Digital Health for Migrants, Ethnic and Cultural Minorities and the Role of Participatory Development: A Scoping Review.

Digital health interventions (DHIs) are increasingly used to address the health of migrants and ethnic minorities, some of whom have reduced access to health services and worse health outcomes than majority populations. This study aims to give an overview of digital health interventions developed for ethnic or cultural minority and migrant populations, the health problems they address, their effectiveness at the individual level and the degree of participation of target populations during development. We used the methodological approach of the scoping review outlined by Tricco. We found a total of 2248 studies, of which 57 were included, mostly using mobile health technologies, followed by websites, informational videos, text messages and telehealth. Most interventions focused on illness self-management, mental health and wellbeing, followed by pregnancy and overall lifestyle habits. About half did not involve the target population in development and only a minority involved them consistently. The studies we found indicate that the increased involvement of the target population in the development of digital health tools leads to a greater acceptance of their use.

Women's views on moderate and low alcohol consumption: stages of the subjective transition from pregnancy to postpartum.

BACKGROUND: Alcohol consumption during pregnancy and breastfeeding is associated with a risk for the child's healthy development. Nevertheless, about 16 to 25% of all women in the European region, including Switzerland, consume alcohol during pregnancy and probably even more during breastfeeding. Little is known about how women perceive this risk and how risk perception changes during the transition to motherhood. The present study aims to explore the subjective transition from the woman's perspective, focusing on perceptions of alcohol as a risk, changes in alcohol consumption in daily life and experienced support from health professionals in this period. METHODS: The longitudinal qualitative, semi-structured interview study was jointly designed and conducted by health sociologists and midwifery researchers. Using the theoretical framework of sociocultural risk and life course transition, we interviewed 46 women from the French and German speaking part of Switzerland during pregnancy and until six months after birth. RESULTS: In our study, we found that pregnant and breastfeeding women perceive alcohol consumption as a risk to the health of the child. Abstinence is sought especially during pregnancy, but this does not preclude occasional and low-level consumption according to some women. Alcohol consumption and risk perception change during the transition to motherhood. We identified five stages that characterise this transition in terms of alcohol consumption and risk perception. From the women's perspective, there was a lack of counselling from health professionals, and the women expressed a desire for respectful and more individualised counselling. CONCLUSION: Many women express a need for guidance and counselling by health care professionals at some stages of the transition to motherhood. The stages identified can be used as pointers to address the subject of alcohol consumption in professional practice. The stage around conception and early pregnancy should be taken more into account, as women experience themselves as particularly vulnerable during this time. Low-threshold counselling services should be therefore offered to women before or in the stage around conception and be continued until the end of the breastfeeding period.

The effectiveness of skilled breathing and relaxation techniques during antenatal education on maternal and neonatal outcomes: a systematic review.

BACKGROUND: Several studies have investigated the relationship between antenatal education classes and pregnancy outcomes. These studies have shown positive effects on mothers, such as a lower epidural rate in the intervention groups. However, until now, the impact on outcomes for mothers and newborns of antenatal education classes that focus on breathing and relaxation techniques has not been examined. AIM: Investigate the effects of skilled breathing and relaxation techniques provided in antenatal education classes on maternal and neonatal birth outcomes. METHODS: The protocol for this study was registered with PROSPERO (ID: CRD42020192289). A systematic literature search was undertaken and completed in January 2022, using the databases MEDLINE, CINAHL, clinicalTrials.gov, Cochrane Library, Embase and MIDIRS according to a priori formulated PICO criteria: population (pregnant women), intervention (antenatal education classes with integrated breathing and relaxation techniques), comparison (antenatal education classes that do not include skilled breathing and relaxation techniques), and outcome (maternal and neonatal outcomes). The quality of the studies was assessed by two reviewers using the standardised instruments RoB 2 and ROBINS-I. RESULTS: Ten studies were included in this review, nine randomised controlled trials and one quasi-experimental study. The results indicate that skilled breathing and relaxation techniques may positively influence self-efficacy, the need for pharmacological support, specifically the use of epidural anaesthesia, and the memory of labour pain. No effects were found in relation to predefined neonatal outcomes. The quality of evidence on maternal and neonatal outcomes is inconsistent across studies, as different antenatal education classes with varying interventions, including breathing and relaxation techniques, were offered in the studies. CONCLUSIONS: Women who attended an antenatal education class with breathing and relaxation techniques appear to benefit from the intervention. This applies to the practical implementation and use of breathing and relaxation techniques during labour, increased self-confidence and self-efficacy, and a increased feeling of being in control during labour. This demonstrates the importance of information provision and a focus on breathing and relaxation techniques in antenatal education.

