Educational interventions in the antenatal period were the focus of four systematic reviews [41–44] that considered education about pelvic floor muscle training (PFMT) and promotion of smoking cessation in pregnancy Lumley et al. Cochrane database of systematic reviews issue 3. Clipboard, Search History, and several other advanced features are temporarily unavailable. Reference lists of identified reviews were manually searched for additional relevant reviews. CAS  resource issues that impact health service access and quality of care at all levels of the health system. NIH Five reviews [46–50] were included in this section and considered either clinical care during labour/delivery or the birthing environment. Whitworth M, Bricker L, Neilson JP, Dowswell T: Ultrasound for fetal assessment in early pregnancy. A systematic search strategy was formulated and definitive search terms used relative to key public health topics within midwifery following consultation with Expert Advisory Group members and Midwifery 2020 Public Health Work Stream members. statement and [52] involved formal or structured breastfeeding education, informal breastfeeding education or breastfeeding support either lay or professional. Scottish Intercollegiate Guidelines Network: Systematic literature review. This strategy has been developed in collaboration of all partners and stakeholders in line with existing policies and the Health Sector Strategic Plan (HSSP II). Int J Gynecol Obstet. Br J Nutr. The focus of this paper is the development of the public health role of the midwife based on effective interventions and highlighting the short, medium and long term effects that these interventions could bring about. Public health has much to do with midwifery and midwifery has much to do with public health. This paper outlines the review methodology and builds on the original review findings by providing new and updated information about effective high quality public health interventions which could be implemented by midwives or other health care providers for women during pregnancy and the postnatal period who have a similar role, for example, public health nurses, obstetric nurses, labour and delivery nurses or health visitors. PubMed  CAS  The Strategic Action Plan for Nursing/Midwifery Development is closely linked to the regional human resources for health (HRH) strategy, of which nursing is a key component. In the case of any disagreement regarding grading of evidence, quality appraisal of reviews or effectiveness of the intervention, consensus was reached by discussion between all three authors. Google ScholarÂ. J Obstet Gynaecol Can. This site needs JavaScript to work properly. Cochrane database of systematic reviews issue 3. 2008, Chichester, UK: John Wiley & Sons, O’Connor AM, Bennett CL, Stacey D, Barry M, Col NF, Eden KB, Entwistle VA, Fiset V, Holmes-Rovner M, Khangura S, Llewellyn-Thomas H, Rovner D: Decision aids for people facing health treatment or screening decisions. ... and round-the-clock commitment of nurses and midwives caring for patients across the NSW public health system. Most importantly, the Strategy's ultimate aim is to help ensure that patients receive the … 2007, Chichester UK: Cochrane Database of Systematic Reviews. Birth. It … Full text was obtained of all eligible reviews and those whose eligibility could not be discerned from reading the abstract. The authors also reported there was no reduction in adverse outcomes or health service use by mothers or infants and long term follow up did not indicate detrimental effect on children’s physical or mental development. As a result of conducting the review and analyzing eligible systematic review evidence, three key areas for future consideration were identified including: recommendation and implementation of effective evidence; gaps in knowledge and developing the role of the midwife in public health which are discussed further in the following sections. Central, Monitoring & Evaluation Division ... Primary Health Care; Public Health Institute ; Reproductive Health. 2008, London: RCOG Press. 2003, 25 (6): 516-522. Midwifery care also includes health promotion, disease prevention, and individualized wellness education and counseling. Reviews (n=4) related to screening reported on interventions relating to ultrasound [26, 27], lower genital tract infection screening [28] and the use of decision making aids [29]. 2009, 25: 147-154. This review was similar in that it covered a broad scope of the evidence in relation to public health, providing a strategic overview while also providing a valuable resource for those who wish to consult individual reviews for additional specific details. Nurs Res Pract. 2003, 93: 224-228. 