In the last few decades, there has been a significant global shift towards birthing in healthcare facilities, but this increase in institutional deliveries brings to the forefront the critical need to evaluate and improve the quality of care provided to expectant mothers and newborns. Central to understanding patients’ perspectives on the quality of healthcare services is the implementation of Patient Reported Outcome Measures (PROMs), which capture patients’ self-assessed health status. A recent systematic review, published in BMC Pregnancy and Childbirth, delves into the availability and potential application of PROMs specifically designed for pregnancy and childbirth. In this article, we will explore the insights from this review and discuss the implications for maternity care quality assessment.
The original systematic review (DOI: 10.1186/s12884-019-2318-3), led by Fiona Dickinson and colleagues from the Centre for Maternal and Newborn Health at Liverpool School of Tropical Health, set out to identify PROMs relevant to pregnancy and childbirth and to appraise their suitability for assessing the quality of care in maternity settings. The review highlights the fragmented nature of available PROMs, underscores the lack of a universally accepted measure, and points towards the necessity of developing robust tools for quality assessment in maternity care.
Search Strategy and Results
The researchers conducted a comprehensive search using databases such as PsycINFO, CINAHL, Medline, Web of Science, as well as examining grey literature sources, to collect data on PROMs associated with pregnancy, childbirth, postnatal care, and broader aspects of women’s health. From the articles retrieved, only six papers met the inclusion criteria, which either directly or indirectly discussed PROMs relating to conditions such as hyperemesis gravidarum, gestational diabetes, obstetric hemorrhage, and postnatal depression.
Within these studies, fourteen different assessment tools were identified. These addressed various physical, psychological, and social health dimensions, some of which were general, while others were specific to certain aspects of childbirth. Only one PROM explicitly focused on childbirth experiences but required women to subjectively define and evaluate the most significant areas of their lives affected by the birth process.
The Gap in Standardized PROMs
Despite the variety of identified tools, the review underscores a glaring gap: there is no agreed-upon PROM that adequately captures the quality of care during pregnancy and childbirth. Such a measure is crucial for not only advancing the quality of maternal and newborn healthcare but also for providing clear, evidence-based data that can guide policymakers and practitioners towards needed reforms.
Importance of PROMs in Maternity Care
PROMs are pivotal in translating patient experiences into quantifiable outcomes that health services can analyze to initiate quality improvements. In maternity care, these measures hold particular significance due to the unique and multifaceted nature of pregnancy and childbirth experiences. They help in recognizing the physical, emotional, and social changes that women undergo, many of which are deeply personal and subjective.
Potential for Development
While the review by Dickinson et al. reveals the absence of a universally utilized PROM for pregnancy and childbirth, it also offers a silver lining by identifying existing measures that could serve as a foundation for future tool development. The present tools assess a broad range of issues from disease-specific conditions like gestational diabetes to wider impacts on postnatal mental health. These could inform comprehensive PROMs that holistically evaluate maternity care services.
Conclusion
This systematic review plays a critical role in spotlighting the current limitations in assessing patient-centered outcomes in the context of pregnancy and childbirth. It beckons the need for a collaborative effort to establish multi-dimensional, validated PROMs that cater specifically to maternity care—measures that can reliably gauge quality and help in shaping evidence-based, patient-centered maternity services globally.
Keywords
1. Patient Reported Outcome Measures
2. Quality of Maternity Care
3. Pregnancy and Childbirth Assessment
4. PROMs in Healthcare Evaluation
5. Maternal Health Quality Improvement
References
1. Dickinson, F. F., McCauley, M. M., Smith, H., & van den Broek, N. N. (2019). Patient reported outcome measures for use in pregnancy and childbirth: a systematic review. BMC Pregnancy Childbirth, 19(1), 155. https://doi.org/10.1186/s12884-019-2318-3
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