Search

Background: A lack of confidence in perinatal bereavement care (PBC) and the psychological trauma experienced by nurses and midwives during bereavement care leads to their strong need for sufficient organisational support. The current study intended to test a hypothesised model of the specific impact paths among organisational support, confidence in PBC, secondary traumatic stress, and emotional exhaustion among nurses and midwives. Methods: A descriptive, cross-sectional survey was conducted in sixteen maternity hospitals in Zhejiang Province, China, from August to October 2021. The sample (n = 779) consisted of obstetric nurses and midwives. A path analysis was used to test the relationships among study variables and assess model fit. Results: Organisational support directly and positively predicted confidence in PBC and demonstrated a direct, negative, and significant association with secondary traumatic stress and emotional exhaustion. Confidence in PBC had a positive direct effect on secondary traumatic stress and a positive indirect effect on emotional exhaustion via secondary traumatic stress. Secondary traumatic stress exhibited a significant, direct effect on emotional exhaustion. Conclusions: This study shows that nurses' and midwives' confidence in PBC and mental health were leadingly influenced by organisational support in perinatal bereavement practice. It is worth noting that higher confidence in PBC may lead to more serious psychological trauma symptoms in nurses and midwives. Secondary traumatic stress plays an essential role in contributing to emotional exhaustion. The findings suggest that support from organisations and self-care interventions were required to improve confidence in PBC and reduce negative psychological outcomes among those providing PBC. The development of objective measures for assessing competence in PBC and organizational support are essential. [ABSTRACT FROM AUTHOR]

Background: A lack of confidence in perinatal bereavement care (PBC) and the psychological trauma experienced by nurses and midwives during bereavement care leads to their strong need for sufficient organisational support. The current study intended to test a hypothesised model of the specific impact paths among organisational support, confidence in PBC, secondary traumatic stress, and emotional exhaustion among nurses and midwives. Methods: A descriptive, cross-sectional survey was conducted in sixteen maternity hospitals in Zhejiang Province, China, from August to October 2021. The sample (n = 779) consisted of obstetric nurses and midwives. A path analysis was used to test the relationships among study variables and assess model fit. Results: Organisational support directly and positively predicted confidence in PBC and demonstrated a direct, negative, and significant association with secondary traumatic stress and emotional exhaustion. Confidence in PBC had a positive direct effect on secondary traumatic stress and a positive indirect effect on emotional exhaustion via secondary traumatic stress. Secondary traumatic stress exhibited a significant, direct effect on emotional exhaustion. Conclusions: This study shows that nurses' and midwives' confidence in PBC and mental health were leadingly influenced by organisational support in perinatal bereavement practice. It is worth noting that higher confidence in PBC may lead to more serious psychological trauma symptoms in nurses and midwives. Secondary traumatic stress plays an essential role in contributing to emotional exhaustion. The findings suggest that support from organisations and self-care interventions were required to improve confidence in PBC and reduce negative psychological outcomes among those providing PBC. The development of objective measures for assessing competence in PBC and organizational support are essential. [ABSTRACT FROM AUTHOR]

Background: Large-scale longitudinal studies with biological samples are needed to examine the associations between prenatal cannabis use and birth and developmental outcomes. Objectives: The aim of this study was to understand the feasibility and acceptability of collecting umbilical cord tissue for the purpose of cannabis use testing in a community sample. Design: This is a mixed methods research study consisted of a prospective cohort study and a qualitative descriptive study. Methods: This study was conducted in Vancouver, British Columbia between January 2021 and August 2022. Participants were recruited during pregnancy, and the umbilical cord tissues were collected at birth and tested for the presence of cannabinoids. After the completion of the study, participants completed an online open-ended questionnaire about their overall experience. Data were analyzed using descriptive and thematic analyses. Results: Among the 85 eligible individuals, 57 people (67%) consented to the study. The cord tissue was collected for 39 participants (68.4%). The collection rates for participants with vaginal, elective, and emergency cesarean delivery were 73.0%, 71.4%, and 53.8%, respectively, and for those with spontaneous and induced labor were 81.5% and 50%, respectively. Four (7.0%) and seven participants (12.3%) reported prenatal cannabis use in direct and probing self-report questions, respectively. The agreement between any self-report and cord tissue test was moderate (kappa 0.53, 95% confidence interval 0.06–0.99). Qualitative findings were classified into five themes. Conclusion: The collection of cord tissue was perceived acceptable by most participants. Implementation of collection protocols for complex labors, a central hospital unit to liaise direct communications and active participants' involvement might increase the feasibility of future studies. [ABSTRACT FROM AUTHOR]