2009, 104: 5-8. Chaillet & Dumont [50] reported from a meta analysis that regular audit, detailed feedback regarding aspects of caesarean section performance (responsibility for decision making, rates, review of cases in clinical practice and multi faceted strategy approaches, such as development of guidelines, education of health professionals and women about vaginal birth after caesarean section (VBAC) were effective for reducing the caesarean section rate (RR 0.81; 95% CI 0.75-0.87). Reviews were rated as medium quality if no evidence of assessment of heterogeneity or publication bias was provided and low quality reviews were those which provided evidence of a search strategy only. The NSW Aboriginal Nursing and Midwifery Strategy aims to: The systematic reviews included in the original review generally indicated that additional support related to diet or exercise for women in the postnatal period was effective, however, only one review was of a high quality. A united health and education policy to inform and educate children and teenagers about the benefits of pre-conceptional care and breastfeeding may be needed. 2002 Mar;37(5):485-93. doi: 10.1046/j.1365-2648.2002.02107.x. Health care providers for women during the reproductive and early postnatal period have the opportunity to encourage women to make choices that will impact positively on maternal and fetal health… Eligible systematic reviews relevant to the intranatal period yielded the smallest number in comparison to either the antenatal or postnatal periods. Key Determinants Influencing the Health Literacy of Pregnant Women in the Czech Republic. Health Technol Assess. Development of the public health role of the midwife will also require strategic thinking and support from planners and commissioners of maternity services to ensure that midwives can influence policy and effectively implement public health strategies. Eligibility criterion included reviews published from 1999 onwards; English language publications and reviews originating from economically developed countries as indicated by membership of the Organisation for Economic Co-operation and Development (OECD). Further consideration needs to be given to how to translate these effective interventions into practice using appropriate channels which are effective to facilitate knowledge transfer. Systematic reviews are generally limited to published work and thus may be subject to publication bias. Clarke M: Interpreting the results of systematic reviews. 2009, 339: b2535-10.1136/bmj.b2535. Cookies policy. [14], which contains similar elements to other tools used to assess review quality, for example, the AMSTAR tool [16]. 2018 Nov 12;4:45. doi: 10.1186/s40795-018-0254-7. [52] and Sikorski et al.[53]. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. The review also identified gaps in knowledge around the impact of core midwifery practice on public health outcomes and the value of this contribution. The strategy reflects a global shift in thinking by focusing on seven priority population groups and aims to shape services around people, patients and their families and change the way the health system works, moving from focusing on treating the symptoms of disease to helping people stay healthy. [27] reviewed the use of ultrasound for fetal assessment in early pregnancy and concluded that it reduces failure to detect multiple pregnancy (RR 0.07 95% CI 0.03-0.17) and accuracy of gestational dating may reduce the number of inductions of labour for post term gestation (RR 0.59; 95% CI 0.42-0.83). p values or odds ratios) are described and whether the review included a meta analysis or not. 10.1016/j.puhe.2007.05.004. 2010, 24 (3): 316-327. One review considered support for women in relation to weight reduction in the post partum period [58] focusing on the effect of diet or exercise or both for reducing weight after childbirth. J Obstet Gynaecol Can. Reviews have been included where a small number of studies reported statistically significant positive effect of the intervention however the wider interpretation of these results is limited. Calcium supplementation was the focus of three reviews [34–36]. [28]. Another example of this is the evidence around home visiting for vulnerable groups of women in the postnatal period. Google ScholarÂ. In addition the results presented may be inconsistent between reviews or inconclusive, however, Smith et al. The final report of the Midwifery 2020 initiative (Delivering Expectations) and full report of the systematic review of reviews [10] are available freely online from: One example of this is systematic review evidence in relation to weight management or obesity; a topic of growing concern to maternity care providers and yet the evidence from systematic reviews is limited in terms of quality. Weaver J, Statham H, Richards M: Are there “Unnecessary” cesarean sections? 