Development and validation of a tool for advising primiparous women during early labour: study protocol for the GebStart Study.

INTRODUCTION: Pregnant women experience early labour with different physical and emotional symptoms. Early admission to hospital has been found to be associated with increased intervention and caesarean section rates. However, primiparous women often contact the hospital before labour progresses because they encounter difficulties coping with symptoms of onset of labour on their own. An evidence-based instrument for assessing the individual needs to advise primiparous women during early labour is currently missing. The study aims to develop and validate a tool to inform the joint decision for or against hospital admission. METHODS AND ANALYSIS: A scale development and validation study will be conducted including following steps: (1) Generation of a pool with 99 items based on a scoping review and focus group discussions with primiparous women, (2) Assessment of content and face validity by an expert panel and item reduction to 32 items, (3) Multicentre data collection in six study sites in Switzerland, with application of the preliminary tool and the validation items with a target sample size of approximately n=400 women and (4), item reduction using exploratory factor analysis, factor loading and item-to-item correlation. Internal consistency of the tool will be assessed using Cronbach's alpha and convergent validity computing correlations of items of the tool with the German versions of the Childbirth Self-Efficacy Inventory and the Cambridge-Worry Scale. Analyses will be performed using Stata V.17. ETHICS AND DISSEMINATION: Ethical approval was obtained by the Ethics Committees Zurich and Northwestern and Central Switzerland (BASEC-Nr. 2021-00687). Results will be disseminated at the final study conference, at national and international congresses and by peer reviewed and not peer-reviewed articles in scientific and professional journals. Approved and anonymised data will be shared. The dissemination of the findings will have a contributable impact on clinical practice, scientific discussions and future research. TRIAL REGISTRATION NUMBER: DRKS00025572, SNCTP000004555.

Job satisfaction of midwives working in a labor ward: A repeat measure mixed-methods study.

INTRODUCTION: Job satisfaction of midwives is important to prevent skill shortage. Those working in midwife-led models of care work more independently and have more responsibility. No previous study investigated if a self-initiated and self-responsible project could enhance job satisfaction of midwives working in a medicalled maternity unit. The aim of this study was therefore to assess job satisfaction before and after the implementation of such a project. METHODS: This is longitudinal observational study at three time points using quantitative and qualitative methods. A total of 43 midwives working in a Swiss labor ward participated in the online surveys and in the focus group discussions. The surveys comprised questions from validated instruments to assess job satisfaction. Descriptive and multivariable time series analysis were used for quantitative and content analysis for qualitative data. RESULTS: Adjusted predicted scores decreased between t0 and t1, and subsequently increased at t2 without reaching baseline values (e.g. 'professional support subscales' between t0 and t1: (0.65; 95% CI: 0.45-0.86 vs 0.26; 95% CI: 0.08-0.45, p=0.005) and between t0 and t2 (0.65; 95% CI: 0.45-0.86 vs 0.29; 95% CI: 0.12-0.47, p=0.004). Focus group discussions revealed four themes: 'general job satisfaction', 'challenges with the implementation', 'continuity of care' and 'meaning for the mothers'. Midwives perceived the additional tasks as stressors. CONCLUSIONS: The implementation of new projects might enhance work-related stress and consequently have negative impacts on job satisfaction in an early phase. Heads of institutions and policy makers should recognize the needs of support and additional resources for staff when implementing new projects.

Giving birth: A hermeneutic study of the expectations and experiences of healthy primigravid women in Switzerland.

