Papers by Yvonne Fontein-Kuipers
Aim: to evaluate the ISeeYou project that aims to equip first year Bachelor midwifery students to... more Aim: to evaluate the ISeeYou project that aims to equip first year Bachelor midwifery students to support them in their learning of providing woman-centred care. Methods: the project has an ethnographic design. First year midwifery students buddied up to one woman throughout her continuum of the childbirth process and accompanied her during her antenatal and postnatal care encounters. Participant-observation was utilised by the students to support their learning. The Client Centred Care Questionnaire (CCCQ) was administered to collect data about women's care experiences. The project was evaluated using the SWOT model. Main findings: 54 first year students completed the project and observed and evaluated on average eight prenatal visits and two postnatal visits. Students gained insight into women's lived experiences during the childbirth process and of received care throughout this period. Students reported that this was meaningful and supported and enhanced their comprehension of women-centred care. Logistic issues (lectures, travel, time) and being conscious of their role as an 'outsider' sometimes constrained, but never hindered, the students in meeting the requirements of the project. Overall, the project provided students with opportunities to expand competencies and to broaden their outlook on midwifery care. Conclusion: the project offers students unique and in-depth experiences supporting and augmenting their professional competencies and their personal, professional and academic development.
This qualitative study, utilizing a feminist perspective, aimed to explore and articulate women's... more This qualitative study, utilizing a feminist perspective, aimed to explore and articulate women's recall of emotional birth trauma experiences. The reason being that one in every five women has a negative recall of childbirth and one in every nine women has experienced birth as a traumatic event, with sometimes detrimental implications for women and their families. Thirty-six individual narrative interviews with Dutch-speaking women were conducted. Consent was obtained and interviews were audiotaped and fully transcribed. Sentences with the 'voice of the 'I'' were extracted from the transcripts and were constructed into I-poems, showing four key themes: (1) The journey-unmet hopes and expectations of women during pregnancy, birth and thereafter; (2) The 'I' in the storm-women's notions of painful thoughts and memories; (3) The other-women's responses to the interaction with healthcare professionals; (4) The environment-sensory awareness of the birthing environment. The results described and showed the rawness and desolation of women's experiences reflected in their narratives of self, context and in relation to others, maternity care providers in specific. This study showed that acknowledging and listening to women's voices are of merit to inform (student) midwives and other healthcare professionals who are involved with childbearing women so that the significance of this experience can be understood.
Background: Pregnant women use childbirth reality programs to prepare themselves for childbirth. ... more Background: Pregnant women use childbirth reality programs to prepare themselves for childbirth. It is unknown how shared decision-making in intrapartum midwifery care is represented in televised birth. We aimed to explore the portrayal of shared decision-making during labour and birth in lifetime documentary series One born every minute.
Methods: We analysed a total of 41 labour and birth storylines, triangulating deductive and inductive content analysis methods. We described the participants’ personal and birth details. We coded, quantified and organised woman-midwife dialogues and selected the shared-decision making data. Content analysis of shared decisionmaking fragments was organised following the three-steps of shared decision-making.
Results: A first investigation resulted in a classification of: ‘building-a relationship’ and ‘decision-making’. The decision-making fragments included ‘unilateral decision-making’ and ‘shared decision-making’. 287 shared decision-making fragments were ordered in three themes: 1. Choice talk: Women presented their personal wishes, resonating their awareness of having intrapartum care options. More often, midwives introduced decision-making with implicit referral to the proposal of choices. 2. Option talk: Midwives predominantly provided detailed information of various options and the consequences of these options. 3. Decision talk mainly included the midwife’s support of women’s decisions for which consent was obtained, albeit it in a rather informal way. Choice talk and decision talk most often occurred, sometimes simultaneously. Listing women’s options, exploring her preferences, wishes and values and deliberation ofwomen’s intrapartum choices were underexposed.
Conclusion: Shared decision-making is being portrayed as both woman and midwife-initiated. The midwives in this study did not always follow the linear stepwise model but tended to utilise a more fluid transition between choice, option and decision talk. Shared decision-making is facilitated by the relationship between the woman and the midwife during the intrapartum period, requiring evaluation and reflection. Birth partners should not be disregarded in intrapartum shared decision-making processes.
Openventio Publishers, 2017
Aim: To explore Dutch pregnant women’s experiences of shared-decision making about place
of birth... more Aim: To explore Dutch pregnant women’s experiences of shared-decision making about place
of birth to better understand this process for midwifery care purposes.
Design: Qualitative exploratory study with a constant comparison/grounded theory design.
Methods: We performed semi-structured interviews, including two focus groups and eight
individual interviews among 16 primarous and multiparous women with uncomplicated
pregnancies. Consent was obtained and interviews were audiotaped and fully transcribed. The
interviews were analyzed utilizing a cyclical process of coding and categorizing, following
which the themes were structured based on the three-step shared-decision making model of
Elwyn.1
Results: We identified the three themes according to Elwyn’s model: Choice talk, Option talk
and Decision talk. We expanded the model with one additional theme: Decision ownership. The
four themes explained women’s decision making process about place of birth. Women perceived
shared-decision making about place of birth as a decision to be taken with their partner instead
of with the midwife. Women and their partners regarded the decision about place of birth as a
choice to be made as a couple and expecting parents; not as a decision in which the midwife
needs to be actively involved. Women and their partners considered their options and developed
a strong preference about where to give birth; even before the initial contact with the midwife
was made. Involvement of the midwife occurred during the later stages of the decision-making
process, where the women sought acknowledgement of their choice which was already made.
Conclusion: Women considered their partners as the most and actively involved in the shareddecision
making process regarding the place of birth. The women’s decision-making process
about the place of birth did not fully occur during the antenatal care period. The midwife should
ideally be involved before or during the early stages of pregnancy to facilitate the process.
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Papers by Yvonne Fontein-Kuipers
Methods: We analysed a total of 41 labour and birth storylines, triangulating deductive and inductive content analysis methods. We described the participants’ personal and birth details. We coded, quantified and organised woman-midwife dialogues and selected the shared-decision making data. Content analysis of shared decisionmaking fragments was organised following the three-steps of shared decision-making.
Results: A first investigation resulted in a classification of: ‘building-a relationship’ and ‘decision-making’. The decision-making fragments included ‘unilateral decision-making’ and ‘shared decision-making’. 287 shared decision-making fragments were ordered in three themes: 1. Choice talk: Women presented their personal wishes, resonating their awareness of having intrapartum care options. More often, midwives introduced decision-making with implicit referral to the proposal of choices. 2. Option talk: Midwives predominantly provided detailed information of various options and the consequences of these options. 3. Decision talk mainly included the midwife’s support of women’s decisions for which consent was obtained, albeit it in a rather informal way. Choice talk and decision talk most often occurred, sometimes simultaneously. Listing women’s options, exploring her preferences, wishes and values and deliberation ofwomen’s intrapartum choices were underexposed.
Conclusion: Shared decision-making is being portrayed as both woman and midwife-initiated. The midwives in this study did not always follow the linear stepwise model but tended to utilise a more fluid transition between choice, option and decision talk. Shared decision-making is facilitated by the relationship between the woman and the midwife during the intrapartum period, requiring evaluation and reflection. Birth partners should not be disregarded in intrapartum shared decision-making processes.
of birth to better understand this process for midwifery care purposes.
Design: Qualitative exploratory study with a constant comparison/grounded theory design.
Methods: We performed semi-structured interviews, including two focus groups and eight
individual interviews among 16 primarous and multiparous women with uncomplicated
pregnancies. Consent was obtained and interviews were audiotaped and fully transcribed. The
interviews were analyzed utilizing a cyclical process of coding and categorizing, following
which the themes were structured based on the three-step shared-decision making model of
Elwyn.1
Results: We identified the three themes according to Elwyn’s model: Choice talk, Option talk
and Decision talk. We expanded the model with one additional theme: Decision ownership. The
four themes explained women’s decision making process about place of birth. Women perceived
shared-decision making about place of birth as a decision to be taken with their partner instead
of with the midwife. Women and their partners regarded the decision about place of birth as a
choice to be made as a couple and expecting parents; not as a decision in which the midwife
needs to be actively involved. Women and their partners considered their options and developed
a strong preference about where to give birth; even before the initial contact with the midwife
was made. Involvement of the midwife occurred during the later stages of the decision-making
process, where the women sought acknowledgement of their choice which was already made.
Conclusion: Women considered their partners as the most and actively involved in the shareddecision
making process regarding the place of birth. The women’s decision-making process
about the place of birth did not fully occur during the antenatal care period. The midwife should
ideally be involved before or during the early stages of pregnancy to facilitate the process.
Methods: We analysed a total of 41 labour and birth storylines, triangulating deductive and inductive content analysis methods. We described the participants’ personal and birth details. We coded, quantified and organised woman-midwife dialogues and selected the shared-decision making data. Content analysis of shared decisionmaking fragments was organised following the three-steps of shared decision-making.
Results: A first investigation resulted in a classification of: ‘building-a relationship’ and ‘decision-making’. The decision-making fragments included ‘unilateral decision-making’ and ‘shared decision-making’. 287 shared decision-making fragments were ordered in three themes: 1. Choice talk: Women presented their personal wishes, resonating their awareness of having intrapartum care options. More often, midwives introduced decision-making with implicit referral to the proposal of choices. 2. Option talk: Midwives predominantly provided detailed information of various options and the consequences of these options. 3. Decision talk mainly included the midwife’s support of women’s decisions for which consent was obtained, albeit it in a rather informal way. Choice talk and decision talk most often occurred, sometimes simultaneously. Listing women’s options, exploring her preferences, wishes and values and deliberation ofwomen’s intrapartum choices were underexposed.
Conclusion: Shared decision-making is being portrayed as both woman and midwife-initiated. The midwives in this study did not always follow the linear stepwise model but tended to utilise a more fluid transition between choice, option and decision talk. Shared decision-making is facilitated by the relationship between the woman and the midwife during the intrapartum period, requiring evaluation and reflection. Birth partners should not be disregarded in intrapartum shared decision-making processes.
of birth to better understand this process for midwifery care purposes.
Design: Qualitative exploratory study with a constant comparison/grounded theory design.
Methods: We performed semi-structured interviews, including two focus groups and eight
individual interviews among 16 primarous and multiparous women with uncomplicated
pregnancies. Consent was obtained and interviews were audiotaped and fully transcribed. The
interviews were analyzed utilizing a cyclical process of coding and categorizing, following
which the themes were structured based on the three-step shared-decision making model of
Elwyn.1
Results: We identified the three themes according to Elwyn’s model: Choice talk, Option talk
and Decision talk. We expanded the model with one additional theme: Decision ownership. The
four themes explained women’s decision making process about place of birth. Women perceived
shared-decision making about place of birth as a decision to be taken with their partner instead
of with the midwife. Women and their partners regarded the decision about place of birth as a
choice to be made as a couple and expecting parents; not as a decision in which the midwife
needs to be actively involved. Women and their partners considered their options and developed
a strong preference about where to give birth; even before the initial contact with the midwife
was made. Involvement of the midwife occurred during the later stages of the decision-making
process, where the women sought acknowledgement of their choice which was already made.
Conclusion: Women considered their partners as the most and actively involved in the shareddecision
making process regarding the place of birth. The women’s decision-making process
about the place of birth did not fully occur during the antenatal care period. The midwife should
ideally be involved before or during the early stages of pregnancy to facilitate the process.