2007, 34 (1): 32-41. The titles and abstracts were obtained and the decision process for eligibility was conducted by all members of the project team in collaboration (JM, FL & FA). More than a midwife? [61] demonstrated an overall positive effect on neurodevelopment from early parental interventions (all involved teaching or enhancing parental skills) lasting up to 36 months. Springer Nature. It clearly outlines and discusses the midwife’s role in health promotion, linking theory and practice. Vanderveen et al. Such benefits will remain elusive without investment in a collaborative, strategic approach to the role of public health in midwifery. Antenatal care and adolescent pregnancy are specifically mentioned as key to achieving this target, both of which are acknowledged widely, as areas of interest to public health [3, 4]. Cochrane database of systematic reviews issue 1. Bricker et al. A medium term outcome of this intervention would focus on optimising lifestyle beyond the perinatal period for example collaborating with health visiting services to provide education and support that would potentially have a longer term outcome of improved family health and well being. volume 12, Article number: 955 (2012) Birth. Wilson RD, on behalf of Genetics Committee of the Society of Obstetricians and Gynaecologists of Canada and The Motherisk Program, The Hospital for Sick Children Toronto, et al: Pre-conceptional vitamin/folic acid supplementation 2007: the Use of folic acid in combination with a multivitamin supplement for the prevention of neural tube defects and other congenital anomalies –guideline No. Is there a place for traditional midwives in the provision of community-health services? The review comprised of three systematic reviews on routine ultrasound in early pregnancy, routine ultrasound in late pregnancy and routine Doppler ultrasound in pregnancy which were published in the Cochrane database around the time of Bricker et al. Primary health care is a fundamental part of midwifery practice (Shah and King, 2006, Homer et al., 2007). 2 Professor of Maternal and Child Health Research & RCM (Scotland) Professor of Midwifery Research, NMAHP Research Unit, Faculty of Health Sciences and Sport, … It is clear from this review of effective interventions, there are areas where evidence has been incorporated into guidelines and thus recommended for implementation into routine practice. Hofmeyr et al. Primary health care within a public health strategy focuses on improving the health of … Inequalities in health care provision: the relationship between contemporary policy and contemporary practice in maternity services in England. It is also aligned with the global Strategic Directions for Strengthening Nursing and Midwifery Services,1 The nursing, midwifery and health professions (NMaHP) workforce has a vital role in developing and delivering work programmes that: improve patient care and public health ; enhance quality and safety; get best value from health and social care services; Head of the profession in Scotland is the … 2018 Sep 14;18(1):712. doi: 10.1186/s12913-018-3502-2. 2008, Chichester, UK: John Wiley & Sons. The authors found a significantly lower rate of PTD <34 wks (RR 0.39; 95% CI 0.18-0.84) although this result was based on two trials (n=291). In order for midwives to utilise their potential in relation to public health it is important not only to consider the interventions that could be implemented but also take cognisance of wider strategies and policy relating to public health. They found that although there was a 50% reduction in the odds of repeat pregnancy compared to comparison-control conditions at 19months (OR 0.474; 95% CI 0.322-0.695), the effect had dissipated by 31 months. This aim of this paper is to identify evidence of effective public health interventions from good quality systematic reviews that could be conducted by midwives. 2009, Chichester, UK: John Wiley & Sons. 2008, 103: 566-579. The logic model demonstrates the need to fill in major gaps in our knowledge on effective interventions to achieve both short and long term public health benefits for women and their families. While the logic model provides a visual outline of midwifery public health roles, using this approach facilitates understanding of how public health programs can be planned and subsequently evaluated. The public health role of the midwives has not been well researched or reviewed and the impact of everyday midwifery practice on longer term, holistic maternal and family well-being outcomes is poorly articulated in review literature. Find out about the different positions and pathways you can take. Midwives save lives. 