Introduction: Current US guidelines for the care of women with obesity generalize obesity‐related risks to all women regardless of overall health status and assume that birth will occur in hospitals. Perinatal outcomes for women with obesity in US freestanding birth centers need documentation. Methods: Pregnancies recorded in the American Association of Birth Centers Perinatal Data Registry were analyzed (n = 4,455) to form 2 groups of primiparous women (n = 964; 1:1 matching of women with normal body mass indices [BMIs] and women with obese BMIs [>30]), using propensity score matching to address the imbalance of potential confounders. Groups were compared on a range of outcomes. Differences between groups were evaluated using χ2 test for categorical variables and Student's t test for continuous variables. Paired t test and McNemar's test evaluated the differences among the matched pairs. Results: The majority of women with obese BMIs experienced uncomplicated perinatal courses and vaginal births. There were no significant differences in antenatal complications, proportion of prolonged pregnancy, prolonged first and second stage labor, rupture of membranes longer than 24 hours, postpartum hemorrhage, or newborn outcomes between women with obese BMIs and normal BMIs. Among all women with intrapartum referrals or transfers (25.3%), the primary indications were prolonged first stage or second stage (55.4%), inadequate pain relief (14.8%), client choice or psychological issue (7.0%), and meconium (5.3%). Primiparous women with obesity who started labor at a birth center had a 30.7% transfer rate and an 11.1% cesarean birth rate. Discussion: Women with obese BMIs without medical comorbidity can receive safe and effective midwifery care at freestanding birth centers while anticipating a low risk for cesarean birth. The risks of potential, obesity‐related perinatal complications should be discussed with women when choosing place of birth; however, pregnancy complicated by obesity must be viewed holistically, not simply through the lens of obesity. [ABSTRACT FROM AUTHOR]

Purpose: Integrating preventive oral care into prenatal care is suggested as a strategy for reducing the burden of oral diseases among pregnant women and their offspring. This scoping review sought to synthesize available information and identify knowledge gaps on integrating oral health into prenatal care. Design/methodology/approach: The scoping review was conducted based on the Joanna Briggs Institute scoping review framework using the following databases: CINAHL, Cochrane Database of Systematic Reviews, Medline, ProQuest Dissertation and theses Global, Psychinfo and Web of Science®. No search limits were used. Content analysis of the included articles was performed to identify conceptual frameworks, types of integration used, study designs, study objectives and outcomes. Findings: Overall, 2,861 references were obtained from the databases search; and based on the inclusion and exclusion criteria 35 references were included in the final analysis. Of these 35 references, one document presented a conceptual model, six documents reviewed guidelines for integrating oral health in prenatal care, two were policy documents aimed at interprofessional collaboration for oral health during pregnancy, eight documents described programs focused on providing oral care during pregnancy, five of the references were literature reviews and the remaining 13 evaluated the impact of integration. Linkages between healthcare professionals were the most common type of integration used. Research limitations/implications: Despite advances in understanding integrated care concepts for healthcare delivery, there is little evidence available on the impact of the various types of, and strategies for, integrating oral health into prenatal care. Future research to bridge the identified gaps is recommended. Originality/value: The originality of this study is to provide evidence on integrated oral healthcare during pregnancy. [ABSTRACT FROM AUTHOR]

The article explores how to improve perinatal outcomes through health and parenting education, shared decision making to reduce maternal and family stress and support arranged by the social worker, during the Covid-19 pandemic. Topics include postpartum disruptions to effective parenting in the maternal–newborn dyad; and the COVID-19 pandemic-associated recession imposes unemployment with ensuing loss of income, and food insecurity.