Switzerland experiences one of the highest caesarean section rates in Europe but it is unclear why and when the decision is made to perform a caesarean section. Many studies have examined from a medical and physiological point of view, but research from a women's standpoint is lacking. Our aim was to develop a model of the emerging expectations of giving birth and the subsequent experiences of healthy primigravid women, across four cantons in Switzerland. This longitudinal study included 30 primigravidae from the German speaking, 14 from the French speaking and 14 from the Italian speaking cantons who were purposively selected. Data were collected by semi-structured interviews taking place around 22 and 36 weeks of pregnancy and six weeks and six months postnatally. Following Gadamer's hermeneutic, which in this study comprised 5 stages, a model was developed. Four major themes emerged: Decisions, Care, Influences and Emotions. Their meandering paths and evolution demonstrate the complexity of the expectations and experiences of women becoming mothers. In this study, women's narrated mode of birth expectations did not foretell how they gave birth and their lived experiences. A hermeneutic discontinuity arises at the 6 week postnatal interview mark. This temporary gap illustrates the bridge between women's expectations of birth and their actual lived experiences, highlighting the importance of informed consent, parent education and ensuring women have a positive birth and immediate postnatal experiences. Other factors than women's preferences should be considered to explain the increasing caesarean section rates.

Midwives' perception of advantages of health care at a distance during the COVID-19 pandemic in Switzerland.

OBJECTIVE: To explore midwives' perceptions of the advantages of telemedicine during the COVID-19 pandemic in Switzerland. DESIGN: Cross-sectional study based on an online survey using quantitative methods. SETTING: Midwives working in Switzerland. PARTICIPANTS: Self-selected convenience sample of 630 members of the Swiss Federation of Midwives. MEASUREMENT: Open questions on advantages of health care at a distance and workrelated characteristics were used in the online questionnaire. The information was coded and integrative content analysis was applied. FINDINGS: A good half of the respondents associated telemedicine with either an advantage beyond the pandemic ("Reduced workload", "Improved health care provision", "Greater self-care of clients"), while the others saw a pandemic-related advantage ("Protection from COVID-19", "Maintaining care/counseling in an exceptional situation"), or no advantage at all. Older, more experienced midwives were less likely to see an advantage beyond the pandemic. The motive "Reduced workload" was positively associated with professionals aged younger than 40 years and midwives with up to 14 years of professional experience, and "Protection from COVID-19" was more likely cited by midwives aged 50 and more and by midwives working solely in hospitals. Midwives who stated "Maintaining care" and "Improved health care provision" as motives to embrace telemedicine were more likely to experience health care at a distance as a positive treatment alternative. KEY CONCLUSION: Midwives' perceptions of the advantages of health care at a distance vary substantially with age and years of professional experience, as well as workrelated characteristics. Further research is necessary to acquire a sound understanding of underlying reasons, including the sources of the general attitudes involved. IMPLICATION FOR PRACTICE: Understanding the differences in perceptions of health care at a distance is important in order to improve the work situation of midwives and the health care they provide to women and families. Different sensitivities represent an important source in the ongoing discussion about the future use of telemedicine in health care.

Work-related stress and intention to leave among midwives working in Swiss maternity hospitals - a cross-sectional study.

BACKGROUND: Health systems around the globe are struggling to recruit qualified health professionals. Work-related stress plays an important role in why health professionals leave their profession prematurely. However, little is known about midwives' working conditions and intentions to leave their profession, although this knowledge is key to work force retention. Therefore, we aimed to investigate work-related stress among midwives working in Swiss maternity hospitals, as well as differences between midwives and other health professionals and the stressors associated with midwives' intention to leave the profession. METHODS: We conducted a data analysis of two cross-sectional studies encompassing midwives working in labour, postpartum and/or gynaecology wards of 12 public Swiss maternity hospitals. Data was collected by self-report questionnaire assessing potential stressors and long-term consequences of stress at work. Data were analysed using descriptive statistics, Kruskal Wallis tests and logistic regression modelling. RESULTS: A total of 98 midwives took part in the study and one in three midwives reported doing overtime sometimes-always. Also, the score for work-private life conflicts was significantly higher among midwives than among other health professionals, with the exception of physicians (M = 37.0 versus 50.2, p < .001). Midwives' meaning of work score (M = 89.4) was significantly higher than that of other health professionals (e.g. nurses (M = 83.0, p < .001) or physicians (M = 82.5, p < .01)). Generation Y midwives showed a significantly higher intention to leave their organisation than did the baby boomers (Mean scores 29.3 versus 10.0, p < .01). Results of the regression model revealed that if midwives could compensate for their overtime in the same month, their intention to leave the profession was lower (OR = 0.23, p < .05). Additionally, the more midwives were affected by work-private life conflicts (OR = 3.01, p < .05) and thoughts about leaving their organisation (OR = 6.81, p < .05), the higher was their intention to leave their profession prematurely. CONCLUSIONS: The comparison with other health professions and the higher intention to leave the profession of younger midwife generations are important findings for heads of institutions as well as policy makers, and should stimulate them to develop strategies for keeping midwives on their staff. More extensive studies should implement and test interventions for reducing work-related stress and increasing the job and occupational satisfaction of midwives.

