Home-based postnatal care following early hospital discharge: A descriptive study of the health care service midwife home.

OBJECTIVE: At St. Olav's University Hospital in Trondheim, Norway, "Midwife Home" (MH) is an integrated home-based postnatal service for mothers who want early discharge (i.e. 6-24 h) after giving birth. The purpose of our study was to evaluate MH by (1) describing the characteristics of mother-newborn pairs followed up by MH to investigate whether the service has an appropriate target group; (2) describing the number and causes of possible readmissions for safety; (3) investigating whether MH follows the criteria set for the service; and (4) exploring whether the service facilitates continuity of care. METHODS: Following a cross-sectional design, we collected data from medical records at St. Olav's University Hospital. RESULTS: In the 212 mother-newborn pairs investigated, most mothers had a high level of education, were multiparous, had vaginal delivery, did not experience postpartum haemorrhage exceeding 500 mL, experienced first-degree or no perineal tear and started breastfeeding before discharge from hospital. Most newborns had a birthweight of 3000-4000 g and an APGAR score exceeding 7 after 5 min. Within the first six weeks postpartum, 1.4 % of the mothers and 2.3 % of the newborns were readmitted. CONCLUSION: Mothers who choose follow-up by MH represent a homogeneous group of healthy, highly educated multiparous mothers with uncomplicated births and healthy newborns. The low number of readmissions imply that MH is a safe service, and that the target group is appropriate.

Early discharge from hospital after birth:How Norwegian parents experience postnatal home visits by midwives - A qualitative study.

BACKGROUND: According to the WHO, the quality of care is not conditioned by the length of stay at the postnatal ward. As long as the postnatal care provided is of high quality, it could be better for the family to stay in their home. AIM: Firstly, to examine parents' experiences of early discharge and home visits by the postnatal ward midwife, in cases where the mother and baby have been discharged within 24 h after birth. Secondly, to examine participants' motivation for opting for early discharge from the hospital. METHODS: 10 individual interviews were conducted, including five where both parents were present. The interviews were carried out 4-12 weeks after birth. The data were analysed using systematic text condensation. RESULTS: The choice of early discharge was influenced by external factors like a wish to be together as a family while receiving sufficient support from both family and midwife. Internal factors, like previous experience, were also significant. The presence and attitude of the midwife, both in professional and practical terms, affected how the parents perceived postnatal care. Home visits from the midwife also affected the parents' feeling of security. CONCLUSION: An offer of home visits from the midwife of the postnatal ward enables parents who wish to leave the hospital shortly after birth to receive the necessary care and support in the early postnatal period. This offer is suitable for healthy women who have given birth to a healthy baby and wish to return home not long after birth.

Women's experiences of home visits by midwives in the early postnatal period.

OBJECTIVE: The aim of the present study is to gain a deeper understanding of women's experiences of midwifery care in connection with home visits during the early postnatal period. RESEARCH DESIGN/SETTING: A qualitative approach was chosen for data collection, and the data presented are based on six focus group interviews (n: 24). The women were both primiparous and multiparous, aged 22-37, and lived with their partners. All participants had given birth at a maternity unit responsible for about 4000 births a year. The transcribed interviews were analysed through systematic text condensation. FINDINGS: The findings are reflected in three main themes: 'The importance of relational continuity', 'The importance of a postpartum talk' and 'Vulnerability in the early postnatal period'. When the woman had a personal relationship with the midwife responsible for the home visit she experienced predictability, availability and confidence. The women wanted recognition and time to talk about their birth experience. They also felt vulnerable in their maternal role in the early postnatal period and the start of the breast-feeding process. CONCLUSIONS: It is important to promote relational continuity models of midwifery care to address the emotional aspects of the postnatal period. Women generally wish to discuss their birth experience, preferably with the midwife who was present during the birth. Due to the short duration of postnatal care in hospitals, the visit from the midwife a few days after childbirth becomes all the more important.

Sense of coherence among healthy Norwegian women in postnatal care: Dimensionality reliability and construct validity of the Orientation to Life Questionnaire.

