No description available.

Over the past twelve years, Philadelphia has undergone an unparalleled large scale shift in the way maternity care is provided, accessed, and considered. Key aspects of the changes to the landscape of birth in Philadelphia include: the closure of the majority of hospital-based maternity units, the activities of local women's health non-governmental organizations (NGOs), and the new set of pregnancy care and birth choices that parents navigate. One of the most striking results of the restructuring of Philadelphia's maternity care system is a drastic reduction in the number of hospitals with maternity units. While the birth rate in Philadelphia has remained consistent around 22,000 per year, since 1997 two-thirds of the hospitals in Philadelphia have eliminated their maternity services. During this time, numerous local women's health-oriented NGOs worked to established themselves in Philadelphia. The aim of each NGO has been to respond to inadequacies in the provision of maternity services that develop as hospitals, the dominant resource for maternity care, withdraw from the maternity care business. With only six hospital maternity units remaining and a couple of local nonprofit organizations attempting to supplement the dearth of services, the current system within which parents and health care providers maneuver is both unstable and inadequate for meeting the maternity care needs of the community. In this research project, I explore the processes through which this new maternity care system is being established in Philadelphia with a particular focus on the influence of neoliberalism as an active force in the restructuring process. I examine the outcomes of this restructured system in terms of how lived experiences are influenced by the social, political, and economic reconfiguration of birth. The case of Philadelphia is of particular value as the City's maternity care system has undergone an accelerated restructuring that is unmatched in other areas of the US. While a similar trend in restructuring can now be found in other locations, these changes happened earlier and have continued in a more extreme manner in Philadelphia, marking Philadelphia as a possible canary in a coal mine. Understanding the outcomes of this large scale change in the system of care provides a basis for contending with similar trends elsewhere. My ethnographic work focuses on the experiences of particular individuals as they navigate Philadelphia's new system of maternity care. Within this restructured system of maternity care, the interests of parents and health care practitioners are increasingly devalued or disregarded, particularly for those whose philosophy of birth differs from dominant biomedical maternity care practices. Midwives, whose non-interventionalist methods of care starkly contrast with the biomedical model of care, and parents who wish to have a low-intervention or natural childbirth struggle to achieve their goals within the confines of Philadelphia's maternity care system. Similarly, individuals running local NGOs strain to intervene in the process of restructuring, and often face the dilemma of remaining true to their mission on one hand or preserving financial security by meeting the imperatives of funders on the other hand. Therefore, I have made the stories of midwives and parents seeking alternatives to biomedical care central to my analysis in addition to conducting in-depth fieldwork with three local women's health-oriented NGOs. This project adds to our understanding of how broad political and economic trends in health care translate into select cultural formations which inform the life choices of individuals. In times such as now, when national policy regarding the provision of health care is under scrutiny, it is essential to connect the dots between the circumstances of individuals and the structure of systems of health care. This research project fuses analyses of civil society institutions, the politics of reproduction, national ideology, and local political and economic agenda to present a complex and inclusive assessment of the landscape of birth in the uniquely positioned city of Philadelphia. / Anthropology

This thesis presents the array of evidence concerning three crucial aspects of Roman maternity: pregnancy, childbirth, and primary care-givers. I explore how these elements of maternity are represented in the ancient sources and observe how the evidence corresponds to and diverges from the established impressions of these facets of maternity. I consider several issues surrounding the critical, initial moments of the life-cycle and how they are informed by biological factors, social structures, and cultural projections. Motherhood and childhood at Rome have garnered a great deal of interest, but issues of conception, gestation, childbirth, and early infant care have received much less attention. In this thesis they are considered together and thus in light of one another. The first chapter of this study surveys the social context of Roman maternity through an examination of the purpose of an extensive reproductive period, its associated problems, and the impact that such a practice had on Roman attitudes towards pregnancy and childbirth. The second and third chapters of this study are dedicated to an examination of the social and cultural identity of the two slaves who provided crucial functions throughout the pregnancy, delivery, and post-natal care of the Roman mother and child: the obstetrix (midwife) and the nutrix (wet-nurse). The final chapter shifts the focus from couples who sought to create a Roman family of their own to those who chose to limit the size of their families through contraception, abortion, infanticide, or infant exposure. I examine the attitudes towards these methods of family limitation and the critical role that parental intent had in the formation of these perceptions. By drawing on a range of ancient material, chief among which are medical writers, jurists, and funerary inscriptions, I argue that social status and demographic realities, such as high maternal and infant mortality rates, played equally significant roles in these central aspects of Roman maternity, and indeed influenced one another. / Thesis / Doctor of Philosophy (PhD)

