Midwifery Model of Care

Background of the Study

The Medical Model of Care involves developing basic assumptions regarding medications which are driven through research and it theorises the psychological or physical difficulties based on causation as well as remediation (Regueiro et al. 2016). Thus, the model mainly uses medication as the only treatment by identifying the causes of illness on the basis of the proposed theory. The Midwifery Model of Care involves monitoring of psychological, physical and social well-being of the pregnant women throughout the cycle of pregnancy, provide individual education, counselling and prenatal care to mother and offer continuous hand-on support during the delivery and labour along with offer support during the postpartum period (Nilsson et al. 2019). This indicates that unlike the medical model of care in this care model proper medications are provided along with holistic care to support effective and quality well-being of the mothers.

The study by Neiterman (2013) mentions that direct consequence of the use of medical model of care for pregnant women is that the women losses their autonomy over their bodies. Moreover, the control is handed over to the physicians who take decision regarding the care of the women during pregnancy (antepartum) as well as during labour (intrapartum). In contrast, the study by Brailey et al. (2017) mentioned that support provided through midwifery care model to the pregnant women allows the women to make decision regarding the care they wish to avail during pregnancy and labour. This is because the pregnant women provide information regarding their needs to the midwives making them develop strategies to fulfil their demands in care. As mentioned by Portocarrero et al. (2017), patients are to be included in providing decision regarding their care. This is to make the patients feel valued and inform the care to be planned in such a way so that their needs and demands are fulfilled in turn offering them satisfaction on receiving care. Thus, it informs that medical model of care due to lack of providing autonomy to the pregnant women to make decision regarding the care is able to make their needs and demands remain unfulfilled offering their less satisfaction.

The public healthcare system in Qatar is mainly operated through the Hamad Medical Corporation (HMC) that mainly directs the way public healthcare facilities in Qatar is to be provided to the individuals. The HMC identifies the healthcare provision for women during their pregnancy to personalise the care according to their needs. This is because the HMC avoid to belief in a single model of care is appropriate for all and therefore have arranged various services to be delivered to the pregnant mother by diagnosing their health condition and well-being (Hamad.qa, 2018). In this purpose, the HMC has led to the partnership formed between Women's Hospital and Partner's HealthCare for the expansion of the Feto-Maternity Unit to offer high quality and well-organised care for the female with high-risk pregnancy (hamad.qa, 2018a). However, in the country, it is found that there is no separate midwifery care model for the female with a low-risk pregnancy. This is because low-risk pregnant mothers are regarded to be considered individuals who do not require any form of medical care or they are not going to access any benefit from medical intervention (hamad.qa, 2019a). In this regard, the low-risk pregnant mothers in Qatar are also not provided the opportunity to choose between the medical model of care or midwifery care which often makes them being partially treated by the healthcare system. This is because the mothers being unable to make choices regarding their Obstetrics care feel lack of support and confusion regarding the health of them as well as their babies.

Aim

The aim of this research is to compare the midwifery and medical models of care, barriers to women in making an informed decision on who cares for them during the antepartum and intrapartum period.

Data Collection

The research designs are of two types which are Quantitative Research Design and Qualitative Research Design which are commonly used for collecting data in the study. The Quantitative Research Design is the systematic investigation of statistical or observable phenomenon through mathematical and computation technique to gather numeric data (LoBiondo-Wood and Haber, 2017). The Qualitative Research Design is the scientific and logical method of executing observation and analysing the perceptions and feelings of the general population or participants of the study to gather non-numeric data that provides in-depth information to resolve the raised research problems (Rutberg and Bouikidis, 2018). In this study, the Qualitative Research Design will be used as it allows capturing the change in attitudes of a target group regarding a certain topic making the researcher develop follow-up data. The design also has the strength to provide explanations regarding the data collected helping the researchers to understand information beyond objective and numeric value. Moreover, the qualitative research design allows the researcher to take a flexible approach in conducting the study (Connelly, 2016). Therefore, the design will be used in executing the study as it allows valid and reliable capture of in-depth data in a feasible way. The quantitative research design will not be used because it limits the researcher in the pursuit to gather data. In addition, the quantitative design allows only objective data to be gathered ignoring the detailed information to be collected regarding the expression and feelings of the participants (Smith et al. 2018).

