Abstract citation ID: ckac131.423 Factors promoting or limiting self-determined childbirth: midwives’ perspectives in Germany

citation ID: ckac131.423 Factors promoting or limiting self-determined childbirth: midwives’ perspectives in Germany


Background:
Claims for self-determined childbirth (SDC) have gained increasing scientific, political and societal attention. However, research on SDC is limited. This study analyzes and compares midwives' experiences and perspectives on factors that promote or limit SDC in hospitals, birthing centers and during home births in Germany. We argue that these insights are essential in order to foster self-determination and to avoid its violation.

Methods:
A qualitative case study was conducted based on semistructured face-to-face interviews with midwives working in hospitals, birthing centers, and offering home births in Germany. In total, nine interviews were conducted in 2021 and have been audiotaped, transcribed, anonymized and analyzed by use of Thematic Analysis.

Results:
The results indicate eight inter-related categories, each of which imply promoting and limiting factors: 1) Structural/ legal conditions; 2) Perception of birth (e. g. as natural or medical process; required competence and control); 3) Trust and atmosphere; 4) Getting acquainted/relationship building; 5) Birthing person's socioeconomic position; 6) Birthing person's preparation/ education; 7) Birthing person's capability of decision making and expression; and 8) Behavior of accompanying persons. Moreover, we identified midwives' strategies to extend possibilities of choice. Several factors clearly differ depending on the birth setting.

Conclusions:
The opportunities for SDC seem to differ according to the setting (e.g. institutional routines), inter-personal relations (e.g. getting acquainted, trust), and individual factors (e.g. socioeconomic position, capabilities). Hence, political, institutional and individual strategies may support SDC in consideration of the above factors. Measures may, among others, include the improvement of information processes, the reduction of economic barriers, relationship building before and during birth as well as respective structural adjustments. Key messages: Self-determination (SD) in childbirth is influenced by several factors at individual, inter-personal, institutional and macro level. Individual, institutional and political strategies may support SD.

Background:
An increase in regionalization of obstetric services is being observed worldwide. This study investigated factors associated with the closure of obstetric units in hospitals in Germany and aimed to examine the effect of obstetric unit closure on accessibility of obstetric care.

Methods:
Secondary data of all German hospital sites with an obstetrics department were analyzed for 2014 and 2019. Multivariate logistic regression was performed to identify factors associated with obstetrics department closure. Subsequently, the driving times to a hospital site with an obstetrics department were mapped, and different scenarios resulting from further regionalization were modelled.

Results:
Of 747 hospital sites with an obstetrics department in 2014, 85 obstetrics departments closed down by 2019. Only the annual number of live births was observed to be a factor significantly associated with the closure of obstetrics departments (odds ratio: 0Á995; confidence interval: 0.993-0.997). Areas in which driving times to the next hospital site with an obstetrics department exceeded the 30 and 40 min threshold increased from 2014 to 2019. Scenarios in which only hospital sites with a pediatrics department or hospital sites with an annual birth volume of ! 600 were considered resulted in large areas in which the driving times would exceed the 30 and 40 min threshold.

Conclusions:
The annual number of live births is a factor significantly associated with the closure of obstetrics departments. Despite the closure, good accessibility is maintained for most areas in Germany. Although further regionalization may ensure highquality care and efficiency, it will have an impact on accessibility.

Background:
The development of theory-based prevention efforts is complex and often not feasible in the daily work of project planners. Planning tools such as the Intervention Mapping Approach (IMA), which is a gold standard for project planning, cannot be used in practice without preconditions. How can prevention planning be evidence-based but also practical? Against this background, the research project WEPI was developed, funded by the Federal Ministry of Health, Germany. WEPI is a digital planning tool based on the IMA, that guides municipalities and schools in planning childhood obesity prevention efforts.

Methods:
From April 2019 to October 2020, the planning tool was developed. In October 2020 and February 2021, WEPI was tested for the first time by selected municipalities (n = 4) in Bavaria and schools (n = 4) in Lower Saxony. Based on this, the modified planning tool was tested for a second time throughout Germany (05-11/2021). Handling and acceptance were evaluated in a questionnaire survey.

Results:
The first test showed that content and technical aspects needed to be optimised in order to bring scientific demands and practical feasibility together. Six municipalities and eight educational institutions participated in the second test phase. The respondents (n = 14) indicated that WEPI facilitates structured project planning (86%) and supports collaboration with colleagues (64%). 93% would use the planning tool again. WEPI offers evidence-based methods for practical implementation as well as a download area, including a template for a project application or a project summary. This service was also evaluated as very helpful (64%).

Conclusions:
Through step-by-step guidance, WEPI facilitates evidencebased project planning and ensures planning quality. Effort and benefit are in good proportion. Further optimisations are needed to improve the user-friendliness. Key messages: WEPI provides a comprehensive roadmap, helping practitioners to approach a structured project planning. Practitioners' participation promotes acceptance and provides a user-friendly development.

Background:
Internet use in pregnancy is very prevalent. However, there are issues with information quality as well as acceptance by healthcare providers which can add to the frustration.

Methods:
An online anonymous survey, shared via Baby Buddy Cyprus, addressed women who are pregnant or recently gave birth in Cyprus. Adapting previously used questionnaires, the survey covered reasons and patterns of internet use, perceptions of trustworthiness, appraisal means and usefulness in decisionmaking.

Results:
Among 357 responses so far in this ongoing survey (38% pregnant, 62% new mums, 66% primiparas, 42% C/S, 78% private sector), searching online seems very frequent, even though 70% report coming across wrong or misleading information often. Checking for consistency across sites and/ or with information by healthcare provider (HP) is the most common technique for assessing trustworthiness. While the majority discuss information with HP, only half characterize their reception as positive and welcoming. As many as 89% believe that HP should recommend sites, but only 6.5% report their HP made recommendations. The role of the internet in assisting decision-making is rated as moderate (M = 3.0, SD = 1.0 on 5-point scale averaged across 11 items); yet more than half search online to be prepared and have control over decisions. Among reasons cited for using the internet is insufficient time with HP and/or is unclear or unsatisfactory information. While only 11.6% prepare material for the next appointment, 54.5 % use the internet to verify information given by HP or for a second opinion.

Conclusions:
While a prevalent source of information, the flow is problematic as it appears that women are more likely to search online to verify information rather than discuss this information with their providers. Insights about characteristics and attributes of internet use in pregnancy suggest that health services need to engage with, rather than ignore, this reality and offer appropriate guidance. Key messages: Pregnant women in Cyprus search for information online, due to insufficient time or information by healthcare providers, even though they recognize there are issues with quality and expect guidance.
In a landscape of unguided information-seeking, searching for consistency and verification, a shift in current practices is needed whereby healthcare providers and services engage with this reality.