoints

Background Alongside midwifery units (AMUs) provide care for women deemed ‘low-risk’ and Birthplace in England found that low risk women received significantly fewer interventions in AMUs compared to obstetric units with no difference in perinatal outcomes. The number of AMUs are increasing, however, little is known regarding How to organise services to improve quality, safety and women’s experiences. Women’s experiences Aim and Methods A Birthplace follow-on study investigated AMU organisation from users’ and professionals’ perspectives. Case study of AMU in 4 NHS Trusts across England. Data collected November 2011 - October 2012: observations (>100 hours); semi-structured interviews with staff, managers and stakeholders (n = 89) and postnatal women and birth partners (n = 47). Results We found several critical touchpoints. Women had unequal access to information enabling them to choose and engage with midwife-led care. Women often experienced care inside AMUs as excellent, but system and provider generated issues in admission and transfer led to difficulties for some in gaining access in early labour. Factors enabling women to feel safe included accompaniment by partners; perception of personalised assessment of progress in labour; being assured of appropriate pain relief, timely transfer if required, and staff prepared to listen, inform, and acknowledge their concerns and needs. Conclusion Greater attention needs to be given to woman-centred care at the critical interface between midwife led settings with antenatal services and OUs.