Centering Women and Newborns in Health Human Resources Planning: A needs-based approach to primary maternity health care in Nova Scotia

Abstract

With a global health human resources (HHR) crisis and increasing health needs, new ways of designing health care in all clinical settings, including primary maternity health care is required. The purpose of this sequential quantitative-qualitative mixed methods study was to identify the primary maternity care needs of women and newborns in Nova Scotia (NS). Informed by established HHR frameworks, data from the NS Atlee Perinatal Database (NSAPD) (n=17,856) were analyzed using univariate and multiple regression analyses to determine the health needs of women and newborns based on various health needs indicators. Using purposeful sampling and poster and email recruitment, focus groups and interview data from women (n=22), health care providers (n=16) and health leaders (n=18) were analyzed using a thematic analysis approach. From the quantitative analysis, rurality, lower maternal education and income and identifying as not Caucasian were significant predictors for various maternal-newborn primary health care needs indicators. In the qualitative analysis, women, health leaders and providers identified the social determinants of health as a prevalent health care need for women and newborns. From a systems perspective, there was a general call for a change in the current paradigm of health care to move from illness and acute care to one that includes a broader definition of health. Study participants also identified a lack of patient-centredness complicated by provider-focused care in our current system. Strategies identified to improve primary maternity health care included care providers practicing to full scope and a need for increased interprofessional/intersectoral collaboration. A number of providers and leaders expressed concern about the various funding models and how these impact the timing and type of care that was provided. From an individual care encounter perspective, the need for respectful, culturally competent and safe care rooted in relationships was identified. Methodologically, the need for improvements to how we understand and measure health and health needs to inform how we design and deliver health care was identified. The integrated findings from this research will inform HHR and health care planning in Nova Scotia and will identify gaps in services for specific populations of women to inform targeted planning.