Background: Rural maternity care in Canada is in crisis, with many communities losing local services. This forces rural women and families to travel for care, leading to heightened stress, expenses, and adverse outcomes. Family physicians, often the primary providers of rural maternity care, are decreasing in numbers, exacerbating the problem. Without enough providers, rural communities struggle to offer safe and accessible maternity services, risking the health of expectant mothers and families. Objective: This research aims to gain a comprehensive understanding of the socio-ecological influences that shape the commitment of family physicians and residents to practice rural maternity care. Methods: A scoping review was conducted, and database searching occurred in Ovid Medline, Ovid Embase, Ovid Emcare, and Web of Science. Primary studies and literature reviews in English were included if they discussed family physicians' and residents' experiences and perspectives in practicing and training for rural maternity care. Articles were restricted to the past 30 years. Thematic analysis was applied to analyze the data, and results were reported in tabular format. Results: Influencing factors were categorized into themes and contextualized across the socio-ecological model: 1) individual factors (i.e. interests, attitudes, motivation, burnout, risk), 2) interpersonal factors (i.e. lifestyle, interprofessional relationships, mentors), 3) organizational factors (i.e. training and professional development, work environment and practice characteristics, resources, regulation and privileging), 4) community-level factors (i.e. practice setting and location, job availability, community context), and 5) systematic factors (healthcare system structure, public policy, legal and regulatory framework). Conclusion: The most salient influencing factors included challenges with Family Medicine residency training and role models, call schedule sustainability and interprofessional collaboration, as well as preserving clinical skills and financial stability with low procedural volume in rural communities. There is a need to implement evidence-based interventions targeting training, recruiting role models, interprofessional collaboration and call, and effective rural remuneration. / Thesis / Master of Science (MSc) / Family physicians (FP) are often the sole care providers of maternity care (MC) in rural communities. Unfortunately, there is a declining number of FPs choosing to provide comprehensive maternity care (CMC). In addition, centralization has resulted in rural maternity center closures across the country. Rural women and families that must travel to access MC experience increased levels of stress, personal costs, and increased rates of adverse outcomes. With fewer FPs available to provide CMC alongside maternity centre closures, rural communities face challenges in ensuring safe and accessible care for expectant mothers. Addressing this issue is vital to protecting the health and well-being of rural families. Although research exists regarding the challenges FPs encounter when providing CMC in rural areas and what influences resident practice intentions, there has yet to be a synthesis of the literature over the last 30 years. To address this, a scoping review was conducted to explore the research on the influences on FPs’ and residents’ commitment to practicing rural MC. This scoping review can help understand what factors have been most influential over time, emerging challenges, and what socio-ecological levels to target for intervention.

Yes / This article considers the difficulties with using Gillon's model for health care ethics in the context of clinical practice. Everyday difficulties can arise when caring for people from different ethnic and cultural s, especially when they speak little or no English. A case is presented that establishes, owing to language and cultural barriers, that midwives may have difficulty in providing ethically appropriate care to women of Pakistani Muslim origin in the UK. The use of interpreters is discussed; however, there are limitations and counter arguments to their use. Training is identified as needed to prepare service providers and midwives for meeting the needs of a culturally diverse maternity population.

Yes

Yes / Aim - This paper explores the concept of migrant women as used in European healthcare literature in context of pregnancy to provide a clearer understanding of the concept for use in research and service delivery. Methods- Walker and Avant's method of concept analysis. Results - The literature demonstrates ambiguity around the concept; most papers do not provide an explicit or detailed definition of the concept. They include the basic idea that women have moved from an identifiable region/country to the country in which the research is undertaken but fail to acknowledge adequately the heterogeneity of migrant women. The paper provides a definition of the concept as a descriptive theory and argues that research must include a clear definition of the migrant specific demographics of the women. This should include country/region of origin and host, status within the legal system of host country, type of migration experience, and length of residence. Conclusion - There is a need for a more systematic conceptualization of the idea of migrant women within European literature related to pregnancy experiences and outcomes to reflect the heterogeneity of this concept. To this end, the schema suggested in this paper should be adopted in future research. / The work of Alena Pařízková was supported by project Migration and maternal health: pregnancy, birth and early parenting (The Czech Science Foundation, grant 16-10953S).