Sampling principles and procedures

The sampling techniques are of two types which are probability sampling and non-probability sampling. The probability sampling technique is the process where participants from a known population are selected in a random way to represent the population as a whole (Garrett, 2018). However, the non-probability sampling technique is the process where participants from the population are chosen based on the mentioned purpose in the study as the participants in this technique are not representative of the population (Santhi et al. 2019). In this research, the non-probability sampling will be used. This is because the non-probability sampling reduces the chances of biasness, in turn, helping to avoid reaching incorrect conclusion in the study. Moreover, this sampling allows selection of the participants in the right manner who has proper knowledge regarding the topic in turn leading to avoid recruitment of unnecessary participants. In addition, the non-probability sampling allows the recruitment of participants from a small population and therefore it will be used in the study (Williams et al. 2018).

The convenience sampling which is a type of non-probability sampling will be used in the study. The focus of convenience sampling is to recruit people who can be easily available for the study (McCrae and Purssell, 2016). The advantage of using this sampling method will be that it would allow the researcher to collect sample in a cheap and efficient way. Moreover, this sampling technique will be used as will allow the researcher to gather basic data and trends related to the study without experiencing any complications (AbuAlRub and Nasrallah, 2017). The sample participants who will be included in the study are the women who have previously received care from the obstetrician in their previous pregnancy and at the present have low-risk pregnancy (Lynch et al. 2018). The women who have not at all received care from the obstetricians are not to be included or those who are pregnant for the first time will not be considered as it would lead to violate the purpose of the study topic.

The sample will consist of 3 pregnant women who have gone through the antepartum and intrapartum period while accessing care from the obstetric ward through the use of Midwifery Model of Care and 3 pregnant women who have gone through the antepartum and intrapartum period while accessing care from the obstetric ward through the use of Medical Model of care in the general hospitals managed by the Hamad Medical Corporations in Qatar. The identification of the pregnant women who have accessed medical model of care and midwifery model of care is to be done by reviewing their medical records in the hospital. This is because the medical records provide detailed information regarding the people involved in caring for the patient as well as the nature of care provided to them and its impact on their health at different stages (Zhong et al. 2018). The selection criteria of the sample would be helpful in answering the framed question as by interviewing the pregnant women who have accessed support through the Medical Model of care the researcher can understand the barriers experienced by them in deciding who is going to finally care for them due to which they are unable to access midwifery care. In addition, the women who have accessed support through Midwifery Model of care are to be interviewed to get informed regarding the facts that supported them to access care through the model instead of medical care model. This is going to help in comparing the factors that are responsible for leading to the choice of the model of care among pregnant women. Moreover, the presence of two different groups of pregnant women who have accessed either of the care models is effective to meet the research aim as comparison between the impacts of the two models on the health of pregnant women can be determined.

Data Collection

The data collection methods are of different types which include direct observation, interview, survey questionnaires and focus group. Out of the mentioned types of data collection, the interview method will be used in the study. This is because interview method allows the issues focused in the research to be studied in-depth to draw essential data as through the process the views, feeling and expression of the participants are identified (Howard and Williams, 2016). Thus, the use of interview will help the researcher to personally ask the pregnant women who have been provided care through the medical model of care and those with Midwifery model of care regarding the barriers and challenges faced by them to be overcome for deciding the nature of care to be received by them. The interview process helps to deepen the understanding of data collected by the researcher (Morgan et al. 2016). This aspects of the interview process lead it to be used in the study as the deeper understanding of the data regarding medical and midwifery model of care would lead the researcher to effectively develop comparing data regarding the models to determine which of them is more efficient than the other.