Does therapy always need touch? A cross-sectional study among Switzerland-based occupational therapists and midwives regarding their experience with health care at a distance during the COVID-19 pandemic in spring 2020.

BACKGROUND: The COVID-19 pandemic impedes therapy and care activities. Tele-health, i.e., the provision of health care at a distance (HCD), is a promising way to fill the supply gap. However, facilitators and barriers influence the use and experience of HCD for occupational therapists (OTs) and midwives. We identified use of services and appraisal of experiences of Switzerland-based OTs and midwives regarding the provision of HCD during the lockdown as it pertains to the COVID-19 pandemic in spring 2020. 1. HYPOTHESIS: Profession, age in years, and area of work have a significant and meaningful influence over whether HCD is provided. 2. HYPOTHESIS: Profession, age in years, area of work, possibility of reimbursement by health insurance, and application used have a significant and meaningful influence on the experience of HCD. METHODS: In a cross-sectional survey, 5755 OTs and midwives were contacted to fill out an online questionnaire with 13 questions regarding demographic information, use of HCD, and experiences while providing the service. Eleven potential facilitators and barriers and areas where there was desire for support were identified. RESULTS: The questionnaire was completed by 1269 health professionals (response rate 22.5%). 73.4% of responding OTs (n = 431) and midwives (n = 501) provided HCD during the COVID-19 pandemic lockdown. Profession and area of work had a significant influence on whether HCD was provided. Age only had a significant influence on the use of videotelephony, SMS, and chat services. OTs experienced HCD significantly more positively than midwives (log odds = 1.3; p ≤ .01). Video-telephony (log odds = 1.1; p ≤ .01) and use of phone (log odds = 0.8; p = .01) were positive predictors for positive experience, while use of SMS (log odds = - 0.33; p = .02) was a negative predictor. Among OTs, 67.5% experienced HCD as positive or mostly positive, while 27.0% experienced it as negative or mostly negative. Among midwives, 39.5% experienced it as positive or mostly positive, while 57.5% experienced it as negative or mostly negative. Most respondents desired support concerning reimbursement by health insurance (70.8%), followed by law and data protection (60.4%). CONCLUSIONS: HCD during the early COVID-19 pandemic was generally perceived as positive by OTs and midwives. There is need for training opportunities in connection with HCD during the COVID-19 pandemic.

Smartphones in the nursery: Parental smartphone use and parental sensitivity and responsiveness within parent-child interaction in early childhood (0-5 years): A scoping review.

The omnipresence of smartphones has not stopped at the door to the nursery. It is especially important to better understand the impact of parental smartphone use on relationships at the beginning of children's lives. Babies and toddlers are essentially dependent on caregivers' sensitive and responsive behaviors within the context of the development of attachment patterns. Disturbances in parental sensitivity can have a negative impact on attachment-related interactional processes between parents and children and on child outcomes, such as self-regulatory capacity. The goal of this review is to compile existing research on the impact of parental mobile device use through technoference or absorption on parental sensitivity and responsiveness within parent-child interactions in the early years (0-5). We conducted a thorough search of the databases PsycInfo and PubMed, additionally consulting data sources such as Google Scholar and Google. In this review, we included 12 studies with a variety of methodical approaches. The research so far indicates that parental smartphone use may be associated with changes in parental sensitivity and responsiveness. Absorption in the device appears to contribute to this association more strongly than short interruptions of relating per se (technoference). However, to better understand these processes, more in-depth, longitudinal research is needed.