Introduction: Intrapartum emergencies occur infrequently but require a prompt and competent response from the midwife to prevent morbidity and mortality of the woman, fetus, and newborn. Simulation provides the opportunity for student midwives to develop competence in a safe environment. The purpose of this study was to determine the inter‐rater reliability of the McMahon Competence Assessment Instrument (MCAI) for use with student midwives during a simulated shoulder dystocia scenario. Methods: A pilot study using a nonprobability convenience sample was used to evaluate the MCAI. Content validity indices were calculated for the individual items and the overall instrument using data from a panel of expert reviewers. Fourteen student midwives consented to be video recorded while participating in a simulated shoulder dystocia scenario. Three faculty raters used the MCAI to evaluate the student performance. These quantitative data were used to determine the inter‐rater reliability of the MCAI. Results: The intraclass correlation coefficient (ICC) was used to assess the inter‐rater reliability of MCAI scores between 2 or more raters. The ICC was 0.86 (95% confidence interval, 0.60‐0.96). Fleiss's kappa was calculated to determine the inter‐rater reliability for individual items. Twenty‐three of the 42 items corresponded to excellent strength of agreement. Discussion: This study demonstrates a method to determine the inter‐rater reliability of a competence assessment instrument to be used with student midwives. Data produced by this study were used to revise and improve the instrument. Additional research will further document the inter‐rater reliability and can be used to determine changes in student competence. Valid and reliable methods of assessment will encourage the use of simulation to efficiently develop the competence of student midwives. [ABSTRACT FROM AUTHOR]

Background: Addressing suboptimal breastfeeding initiation and duration rates is a priority in the United States. To address challenges to improving these rates, the voices of the providers who work with breastfeeding mothers should be heard. Research aim: The purpose of this study was to explore lactation consultants’ perceived barriers to managing early breastfeeding problems. Methods: This qualitative study was conducted with a grounded theory methodological approach. In-depth interviews were conducted with 30 International Board Certified Lactation Consultants across Florida. Lactation consultants were from a range of practice settings, including hospitals, Special Supplemental Nutrition Program for Women, Infants, and Children clinics, private practice, and pediatric offices. Data were digitally recorded, transcribed, and analyzed in Atlas.ti. Results: A range of barriers was identified and grouped into the following categories/themes: indirect barriers (social norms, knowledge, attitudes); direct occupational barriers (institutional constraints, lack of coordination, poor service delivery); and direct individual barriers (social support, mother’s self-efficacy). A model was developed illustrating the factors that influence the role enactment of lactation consultants in managing breastfeeding problems. Conclusion: Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration among various healthcare providers and the family. Findings provide insight into the professional management issues of early breastfeeding problems faced by lactation consultants. Team-based, interprofessional approaches to breastfeeding support for mothers and their families are needed; improving interdisciplinary collaboration could lead to better integration of lactation consultants who are educated and experienced in providing lactation support and management of breastfeeding problems. [ABSTRACT FROM AUTHOR]

Introduction Socioeconomic deprivation in high-income industrialized countries is a key factor in poor perinatal outcomes. Limited access, utilization, and quality of antenatal care seem to play an important role in poor perinatal outcomes. Methods This integrative review aimed to explore experiences of antenatal care among women who are socioeconomically deprived in high-income industrialized countries. A search was conducted using 5 databases for articles published from 2004 to 2014. Six qualitative and 3 quantitative articles were selected. These were systematically appraised for quality independently by 3 researchers. Relevant themes were identified and organized into categories. Results The disadvantages experienced in antenatal care by women who are socioeconomically deprived start before the first contact with health care services and are notable throughout the entire pregnancy. There is disparity in choice of medical or midwifery service provision models. Six categories emerged during review: choice of service provision model, feeling valued, various types of discrimination, structural and interpersonal accessibility, comprehensibility and trustworthiness of information, and engagement and sense of responsibility. Categories underscored the importance of the woman's relationship with the antenatal care provider. Discussion Antenatal care models with women-centered approaches and continuity of care, such as midwifery models, have potential to increase the satisfaction of women with low socioeconomic status with care; this may increase antenatal care utilization and improve perinatal outcomes. [ABSTRACT FROM AUTHOR]

