Listening, Learning and leading change: The ACT Maternity Experience Survey

Interpersonal violence around pregnancy is of increasing global public healthconcern affecting both women themselves and their children. The primary aim ofthis study is to explore and identify potential correlates of such violence andto examine maternal and birth outcomes subsequent to that violence in anationally representative sample of urban and rural women in Canada. The dataare from the Maternity Experiences Survey (MES), a Canadian population-basedpostcensus survey administered to 6,421 Canadian mothers in 2006. Surveyparticipants were 15 years and older and had given birth to a singleton andcontinued to live with their infant at the time of the survey. The surveyresponse rate was 78%. Multivariable logistic regression analyses were used inthe analysis with adjustments made for confounding variables. The study findingsindicated that living in an urban environment was associated with an increasedrisk of interpersonal violence experience around the time of pregnancy(OR = 1.31, 95% CI: 1.03-1.66). In addition, beingaboriginal, young, unmarried, economically disadvantaged, a nonimmigrant, andhaving more than four pregnancies, as well as cigarette smoking, alcoholdrinking and drug use before the pregnancy were correlated with interpersonalviolence around pregnancy. Maternal interpersonal violence experiences were alsoassociated with postnatal depression and stressful life events among both urbanand rural mothers. However, maternal interpersonal violence experiences wereonly associated with preterm birth among rural mothers but not among urbanmothers. The present study highlights the need to implement effectiveinterventions for women experiencing interpersonal violence around pregnancy dueto its potential impact on maternal and newborn’s physical and mental health.Screening and intervention should be targeted high-risk women particularly thosewho are indigenous, young, unmarried, nonimmigrants, of lower socioeconomicstatus, and manifesting high risk health behaviors.

With a focus on socioeconomic position, we examined the association between maternal education and nonsupine infant sleep position, and examined patterns of effect modification with additional sociodemographic, maternal, infant, and health services predictors. Data were from the Maternity Experiences Survey, a national population-based sample of 76 178 new Canadian mothers (unweighted n = 6421) aged 15 years or older interviewed in 2006-2007. Using logistic regression, we developed multivariate models for 3 maternal education strata. Level of maternal education was significantly and inversely related to nonsupine infant sleep position. Stratified analyses revealed different predictive factors for nonsupine infant sleep position across strata of maternal education. Postpartum home visits were not associated with use of this sleep position among new mothers with less than high school completion. Adequacy of postpartum information regarding sudden infant death syndrome was not associated with nonsupine infant sleep position in any of the educational strata. These findings suggest a need to revisit Back to Sleep health promotion strategies and to ensure that these interventions are tailored to match the information needs of all families, including mothers with lower levels of formal education.

BackgroundOne of the biggest challenges for population health studies is the recruitment of participants. Questions that investigators have asked are “who volunteers for studies?” and “does recruitment method influence characteristics of the samples?” The purpose of this paper was to compare sample characteristics of two unrelated pregnancy cohort studies taking place in the same city, in the same time period, that employed different recruitment strategies, as well as to compare the characteristics of both cohorts to provincial and national statistics derived from the Maternity Experiences Survey (MES).MethodsOne pregnancy cohort used community-based recruitment (e.g. posters, pamphlets, interviews with community media and face-to-face recruitment in maternity clinics); the second pregnancy cohort used both community-based and population-based (a centralized system identifying pregnant women undergoing routine laboratory testing) strategies.ResultsThe pregnancy cohorts differed in education, income, ethnicity, and foreign-born status (p < 0.01), but were similar for maternal age, BMI, and marital status. Compared to the MES, the lowest age, education, and income groups were under-represented, and the cohorts were more likely to be primiparous.ConclusionsThe findings suggest that non-stratified strategies for recruitment of participants will not necessarily result in samples that reflect the general population, but can reflect the target population of interest. Attracting and retaining young, low resource women into urban studies about pregnancy may require alternate and innovative approaches.