The interview allows the researcher to discuss regarding the sensitive topic for gathering detailed information (Klomp et al. 2017). Thus, the interview process will be used in the study so that the pregnant women do not feel uncomfortable to share details regarding the nature of care provided through the model during the antepartum and intrapartum period of pregnancy. The interview of the participants will be executed by the researcher in a face-to-face manner through the use of Skype. This is because it would allow the pregnant women to avoid travelling to the researcher ensuring them protection from getting exhausted. Moreover, Skype interview also allows geographic barriers to be avoided allowing selection of participants from any areas according to the wish of the researcher. The semi-structured questionnaires will be used for gathering information from the selected participants. This is because semi-structured question allows the interviewers to get prepared before the initiation of the interaction regarding the questions to be asked so that the participants can be directed on the right path to share information that is required in enriched execution of the study (Keely et al. 2017). Thus, use of the semi-structured questionnaires will be able to initiate open-ended responses from the pregnant women to determine various barriers faced by them which led some of them to access carte through Midwifery model whereas others were offered support through the medical model of care.

Data Analysis

The data analysis is the process to identify, transform and model data for discovering useful information for making decision or resolving raised problem in the study (Christmals and Gross, 2017). The data gathered in the study will be analysed with the help of thematic analysis. The thematic analysis is the process of analysing qualitative data. The process of thematic analysis at the first includes familiarisation of the researcher with the collected data. This indicates that the researcher by hearing the recordings of the interview transcripts are to develop initial ideas and write down notes regarding the described content by the participants (Nowell et al. 2017). After familiarisation, the researcher is to generate codes regarding the information being mentioned so as to initiate proper organisation of data in the form of meaningful groups. In the third stage, the themes are to be searched by analysing active interpretation of the coded data developed from the interview transcript. In this stage, all the codes are not going to get related with one theme and this would result to develop two or more themes so that proper presentation of data can be made (Castro and Andrews, 2018).

In the fourth stage of thematic analysis, the themes developed are to be reviewed to determine if any contradictory codes or data are mentioned within them that may lead to create error in the presentation of the research (Tuominen et al. 2020). In the fifth stage, the names of the theme are to be described and mentioned in manner so that it is engaging. In the last stage, the reports are to be mentioned properly with the themes. The strength of using thematic analysis is that it allows data to be presented in flexible manner and various theories can be implemented in the process to describe data. The analysis is suited to be used for explaining vast data and it makes the researcher develop ability to present findings beyond their individual experiences. Moreover, the thematic analysis allows categorisation of the information to evolve from the data (Varagona and Hold, 2019). Therefore, the thematic analysis will be used for data analysis in the study. However, there are few limitations with the approach such as it may create variation in data presentation and may result in the mixing of information. Moreover, the researcher at times in thematic analysis may face issues to maintain continuity in data presentation.

Ethical Considerations

The ethical consideration in research is to be followed so that any legal issues can be avoided and the protection of the participants can be assured. In order to maintain ethics, the research participants in the study will be provided with information regarding the way their responses are to be used to make them provide informed consent. The researcher will ensure no personal details of the participants are shared publicly so that confidentiality is maintained. This is because sharing of personal details may lead the participants to become vulnerable to get abused or harmed in society (Macdonald et al. 2018). The anonymity of the participants will be maintained so that their privacy is ensured. The voluntary participation of the participants will be promoted in the study which indicates that individuals will be allowed to include in the study on their free will.

The participants will be allowed to withdraw from the study any time in the middle if they feel their privacy or confidentiality is hindered. The participants will be allowed to skip any questions regarding the interview and the researcher will not force the participants to provide any response regarding any question to maintain ethical principles. The dignity of the participants recruited for the interview will be ensured by the researcher and any exaggeration of the data collected will be avoided to maintain ethics. The communication to be established by the researcher during interviewing the participants will be maintained in an honest and transparent manner so that any misleading interaction can be avoided that hinders the ethics in the study (Steege and Rainbow, 2017).

The presentation of the content mentioned by the participants will be done in the study without any biased preferences by the researcher as it would lead to error in the study and hinder the ethical consideration by presentation of manipulated data. The use of any discriminatory or offensive languages will be avoided in the study. The Ethics approval for the project is approved from the Ministry of Health by the HMC according to which the researcher will be following the national guidelines related by the local Institutional Review Board (IRB) mentioned regarding studies that include vulnerable participants such as pregnant women (hamad.qa, 2011). The written consent from the participants will be accessed by the researcher and consent regarding the publication of anonymous quotes will also be received from the participants. The written consent from the participants will be avoided to be accessed to protect their confidentiality in the study as the signature may reveal their name and identity (Chiumento et al. 2018).

