scholarly journals General Practitioners providing obstetric care in New Zealand. What differentiates GPs who continue to deliver babies?

2017 ◽  
Vol 9 (1) ◽  
pp. 9 ◽  
Author(s):  
Zara Mason ◽  
Chrys Jaye ◽  
Dawn Miller
Keyword(s):  
New Zealand ◽  
Maternity Care ◽  
Obstetric Care ◽  
Shared Care ◽  
Structured Interviews ◽  
Birth Process ◽  
Professional Isolation ◽  
Local Solutions ◽  
Legislative Changes ◽  
Maternity Practice

ABSTRACT AIM To identify factors that have enabled some New Zealand general practitioner obstetricians (GPOs) to continue providing maternity care and factors implicated in decisions to withdraw from maternity care. METHOD Semi-structured interviews and one focus group (n = 3) were conducted with 23 current and former GPOs. Interviews were transcribed and analysed thematically. RESULTS Current and former GPOs practiced maternity care because they enjoyed being involved in the birth process and delivery suite environment. Their maternity practice was framed by a philosophy of lifelong continuity of care for patients. Legislative changes in New Zealand and barriers to shared care that resulted in many GPOs withdrawing from maternity care left remaining GPOs feeling professionally isolated; another reason for ceasing maternity care. Funding was perceived to be inadequate and on-call demands were both major disincentives to providing maternity and intrapartum care. Current GPOs often have strong supportive local relationships with other maternity providers when compared with those no longer practicing. Local shared care arrangements enhance professional support and reduce professional isolation. CONCLUSION GPOs still practicing in New Zealand do so because they find maternity care highly rewarding despite their perceptions that the current maternity care model is incompatible with general practice. They have often developed local solutions that support their practice, particularly around shared care arrangements.

scholarly journals Lead maternity care midwives' perspectives on the effect of severe perineal trauma on their relationship with women

2021 ◽  
Author(s):  
◽  
Audrene Samuel
Keyword(s):  
New Zealand ◽  
Maternity Care ◽  
Genital Tract ◽  
Postnatal Period ◽  
Perineal Trauma ◽  
Structured Interviews ◽  
Geographical Regions ◽  
Severe Perineal Trauma ◽  
Ongoing Relationship ◽  
The Impact

<p>Although childbirth is a time of happiness and joy for couples, happiness can be flawed by pain and discomfort associated with perineal trauma sustained during childbirth. It is estimated that 85% of vaginal births are accompanied by trauma to the perineum. A higher risk of trauma is sustained at the first birth compared with subsequent vaginal births. In New Zealand, midwives work in partnership with the woman. The Lead Maternity Care (LMC) midwife has an ongoing relationship with the woman in her care that starts when the pregnant woman books with the midwife and ends at six weeks postpartum. The relationship between the woman and the LMC midwife involves trust, shared control, responsibility and a shared meaning through mutual understanding. Midwives fear they will be held responsible by women who sustain severe perineal trauma during their birth for the outcome. There is a lack of research into how New Zealand midwives’ relationships are affected when women in their care sustain severe perineal trauma. This research sought to explore the experiences of LMC midwives who have cared for women who sustained severe perineal trauma during childbirth. The objective of this study was to understand the effects of severe perineal trauma on the midwife/ woman relationship. The aim was to explore LMC midwives` perception of how they were affected when women in their care sustained severe genital tract trauma during birth. Qualitative descriptive methodology was used. Face-to-face semi-structured interviews were conducted with LMC midwives from three geographical regions in lower North Island of New Zealand. The participants were eight midwives who had personal experience of caring for a woman who sustained severe genital tract trauma during childbirth. The findings revealed three themes: building a relationship with women, participants’ perceptions of the effects of severe perineal trauma on women, and the impact of severe perineal trauma on the midwife. The findings demonstrate that LMC midwives build relationships with women during the antenatal period. This relationship ensures an excellent partnership, established on the foundation of trust and respect, developed with the women. Midwives are affected on a personal and professional level when woman sustains trauma during childbirth, and the midwife adopts ways of coping. In the aftermath of severe perineal trauma, the woman may suffer health problems. This can impact her relationship with her LMC midwife during the postnatal period.</p>

scholarly journals Lead maternity care midwives' perspectives on the effect of severe perineal trauma on their relationship with women

2021 ◽  
Author(s):  
◽  
Audrene Samuel
Keyword(s):  
New Zealand ◽  
Maternity Care ◽  
Genital Tract ◽  
Postnatal Period ◽  
Perineal Trauma ◽  
Structured Interviews ◽  
Geographical Regions ◽  
Severe Perineal Trauma ◽  
Ongoing Relationship ◽  
The Impact

<p>Although childbirth is a time of happiness and joy for couples, happiness can be flawed by pain and discomfort associated with perineal trauma sustained during childbirth. It is estimated that 85% of vaginal births are accompanied by trauma to the perineum. A higher risk of trauma is sustained at the first birth compared with subsequent vaginal births. In New Zealand, midwives work in partnership with the woman. The Lead Maternity Care (LMC) midwife has an ongoing relationship with the woman in her care that starts when the pregnant woman books with the midwife and ends at six weeks postpartum. The relationship between the woman and the LMC midwife involves trust, shared control, responsibility and a shared meaning through mutual understanding. Midwives fear they will be held responsible by women who sustain severe perineal trauma during their birth for the outcome. There is a lack of research into how New Zealand midwives’ relationships are affected when women in their care sustain severe perineal trauma. This research sought to explore the experiences of LMC midwives who have cared for women who sustained severe perineal trauma during childbirth. The objective of this study was to understand the effects of severe perineal trauma on the midwife/ woman relationship. The aim was to explore LMC midwives` perception of how they were affected when women in their care sustained severe genital tract trauma during birth. Qualitative descriptive methodology was used. Face-to-face semi-structured interviews were conducted with LMC midwives from three geographical regions in lower North Island of New Zealand. The participants were eight midwives who had personal experience of caring for a woman who sustained severe genital tract trauma during childbirth. The findings revealed three themes: building a relationship with women, participants’ perceptions of the effects of severe perineal trauma on women, and the impact of severe perineal trauma on the midwife. The findings demonstrate that LMC midwives build relationships with women during the antenatal period. This relationship ensures an excellent partnership, established on the foundation of trust and respect, developed with the women. Midwives are affected on a personal and professional level when woman sustains trauma during childbirth, and the midwife adopts ways of coping. In the aftermath of severe perineal trauma, the woman may suffer health problems. This can impact her relationship with her LMC midwife during the postnatal period.</p>

scholarly journals General practice registrars' views on maternity care in general practice in New Zealand

2015 ◽  
Vol 7 (4) ◽  
pp. 316 ◽  
Author(s):  
Hanna Preston ◽  
Chrystal Jaye ◽  
Dawn Miller
Keyword(s):  
General Practice ◽  
New Zealand ◽  
General Practitioners ◽  
Maternity Care ◽  
Shared Care ◽  
Online Questionnaire ◽  
Maternity Services ◽  
Training Support ◽  
Learning Platform ◽  
Practice Education

INTRODUCTION: The number of general practitioners (GPs) providing maternity care in New Zealand has declined dramatically since legislative changes of the 1990s. The Ministry of Health wants GPs to provide maternity care again. AIM: To investigate New Zealand general practice registrars' perspectives on GPs' role in maternity care; specifically, whether maternity services should be provided by GPs, registrars' preparedness to provide such services, and training opportunities available or required to achieve this. METHODS: An anonymous online questionnaire was distributed to all registrars enrolled in The Royal New Zealand College of General Practitioners' (RNZCGP's) General Practice Education Programme (GPEP) in 2012, via their online learning platform OWL. RESULTS: 165 of the 643 general practice registrars responded (25.7% response rate). Most (95%) believe that GPs interested and trained in maternity care should consider providing antenatal, postnatal or shared care with midwives, and 95% believe women should be able to access maternity care from their general practice. When practising as a GP, 90% would consider providing antenatal and postnatal care, 47.3% shared care, and 4.3% full pregnancy care. Professional factors including training and adequate funding were most important when considering providing maternity care as a GP. DISCUSSION: Ninety-five percent of general practice registrars who responded to our survey believe that GPs should provide some maternity services, and about 90% would consider providing maternity care in their future practice. Addressing professional issues of training, support and funding are essential if more GPs are to participate in maternity care in New Zealand. KEYWORDS: General practice; education; maternity care; New Zealand; rural health services

scholarly journals Centralisation of acute obstetric care in the Netherlands: a qualitative study to explore the experiences of stakeholders with adaptations in organisation of care

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lauri M.M. van den Berg ◽  
Bernardus Benjamin Maria Gordon ◽  
Sophia M. Kleefstra ◽  
Lucie Martijn ◽  
Jeroen van Dillen ◽  
...  
Keyword(s):  
Qualitative Study ◽  
The Netherlands ◽  
Maternity Care ◽  
Obstetric Care ◽  
Structured Interviews ◽  
Collaborative Process ◽  
Organisation Of Care ◽  
The Past ◽  
Inductive Thematic Analysis

Abstract Background In the past decade, acute obstetric care (AOC) has become centralised in many high-income countries. In this qualitative study, we explored how stakeholders in maternity care perceived and experienced adaptations in the organisation of maternity care in areas in the Netherlands where AOC was centralised. Methods A heterogenic group of fifteen maternity care stakeholders, including patients, were purposively selected for semi-structured interviews. An inductive thematic analysis was used. Results Three main themes were identified: (1) lack of involvement. (2) the process of making adaptations in the organisation of maternity care. (3) maintaining quality of care. Stakeholders in this study were highly motivated to maintain a high quality of maternity care and therefore made adaptations at several organisational levels. However, they felt a lack of involvement during the planning of centralisation of AOC and highlighted the importance of a collaborative process when making adaptations after centralisation of AOC. Conclusions Regions with AOC centralisation plans should invest time and money in change management, encourage early involvement of all maternity care stakeholders and acknowledge centralisation of AOC as a professional life event with associated emotions, including a feeling of unsafety.

Analysis of Selected Recommendations of Parents for Improvement of Shared Care and Joint Custody After Parents/Partners´ Divorce/Separation

2018 ◽  
Vol 52 (1) ◽  
pp. 60-69
Author(s):  
Dagmar Kopčanová ◽  
Bibiana Filípková
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Research Work ◽  
Structured Interview ◽  
Shared Care ◽  
Team Work ◽  
Joint Custody ◽  
Shared Parenting ◽  
Methodological Problems ◽  
Legislative Changes

Abstract The content of this scientific study is based on the qualitative analysis of selected answers of parents, in the framework of semi-structured interview. The qualitative research is apart of bigger research work P-155/A, dealing with mental health of children in family and school settings. The main goal is to learn and analyse the empirical experience and views of participants, related to joint custody and shared care. The research sample consisted of randomly selected 9 participants who visited Výskumný ústav detskej psychológie apatopsychológie on behalf of some problems regarding custody after divorce/separation. In this contribution the parents´ attitudes towards mutual communication of former partners/parents, functioning of joint custody and shared care and some views related to some limits in this form of shared parenting have been analysed. Some valuable remarks with regard to the need of multi-professional team work, addressed to parents within the process of their divorce/separation proved to be very useful. Parents proposed they would extremely welcome some more help from mental health professionals and their crises intervention actions. On behalf of discussion we notice that the juridical institute of joint custody and shared care is a very important tool, however, some legislative changes of this law should be still done. Concluding the study, we state that in spite of some methodological problems – like a limited number of research participants, we believe that the results can serve as a basis for the next deeper research, bringing more proposals for improvement in this field.

Cytisine as an alternative smoking cessation product for Pacific smokers in New Zealand

2018 ◽  
Vol 21 (2) ◽  
pp. 89-95
Author(s):  
Vili Nosa ◽  
Kotalo Leau ◽  
Natalie Walker
Keyword(s):  
Smoking Cessation ◽  
New Zealand ◽  
Nicotinic Acetylcholine Receptors ◽  
Cultural Practices ◽  
Partial Agonist ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Liquid Form ◽  
Pacific People ◽  
The Pacific

ABSTRACT Introduction: Pacific people in New Zealand have one of the highest rates of smoking.  Cytisine is a plant-based alkaloid that has proven efficacy, effectiveness and safety compared to a placebo and nicotine replacement therapy (NRT) for smoking cessation.  Cytisine, like varenicline, is a partial agonist of nicotinic acetylcholine receptors, and blocks the rewarding effects of nicotine. Cytisine is naturally found in some plants in the Pacific region, and so may appeal to Pacific smokers wanting to quit. This paper investigates the acceptability of cytisine as a smoking cessation product for Pacific smokers in New Zealand, using a qualitative study design. Methods: In December 2015, advertisements and snowball sampling was used to recruit four Pacific smokers and three Pacific smoking cessation specialists in Auckland, New Zealand. Semi-structured interviews where undertaken, whereby participants were asked about motivations to quit and their views on smoking cessation products, including cytisine (which is currently unavailable in New Zealand). Interviews were recorded and transcribed verbatim, with thematic analysis conducted manually. Findings: Pacific smokers reported wanting to quit for loved ones and family, but did not find currently available smoking cessation products effective. Almost all participants had not previously heard of cytisine, but many of the Pacific smokers were keen to try it. Participants identified with cytisine on a cultural basis (given its natural status), but noted that their use would be determined by the efficacy of the medicine, its cost, side-effects, and accessibility. They were particularly interested in cytisine being made available in liquid form, which could be added to a “smoothie” or drunk as a “traditional tea”.  Participants thought cytisine should be promoted in a culturally-appropriate way, with packaging and advertising designed to appeal to Pacific smokers. Conclusions: Cytisine is more acceptable to Pacific smokers than other smoking cessation products, because of their cultural practices of traditional medicine and the natural product status of cytisine.