Problem Little is known about postpartum immune recovery and relationships of common dysphoric moods, stress, immunology, and endocrinology. Method of study Healthy women ( n = 72) were followed for six postpartum months with immune and hormone measures and dysphoric moods and stress scales. A panel of cytokines produced in mitogen-stimulated whole blood assays were measured at each time, along with plasma levels of hs C-reactive protein (hs CRP), Interleukin-6 ( IL-6), and a panel of hormones. Results Cellular immunity, measured by production of Interferon-gamma ( IFNγ) and (Interleukin-2 ( IL-2) from stimulated whole blood culture, was low in the early postpartum with changes by 3 months. Tumor necrosis factor alpha ( TNFα) showed a similar pattern. Plasma levels of CRP and Interleukin-6 ( IL-6) showed higher levels in the early postpartum. Mood disturbance scores dropped across the postpartum with a change in slope at 3 months. No significant relationships were found between immune, endocrine, and psychosocial measures. Conclusion Return to normal cellular immune function may take 3-4 months in the postpartum. Some aspects of early immunology (hs CRP and IL-6) probably reflect the latter stage of pregnancy, the stress of birth and the inflammation associated with involution. Dysphoric moods are higher in the early postpartum but are not related to immune factors or hormones. [ABSTRACT FROM AUTHOR]

Background. Postpartum thyroiditis (PPT) is a common triphasic autoimmune disease in women with thyroid peroxidase (TPO) autoantibodies. This study evaluated women's thyroid disease symptoms, physical findings, stress levels, and thyroid stimulating hormone (TSH) levels across six postpartum months in three groups, TPO negative, TPO positive, and PPT positive women. Methods. Women were recruited in midpregnancy (n = 631) and TPO status was determined which then was used to form the three postpartum groups. The three groups were compared on TSH levels, thyroid symptoms, weight, blood pressure, heart rate, a thyroid exam, and stress scores. Results. Fifty-six percent of the TPO positive women developed PPT. Hypothyroid group (F (2, 742) = 5.8, P = .003) and hyperthyroid group (F (2, 747) = 6.6, P = .001) subscale scores differed by group. Several symptoms and stress scores were highest in the PPT group. Conclusions. The normal postpartum is associated with many symptoms that mimic thyroid disease symptoms, but severity is greater in women with either TPO or PPT positivity. While the most severe symptoms were generally seen in PPT positive women, even TPO positive women seem to have higher risk for these signs and symptoms. [ABSTRACT FROM AUTHOR]

Background. Postpartum thyroiditis (PPT) is a common triphasic autoimmune disease in women with thyroid peroxidase (TPO) autoantibodies. This study evaluated women's thyroid disease symptoms, physical findings, stress levels, and thyroid stimulating hormone (TSH) levels across six postpartum months in three groups, TPO negative, TPO positive, and PPT positive women. Methods. Women were recruited in midpregnancy (n = 631) and TPO status was determined which then was used to form the three postpartum groups. The three groups were compared on TSH levels, thyroid symptoms, weight, blood pressure, heart rate, a thyroid exam, and stress scores. Results. Fifty-six percent of the TPO positive women developed PPT. Hypothyroid group (F (2, 742) = 5.8, P = .003) and hyperthyroid group (F (2, 747) = 6.6, P = .001) subscale scores differed by group. Several symptoms and stress scores were highest in the PPT group. Conclusions. The normal postpartum is associated with many symptoms that mimic thyroid disease symptoms, but severity is greater in women with either TPO or PPT positivity. While the most severe symptoms were generally seen in PPT positive women, even TPO positive women seem to have higher risk for these signs and symptoms. [ABSTRACT FROM AUTHOR]