La omnipresencia de los teléfonos inteligentes no se ha detenido a la puerta de la guardería. En especial, es importante entender mejor el impacto del uso de teléfonos inteligentes por parte de los padres en sus relaciones al comienzo de las vidas de sus niños. Los bebés y niños pequeñitos son esencialmente dependientes del comportamiento sensible y atento de quienes les cuidan, dentro del contexto del desarrollo de patrones de afectividad. Las interrupciones en la sensibilidad de los padres pueden tener un impacto negativo en los procesos interaccionales relacionados con la afectividad entre padres y niños y en los resultados en el niño tales como la capacidad de autorregularse. El propósito de la presente revisión es compilar la investigación existente acerca del impacto que el uso de aparatos móviles por parte de los padres a través de la tecno-conferencia o absorción tiene sobre la sensibilidad y la atención dentro de las interacciones padres-niños en los primeros años (0-5). Llevamos a cabo una investigación exhaustiva de los bancos de datos PsycInfo y PubMed, consultando adicionalmente las fuentes de datos como el Investigador Google y Google. En esta revisión incluimos 12 estudios con una variedad de acercamientos metodológicos. La investigación hasta ahora indica que el uso de los teléfonos inteligentes por parte de los padres pudiera estar asociado con cambios en la sensibilidad y atención de los padres. La absorción en los aparatos parece contribuir a esta asociación más fuertemente que interrupciones cortas o relacionadas de por sí (tecno-conferencia). Sin embargo, para entender mejor estos procesos, se necesita una más profunda y longitudinal investigación.

L'omniprésence des téléphones smartphones ne s'est pas arrêtée à la porte de la chambre du bébé. Il est particulièrement important de mieux comprendre l'impact de l'utilisation parentale des smartphones sur les relations au début de la vie des enfants. Les bébés et les petits enfants sont essentiellement dépendants des comportements sensibles et réactifs des aidants naturels dans le contexte du développement de patterns d'attachement. Des perturbations de la sensibilité parentale peuvent avoir un impact négatif sur les processus interactionnels liés à l'attachement entre les parents et les enfants et sur les résultats de l'enfant, comme par exemple la capacité régulatoire. Le but de ce passage en revue est de compiler les recherches qui existent sur l'impact de l'utilisation parentale des appareils mobiles à travers la technoférence ou l'absorption sur la sensibilité parentale et la réaction au sein des interactions parent-enfant durant les premières années (0-5 ans). Nous avons fait une recherche approfondie des bases de données PsycInfo et PubMed, et également consulté des sources de données telles que Google Scholar et Google. Dans cette revue nous incluons 12 études avec une variété d'approches médicales. Jusqu'à présent les recherches indiquent que l'utilisation parentale du smartphone peut être lié à des changements dans la sensibilité parentale et la réaction. Le fait d'être absorbé par le téléphone semble contribuer à cette association plus fortement que de courtes interruptions à la relation en elle-même (technoférence). Cependant, afin de mieux comprendre ces processus, des recherches plus approfondies et longitudinales sont nécessaires.

How much synthetic oxytocin is infused during labour? A review and analysis of regimens used in 12 countries.

OBJECTIVE: To compare synthetic oxytocin infusion regimens used during labour, calculate the International Units (IU) escalation rate and total amount of IU infused over eight hours. DESIGN: Observational study. SETTING: Twelve countries, eleven European and South Africa. SAMPLE: National, regional or institutional-level regimens on oxytocin for induction and augmentation labour. METHODS: Data on oxytocin IU dose, infusion fluid amount, start dose, escalation rate and maximum dose were collected. Values for each regimen were converted to IU in 1000ml diluent. One IU corresponded to 1.67µg for doses provided in grams/micrograms. IU hourly dose increase rates were based on escalation frequency. Cumulative doses and total IU amount infused were calculated by adding the dose administered for each previous hour. Main Outcome Measures Oxytocin IU dose infused. RESULTS: Data were obtained on 21 regimens used in 12 countries. Details on the start dose, escalation interval, escalation rate and maximum dose infused were available from 16 regimens. Starting rates varied from 0.06 IU/hour to 0.90 IU/hour, and the maximum dose rate varied from 0.90 IU/hour to 3.60 IU/hour. The total amount of IU oxytocin infused, estimated over eight hours, ranged from 2.38 IU to 27.00 IU, a variation of 24.62 IU and an 11-fold difference. CONCLUSION: Current variations in oxytocin regimens for induction and augmentation of labour are inexplicable. It is crucial that the appropriate minimum infusion regimen is administered because synthetic oxytocin is a potentially harmful medication with serious consequences for women and babies when inappropriately used. Estimating the total amount of oxytocin IU received by labouring women, alongside the institution's mode of birth and neonatal outcomes, may deepen our understanding and be the way forward to identifying the optimal infusion regimen.