2008, 122: 42-52. JAMA. The third edition of this evidence-based text covers essential topics such as breastfeeding, smoking, mental health, behaviour change and sexual health … Alderdice F, McNeill J, Rowe R, Martin D, Dornan J: Inequalities in the reported offer and uptake of antenatal screening. Epub 2017 Jul 2. In J Epidemiol. Horvath et al. Barlow J, Schrader McMillan A, Kirkpatrick S, Ghate D, Smith M, Barnes J: Health-led parenting interventions in pregnancy and early years. J Obstet Gynecol Neonatal Nurs. This paper has reported on high quality effective interventions identified from a larger systematic review on public health interventions that could be delivered primarily by midwives or maternity care providers. The methodological quality of included reviews was assessed and rated as low, medium or high quality. eCollection 2020. 2010, Scotland: NHS Education for Scotland. Article  2006 Jan-Feb;62(1):53-67. 2000, 16: 1-193. Health (MoH) has developed the country’s first National Community Health Strategy (NCHS) for the period of 2017-2022. For the pregnant teenager the extended family may need to be included in health promotion activities particularly if breastfeeding targets are to be met. Midwifery 2020 Programme: Midwifery 2020: Delivering Expectations.,,,,, Health policies, systems and management in high-income countries. The strategy takes into account the dynamism of global health – five years from now, WHO and partners will take stock and continue to align strategies with evidence-based global health trends. This was seen as the key to attaining Health for All . Cochrane database of systematic reviews issue 9. This article is published under license to BioMed Central Ltd. 10.1111/j.1471-0528.2007.01389.x. Clarke [15] suggests the successful interpretation of results from systematic reviews should consider the methodological conduct of the review. those which do not work and sometimes are deeply embedded into practice, for example, routine antenatal CTG for fetal assessment [20]. 10.1016/j.jclinepi.2008.10.009. Recognition of the importance of the relationship between public health and midwifery was highlighted when a general review of midwifery in the UK [1], named public health as one of five key areas of interest. The cost effectiveness of this method was also emphasised, however, further research is necessary to determine the intensity level of the intervention to maximise effectiveness. The mean birth weight was higher (11 studies; WMD 54g; 95% CI 36-72g) in infants born to mothers who had micronutrient supplementation compared to iron-folic acid supplementation (no difference with placebo). Cochrane database of systematic reviews issue 4, . Data were extracted on: number of papers included in the review; methodological details; midwifery intervention; outcome measures and results. A Qualitative Study. Cochrane database of systematic reviews issue 8. The Australian Digital Health Agency is tasked with ... consultation sessions, written submissions, and a public survey between December 2019 and March 2020. perceptions of women and obstetricians about cesarean sections for nonclinical indications. Public health nursing and midwifery Posted by: Viv Bennett , Posted on: 12 February 2015 - Categories: midwifery , Nursing In Jan 2015, the Department of Health (DH) and Public Health England (PHE) announced that ‘responsibility for public health nursing and midwifery leadership will transfer to PHE from April, … BMC Nutr. There was no difference between groups for birth by caesarean section (RR 0.96; 95% CI 0.87-1.06) and no statistically significant differences in fetal loss/neonatal death of at least 24 weeks (RR 1.01; 95% CI 0.67-1.53) or fetal/neonatal death overall (RR 0.83; 95% CI 0.70-1.00) and their babies were more likely to have a shorter length of hospital stay (mean difference in days: -2.00; 95% CI −2.15 to −1.85). Midwives should seek to respond positively to service changes to achieve the goal of multidisciplinary, non-hierarchical patient-centred services. Contributions were received from nurses, midwives, educational experts, and nursing and midwifery ... National … 10.1136/bmj.39320.843947.BE. Description This subject contributes to students' understanding of midwifery as a public health strategy situated in a woman-centred and primary healthcare framework. Smoking cessation in New Zealand: education and resources for use by midwives for women who smoke during pregnancy. Hofmeyr GJ, Duley L, Atallah A: Dietary calcium supplementation for prevention of pre-eclampsia and related problems: a systematic review and commentary. There was a significant reduction of smoking in late pregnancy (RR 0.94; 95% CI 0.93-0.96), reduction in LBW (RR 0.83; 95% CI 0.73 -0.95), preterm birth (RR 0.86; 95% CI 0.74-0.98) and an increase in mean birth weight (53.91g; 95% CI 10.44g - 95.38g). 2012, 10.1016/j.midw.2012.01.002. 2010, Chichester, UK: John Wiley & Sons. IMPLICATIONS FOR PRACTICE: Midwifery practice can have a profound impact on maternal and infant health both short and long-term, so it is critical that all midwives take up the public health challenge for the benefit of the population they serve. Abstract. Electronic address: Article  BJOG. Identification of effective reviews of high quality *some reviews which were included at the request of funder have been excluded from this paper eg economic reviews (n=6) **non significant, non effective or inconclusive reviews, reviews graded 2++,2+ or 2- and medium or low quality reviews are not discussed in this paper. The findings section also presents the logic model which was developed in parallel with the searching and analysis of reviews. 10.1016/S0140-6736(00)04723-1. Hatem M, Sandall J, Devane D, Soltani H, Gates S: Midwife-led versus other models of care for childbearing women. Logic models highlight the causal linkage between inputs, outputs and outcomes (24). 2003 Dec;18(4):315-25. doi: 10.1093/heapro/dag405. A summary of included reviews is provided in Table 3. These findings were supported by Chung et al. This strategy has been developed in collaboration of all partners and stakeholders in line with existing policies and the Health Sector Strategic Plan (HSSP II). Cochrane database of systematic reviews issue 4. The search strategy utilised in the review was specifically focused on the public health role of the midwife and therefore incorporated key terms relative to key areas. Rabe et al. Reviews on this topic generally related to either support or promotion of breastfeeding. Midwives' Role in Providing Nutrition Advice during Pregnancy: Meeting the Challenges? Proactive support for our professions 3. Paediatr Perinat Epidemiol. 2007, 98: 253-259. Reading from left to right on the model indicates that the midwifery public health intervention is next so for example if a midwife provides information about antenatal screening for HIV (input), then uptake of screening may improve and at risk women will be identified earlier (outputs) and the effect will improve maternal and infant health during pregnancy. health equity audits, engaging the community, and the transition. The flow chart in Figure 1 presents the sequential process of identifying reviews eligible for inclusion in this paper. Dyson L, McCormick FM, Renfrew MJ: Interventions for promoting the initiation of breastfeeding. School of Nursing & Midwifery, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, Ireland, Jenny McNeill, Fiona Lynn & Fiona Alderdice, You can also search for this author in While the authors were unable to conduct a meta analysis they found from individual trials, statistically significant results relating to kangaroo care, peer counselling, in home breast milk measurement, and post discharge lactation support for improving breast feeding outcomes. The final conclusions of Bricker et al. Vanderveen JA, Bassler D, Robertson CM, Kirpalani H: Early interventions involving parents to improve neurodevelopmental outcomes of premature infants: a meta-analysis. Corcoran & Pillai [59] reviewed rates in repeat pregnancy following the introduction of hospital-based programmes providing education and counselling to a sample of adolescent mothers. 2010, London: HMSO. [49] concluded that continuous support should be the norm rather than the exception for all women and further research is required as to the effectiveness of doula or lay support. Chung et al. public health skills and careers framework (Public Health Resource Unit/ Skills for Health 2009) Midwives with strategic responsibility in the field of public health working with local authority public health departments and nationally with Public Health England Midwifery leaders: Heads of Midwifery and Local Supervisory … In facilitating change midwives seek to use their influence to the benefit of the pregnant woman. Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, Grimshaw J, Henry DA, Boers M: AMSTAR is a reliable and valid measurement toll to assess the methodological quality of systematic reviews. J Fam Psychol. Health promotion is of particular importance to midwives who promote health rather than manage disease and ill health. Carroli G, Piaggio G, Khan-Neelofur D: WHO systematic review of randomised controlled trials of routine antenatal care. Eight reviews [30–37] considered supplementation during pregnancy including iron, micronutrients, folic acid, calcium and Long Chain-Poly Unsaturated Fatty Acids (LC-PUFA’s). eCollection 2018. Maternal death or serious morbidity was reduced (RR 0.80; 95% CI 0.65-0.97) although this was mostly in low risk women and women with low calcium and there was no effect on preterm births, stillbirth or death before discharge. 10.1111/j.1523-536X.2010.00459.x. In addition, women who were randomised to receive midwife-led care were less likely to experience fetal loss before 24 weeks’ gestation (RR 0.79; 95% CI 0.65-0.97). Download. CAS  More information. It Find NCBI SARS-CoV-2 literature, sequence, and clinical content: Cignacco E, Zu Sayn-Wittgenstein F, Sénac C, Hurni A, Wyssmüller D, Grand-Guillaume-Perrenoud JA, Berger A. BMC Health Serv Res. This is illustrated very clearly in relation to support for parents in the form of parenting interventions (input) which can result in the short term outcome of increasing support for women to improve health and lifestyle; optimize lifestyle and child development beyond the immediate perinatal period (medium term) and in the long term improve family health and wellbeing for this generation and those to come. Cochrane database of systematic reviews issue 4. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. They found that women who took part in a diet (1 trial; n=45; WMD −1.70 kg; 95% CI −2.08 to −1.32; z=8.73; p<0.00001), and women on a diet plus exercise programme (4 trials; n=169; WMD −2.89 kg; 95% CI −4.83 to −0.95; z=2.92; p<=0.00049), lost significantly more weight than women in the usual care. Zdr Varst. There are a number of methodological challenges in using systematic review evidence which must be taken into account. One review focused on improving maternal mental health and considered postnatal psychological and psychosocial interventions [57]. IMPLICATIONS FOR PRACTICE: Midwifery practice can have a profound impact on maternal and infant health both short and long-term, so it is critical that all midwives take up the public health challenge for the benefit of the … Well-trained midwives could help avert roughly two thirds of all maternal and newborn deaths, according to the most recent State of the World’s Midwifery report. 10.1038/jp.2008.229. J Obstet Gynecol Neonatal Nurs. Dennis & Hodnett [57] reported that any psychosocial or psychological intervention compared to usual postpartum care was associated with a reduction in the likelihood of continued depression from their review of nine trials. 2009, 4: 206-210. A shift in research, policy and practice is needed to fully articulate the public health role of the midwife. Breastfeeding interventions included in both Britton et al. Integrate efficient and effective hospital services across healthcare providers. Get the latest research from NIH: In addition, due to the inclusion and exclusion criteria applied, it is possible that extensive broad reviews on particular topics have been excluded from this review due to the nature of evidence included within them, for example, the NICE Guideline on Antenatal and Postnatal Mental Health [9]. The most recent review [36] conducted by several of the same authors as Hofymeyr et al.  |  The authors report a positive effect on breast feeding (3 trials; n=618; RR=1.18; 95% CI 1.05-1.33), low birth weight (3 trials; n=2,027; RR=0.78; 95% CI 0.63-0.97) and postpartum depression at 4 weeks (RR 0.24; 95% CI 0.06-1.00) and 8 weeks (RR 0.30; 95% CI 0.10-0.92), although all were from small numbers of trials and the finding on postpartum depression was from one pilot trial including 42 women. Primary health care within a public health strategy focuses on improving the health of the population. This paper sought to report on systematic reviews providing high quality evidence of effective interventions, in essence the ‘cream of the crop’. To improve health outcomes, the Aboriginal Nursing and Midwifery Strategy has made it a priority to provide employment opportunities and support Aboriginal and Torres Strait Islander nurses and midwives working in NSW Health. The authors also highlighted an increased rate (22%) of any (RR 1.22; 95%CI 1.08-1.37) and exclusive (RR 1.65; 95%CI 1.03-2.63) short term breastfeeding with interventions that included a component of lay support. The PHE Strategy 2020 to 2025 sets out how Public Health England will work to protect and improve the public’s health and reduce health inequalities over the next 5 years.. [26] indicated that a two stage regimen of USS in pregnancy, one in early pregnancy (booking USS) and a second anomaly USS around 20 weeks, was recommended. J Adv Nurs. Included reviews have been grouped into screening, supplementation, support, education and mental health. Hodnett & Fredericks [39] assessed the value of emotional support to women who were judged, by a health professional, to be at increased risk of preterm delivery or having a low birth weight baby.

midwifery public health strategy

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