OBJECTIVE: Salutogenesis focuses on identifying the causes of health rather than the causes of illness, and in this way offers a health promotion framework for maternity services. The application of salutogenesis theory in empirical studies of healthy women in maternity care appears to be rare, and mostly incomplete. The objective of this study is to examine the psychometric properties of the Orientation to Life Questionnaire (OLQ) assessing sense of coherence (SOC) in a population of healthy Norwegian women during the postnatal period. METHODS: Self-reported cross-sectional data were collected from 183 women six weeks into the postnatal period. The data were analysed by descriptive statistics and confirmative factor analysis. RESULTS: Discriminant validity was supported by significant negative correlations between SOC, meaningfulness, comprehensibility, manageability, anxiety and depression. Inter-item consistency with Cronbach's alpha (0.62-0.87) and composite reliability (0.60-0.92) revealed acceptable to good values approving the reliability. The original one-dimensional concept of sense of coherence was confirmed in this study. However, in accordance with previous research, some misspecifications in reference to correlated error variances between the items OLQ2 and OLQ3 were discovered. CONCLUSION: This study lends support to the original one-dimensional construct of sense of coherence, and sheds more light upon the troublesome pair of items OLQ2-OLQ3. Further studies are required. However, based on our results, a rewording or deletion of one of these two items seems necessary in order to achieve a reliable and valid instrument measuring SOC among healthy postnatal women.

How can midwives promote a normal birth and a positive birth experience? The experience of first-time Norwegian mothers.

OBJECTIVE: The purpose of this study is to gain a deeper understanding of the experience of first-time mothers regarding how the midwife may promote a normal birth and a positive birth experience. METHODS: A qualitative approach was chosen for data collection, and the data presented are based on in-depth interviews. Twelve healthy, first-time Norwegian mothers, aged 22-34, who had experienced a normal and positive childbirth were interviewed five to six weeks after giving birth. The transcribed interviews were analysed with the help of systematic text condensation. RESULTS: The findings included two main themes: "To be seen as an individual" and "Health-promoting perspective". The experience of being cared for by a midwife who provides presence is vital for the woman to be seen as an individual. When the midwife has a health-promoting perspective, she can more easily assist the woman in developing inner strength and coping strategies. CONCLUSION: Midwives have a pivotal role in helping to promote a normal birth and positive birth experience. The women consider the midwife's attitude and behaviour as essential for their ability to feel safe and cared for. The midwife's individualized and motivating approach promotes the women's inner strength and belief in their own capability to handle the birth. Based on this salutogenic view, the midwife must focus on the woman's resources in order to promote good health during the childbearing process.

Promoting a normal birth and a positive birth experience - Norwegian women's perspectives.

OBJECTIVE: the aim of this study is to gain a deeper understanding of a woman's internal factors and factors in her environment that are important for a normal birth and a positive birth experience. DESIGN/SETTING: a qualitative approach was selected for data collection, and the data presented are derived from in-depth interviews. Twelve healthy first time Norwegian mothers, aged 22-34, with a normal childbirth and a positive birth experience were interviewed five to six weeks after giving birth. All participants had given birth at a maternity unit, where 4000 births take place per year. The transcribed interviews were analysed through systematic text condensation. FINDINGS: the findings included two main themes: safe environment and emotional strength. Stability in everyday life and close relationships provided the women with the safe environment they needed. The women had a positive attitude to childbirth and they had all previously developed coping strategies. They highlighted that these acquired coping strategies contributed to higher emotional strength and a positive birth experience. CONCLUSIONS: the women experienced that a safe environment and network contributed to a sense of trust and emotional strength, which were positive factors promoting a normal birth and a positive birth experience. The women had a positive attitude towards the birth and used acquired coping strategies to deal with it, which in turn led to a positive birth experience. The natural vision the women had in connection with childbirth was part of their antenatal preparation, which also contributed to a positive experience of childbirth.

The woman's birth experience---the effect of interpersonal relationships and continuity of care.

OBJECTIVE: the aim of the present study was to gain a deeper understanding of how relational continuity in the childbearing process may influence the woman's birth experience. RESEARCH DESIGN/SETTING: a Q-methodological approach was chosen, as it allows the researcher to systematically assess subjectivity. 23 women were invited to sort a sample of 48 statements regarding their subjective view of birth experience after having participated in a pilot project in Norway, where six midwifery students provided continuity of care to 58 women throughout the childbearing process. The sorting patterns were subsequently factor-analysed, using the statistical software 'PQ' which reveals one strong and one weaker factor. The consensus statements and the defining statements for the two factors were later interpreted. FINDINGS: both factors seemed to represent experiences of psychological trust and a feeling of team work along with the midwifery student. Both factors indicated the importance of quality in the relation. Factor one represented experiences of presence and emotional support in the relationship. It also represented a feeling of personal growth for the women. Factor two was defined by experiences of predictability in the relation and process, as well as the feeling of interdependency in the relation. According to quality in the relation, women defining factor two experienced that the content, not only the continuity in the relation, was important for the birth experience. KEY CONCLUSIONS: relational continuity is a key concept in the context of a positive birth experience. Quality in the relation gives the woman a possibility to experience positivity during the childbearing process. Continuity in care and personal growth related to birth promote empowerment for both the woman and her partner. Relational continuity gives an opportunity for midwives to provide care in a more holistic manner.