Yes / To summarize studies that have examined patient safety culture (PSC) in maternity units and describe the different purposes, study designs and tools reported in these studies, whilst highlighting gaps in the literature. Methodology: Peer-reviewed studies published in English during 1961-2016 across eight electronic databases were subjected to a narrative literature review. Findings: Among 100 articles considered, 28 met the inclusion criteria. The main purposes for studying PSC were: (a) assessing intervention effects on PSC (n= 17); and (b) assessing PSC level (n=7). Patient safety culture was mostly assessed quantitatively using validated questionnaires (n=23). The Safety Attitude Questionnaire was the most commonly used questionnaire (n=17). Intervention varied from a single action lasting five weeks to a more comprehensive package lasting more than four years. The time between the baseline and the follow-up assessment varied from six months up to 24 months. No study reported measurement or intervention costs, and none incorporated the patient’s voice in assessing PSC. Practical Implications: Assessing PSC in maternity units is feasible using validated questionnaires. Interventions to enhance PSC have not been rigorously evaluated. Future studies should report PSC measurement costs, adopt more rigorous evaluation designs, and find ways to incorporate the patient’s voice. Originality/Value: This review summarized studies examining PSC in a highly important area and highlighted main limitations that future studies should consider.

No / Rational, aim, and objectives: A positive patient safety culture in maternity units is linked to higher quality of care and better outcomes for mothers. However, safety culture varies across maternity units. Analyses of variation in safety culture using statistical process control (SPC) methods may help provider units to learn from each other's performance. This study aims to measure patient safety culture across maternity units in Oman using SPC methods. Methods: The 36-item Safety Attitude Questionnaire (SAQ) was distributed to all doctors, nurses, and midwifes working in ten maternity care units in Oman's hospitals and analysed using SPC methods. The SAQ considers six domains: job satisfaction, perception of management, safety climate, stress recognition, teamwork, and work condition. Results: Of the 892 targeted participants, 735 (82%) questionnaires were returned. The overall percentage of positive safety responses in all hospitals ranged from 53% to 66%, but no hospital had the targeted response of above 75%. Job satisfaction had the highest safety score (4.10) while stress recognition was the lowest (3.17). SPC charts showed that the overall percentage of positive responses in three maternity units (H1, H7, and H10) was above and one (H4) was below the control limits that represent special cause variation that merits further investigation. Conclusion: Generally, the safety culture in maternity units in Oman is below target and suggests that considerable work is required to enhance safety culture. Several maternity units showed evidence of high/low special cause variation that may offer a useful starting point for understanding and enhancing safety culture.

Yes / Patient safety culture/climate in maternity units has been linked to better safety outcomes. Nurses have a crucial role in patient safety and represent the majority of staff in maternity units. In many countries, nurses are recruited from abroad, bringing their own perceptions of patient safety culture. Nonetheless, little is known about the relationship between perceptions of patient safety culture and nurses’ nationality. Understanding this relationship will assist stakeholders in designing a responsive programme to improve patient safety culture. Aims: To investigate the association between nurses’ nationality and their perceptions about patient safety culture in maternity units in Ministry of Health hospitals in Oman. Methods: In 2017, the Safety Attitude Questionnaire (SAQ) was distributed to all staff (892 distributed, 735 returned) in 10 maternity units. Results: About three-quarters (74%, 541/735) of the returned SAQs were completed by nurses, of whom 34% were non-Omani, 21.8% were Omani and 44.7% did not report their nationality (missing). Overall, the mean safety score for non-Omani nurses was significantly higher than for the Omani nurses: 3.9 (SD 1.3) vs 3.6 (SD 1.2) (P < 0.001). The mean safety score for stress recognition was significantly lower for non-Omani nurses: 2.8 (SD 1.5) vs 3.2 (SD 1.3) (P < 0.001). Conclusion: Non-Omani nurses have a more positive perception of patient safety culture than Omani nurses except in respect of stress recognition. Decision-makers, directors, and clinicians should consider these differences when designing interventions to improve patient safety culture. / This study is part of a PhD study that was funded by the Ministry of Health in Oman