Evaluation of a midwifery network to guarantee outpatient postpartum care: a mixed methods study.

BACKGROUND: The necessity of outpatient postpartum care has increased due to shorter hospital stays. In a health care system, where postpartum care after hospital discharge must be arranged by families themselves, this can be challenging for those experiencing psychosocial disadvantages. Therefore, we compared characteristics of users of a midwifery network which referred women to outpatient postpartum care providers with those of women organising care themselves. Additionally, we investigated benefits of the network for women and health professionals. METHODS: Evaluation of the services of a midwifery network in Switzerland. We combined quantitative secondary analysis of routine data of independent midwives with qualitative telephone interviews with users and a focus group with midwives and nurses. Descriptive statistics and logistic regression modelling were done using Stata 13. Content analysis was applied for qualitative data. RESULTS: Users of the network were more likely to be: primiparas (OR 1.52, 95% CI [1.31-1.75, p < 0.001]); of foreign nationality (OR 2.36, 95% CI [2.04-2.73], p < 0.001); without professional education (OR 1.89, 95% CI [1.56-2.29] p < 0.001); unemployed (OR 1.28, 95% CI [1.09-1.51], p = 0.002) and have given birth by caesarean section (OR 1.38, 95% CI [1.20-1.59], p < 0.001) compared to women organising care themselves. Furthermore, users had cumulative risk factors for vulnerable transition into parenthood more often (≥ three risk factors: 4.2% vs. 1.5%, p < 0.001). Women appreciate the services provided. The collaboration within the network facilitated work scheduling and the better use of resources for health professionals. CONCLUSIONS: The network enabled midwives and nurses to reach families who might have struggled to organise postpartum care themselves. It also facilitated the work organisation of health professionals. Networks therefore provide benefits for families and health professionals.

Changing behaviour in pregnant women: A scoping review.

OBJECTIVES: Behaviour change programmes (BCPs) for pregnant women are frequently implemented as part of health promotion initiatives. At present, little is known about the types of behaviour change programmes that are being implemented and whether these programmes are designed and delivered in accordance with the principles of high quality maternity care. In this scoping review, we provide an overview of existing interventions related to behaviour change in pregnancy with a particular emphasis on programmes that include empowerment components to promote autonomy and woman-led decision-making. METHODS: A systematic search strategy was applied to check for relevant papers in August 2017 and again in October 2018. RESULTS: Thirty studies met the criteria for inclusion. These studies addressed weight management, smoking cessation, general health education, nutrition, physical activity, alcohol consumption and dental health. The main approach was knowledge gain through education. More than half of the studies (n = 17) included three or more aspects of empowerment as part of the intervention. The main aspect used to foster women`s empowerment was skills and competencies. In nine studies midwives were involved, but not as programme leaders. CONCLUSIONS: Education for knowledge gain was found to be the prevailing approach in behaviour change programmes. Empowerment aspects were not a specific focus of the behaviour change programmes. This review draws attention to the need to design interventions that empower women, which may be beneficial through their live. As midwives provide maternal healthcare worldwide, they are well-suited to develop, manage, implement or assist in BCPs.

[Occupational Situation of Midwives in Institutions with and without Midwife-led Care in in a Swiss Canton]. / Berufssituation der Hebammen in Einrichtungen mit und ohne hebammengeleitete Geburtshilfe in einem Schweizer Kanton.

