School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, Scotland EH11 4BN, United Kingdom.
Department of Health and Science, School of Midwifery, Artesis Plantijn Hogeschool Antwerpen, Noorderplaats 2, Antwerp 2000, Belgium.
Women Birth. 2024 Nov;37(6):101840. doi: 10.1016/j.wombi.2024.101840. Epub 2024 Oct 31.
BACKGROUND/PROBLEM: To integrate midwife-led care in Belgian maternity services, understanding whether midwives are primed of executing the change is needed.
To explore Belgian midwives' readiness for midwife-led care and understand the underlying processes.
A mixed-methods sequential study: 1) A survey including 414 practising midwives and 2) individual interviews with 12 (student) midwives. General linear model analysis was used to examine the trend between knowledge, self-efficacy and performance mean scores - indicators of midwife-led care readiness - proposed in a 27-item questionnaire. The Readiness Assessment Framework served as a template for qualitative thematic analysis.
Template analysis illustrated the underlying mechanisms of midwifery-led care readiness: Governmental and institutional steering and rule-making functions, regulation and reimbursement, awareness of midwife-led care among stakeholders, capacity to extend primary care postpartum services to antenatal and intrapartum care and healthcare professionals' lack of awareness of available data of women's experiences and midwife-led care efficacy in Belgium. These qualitative findings contribute to the understanding of the significant trend with decreasing function for knowledge, self-efficacy and performance mean scores of 25 midwife-led care readiness indicators, and the two non-significant indicators referring to a physiological postpartum period.
DISCUSSION/CONCLUSION: In determining midwife readiness for midwife-led care, we observed adequate knowledge mean scores, associated with low self-efficacy and even lower midwife-led care performance mean scores. Our findings suggest limited readiness for MLC in antenatal and intrapartum care. Belgian midwives are the domain experts of postpartum services but face challenges in extending midwife-led care to antenatal and intrapartum services.
背景/问题：为了在比利时的产妇护理服务中整合助产士主导的护理，需要了解助产士是否准备好执行这种转变。
探索比利时助产士对助产士主导的护理的准备情况，并了解潜在的过程。
一项混合方法的顺序研究：1）一项包括 414 名执业助产士的调查，2）对 12 名（学生）助产士进行的个人访谈。一般线性模型分析用于检查在一个包含 27 个项目的问卷中提出的助产士主导的护理准备的知识、自我效能和绩效平均得分的趋势 - 助产士主导的护理准备的指标。准备评估框架作为定性主题分析的模板。
模板分析说明了助产士主导的护理准备的潜在机制：政府和机构的指导和规则制定功能、监管和报销、利益相关者对助产士主导的护理的认识、将初级产后护理服务扩展到产前和产时护理的能力以及医疗保健专业人员对妇女在比利时的经验和助产士主导的护理效果的可用数据的认识不足。这些定性发现有助于理解具有重要意义的趋势，即 25 个助产士主导的护理准备指标的知识、自我效能和绩效平均得分的功能下降，以及两个与生理产后阶段有关的非显著指标。
讨论/结论：在确定助产士对助产士主导的护理的准备情况时，我们观察到足够的知识平均得分，与低自我效能甚至更低的助产士主导的护理绩效平均得分相关。我们的发现表明，在产前和产时护理中，助产士主导的护理的准备程度有限。比利时助产士是产后服务的领域专家，但在将助产士主导的护理扩展到产前和产时服务方面面临挑战。