Issue Patient experiences are central to the delivery of quality, person-centred care and an important predictor of outcomes. Prior to 2017, there was no unified, national approach to the collection of care experience data in Ireland. Description of the problem The National Care Experience Programme is a partnership between a regulator, policy makers and the Irish public health service, with a suite of surveys of inpatient, maternity, nursing home and end of life care. The surveys aim to learn from people's feedback on health and social care services to identify areas of good experience and areas requiring improvement. Results Findings have informed national policies, including a healthcare communication programme to support staff to develop communication skills with patients and families. Survey data provide a key input to the Irish health quality indicator framework and the Health Systems Performance Assessment Framework, which assess the overall performance of the Irish health system. National Maternity Experience Survey results informed the allocation of funding for post-natal supports and new lactation consultant posts, and supported the implementation of a specialist perinatal mental health services model of care, leading to increased diagnosis and vigilance of mental health issues ante- and postnatally. National Nursing Home Experience Survey findings supported legislative amendments, including provision for the delivery of in-person advocacy awareness campaigns and the strengthening of complaints processes within nursing homes. Lessons In order to maximise the use of survey findings and ensure the voices of people using health and social care services are acted on, routine surveying of care experiences is required to track the impact of policy and practice initiatives. The programme is currently expanding to include people's experiences of cancer care and mental health services, in addition to exploring options for continuous, local care experience surveys.

Women's experiences of initiating feeding shortly after birth in Ireland: A secondary analysis of quantitative and qualitative data from the National Maternity Experience Survey

Listening to Mothers is the first national United States survey that explored women's attitudes, feelings, and knowledge about their maternity care and childbearing experiences. The report also systematically documented at the national level the frequency of many aspects of childbearing from prepregnancy care through postpartum physical and mental health outcomes. The results have increased understanding about many dimensions of childbearing in the United States and identified opportunities for improving the maternity experience in the country. The survey was a project of the Maternity Center Association in New York City, which also developed recommendations published in response to survey results.

Background Patient experience surveys are a key source of evidence for supporting decision-making and quality improvement in healthcare services. These surveys contain two main types of questions: closed and open-ended, asking about patients’ care experiences. Apart from the knowledge obtained from analysing closed-ended questions, invaluable insights can be gleaned from free-text data. Advanced analytics techniques are increasingly used to harness free-text data, yet existing approaches do not offer the rigour required to support formal decision-making through free-text. Methods This study addresses the challenge of effectively and rigorously analysing patients’ free-text feedback to improve maternity and acute hospital services in Ireland. Aspects of healthcare services (i.e. themes) that could be improved were determined using computational text analytics and predictive modelling. Themes extracted from comments were prioritised based on volume, the intensity of negative affect expressed in the texts, and the estimated influence of the themes on overall patient satisfaction. Results Results demonstrate the viability of producing rigorous evidence for prioritising interventions to improve healthcare services based on free-text feedback. Specifically, consistency in advice and support in breastfeeding were among the most important issues for maternity services. For acute hospital services, meals quality and access, A&amp;E waiting time, ward hygiene and communication at discharge were among the most important issues. Women also wanted more emphasis on prior birth experience and complications in future maternity care surveys. Conclusions Advances in computational text modelling enable the extraction of concrete and actionable insights from the analysis of free-text data. This approach also allows decision-makers to prioritise emergent themes and inform actions that will positively impact overall patient satisfaction.

The study aims to describe overall gestational weight gain among Canadian women and to assess demographic, socio-economic, maternal, and pregnancy-related characteristics of gestational weight gain including uncovering the predictors above or below the range recommended by Health Canada. This study proceeds as a secondary data analysis of the Maternity Experiences Survey targeting women aged ≥15years who had singleton live births in the Canadian provinces and territories in 2005/2006. The outcome variable considered was gestational weight gain within and outside the recommended guidelines. Various factors including demographic, socio-economic, maternal, and pregnancy-related characteristics were considered using multivariate statistical techniques. Bootstrapping was performed to account for the complex sampling design. One-third of women gained within the recommended guideline (32.6%), 18.7% gained below, and 48.7% gained above the recommended guideline. More than half of overweight (67.6%) or obese women (60.0%) gained above the guideline, and women with lower socio-economic status were more likely to gain above the recommended range. Conversely, being an immigrant, multiparous, and having health problems during pregnancy were associated with less weight gain during pregnancy as well as higher odds of gaining insufficient weight to meet the minimal weight gain guideline. In Canada, almost half of the women gain above the recommended guideline for weight gain in pregnancy. The findings may be useful to design interventions that target those at risk of gaining outside of the recommended guidelines and to reduce outcomes associated with inadequate or excessive gestational weight gain.

Review question/objective The overall aim of this systematic review is to identify the appropriateness and meaningfulness of maternal-child simulation-based learning for undergraduate or pre-registration nursing students in educational settings to inform curriculum decision-making. 1. What are the experiences of nursing or health professional students participating in undergraduate or pre-licensure maternal-child simulation-based learning in educational settings? 2. What are the experiences of educators participating in undergraduate or pre-licensure maternal-child simulation-based learning in educational settings? 3. What teaching and learning practices in maternal-child simulation-based learning are considered appropriate and meaningful by students and educators? Inclusion criteria Types of participants Participants will include undergraduate or pre-registration or pre-licensure nursing or midwifery or health professional students and educators participating in maternal-child simulation-based learning. Midwifery or undergraduate medical students are included as participants as their clinical learning experiences are similar to undergraduate nursing students. However students in graduate, postgraduate, or specialty education programs and practising nurses or other health care professionals (continuing education) will be excluded from this review because the purpose is to identify the implications for undergraduate or pre-registration nursing programs. Undergraduate or pre-registration education differs from continuing professional education as students are more likely to be learning this way of thinking or clinical reasoning for the first time. The pedagogical approaches used also differ from continuing professional development. Phenomena of interest This review will consider studies that investigate simulation-based learning experiences that are relevant to maternal-child nursing. Our primary interest in this review is in preparing nursing students for senior level maternal-child practice placements and transition to working as an Registered Nurse. However, we will include all qualitative studies and case reports of simulation-based learning that involve pre-registration nursing or health professional students. Context The purpose of this review is to identify the implications of this body of knowledge for undergraduate or pre-registration nursing programs in Canada This review will include qualitative research that may be applicable to the Canadian context for nursing education, such as reports from North America, Europe, Australia and New Zealand.

Satisfaction is a key component of the care experience and part of the health system "triple aim," along with improving population health and reducing per capita health care costs, the other two parts of the "triple aim." The objectives of the study were to examine birth-experience satisfaction among women in Ontario, Canada, who received care from midwives, family physicians, and obstetricians. We used Statistics Canada's 2006 national Maternity Experiences Survey. The sample includes 1900 Ontario women and is, with appropriate weighting, representative of an estimated population of 29700 women who gave birth in Ontario to a singleton baby during the study period. Information was collected on respondents' satisfaction with their health care providers, demographic characteristics, and a range of pregnancy, labor, birth, and postpartum experiences. We used logistic regression analysis to assess differences in patient/client satisfaction by type of health care provider. Women cared for by midwives were three times more likely to be satisfied with their care (OR 3.32 [95% CI 2.26-4.86]) when compared with obstetrician-led care. Depression symptoms, having to travel outside the respondents' community to give birth, and being born in an East Asian country were associated with lower levels of satisfaction. Given recent health system reforms emphasizing the importance of shifting from expensive acute hospital-based care to community-based care, our findings support empirically the importance of supporting women's access to midwifery services within their communities. Findings of ethnocultural differences in satisfaction with care can inform policy makers as health systems move to provide culturally appropriate care to increasingly diverse populations.

