Development Of Core Midwife-led Continuity-of-care Program For High-risk Pregnant Women

Objective1.To explore the needs of high-risk pregnant women on nursing service during pregnancy,labour and postpartum period.2.To summarize the cognition and suggestions of obstetric staff on the current situation of nursing service for high-risk pregnant women.3.To develop core midwife-led continuity of care program for high-risk pregnant women.Methods1.Semi-structured interviews were conducted and we interviewed 17 women diagnosed as high-risk pregnancy and 8 obstetric staff in a tertiary hospital in Fuzhou.A descriptive qualitative study was employed,to understand the real needs for care of women with high-risk pregnancy,and learn about obstetric medical staff opinion on current situation of maternal service.2.We searched databases for literatures related to core midwives and continuity of care for pregnant women,and used evidence-based methods to evaluate nursing guidelines related to care for high-risk pregnancy.Combined the results of literature study with the results of high-risk pregnant women and obstetric staff interviews,the draft of the program was formed after discussion in our study group.3.We used Delphi method to gather expert opinions,in order to demonstrate and determine the content of the subprogram of"core midwife-led continuity-of-care for pregnant women".On this basis,Expert meeting was held to demonstrate the two subprograms of“core midwife-led continuity-of-care program for high-risk pregnant women”,and finally the complete program was determined.Results1.Three themes were extracted from the interview data:(1)concerns in services for high-risk pregnant women,including demands in pregnancy,demands in labour,demands in postpartum,lack of awareness of high-risk pregnancy and adherence.(2)current situation of services for high-risk pregnant women,including service content for high-risk pregnant women and weaknesses of existing services.(3)influencing factors of the implementation of continuity-of-care program for high-risk pregnant women including promoting factors and obstacles factors.2.By analyzing relevant literature on core midwife services and care for high-risk pregnant women,two subprograms,"Core midwife-led continuity-of-care for pregnant women"and"Management of risk factors",were preliminarily constructed.After revision on the expert’s demonstration,core midwife-led continuity-of-care program for high-risk pregnant women was determined:(1)"Core midwife-led continuity-of-care for pregnant women",including(1)"Role definition of core midwife",with 6 items of"qualification standard"and 7 items of"service specification",(2)"Nursing practice content"with 3 first-level items,19 second-level items and 58 third-level items;(2)"Management of high risk factors of pregnancy",including(1)40 items of"Management of pregnant women with abnormal body weight(BMI>25kg/m~2)in the first trimester",(2)23 items of"Management of senior pregnant women",(3)25 items of"Management of pregnant women with scar uterus",(4)53 items of"Management of pregnant women with hypertension",(5)41 items of"Management of pregnant women with diabetes mellitus".Conclusion1.High-risk pregnant women had different specific contents in different periods.Different individual demands differed in emphasis and degree.And their awareness of high-risk pregnancy and adherence should both be enhanced.2.As limited human resource in hospital and midwives’worries about the new service model,the hospital was supposed to provide sufficient support of human resource,financial resources and policy,in order to carry out core midwife-led service for high-risk pregnant women and reasonably organize midwives’work.3.Core midwife-led continuity-of-care program for high-risk pregnant women included 2subprograms,"core midwife-led continuity-of-care for pregnant women”and"management of risk factors",which could provide reference for high-risk pregnancy care.