Continuity of midwifery care: models around the world

Uvod: Kontinuirana babiška obravnava je model oskrbe, pri katerem poznana ali zaupanja vredna babica ali manjša skupina babic podpira žensko od začetka nosečnosti, skozi porod in vse do konca puerperija. Takšna obravnava vključuje spremljanje telesnega, psihološkega, duhovnega in socialnega počutja ženske ter družine med celotnim ciklom prehoda v starševstvo. Pri tem je kontinuiteta oskrbe nepogrešljiv del koncepta celostne obravnave in je temelj babiške prakse. Kontinuiran babiški model prinaša ženskam večje zadovoljstvo s porodno izkušnjo in boljše porodne izide. Tudi babice so bolj zadovoljne zaradi vloge, ki jo imajo v tem modelu. Namen: V prvem delu diplomskega dela smo želeli pregledati različne modele kontinuirane babiške obravnave po svetu. V drugem delu pa smo želeli ugotoviti, ali so babice v Sloveniji pripravljene in željne za delo v takšnem modelu. Metode dela: Za pregled literature smo uporabili deskriptivno metodo dela, v empiričnem delu pa kavzalno neeksperimentalno metodo. Pri tem smo se poslužili kvantitativnega pristopa in za inštrument zbiranja podatkov uporabili anketni vprašalnik. Raziskovalni vzorec je bil uporabljen po vzorcu snežene kepe. Sodelovale so babice, ki so zaposlene v zdravstvenih ustanovah ali opravljajo zasebno babiško prakso. Sodelovanje je bilo anonimno in prostovoljno. Rezultati: V raziskavi je več kot polovica babic navedla, da se počutijo pripravljene za delo v kontinuiranem modelu. Babice večinoma niso zadovoljne s trenutnim modelom izvajanja oskrbe žensk v rodnem obdobju. Skoraj vsi vprašani se strinjajo, da je potreben dostop do kontinuirane babiške obravnave v Sloveniji. Več kot dve tretjini babic je pripravljenih poskusiti delo v kontinuiranem modelu. Babice niso zadovoljne s trenutnimi kompetencami in želijo, da se jih v prakso prenese več. Prav tako se jim zdi pomembno, da med izvajanjem kontinuirane obravnave razvijajo odnos z ženskami. Razprava in zaključek: Kontinuiran model obravnave ima dokazane prednosti za mamo, novorojenčka in babico. Babice so izrazile željo za delo v kontinuiranem babiškem modelu. Vključitev kontinuitete v sedanji zdravstveni sistem zahteva korenite spremembe v načinu dela tako za babice kot tudi za celotni zdravstveni sistem. Zavedati pa se moramo, da takšen model ne bo ustrezal vsem babicam in tudi ne ženskam. Zato je pomembno, da imajo babice možnost izbire, v kakšnem modelu želijo delati.Introduction: Midwife-led continuity models are models of care where the same midwife or team of midwives provide care during the pregnancy, birth, and postpartum period. Midwifery care promotes and maintains the physical, spiritual, emotional, and mental wellbeing of the woman and her family. Continuity of care is indispensable to the concept of holistic woman-centred care and fundamental for midwifery practice. Women who received midwife-led continuity care were less likely to experience interventions and were more likely to be satisfied with their care. Midwives were also more satisfied due to the role they have in the model. Purpose: The objective of this diploma work is to compare different models of care around the world and to determine whether midwives in Slovenia are willing and eager to work in a midwife-led continuity model. Methods: For a systematic review, a descriptive approach is used, and for empirical research, a causal non-experimental research design. The instrument used for quantitative analysis was an online questionnaire. Participants in the survey were midwives who work in hospitals and community or independent practice. Participation was anonymous and voluntary. Results: In the study, more than half of the midwives feel equipped enough to work in a continuity model of care. Most of them are not content with the current model of care for women in the childbearing phase. Almost all of the participants agree that there is a need for a midwife-led continuity model in Slovenia, and more than two-thirds of them are willing to work in a continuity model of care. Midwives are not content with the competencies they currently have and would like to have more autonomy in their practice. To have a relationship with women well established is essential for midwives. Discussion and conclusion: The midwife-led continuity model brings proven benefits to mothers, babies and midwives. In the study, Slovenian midwives expressed their willingness to work in a continuity model of care. Implementation of the midwifery model of continuity demands a radical change in the health system and in the way midwives work. Even though continuity model will not suit all women and midwivesthe midwives need to have a choice in what model of care they want to work