BACKGROUND: The aim of the present investigation was to uncover whether adverse events related to care in obstetric units have been preceded by specific health care conditions, and whether such causal relations could be classified into general categories. MATERIAL AND METHOD: The data cover 47 supervision cases within the area of pregnancy--and birth care. The cases were handled by the Norwegian Board of Health centrally (n = 32) and the Norwegian Board of Health in the counties (n = 15) in the period 2003-2006. RESULTS: Several conditions caused the adverse events. They could be classified into the four main categories: communication--and cooperation failure, uncertain lines of responsibility, lack of qualification, and weaknesses in the organization. The examination of the material disclosed that at least 2/3 of the adverse event causes could be traced back to organization of the facility and uncertain lines of responsibility. INTERPRETATION: The causes of adverse events in obstetric units are often due to circumstances over which the individual health care personnel had no control. The classification of causes into four main categories can be used as a supplement tool in the internal improvement process at departments of obstetrics.
A philosophy of family-centered maternity and newborn care requires that there be open communication between a woman, her family and health professionals; that the woman be able to choose people to support her, and have those people present during labour and birth; and that the mother and infant remain in close contact whenever possible following birth. Using data from a 1993 survey, the authors conclude that Canadian hospitals still have a long way to go before putting these ideals into practice.
The large obstetric units typical of industrialised countries have come under criticism for fragmented and depersonalised care and heavy bureaucracy. Interest in midwife-led continuity models of care is growing, but knowledge about the accompanying processes of organisational change is scarce. This study focuses on midwives' role in introducing and developing caseload midwifery. Sociological studies of midwifery and organisational studies of professional groups were used to capture the strong interests of midwives in caseload midwifery and their key role together with management in negotiating organisational change.
We studied three hospitals in Denmark as arenas for negotiating the introduction and development of caseload midwifery and the processes, interests and resources involved. A qualitative multi-case design was used and the selection of hospitals aimed at maximising variance. Ten individual and 14 group interviews were conducted in spring 2013. Staff were represented by caseload midwives, ward midwives, obstetricians and health visitors, management by chief midwives and their deputies. Participants were recruited to maximise the diversity of experience. The data analysis adopted a thematic approach, using within- and across-case analysis.
The analysis revealed a highly interdependent interplay between organisational and professional projects in the change processes involved in the introduction and development of caseload midwifery. This was reflected in three ways: first, in the key role of negotiations in all phases; second, in midwives' and management's engagement in both types of projects (as evident from their interests and resources); and third in a high capacity for resolving tensions between the two projects. The ward midwives' role as a third party in organisational change further complicated the process.
For managers tasked with the introduction and development of caseload midwifery, our study underscores the importance of understanding the complexity of the underlying change processes and of activating midwives' and managers' interests and resources in addressing the challenges. Further studies of female-dominated professions such as midwifery should offer good opportunities for detailed analysis of the deep-seated interdependence of professional and organisational projects and for identifying the key dimensions of this interdependence.
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The relationship between centralization of obstetric care and perinatal mortality was studied in 19 Norwegian counties for the period 1986-90. No significant trend was found. However, during the period 1988-1990 prenatal mortality was significantly higher, with a relative risk of 1.21 (95% confidence interval 1.00-1.45), in the three counties with only one obstetric department than it was in all other counties. The analysis did not support the notion that greater centralization of obstetric care would decrease perinatal mortality.
Comment In: Tidsskr Nor Laegeforen. 1992 Nov 20;112(28):3585-61462334
Comment In: Tidsskr Nor Laegeforen. 1993 Jan 10;113(1):66-78424257
BACKGROUND: As small obstetrical departments may not be able to give second-level perinatal care, the delivery unit at Lofoten hospital was for the years 1997-98 reorganized to a modified midwife managed unit. Women at low obstetrical risk were delivered at this unit and women at high risk were referred to the central hospital. We assessed the effectiveness of the risk selection. MATERIAL AND METHODS: The study was a prospective, pragmatic, population-based trial. Desired outcome was defined as a non-operative delivery at 35-42 weeks gestational age giving an infant not needing resuscitation. Intermediate outcomes: Operative deliveries, infants transferred to neonatal intensive care unit and infants diverging from normal. The intended place of delivery was ultimately decided at admittance to the midwife managed unit. RESULTS: Of the 628 women in study 435 (69.3%) gave birth at the midwife managed unit, 152 (24.2%) were selected to be delivered at the central hospital and 41 (6.5%) were transferred to the central hospital after admittance to the midwife managed unit. Desired outcome was recorded in 94% of the deliveries at the midwife managed unit as compared to 50.3% at the central hospital. Women who intended to be delivered at the midwife managed unit, needed fewer operative deliveries and relatively few infants were transferred to the neonatal intensive care unit or diverged from normal. CONCLUSIONS: As nearly 70% of the births occurred at the midwife managed unit and 94% of these deliveries had a desired outcome, this indicates an effective selection process. This model might be an alternative to centralization of births in sparsely population areas.