INTRODUCTION: Compared to traditional models of care, midwife-led models of care provide better opportunities for midwives to make use of their full scope of practice. This has consequences for their professional satisfaction. The aim of this survey was to gain an overview of the occupational situation of midwives in the maternity units of a Swiss canton and to compare the situations between institutions with and without midwife-led care. METHODS: An online-survey was developed based on a literature search. All 17 institutions with maternity units in the canton of Zurich were eligible to participate. Data was analysed descriptively using Stata 15. RESULTS: 16 maternity units (94.1%) participated in the survey: 12 public hospitals, 2 private hospitals, and 2 midwifery-led birthing centres. A total of 5 units (31.3%) provided midwife-led births or were birthing centres. In institutions providing midwife-led care, women and midwives were more likely to know each other before admission to birth (60.0 vs. 9.1%, p=0.063), fewer routine interventions were carried out (e. g. venous access: 20.0 vs. 81.8%, p=0.036), midwives had more decision-making competences as well as responsibility (e. g. autonomous discharge check-up: 60.0 vs. 9.1%, p=0.063) and used supervisions more often (60.0 vs. 9.1%, p=0.013). CONCLUSION: Fostering midwife-led models of care increases continuity of care and decreases the application of routine interventions. It also fosters the independent assumption of tasks.

Integrative power in Swiss home-like childbirths: A qualitative multiple case study.

OBJECTIVE: To increase understanding of integrative power in decision-making in home-like childbirth from midwives' and women's perspectives. DESIGN: A qualitative multiple case study. SETTING: Two regions of Switzerland, a French and a German-speaking. PARTICIPANTS: Twenty interviews with midwives and 20 with women and some partners who had experienced complications in home-like births. METHODS: Data were collected from in-depth interviews relevant for casestudy. Four cases during second stage of labour were carefully selected using literal replication logic. Interview transcripts were analysed in developing case descriptions and in interpreting mechanisms related to perception of power in making decision. FINDINGS: The analysis of each case and a cross-case comparison showed that mechanisms for building integrative power, such as creation of relationships, cooperation, loyalty, legitimacy and respect, were highly visible in midwifery decision-making activities. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The study highlighted the visibility of integrative power mechanisms in decision-making in homelike settings. Until now, mechanisms of positive power in midwifery have been poorly described in literature. Integrative power could be a promising strategy to reinforce decision-making strategies. Therefore, clinical and policy measures explicitly addressing the positive aspects of power should be developed and evaluated.

Communication barriers in maternity care of allophone migrants: Experiences of women, healthcare professionals, and intercultural interpreters.

AIM: To describe communication barriers faced by allophone migrant women in maternity care provision from the perspectives of migrant women, healthcare professionals, and intercultural interpreters. BACKGROUND: Perinatal health inequality of migrant women hinges on barriers to services, with a major barrier being language. Their care is often also perceived as demanding due to conflicting values or complex situations. Potentially divergent perceptions of users and providers may hinder efficient communication. DESIGN: Qualitative explorative study. METHODS: A convenience sample of 36 participants was recruited in the German speaking region of Switzerland. The sample consisted of four Albanian and six Tigrinya speaking women, 22 healthcare professionals and four intercultural interpreters (March-June 2016) who participated in three focus group discussions and seven semi-structured interviews. Audio recordings of the discussions and interviews were transcribed and thematically analysed. RESULTS: The analysis revealed three main themes: the challenge of understanding each other's world, communication breakdowns and imposed health services. Without interpretation communication was reduced to a bare minimum and thus insufficient to adequately inform women about treatment and address their expectations and needs. CONCLUSION: A primary step in dismantling barriers is guaranteed intercultural interpreting services. Additionally, healthcare professionals need to continuously develop and reflect on their transcultural communication. Institutions must enable professionals to respond flexibly to allophone women's needs and to offer care options that are safe and in accordance to their cultural values. IMPACT: Our results give the foundation of tenable care of allophonic women and emphasize the importance of linguistic understanding in care quality.

Postnatal quality of life - A content analysis of qualitative results to the Mother-Generated Index.