Background: There have been recent reports that lactational history is associated with long-term women's health benefits. Most of these studies are epidemiological. If particular cardiometabolic changes that occur during lactation ultimately influence women's health later is unknown. Methods: Seventy-one healthy women participated in a prospective postpartum study that provided an opportunity to study anthropometric, endocrine, immune, and behavioral variables across time. Variables studied were heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), C-reactive protein, body mass index (BMI), perceived stress, and hormones. A cohort of women without a change in breastfeeding ( N=22) or formula feeding ( N=23) group membership for 5 months was used for analysis of effects of feeding status. The data were analyzed using factorial repeated measures analysis of variance and analysis of covariance. Results: SBP and HR declined across the postpartum and were significantly lower in breastfeeding compared to formula feeding mothers ( p<0.05). These differences remained statistically significant when BMI was added to the model. Other covariates of income, stress, marital status, and ethnicity were not significantly associated with these variables over time. DBP was also lower, but the significance was reduced by the addition of BMI as a covariate. Stress also was lower in breastfeeders, but this effect was reduced by the addition of income as a covariate. Conclusions: These data suggest that there are important physiological differences in women during months of breastfeeding. These may have roles in influencing or programming later risks for a number of midlife diseases. [ABSTRACT FROM AUTHOR]

Abstract: The majority of maternal deaths occur in sub-Saharan Africa and reports show that the sub-Saharan region along with Asia contribute 87% of the world's maternal deaths (United Nations (UN), 2010). The risk of dying for a woman in the reproductive age group in sub-Saharan Africa is 1 in 31, compared with 1 in 4300 in the developed countries (Rogo et al, 2006). Equipping the public with the proper information as to why women die and what could have been done to save their lives is feasible even in developing regions (World Health Organization (WHO), 2004). This article intends to provide a brief overview of issues related to maternal mortality, progress made towards mortality reduction, future trends and recommendations for the improvement of maternal health, with a focus to Eritrea, an east African nation. [ABSTRACT FROM AUTHOR]

A qualitative content analysis was conducted on narratives written by 127 mothers at four to six weeks postpartum. This study aimed to identify and compare postpartum stressors to the Tennessee Postpartum Stress Scale (TPSS). The TPSS is a guide to common postpartum stressors and an instrument to assess postpartum stress. Most participants in this study were white (91%), married (72%), and not working (70%). Eighteen stressor categories aggregated into two themes: Stressors Arising within the Maternal-Newborn Dyad and Stressors External to the Maternal-Newborn Dyad. Sixteen of 20 items on the TPSS were identified in the narratives. No stressor categories outside the TPSS were identified. [ABSTRACT FROM AUTHOR]

BACKGROUND:The reported rates of perinatal depression range from 10% to 15%. Many communities have limited resources for diagnosis and treatment of depression.OBJECTIVE:The purposes of this descriptive study were to evaluate the feasibility of screening women over time for perinatal depression and making appropriate referrals for diagnosis and treatment.DESIGN:Registered nurses, including community health nurses and a midwife, attempted to screen clients during the prenatal period and at 72 hours and 6 weeks postpartum. The Edinburgh Postnatal Depression Scale was used.RESULTS:Registered nurses were able to screen 180 women at least one time. Based on the initial screen, 63 (35%) women screened positive for depression and had the potential to be referred to a licensed social worker for diagnosis and/or treatment.CONCLUSION:Registered nurses were successful in screening for perinatal depression and making appropriate referrals. Longitudinal screening was difficult due to client refusal to be screened, participants being lost to follow-up, and/or moving outside the designated census tracts. Consistent with the literature, 10.6% of women were diagnosed with a depressive disorder. [ABSTRACT FROM PUBLISHER]

The National Practitioner Data Bank (NPDB), mandated by federal legislation in 1986, serves as a mechanism to protect the public from unsafe practitioners who attempt to avoid discovery of prior negligent behavior or malpractice record(s) by moving from state to state. Reporting to the NPDB about malpractice payments on behalf of nurse-midwives began in 1990. Reporting of providers excluded from Medicare and Medicaid program participation began in September 1999. Practitioners who were already in an excluded status at that time were reported. