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Rural Women's and Care Providers' Experiences of Maternity Care Wijaya, Hardy Apr 6, 2009

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Rural Women’s and Care Providers’ Experiences of Maternity Care  Hardy Wijaya CRHR  Centre for Rural Health Research • Collaborative Team – Academic and community-based researchers – Policy makers – Administrators – Key stakeholdes  Team arriving at Bella Coola  Centre for Rural Health Research Rural Women’s & Care Providers Experiences of Maternity Care  Stress and Pregnancy  Fetal Fibronectin Testing at Term  Inter-professional Collaboration Study  PROJECTS  Referral Hospital Project  GP Surgeon Project  Rural Birth Index (RBI) Project  Centre for Rural Health Research Rural Women’s & Care Providers Experiences of Maternity Care  Stress and Pregnancy  Fetal Fibronectin Testing at Term  Inter-professional Collaboration Study  PROJECTS  Referral Hospital Project  GP Surgeon Project  Rural Birth Index (RBI) Project  •  By the end of presentation, audience could hopefully… 1. Be informed about rural maternity ‘crisis’ in BC 2. Appreciate the challenges faced by women in rural BC 3. Appreciate the difficulties faced by local leaders and care providers  INTRODUCTION • Rural maternity care services are in decline in Canada • In BC, over 20 closures since 2000  Nakusp  INTRODUCTION • For the women… have to travel outside of their communities to access intrapartum and/or prenatal services. • For care providers… feel unsupported? sense of loss?  How is the change being experienced by the women and the care providers?  METHODS • Approach: • Sites: qualitative, community based – Focus group / group interview – One-on-one interview Haida Gwaii  Alert Bay North Island Sparwood  METHODS • Participants: Women  Care Providers, Local Leaders, Administrators  Group interview (25 participants)  Group interview (5 participants)  One-on-one unstructured (20 participants)  One-on-one semi-structured (30 participants)  METHODS • Analysis: – Transcribing (audio  text) – Coding into “themes” – QSR NU*DIST software  RESULTS Importance of Local Birth • •  Comfort of Local Birth Positive Community Experience  Women’s Experience of Maternity Care  RESULTS Importance of Local Birth • •  Comfort of Local Birth Positive Community Experience  Women’s Experience of Maternity Care “The hospital sent me a card and thanked me, because there had been some major tragedy in this community just before and that was really sad for a passing away and all this crazy stuff, and so it was really a huge thing for the hospital to experience some positive life coming in.” (Town 4 – 010)  RESULTS Importance of Local Birth  Challenges for Having Local Birth  • •  • • • •  Comfort of Local Birth Positive Community Experience  Women’s Experience of Maternity Care  Lack of continuity of care ‘Scared’ by consent form Influence of care providers Considerations of risk  RESULTS Importance of Local Birth  Challenges for Having Local Birth  • •  • • • •  Comfort of Local Birth Positive Community Experience  Lack of continuity of care ‘Scared’ by consent form Influence of care providers Considerations of risk  Women’s Experience of Maternity Care “They don’t have an... ICU… they don’t have any of that type of stuff here in case something is wrong with her; they have to medivac her out and that just takes too long… the baby could be like dead by then.” (Town 2 – 002)  RESULTS Importance of Local Birth  Challenges for Having Local Birth  • •  • • • •  Comfort of Local Birth Positive Community Experience  Lack of continuity of care ‘Scared’ by consent form Influence of care providers Considerations of risk  Women’s Experience of Maternity Care Experience in Referral Hospitals • • •  Family issue Financial cost Stress of birth  RESULTS Importance of Local Birth  Challenges for Having Local Birth  • •  • • • •  Comfort of Local Birth Positive Community Experience  Lack of continuity of care ‘Scared’ by consent form Influence of care providers Considerations of risk  Women’s Experience of Maternity Care “I think the biggest one was not having my family. That was really that was one of the sacrifices we made that probably had the biggest impact.” (Town 2 – 016)  Experience in Referral Hospitals • • •  Family issue Financial cost Stress of birth  RESULTS Importance of Local Birth  Challenges for Having Local Birth  • •  •  Comfort of Local Birth Positive Community Experience  • •  Lack of continuity of care ‘Scared’ by consent form Influence of care providers Considerations of risk  Women’s Experience of Maternity Care Expressed Desires •  Access to midwifery care  Experience in Referral Hospitals • • •  Stress of birth Family issue Financial cost  RESULTS Challenges for Providing Local Maternity Care • Difficulties in maintaining competence/skills • Safety issues  Importance of Local Birth •  Community ethos  Care Providers, Local Leaders, and Administrators Experience of Maternity Care  – Emergency transport  •  Fear or bad outcome – Litigation – Loss of license  Dilemma • Birth will always happen  RESULTS Challenges for Providing Local Maternity Care • Difficulties in maintaining competence/skills • Safety issues  Importance of Local Birth •  Community ethos  Care Providers, Local Leaders, and Administrators Experience of Maternity Care “As long as you have women of child bearing age [here], you are potentially going to be having women having their babies here… I don’t know how many doctors would be willing, to get a court order and force a woman to travel off island if she was refusing to do so.” (Town 2 – 023 : 507--514)  – Emergency transport  •  Fear or bad outcome – Litigation – Loss of license  Dilemma • Birth will always happen  RESULTS Challenges for Providing Local Maternity Care • Difficulties in maintaining competence/skills • Safety issues  Importance of Local Birth •  Community ethos  Care Providers, Local Leaders, and Administrators Experience of Maternity Care  Effect in job satisfaction •  Maternity care one of “highlights” of practice  – Emergency transport  •  Fear or bad outcome – Litigation – Loss of license  Dilemma • Birth will always happen  WHAT CAN BE DONE • Recommendations: – Submitted in report  Rural Women’s & Care Providers Experiences of Maternity Care  Stress and Pregnancy  Fetal Fibronectin Testing at Term  Inter-professional Collaboration Study  PROJECTS  Referral Hospital Project  http://www.ruralmatresearch.net/index.htm  GP Surgeon Project  Rural Birth Index (RBI) Project  •  Has this presentation helped you to… 1. Be informed about rural maternity ‘crisis’ in BC 2. Appreciate the challenges faced by women in rural BC 3. Appreciate the difficulties faced by local leaders and care providers  THANK YOU Question?  http://www.ruralmatresearch.net/index.htm  hardy@ruralmatresearch.net  .  

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