Development of a Quality Assurance Assessment Tool to meet accreditation standards for midwifery education: A Delphi study.

BACKGROUND: Ensuring the quality of midwifery education is critical for producing a qualified and competent midwifery workforce for sexual, reproductive, maternal, and newborn care services. While global standards advocate for quality enhancement and accreditation systems, challenges persist, particularly in low-income countries like Bangladesh. AIM: To validate and culturally adapt a Quality Assurance Assessment tool aligned with global midwifery education standards for application in Bangladesh. The goal of the tool is to guide and assess an internal quality education assurance process tailored to meet the national accreditation standards. METHODS: A modified Delphi technique was conducted with a panel of 55 experts, including educators, principals, and researchers from Bangladesh, India, and Sweden. The study underwent three rounds: tool development, field testing, and consensus building. RESULTS: The first round was completed by 25 workshop panel members, the second was completed by 30 participants during field testing, and the third was completed by the 25 workshop panel members from the first round. The developed Quality Assurance Assessment Tool demonstrated face and content validity through expert consultation and field testing, aligning with both global education and national accreditation standards. Minor revisions enhanced clarity and feasibility. CONCLUSION: The Delphi rounds resulted in a validated Quality Assurance Assessment Tool that offers a robust framework for assessing and enhancing midwifery education quality, aiding progress towards meeting national accreditation standards. This study provides a valuable resource for countries seeking to develop similar tools aligned with global and national education priorities.

Cultural adaptation and psychometric evaluation of Childbirth Experience Questionnaire 2 in Karnataka state, India.

BACKGROUND: Women's birthing experience is a sensitive indicator of the quality of childbirth care and can impact the physical and mental health of both women and their neonates. Negligible evidence exists on Indian women's birth experiences and-to the best of authors' knowledge-no questionnaire has been tested in India for measuring women's birthing experiences. This study aimed to test the construct validity and reliability of the Kannada-translated Revised Childbirth Experience Questionnaire. METHODOLOGY: A cross-sectional survey was carried out among postnatal women (n = 251, up to six months postpartum, with a live healthy neonate) who had given birth at a public or private health facility using the Kannada-translated CEQ2 in two districts of Karnataka. Data were collected at participants' homes after seeking written informed consent. Model fit was determined by Confirmatory Factor Analyses. RESULTS: The 4-factor model of the CEQ2 showed good fit after deletion of one item (item 8, subcategory "participation") with CMIN = 1.33; SRMR = 0.04; GFI = 0.92, CFI = 0.98, TLI = 0.99, RMSEA = 0.037 and p value 0.002). The Cronbach alpha values were acceptable for the four subscales (0.92, 0.93, 0.97, 0.91) as well as for the overall 21-item scale (0.84). CONCLUSIONS: The Kannada-translated CEQ2 is a reliable tool to measure the childbirth experiences among Kannada-speaking women and can serve as a reliable ongoing evaluation of women's birth experiences.

Contextual factors influencing the implementation of midwifery-led care units in India.

BACKGROUND: The Government of India has committed to educate 90,000 midwives functioning in midwifery-led care units (MLCUs) to care for women during labour and birth. There is a need to consider local circumstances in India, as there is no 'one size fits all' prescription for MLCUs. AIM: To explore contextual factors influencing the implementation of MLCUs across India. METHOD: Data were collected through six focus group interviews with 16 nurses, midwives, public health experts and physicians, representing six national and international organisations supporting the Indian Government in its midwifery initiative. Transcribed interviews were analysed using content analysis. FINDINGS: Four generic categories describe the contextual factors which influence the implementation of MLCUs in India: (i) Perceptions of the Nurse Practitioner in Midwifery and MLCUs and their acceptance, (ii) Reversing the medicalization of childbirth, (iii) Engagement with the community, and (iv) The need for legal frameworks and standards. CONCLUSION: Based on the identified contextual factors in this study, we recommend that in India and other similar contexts the following should be in place when designing and implementing MLCUs: legal frameworks to enable midwives to provide full scope of practice in line with the midwifery philosophy and informed by global standards; pre- and in-service training to optimize interdisciplinary teamwork and the knowledge and skills required for the implementation of the midwifery philosophy; midwifery leadership acknowledged as key to the planning and implementation of midwifery-led care at the MLCUs; and a demand among women created through effective midwifery-led care and advocacy messages.

Contextual factors influencing the implementation of a new midwife education programme in India: a qualitative study.

The Indian Government has committed to educate 90,000 midwives in accordance with international norms. This goal is critical as midwives provide evidence-based, high-quality midwifery care. There is a need to explore the contextual factors influencing this new midwifery education programme. Hence, the aim of this study is to explore contextual factors influencing the implementation of the national midwifery education programme for midwifery educators and the future Nurse Practitioners in Midwifery (NPMs) in India. A qualitative research design was used, with data collected through focus group discussions (n = 8) with a total of 27 participants representing seven national and international organisations supporting the Indian Government in its midwifery initiative. Transcribed interviews were analysed using content analysis. This study on contextual factors influencing the implementation of the new midwifery education programme in India showed that organisational and administrative processes are complex and the development of midwifery educators and nurse practitioners in midwifery needs to be fast tracked. The education of educators and future midwives in India, and elsewhere in similar settings, could benefit from efforts to simplify the organisational and administration processes and, in parallel, mobilize innovative teaching and learning approaches to bridge theory and practice.

Evaluation of the psychometric properties of Hindi-translated Scale for Measuring Maternal Satisfaction among postnatal women in Chhattisgarh, India.

Satisfaction with childbirth services is a multi-dimensional phenomenon, providing relevant insights into women's opinion on quality of services received. Research studies report a dearth of standardised scales that quantify this phenomenon; and none have been tested in India to the best of authors' knowledge. The current study was undertaken to evaluate psychometric properties of Hindi version of the Turkish Scale for Measuring Maternal Satisfaction: Normal and Caesarean Births versions in order to fill this gap. A cross-sectional survey was conducted in selected public health facilities in Chhattisgarh, India. Healthy women (n = 1004) who gave birth to a single, live neonate, vaginally or via Caesarean section participated. Psychometric assessment was carried out in four steps: 1) scales translated from Turkish to Hindi; 2) Content Validity Index scores calculated for Hindi scales; 3) data collection; 4) statistical analyses for Hindi scales (Normal and Caesarean Birth). A 10-factor model with 36 items emerged for both scales. The Hindi- translated Normal Birth and Caesarean Birth scales had good internal reliability (Cronbach's α coefficients of 0.85 and 0.80, respectively). The Hindi Scales for Measuring Maternal Satisfaction (Normal and Caesarean Birth) are valid and reliable tools for utilization in Indian health facilities. Their multi-dimensional nature presents an opportunity for the care providers and health administrators to incorporate women's opinions in intervention to improve quality of childbirth services. Having an international tool validated within India also provides a platform for comparing cross-country findings.

Fear of childbirth and depressive symptoms among postnatal women: A cross-sectional survey from Chhattisgarh, India.

BACKGROUND: Prevalence rates of Fear of Birth and postnatal depressive symptoms have not been explored in Chhattisgarh, India. OBJECTIVE: To validate Hindi Wijma Delivery Experience Questionnaire and to study the prevalence of Fear of Birth and depressive symptoms among postnatal women. METHODS: A cross-sectional survey at seventeen public health facilities in two districts of Chhattisgarh, India among postnatal women who gave birth vaginally or through C-section to a live neonate. Participants were recruited through consecutive sampling based on health facility records of daily births. Data were collected through one-to-one interviews using the Wijma Delivery Experience Questionnaire Version B and the Edinburgh Postnatal Depression Scale. Non-parametric associations and linear regression data analyses were performed. RESULTS: The Hindi Wijma Delivery Experience Questionnaire Version B had reliable psychometric properties. The prevalence of Fear of Birth and depressive symptoms among postnatal women were 13.1% and 17.1%, respectively, and their presence had a strong association (p<0.001). Regression analyses revealed that, among women having vaginal births: coming for institutional births due to health professionals' advice, giving birth in a district hospital and having postnatal depressive symptoms were associated with presence of FoB; while depressive symptoms were associated with having FoB, perineal suturing without pain relief, and giving birth to a low birth-weight neonate in a district hospital. CONCLUSION: The prevalence of Fear of Birth and depressive symptoms is influenced by pain management during childbirth and care processes between women and providers. These care practices should be improved for better mental health outcomes among postnatal women.

Satisfaction with childbirth services provided in public health facilities: results from a cross- sectional survey among postnatal women in Chhattisgarh, India.

BACKGROUND: A woman's satisfaction with childbirth services can have a significant impact on her mental health and ability to bond with her neonate. Knowing postnatal women's opinions and satisfaction with services makes the services more women-friendly. Indian women's satisfaction with childbirth services has been explored qualitatively, or by using non-standard local questionnaires, but scientific data gathered with standardised questionnaires are extremely limited. OBJECTIVE: To measure postnatal Indian women's satisfaction with childbirth services at selected public health facilities in Chhattisgarh, India. METHODS: Cross-sectional survey using consecutive sampling (n = 1004) was conducted from March to May 2015. Hindi-translated and validated versions of the Scale for Measuring Maternal Satisfaction for Vaginal Births (VB) and Caesarean Births (CB) were used for data collection. RESULTS: Although most of the women (VB 68.7%; CB 79.2%) were satisfied with the overall childbirth services received, those who had VB were least satisfied with the processes around meeting their neonates (mean subscale score 1.8, SD 1.3), while women having CB were least satisfied with postpartum care received (mean subscale score 2.7, SD 1.2). Regression analyses revealed that among women having VB, interacting with care providers, being able to maintain privacy, and being free from fear of childbirth had a positive influence on overall satisfaction with the childbirth. Among women having CB, earning their own salary and having a positive perception of self-health had associations with overall birth satisfaction. CONCLUSIONS: Improving interpersonal interaction with nurse-midwives, and ensuring privacy during childbirth and hospital stay, are recommended first steps to improve women's childbirth satisfaction, until the supply gap is eliminated.

Cashless childbirth, but at a cost: A grounded theory study on quality of intrapartum care in public health facilities in India.

AIM: this study aimed to explore and understand the perceptions and experiences of women regarding quality of care received during childbirth in public health facilities. DESIGN: qualitative in-depth interviews were conducted and analysed using the Grounded Theory approach. PARTICIPANTS: thirteen women who had given vaginal birth to a healthy newborn infant. SETTING: participants were interviewed in their homes in one district of Chhattisgarh, India. DATA COLLECTION: the interview followed a pre-tested guide comprising one key question: How did the women experience and perceive the care provided during labour and childbirth? FINDINGS: 'cashless childbirth but at a cost: subordination during childbirth' was identified as the core category. Women chose a public health facility due to their socio-economic limitations, and to have a cashless and safe childbirth. Participants expressed a sense of trust in public health facilities, and verbalised that free food and ambulance services provided by the government were appreciated. Care during normal birth was medicalised, and women lacked control over the process of their labour. Often, the women experienced verbal and physical abuse, which led to passive acceptance of all the services provided to avoid confrontation with the providers. CONCLUSIONS: increasingly higher numbers of women give birth in public health facilities in Chhattisgarh, India, and women who have no alternative place to have a safe and normal birth are the main beneficiaries. The labour rooms are functional, but there is a need for improvement of interpersonal processes, information-sharing, and sensitive treatment of women seeking childbirth services in public health facilities.