BackgroundThe aim of this study was to investigate the factors associated with the timing of the first prenatal ultrasound in Canada.MethodsThis was a secondary data analysis of the Maternity Experiences Survey, a cross-sectional survey covering different aspects of pregnancy, labour, birth and the post-partum period. Bivariate and multivariate multinomial logistic regressions were performed to assess the relationship between timing of first prenatal ultrasound and different independent variables.Results68.4% of Canadian women received an optimally timed first prenatal ultrasound, 27.4% received early ultrasounds and 4.3% received late ultrasound. The highest prevalence of early ultrasound was in Ontario (33.3%) and the lowest was in Manitoba (13.3%). The highest prevalence of late ultrasound was found in Manitoba (12.1%) and the lowest was in British Columbia and Ontario (3.5% each). The highest prevalence of optimal timing of first prenatal ultrasound was in Quebec (77%) and the lowest was in Ontario (63.2%). Factors influencing the timing of ultrasound included: Early – maternal age < 20 (adjusted OR = 0.54, 95%CI:0.34–0.84), alcohol use during pregnancy (adjusted OR = 0.69, 95%CI:0.53–0.90), history of premature birth (adjusted OR = 1.41, 95%CI:1.06–1.89), multiparity (adjusted OR = 0.67, 95%CI:0.57–0.78), born outside of Canada (adjusted OR = 0.82, 95%CI:0.67–0.99), prenatal care in Newfoundland and Labrador (adjusted OR = 1.66, 95%CI:1.20–1.30), Nova Scotia (adjusted OR = 1.68, 95%CI:1.25–2.28), Ontario (adjusted OR = 2.16, 95%CI:1.76–2.65), Saskatchewan (adjusted OR = 1.50, 95%CI:1.05–2.14), Alberta (adjusted OR = 1.37, 95%CI:1.05–1.77) British Columbia (adjusted OR = 1.90, 95%CI:1.45–2.50) and Manitoba (adjusted OR = 0.66, 95%CI:0.45–0.98) Late – unintended pregnancy (adjusted OR = 1.89, 95%CI:1.38–2.59), born outside of Canada (adjusted OR = 1.75, 95%CI:1.14–2.68), prenatal care in Manitoba (adjusted OR = 2.88, 95%CI:1.64–5.05) and the Territories (adjusted OR = 4.50, 95%CI:2.27–8.93). An interaction between history of miscarriage and having ‘other’ prenatal care provider significantly affected timing of ultrasound (adjusted OR = 0.31, 95%CI:0.14–0.66).ConclusionOnly 68% of Canadian women received an optimally timed prenatal ultrasound which was influenced by several factors including province of prenatal care, maternal age and country of birth, and an interaction effect between prenatal care provider and history of miscarriage. These findings establish a baseline of factors influencing the timing of prenatal ultrasound in Canada, which can be built upon by future studies.

To describe national and regional prevalence rates for significant depressive symptoms in women after 12 weeks during the postpartum period, and to identify predictors of postpartum depressive symptoms during this later time period. Data from the Maternity Experiences Survey of the Canadian Perinatal Surveillance System were analyzed. Participants completed a computer-assisted telephone interview between 5 and 14 months during the postpartum period (n = 6421). Depressive symptomatology was measured using the Edinburgh Postnatal Depression Scale (EPDS ≥ 13). Proportions and odds ratios with 95% confidence intervals were calculated using bootstrap methods to account for sample design and weighting adjustments. About 8% of Canadian women exhibited depressive symptoms past 12 weeks during the postpartum period. Prevalence rates varied between regions. In multivariable analysis, previous history of depression (OR 1.87; 95% CI 1.43 to 2.45, P < 0.001), low household income (OR 1.64; 95% CI 1.27 to 2.11, P < 0.001), low postpartum social support (OR 3.95; 95% CI 2.77 to 5.62, P < 0.001), stressful life events (OR 2.43; 95% CI 1.88 to 3.15, P < 0.001), interpersonal violence (OR 1.40; 95% CI 1.04 to 1.87, P = 0.02), and poor self-perceived maternal health (OR 4.48; 95% CI 3.15 to 6.38, P < 0.001) were independently associated with postpartum depressive symptoms. Regional differences in correlates of postpartum depressive symptoms were found. The finding that depression rates are elevated throughout the first postpartum year is important because of the known negative impact of postpartum depression (PPD). Targeted public health interventions may be needed to reduce the prevalence of PPD and its associated impact.

