Martin-Luther University Halle-Wittenberg, Institute of Health and Nursing Science, Magdeburger Strasse 8, 06112 Halle, Saale, Germany.
Midwifery. 2012 Aug;28(4):E469-77. doi: 10.1016/j.midw.2011.05.009. Epub 2011 Jul 23.
the aim of two related studies was an in-depth knowledge of psychosocially and health-related vulnerable families and the 'portfolio' of care that family midwives (FM) provide. Besides factors which influence acceptance and access from the mothers' perspective, the effectiveness of FM with regard to care, infant nutrition, and parent-child relationship as well as multidisciplinary collaboration were of interest, especially against the backdrop of Germany's national aim to strengthen prevention of neglect and abuse of infants. In addition, the reasons why families did not want FM care were explored.
two FM model projects in Saxony-Anhalt (SA) and Lower Saxony (LS), Germany, were evaluated. Quantitative data were prospectively collected on 93% of vulnerable families being cared for by FM (SA) and regarding vulnerable families that declined FM care (LS). These data were complemented by problem-focused interviews with 14 mothers and six social workers (LS).
the 33 FM in SA and 11 FM in LS are community-based and visit vulnerable families from pregnancy up to the first birthday of the child, maximally. They provide health promotion, maternal and infant care, and multidisciplinary support geared towards early prevention of child neglect and abuse.
from May 2006 until 2008 (SA) and from January 2008 until December 2009 (LS) 814 and 235 vulnerable families, respectively, were cared for by FM. Complete data on 734 families were analysed (SA) as were 30 questionnaires on 'non-compliant' families (LS). Problem-focused interviews were conducted with 14 mothers and 6 social workers (LS).
many families exhibited a high vulnerability score of complex risk factors. Four vulnerability patterns were statistically extracted explaining 40% of the total variance. The highest frequencies of care activities related to infant care and nutrition, giving advice on the Mother-Child relationship, and psychosocial support. The Youth Welfare Services (YWS) were significant collaboration partners, especially regarding families whose child was taken out for safety reasons. By conclusion of care, significantly higher mean scores were observed regarding 'parent-child relationship' and 'maternal care for child' (compared to the outset of care) when mean duration of care was at least 6 months. The children who were taken out of their families had significantly lower scores in nutritional care, and were given solids at a significantly earlier time. From the mothers' perspective it was important to have early access to the FM and easy between-visits communication via phone calls, or text messages. They appreciated the physical and psychosocial care for the infant and herself, an uncomplicated transition from caseload midwifery, and collaboration among providers. Families who declined FM care wanted to stay with their self-chosen midwife, were afraid of external control, or felt they were able to cope without professional support.
when families can access FM early on and home-visits are sustained, maternal competencies in caring for, and relating to, the child can potentially be strengthened. FM seem to fill a gap between standard care by caseload midwives ending at 8 weeks postpartum and YWS whose personnel is not skilled in the assessment of health-related problems, such as inadequate infant nutrition. As a relatively high percentage of the families were challenged by domestic violence, drug addiction, and teenage pregnancy, ongoing educational activities should address these topics.
两项相关研究的目的是深入了解在心理社会和健康方面脆弱的家庭以及家庭助产士（FM）提供的“组合”护理。除了从母亲的角度出发影响接受和获取的因素外，FM 在护理、婴儿营养、亲子关系以及多学科合作方面的有效性也引起了人们的兴趣，尤其是在德国加强预防婴儿忽视和虐待的国家目标背景下。此外，还探讨了为什么有些家庭不希望接受 FM 护理。
对德国萨克森-安哈尔特州（SA）和下萨克森州（LS）的两个 FM 示范项目进行了评估。对 93%由 FM （SA）护理的脆弱家庭和拒绝 FM 护理的脆弱家庭（LS）进行了前瞻性收集定量数据。这些数据由 14 位母亲和 6 位社会工作者（LS）的问题导向访谈补充。
SA 的 33 名 FM 和 LS 的 11 名 FM 都是以社区为基础的，最多可以从怀孕到孩子一岁时为脆弱家庭提供服务。他们提供健康促进、母婴护理和多学科支持，旨在早期预防儿童忽视和虐待。
2006 年 5 月至 2008 年（SA）和 2008 年 1 月至 2009 年 12 月（LS）期间，分别有 814 名和 235 名脆弱家庭接受了 FM 护理。对 734 个家庭（SA）进行了完整数据分析，对 30 个“不遵守”家庭（LS）的问卷进行了分析。对 14 位母亲和 6 位社会工作者（LS）进行了问题导向访谈。
许多家庭表现出复杂风险因素的高脆弱性评分。统计提取了四个脆弱性模式，解释了总方差的 40%。与婴儿护理和营养、母婴关系咨询以及心理社会支持相关的护理活动频率最高。青年福利服务（YWS）是重要的合作伙伴，尤其是对于那些因安全原因而将孩子带走的家庭。在护理结束时，与护理开始时相比，“母婴关系”和“母亲对孩子的照顾”的平均得分显著更高，当护理时间至少为 6 个月时。被带出家庭的孩子在营养护理方面的得分明显较低，并且更早开始食用固体食物。从母亲的角度来看，尽早接触 FM 和通过电话或短信进行便捷的访后沟通非常重要。他们赞赏 FM 对婴儿和自己的身体和心理社会护理，以及从案例助产护理到提供者之间合作的顺利过渡。拒绝 FM 护理的家庭希望继续与他们选择的助产士在一起，担心受到外部控制，或者觉得自己可以在没有专业支持的情况下应对。
当家庭能够及早获得 FM 护理并持续进行家访时，母亲在照顾和与孩子相处方面的能力可能会得到加强。FM 似乎填补了标准案例助产护理在产后 8 周结束和 YWS 之间的空白，后者的人员不具备评估婴儿营养等健康相关问题的技能。由于相当一部分家庭面临家庭暴力、吸毒和青少年怀孕的挑战，因此应继续开展教育活动来解决这些问题。