Deliverables

The study will produce knowledge regarding the difference between the medical model of care and the midwifery model of care used for supporting pregnant women. The development of clear concept regarding both the models is required to understand in which aspect they are better than one another. The study will also provide knowledge regarding the barriers faced by low-risk pregnant women in Qatar to access care through the midwifery model of care compared to the medical model of care. In addition, the study will provide knowledge regarding the challenges faced by low-risk pregnant women in Qatar due to lack of access to midwifery care model. The study will also reflect on the causes that lead the high-risk pregnant women in Qatar to be able to avail the midwifery care model and the low-risk women are being avoided. The study will also produce knowledge regarding the reason behind the preference of the low-risk pregnant women in Qatar to avail care through the midwifery model.

The impact of the study will be that it would inform the physicians as well as nurses and other health professionals regarding the way low-risk pregnant women are suffering to access proper care due to their lack of ability to choose the model of care. In addition, the study findings will impact to understand the reason behind the current differences in the use of the model for the low-risk and high-risk pregnant women. The study finding will impact on to make health professionals understand the barriers to be resolved for low-risk pregnant women so that they have opportunity makes better care choices for them. The impact of the findings will be that the Obstetricians will understand the need behind the midwifery model of care to be made available for the low-risk women, in turn, allowing them to provide more satisfactory and quality care to the women.

Estimated resources required in the study

The initial resources that will be required in the study include a semi-structured questionnaire. The questionnaire is to include few formalised questions based on which the researcher is going to initiate the interaction and later further related question is to be raised for gathering information. The presence of computer along with proper net connection and video calling facility is required so that the participants can be called through Skype to gather information. An estimated $700-1000 will be required as finances to complete the study. Travelling expenses of $500 will be required by the researcher to gather information from participants in case they cannot contact through Skype. A part-time co-investigator will be required in executing the study. This is because the person would revaluate the findings to be presented by the researcher to ensure no biases in the data interpretation is made through the influence of the feelings and preferences of the researcher.

Reflection

The strength of the study is that it will help healthcare professionals understand the way a low-risk midwifery care model can be developed to support women with normal pregnancy. The study also has the strength of being executed with less expenditure as well as provides opportunity to know in details the attitudes of the low-risk pregnant women in Qatar regarding not being able to have their choice of care. The weakness to be faced in the study is that the use of non-probability sampling will limit the researcher to understand the extent to the selected population is representative (Gibbon and Crane, 2018). Moreover, it creates limitations in the study by not allowing the researcher to calculate margin of error or confidence intervals (Elmore et al. 2018). A mixed-method of sampling will be effective as it would lead to resolve the limitation through the use of the strength of the probability sampling method. The other weakness to be faced by the study is the use of the interview process as it will lead the researcher to remain disappointed at times to be unable to collect the needed data even after asking several questions. The incomplete responses of the participants during the interview will lead the study to have limitation of incomplete data collection, in turn, reducing the richness of the study (Ingham-Broomfield, 2016).

In the study, the small sample size will act as weakness as too small number of sample lower the study power as well as it increases the error margin in the research that rends the research to be performed without any meaning. In addition, it creates weakness for the researchers to consider less conclusive findings, in turn, hindering the validity of the study. The use of only qualitative research design will create weakness for the study by analysing the findings through dependency on the experience of the researcher. Moreover, the qualitative design leads to develop multiple sessions to be performed which will lead to create time management issue within the study. The other weakness to be faced with the use of qualitative data will be that it may lead the researcher to develop misleading conclusions (Holloway and Galvin, 2016). Since the findings are to be presented based on the analysis of the responses of participants by the researcher, thus there is an issue to develop biased findings as the analysis may be influenced by the preference and thinking of the researcher.

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