Meeting the Needs of Gifted Learners Who Just Don’t ‘Fit’: Parent Perspectives

2019 ◽  
pp. 6-16
Author(s):  
Nadine Ballam ◽  
Anne Sturgess
Keyword(s):  
New Zealand ◽  
Gifted Education ◽  
Support Staff ◽  
Learning Approach ◽  
Full Time ◽  
Parent Perspectives ◽  
Structured Interviews ◽  
Gifted Learners ◽  
Initial Cohort ◽  
Data Informed

In February 2018, a full-time provider of gifted education opened in New Zealand with its initial cohort of children. This provider catered for learners from ages 1-15 years who did not ‘fit’ in mainstream education settings. This paper reports on a research project that focused on the effectiveness of the learning approach at this school in its inaugural year. Two sources of data informed this research, including semi-structured interviews with parents and learning and support staff, and an analysis of documents related to the philosophy, curriculum, and learning approach. This paper reports on benefits and limitations of the learning approach identified by the parent participants in the study.

Risk perception on the labour ward: A mixed methods study

2021 ◽  
Vol 26 (2) ◽  
pp. 56-63
Author(s):  
Claire McCarthy ◽  
Sarah Meaney ◽  
Marie Rochford ◽  
Keelin O’Donoghue
Keyword(s):  
Mixed Methods ◽  
Lived Experience ◽  
Healthcare Providers ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Daily Basis ◽  
Mixed Methods Study ◽  
Structured Interviews ◽  
Staff Support ◽  
Staff Wellbeing

Healthcare providers commonly experience risky situations in the provision of maternity care, and there has been increased focus on the lived experience in recent years. We aimed to assess opinions on, understanding of and behaviours of risk on the LW by conducting a mixed methods study. Staff working in a LW setting completed a descriptive questionnaire-based study, followed by qualitative structured interviews. Statistical analysis was performed with SPSS on quantitative data and thematic analysis performed on qualitative data. Nearly two thirds of staff (64%; 73/114) completed the questionnaire, with 56.2% (n = 47) experiencing risk on a daily basis. Experiencing risk evoked feelings of apprehension (68.4%; n = 50) and worry (60.2%; n = 44) which was echoed in the qualitative work. Structured clinical assessment was utilised in risky situations, and staff described “ going on autopilot” to manage these situations. A large number of respondents reflected on their provision of care following an adverse event (87.7%; n = 64). Debriefing was mentioned as an important practice following such events by all respondents. This study describes the negative terminology prevailing in emergency obstetric care. These experiences can have a profound impact on staff. Risk reduction strategies and the provision of increased staff support and training are crucial to improve staff wellbeing in stressful scenarios.

scholarly journals Experiences of New Zealand Haemodialysis Patients in Relation to Food and Nutrition Management: A Qualitative Study

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2299
Author(s):  
Rachael M. McLean ◽  
Zhengxiu Xie ◽  
Vicky Nelson ◽  
Vili Nosa ◽  
Hla Thein ◽  
...  
Keyword(s):  
New Zealand ◽  
Qualitative Study ◽  
Thematic Analysis ◽  
Extended Family ◽  
Culturally Appropriate ◽  
Structured Interviews ◽  
Nutrition Management ◽  
Healthcare Needs ◽  
Food And Nutrition ◽  
Major Disruption

People receiving haemodialysis have considerable and complex dietary and healthcare needs, including co-morbidities. A recent New Zealand study has shown that few patients on haemodialysis are able to meet nutritional requirements for haemodialysis. This study aims to describe the perspectives and experiences of dietary management among patients on haemodialysis in New Zealand. This exploratory qualitative study used in-depth semi-structured interviews. Purposive sampling was used to recruit participants from different ethnic groups. Forty interviews were conducted, audio-recorded and transcribed verbatim. An inductive approach was taken using thematic analysis. Forty participants were interviewed. Participants spoke of major disruption to their lives as a result of their chronic kidney disease and being on haemodialysis, including loss of employment, financial challenges, loss of independence, social isolation and increased reliance on extended family. Most had received adequate dietary information, although some felt that more culturally appropriate support would have enabled a healthier diet. These findings show that further support to make the recommended dietary changes while on haemodialysis should focus on socio-cultural factors, in addition to the information already provided.

scholarly journals Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kirsten Austad ◽  
Michel Juarez ◽  
Hannah Shryer ◽  
Patricia L. Hibberd ◽  
Mari-Lynn Drainoni ◽  
...  
Keyword(s):  
Health Workers ◽  
Positive Impact ◽  
Qualitative Evaluation ◽  
Obstetric Care ◽  
Hospital Staff ◽  
Public Hospitals ◽  
Future Research ◽  
Care Seeking ◽  
Structured Interviews ◽  
The Impact

Abstract Background Global disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands. Methods We conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff—namely physicians, nurses, and social workers—of the main public hospital in the pilot’s catchment area (Chimaltenango). Interviews queried OCN’s impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis. Results Maternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks. Conclusions Many barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers’ experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff—especially nurses—appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers’ future care seeking behavior.

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