To assess whether partner disengagement from pregnancy is associated with adverse maternal and infant outcomes. We analyzed data from the 2006-2007 Canadian Maternity Experiences Survey, comprising a cross-sectional representative sample of 6,421 childbearing women. Multiple logistic regression assessed the association between adverse outcomes and three indicators of partner disengagement: (1) partner did not want the pregnancy, (2) partner argued more than usual in the year prior to the baby's birth, and (3) partner was absent at the delivery. Of all respondents, 3.8% had partners who did not want the pregnancy, 16.1% argued more than usual with their partner in the past year, and 7.6% had partners who were absent at the delivery. Women whose partner did not want the pregnancy were more likely to report intimate partner violence (IPV) (adjusted odds ratio [AOR] 3.55; 95% confidence interval [95% CI] 2.36-5.14), elevated depressive symptoms in the extended postpartum period (AOR 2.56, 95% CI 1.70-3.83), and nonroutine child healthcare visits after birth (AOR 1.54, 95% CI 1.13-2.11). Women whose partner argued more in the past year had higher odds of IPV (AOR 4.82, 95% CI 3.69-6.30), elevated depressive symptoms in the extended postpartum period (AOR 3.63; 95% CI 2.84-4.64), and nonroutine child healthcare visits (AOR 1.49, 95% CI 1.26-1.77), after adjustment for potential confounders. Partner disengagement is common and is associated with adverse maternal and infant outcomes. Affected women may benefit from special assistance during pregnancy and after delivery.

Prenatal maternal stress has been linked to multiple adverse outcomes. Researchers have used a variety of methods to assess maternal stress. The purpose of this study was to explore and compare factors associated with stress in pregnancy as measured by perceived stress and stressful life events. We analyzed data from the Canadian Maternity Experiences Survey. A randomly selected sample of 8,542 women who had recently given birth was drawn from the 2006 Canadian Census. Women were eligible if they were at least 15 years of age, had delivered a live, singleton infant, and were living with their infant at the time of the interview (5-14 months postpartum). Prevalence estimates and odds ratios were calculated using sample weights of the survey and their variances were calculated using bootstrapping methods. Bivariate analyses identified statistically significant factors associated with each stress measure. Backward stepwise multivariate logistic regression models were constructed. A total of 6,421 women (78%) participated in the computer assisted telephone interview. Twelve percent of women experienced high levels of perceived stress and 17.1% reported having three or more stressful life events in the year prior to the birth of their baby. In the final model, psychosocial variables were associated with both outcomes, whereas demographic factors were associated only with life event stress. Different factors contributed to perceived stress and life event stress, suggesting that these concepts measure different aspects of stress. These findings can inform routine psychosocial risk assessment in pregnancy.

BackgroundLow or high prepregnancy body mass index (BMI) and inadequate or excess gestational weight gain (GWG) are associated with adverse neonatal outcomes. This study estimates the contribution of these risk factors to preterm births (PTBs), small-for-gestational age (SGA) and large-for-gestational age (LGA) births in Canada compared to the contribution of prenatal smoking, a recognized perinatal risk factor.MethodsWe analyzed data from the Canadian Maternity Experiences Survey. A sample of 5,930 women who had a singleton live birth in 2005-2006 was weighted to a nationally representative population of 71,200 women. From adjusted odds ratios, we calculated population attributable fractions to estimate the contribution of BMI, GWG and prenatal smoking to PTB, SGA and LGA infants overall and across four obstetric groups.ResultsOverall, 6% of women were underweight (<18.5 kg/m2) and 34.4% were overweight or obese (≥25.0 kg/m2). More than half (59.4%) gained above the recommended weight for their BMI, 18.6% gained less than the recommended weight and 10.4% smoked prenatally. Excess GWG contributed more to adverse outcomes than BMI, contributing to 18.2% of PTB and 15.9% of LGA. Although the distribution of BMI and GWG was similar across obstetric groups, their impact was greater among primigravid women and multigravid women without a previous PTB or pregnancy loss. The contributions of BMI and GWG to PTB and SGA exceeded that of prenatal smoking.ConclusionsMaternal weight, and GWG in particular, contributes significantly to the occurrence of adverse neonatal outcomes in Canada. Indeed, this contribution exceeds that of prenatal smoking for PTB and SGA, highlighting its public health importance.