Women-Centred Care In The Postnatal Period

Women-Centred Care In The Postnatal Period

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7101NRS: Transforming and Leading Healthcare

Word count (excl. title page and reference list): 1,999 words

Women-Centred Care In The Postnatal Period

Person-centred care is the philosophy of putting the patient at the centre of every action and decision. The core themes of people, practice and power underpin the concept of person-centred care, but how it manifests clinically varies in the health context (Byrne et al., 2020). A growing area of demand within the Victorian health sector is maternity care, with more women having babies. The annual births in Victoria recorded an increase of 6.2 percent in 2020 and an additional 5.3 percent in 2021 (Australian Government Centre for Population, 2021). As the maternity sector works to manage this increase, it is an opportunity for improvements to be made in the postnatal care provided. In particular, it is imperative that the quality of care, and its person-centred nature, does not decline. In order to effectively implement both changes and improvements, strong leadership is required. One way to achieve this is through the utilisation of transformational leaders, implemented through a leadership model (Kouzes & Posner, 2006). This essay will elaborate on the needs of the maternity postnatal sector, before analysing the theory of transformational leaders, and providing in-depth exploration of strategies to improve care, within Kouzes and Posners leadership framework.

Within the context and language of midwifery, patients are referred to by the title of woman. Midwifery is underpinned by the philosophy of women-centred care, with the core definition of a midwife meaning to be with woman (Bradfield et al., 2019). A comprehensive literature review completed by Brady et al (2019) identified the key elements of women-centred care including choice and control, empowerment, protecting normal birth, and continuity of care (Brady et al., 2019). The benefits of this have been thoroughly explored in the literature, with particular focus on positive impacts of continuity of care models. The antenatal period is a critical time for preparation, the intrapartum period being one of transformation into motherhood, and the postnatal period becoming a journey of discovery for the maternal-neonatal dyad (Bradfield et al., 2019). Currently there is increasing pressure in the public health sector, specifically within metropolitan Victoria, regarding adequate staffing and appropriate skill levels. This is resulting in increased pressure for women to be discharged earlier from hospitals following delivery, as well as referring home visits to external community services for continued postnatal support. Subsequently, the care that women are receiving is becoming less specific to their individual needs and increasingly fragmented (Hyde et al., 2022). This fractured care fails to uphold the values of women-centred care, especially the elements of continuity, choice and control. Structural change is required of postnatal care in order to improve the women-centredness of care being provided, with transformational leaders being a vital element necessary for this change to occur (Brady et al., 2019).

Transformational leadership is defined as an approach to leadership that causes change on multiple levels, both that of the individual and within a system. There are four underpinning principles to Basss model of transformational leadership which manifest into certain positive attributes associated with this charismatic leadership style. These theoretical principles include idealised influence, intellectual stimulation, inspirational motivation and individualised consideration (Bass & Riggio, 2014). Idealised influence refers to leaders acting as a role model who is passionate about leading by example, desires to be respected and trusted by their colleagues, and seeks to develop the confidence of those who they are leading (Reza, 2019). Intellectual stimulation encompasses creative innovation while supporting staff to challenge existing practices and beliefs on individual and organisational levels (Benmira & Agboola, 2021). Inspirational motivation is communicating high expectations and facilitating the intrinsic motivation to inspire team members to achieve their goals (Reza, 2019). Finally, individualised consideration refers to acting as a coach and a mentor, which intrinsically requires leaders to know the individual needs and goals of their team members, and have the emotional intelligence to provide necessary guidance and/or support (Benmira & Agboola, 2021). However, no one form of leadership is flawless, and critical evaluation of transformational leadership is important prior to adapting this style.

While there are numerous positive aspects to transformational leaders, it is important to recognise their weaknesses, and knowing how to overcome them. Transformational leaders can exhibit a lack of focus upon essential tasks, as they can be preoccupied with role model behaviours for others. For some, this can result in inadequate structure from an organisational level, but can be overcome with clear delegation and specific, measurable, achievable, realistic and timely (SMART) goals (Ogbeiwi, 2021). Transformational leadership relies solely upon intrinsic motivation, with the lack of external motivation - be that rewards or bonuses - leading to staff feeling overworked, underappreciated and ultimately, burnout. An emphasis on the importance of work-life balance is a key element in prevention of burnout amongst all staff, including leaders (Ajanaku & Lubbe, 2021). The charismatic nature of transformational leadership is effective for role-modelling, but not all role-modelling has a positive impact. Negative outcomes that are detrimental to either the target workforce or target audience are due to leaders misusing their influence, whether intentional or not (Caza et al., 2021). Similarly, the reliance on a certain personality type can lead to inappropriate promotion of staff into leadership positions, as well as the potential for favouritism to have an impact on staff dynamics (Ravindran, 2020). Although these weaknesses exist, the necessity of these leaders can not be denied when attempting to implement systematic change. These leaders are most effective when change is being implemented while applying an established framework, such as Kouzes and Posners leadership framework (Kouzes & Posner, 2006).

Utilising a leadership framework is one way to ensure that change is being implemented effectively, efficiently and consistently (Robbins & Davidhizar, 2020). There are five phases to Kouzes and Posners framework: modelling the way, inspiring a shared vision, challenging the process, enabling others to act and encouraging the heart (Kouzes & Posner, 2006). These elements are critical in order to improve women-centredness in the postnatal period. This can be achieved through the implementation of a variety of different strategies, which will be discussed in the following paragraphs.

The first phase of the framework is to model the way, which refers to an individual being able to find their own voice as a leader. This is achieved by first clarifying their values to themselves, and then learning how to express them in an organic language (Kouzes & Posner, 2006). Being able to speak their own words while understanding their personal values and beliefs will motivate individuals to develop into a more authentic and inspiring leader. Setting an example as a leader who aligns their actions with the values they hold is an integral part of modelling the way (Sammut & Scicluna, 2020). In the context of postnatal care, this would include being passionate about the values of women-centred care and advocating for the maternal-neonatal dyad to have choice, control and continuity in their care.

The second phase is inspiring a shared vision, which involves being able to look forward and imagine an exciting future full of potential (Kouzes & Posner, 2006). Having a vision that opens up new possibilities assists in determining how to act and guides the direction of decision making. Transformational leaders need to communicate these aspirations with others by appealing to shared values and uniting the team with a common vision. This unity provides clarity in what these leaders are attempting to achieve or change (Metz et al., 2019). Within the maternity sector, this would involve uniting all who are passionate about ensuring postnatal women are provided care that is empowering and women-centred. This would include all relevant healthcare professionals across the pregnancy care continuum as well as birthing women and their families.

The third phase is challenging the process, requiring leaders to recognise opportunities to meaningfully question how practices are currently undertaken (Kouzes & Posner, 2006). Searching for these opportunities requires innovation to develop and improve practices. Leaders need to take risks and experiment with changes, whilst being willing to accept feedback and learn from gradually implemented adjustments (Hussain & Khayat, 2021). There are a wide variety of different strategies and changes which can be trialled within the postnatal period. One strategy would be the inclusion of newborns in the midwifery ratios on the postnatal wards. Currently in Victoria, newborns are not included in midwifery ratios, instead the maternal-neonatal dyad is one allocation. This results in midwives caring for four mothers and their babies during the day and six overnight, with an even higher total number of patients when there are twins. The inclusion of newborns in the midwifery ratios would reduce the overall workload per midwife. This would enable more time and focus per maternal-neonatal dyad, resulting in more in-depth education and increased women-centred support (Turner et al., 2022). Another strategy would include increasing availability of private rooms to accommodate partners staying overnight, and expanding this capacity to include siblings. This would strengthen the family unit, providing more choice and control. A further strategy would be establishing a 24/7 phone service that women are able to call and speak with a hospital midwife during the immediate postpartum in an attempt to reduce hospital presentations and readmissions. And finally, a daily phone call to women at home on the alternative days to their physical home visits would provide greater continuity and support, until engaging with their Maternal Child Health Nurse (Finlayson et al., 2020).

The fourth phase is enabling others to act, which involves the collaboration of the team and developing the strength of the individual (Kouzes & Posner, 2006). In order to achieve this, a safe environment which facilitates trust and fosters a sense of partnership is required. Empowering team members to develop their own confidence and competence enables them to evolve their practices and contribute towards the collective goal (Sammut & Scicluna, 2020). Enabling greater use of multi-disciplinary resources within the postnatal space would be one strategy that could improve the women-centredness of care. This would include having more lactation consultants readily available to assess all inpatient postnatal women, and provide any support or suggestions in a less formal structure, negating the need for referrals. This approach to breastfeeding support would remove the access barrier and potentially reduce the stigma of needing assistance with breastfeeding (Lojander et al., 2022). Another resource which could be expanded is the Registered Undergraduate Students of Midwifery (RUSOM) model to facilitate more education and support for new mothers and their families while in the inpatient setting (Mumford et al., 2022).

The fifth and final phase of the framework is encouraging the heart, and this refers to ensuring that all members of the team feel recognised and valued (Kouzes & Posner, 2006). It is important for transformational leaders to pay attention to the accomplishments of individuals, and appreciate and celebrate their achievements and excellence. Creating an environment where individuals feel seen and valued develops a positive, inclusive community, which is important for maintaining change (Metz et al., 2019). If the above strategies for improving women-centred care in the postnatal period were to be implemented, this would result in a lot of disruption to how care is currently provided. It would be important to recognise that while the long-term aim of these changes are for the better, the transition would be challenging for staff (Ajanaku & Lubbe, 2021). As such, it would be imperative to appreciate how individual team members are feeling during this transitional time, by providing encouragement and support, and celebrating the positive impacts these changes are providing to women and their newborns.

In conclusion, women-centred care is vital across the entire pregnancy continuum, but significant improvements are required in the postnatal period. As the maternity sector grows, it is an opportune time to implement a variety of strategies to further develop the care provided to mothers and their newborns (Finlayson et al., 2020). One way to implement this change is by applying a leadership framework, such as Kouzes and Posners model, and utilising transformational leaders. Despite their imperfections, transformational leaders have a critical role to play in the successful implementation of these changes (Ajanaku & Lubbe, 2021; Kouzes & Posner, 2006).

References

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Australian Government Centre for Population. (2021, October 1). National, state and territory population, December 2021. National, state and territory population, December 2021 | Centre for Population. Retrieved January 24, 2023, from https://population.gov.au/data-and-forecasts/key-data-releases/national-state-and-territory-population-december-2021#:~:text=Natural%20increase%20(births%20minus%20deaths,annual%20births%20figure%20since%202016

Bass, B. M., & Riggio, R. E. (2014). Transformational leadership (2nd ed.). Routledge.

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