Andrew Symon
University of Dundee
Andrew Symon is a Senior Lecturer in the Mother and Infant Research Unit, University of Dundee. Current research is focusing on models of antenatal care, and alcohol use in pregnancy.
Background, including element of originality Midwifery-led continuity models have demonstrated improved clinical, psychosocial and organisational outcomes (Sandall et al 2016), but their underlying causal mechanisms are poorly... [ view full abstract ]
Background, including element of originality
Midwifery-led continuity models have demonstrated improved clinical, psychosocial and organisational outcomes (Sandall et al 2016), but their underlying causal mechanisms are poorly understood. Quality care’s components and characteristics are detailed in the Quality Maternal and Newborn Care (QMNC) Framework (Renfrew et al 2014). However, it is not clear how service users and providers in different care models understand or experience these. Using the QMNC Framework, we are exploring user and provider perceptions of three models of care: midwifery continuity of care in hospital / out of hospital, and ‘standard’ care with no or little prescribed midwifery continuity of care.
Method
Pilot qualitative study (February-May 2017) using twelve midwife researcher-led focus groups with pregnant women, new mothers, midwives and doctors in eastern Scotland. Data are being analysed thematically and mapped back to the QMNC Framework.
Results
Preliminary results from eight focus groups (n=41 participants) indicate that the QMNC Framework allows both positive and negative aspects of the maternity care experience to be explored. ‘Organisation of Care’ featured more prominently than ‘Philosophy’ or ‘Values’. While service providers saw continuity of care as valuable, blurring of working boundaries (‘inappropriate referrals’) and working outside or beyond the perceived scope of practice impacted negatively on quality care. Addressing the needs of high risk women requires more time. Although case loading was positively evaluated, and women feel their care is generally respectful and woman-centered, the organisation of care sometimes limits their capacity to be informed and empowered. There is great scope for developing social capital.
Discussion
The QMNC Framework details the essential features of quality care. Discussing these complex concepts requires careful preparation and effective moderation. Organisation of Care’s predominance may reflect its immediacy over more abstract concepts (e.g. ‘Optimising Processes’). The questions continues to evolve as we determine how best to reflect the Framework as a tool to explore quality maternity care.
Conclusion
Detailed analysis will be ready by September. The QMNC Framework is valuable in exploring both positive and negative aspects of care. Exploring these features contributes to the understanding of how some models produce better outcomes than others.
Studies of and contributions to practice and/or service organisation , Methodological innovations inthis and associated areas