BACKGROUND: The Mother-Generated Index (MGI) assesses postnatal quality of life (QoL) without providing a predefined checklist, thus offering mothers the opportunity to identify areas of life affected by having a baby. AIM: To identify: (a) details and particularities of areas of life affected after childbirth and thus specific domains defining postnatal quality of life; (b) changes in the importance of domains specifying QoL within the first weeks postpartum; and (c) the potential role of cultural differences with regard to the nature of QoL definitions. METHODS: Prospective, cross-cultural, longitudinal survey. We applied a qualitative content analysis to Mother-Generated Index data collected in Switzerland and Germany using combined deductively and inductively category building. RESULTS: Women participated at three days (n=124) and six and a half weeks (n=82) postpartum. Eleven domains were identified, each with several subdomains: 'physical well-being' (e.g. fatigue), 'psychological well-being' (e.g. happiness, emotional confusion), 'general well-being', 'motherhood' (e.g. bonding with the baby), 'family and partnership' (e.g. time for partner and children), 'social life' (e.g. friends, being isolated), 'everyday life' (e.g. organisation daily routine), 'leisure' (e.g. less time), 'work life' (e.g. worries about job), 'financial issues' (e.g. less money), and further aspects. The most frequently indicated domains were 'motherhood' and 'family and partnership'. Differences between the stages of assessment and countries were identified. DISCUSSION: Mothers faced challenges in defining their new role but welcomed the slowdown in the rhythm of life and experienced overwhelming maternal feelings. CONCLUSION: Our findings suggest that postnatal quality of life is a concept that changes over time and differs between countries.

Barrier-free communication in maternity care of allophone migrants: BRIDGE study protocol.

AIM: To describe communication and access barriers encountered by allophone women of different migration backgrounds in the Swiss maternity care services, from the perspective of users, healthcare professionals and intercultural interpreters. BACKGROUND: In addition to the challenges of maternal adjustment, pregnant migrant women must also deal with an unfamiliar health service system. Some must overcome language barriers and the stress of uncertain residence status. Limited access to maternity care increases perinatal morbidity and mortality. Almost 10% of foreigners speak none of Switzerland's official languages. Factors that facilitate or hinder communication between migrant women and perinatal healthcare professionals are under-studied and must be understood if we are to overcome those barriers in clinical practice. DESIGN: Qualitative exploratory study with quantitative sub-study. METHODS: Participants will be drawn from German to speaking regions of Switzerland. We will conduct focus group discussions and semi-structured interviews with users in their own language (Albanian and Tigrinya) and with healthcare professionals and intercultural interpreters (March-June 2016), then perform Thematic Analysis on the data. In the sub-study, midwives will report their experience of using a telephone interpreting service during postnatal home visits in a questionnaire (October 2013-March 2016). Data will be analysed with descriptive statistics. DISCUSSION: Our study will reveal patterns in communications between allophone migrant women and healthcare providers and communication barriers. By incorporating multiple perspectives, we will describe the challenges all parties face. Our results will inform those who draft recommendations to improve provision of maternity care to allophone women and their families. TRIAL REGISTRATION: ClinicalTrials.gov ID: BernUAS NCT02695316.

Decision-making in Swiss home-like childbirth: A grounded theory study.

BACKGROUND: Decision-making in midwifery, including a claim for shared decision-making between midwives and women, is of major significance for the health of mother and child. Midwives have little information about how to share decision-making responsibilities with women, especially when complications arise during birth. AIM: To increase understanding of decision-making in complex home-like birth settings by exploring midwives' and women's perspectives and to develop a dynamic model integrating participatory processes for making shared decisions. METHODS: The study, based on grounded theory methodology, analysed 20 interviews of midwives and 20 women who had experienced complications in home-like births. FINDINGS: The central phenomenon that arose from the data was "defining/redefining decision as a joint commitment to healthy childbirth". The sub-indicators that make up this phenomenon were safety, responsibility, mutual and personal commitments. These sub-indicators were also identified to influence temporal conditions of decision-making and to apply different strategies for shared decision-making. Women adopted strategies such as delegating a decision, making the midwife's decision her own, challenging a decision or taking a decision driven by the dynamics of childbirth. Midwives employed strategies such as remaining indecisive, approving a woman's decision, making an informed decision or taking the necessary decision. DISCUSSION AND CONCLUSION: To respond to recommendations for shared responsibility for care, midwives need to strengthen their shared decision-making skills. The visual model of decision-making in childbirth derived from the data provides a framework for transferring clinical reasoning into practice.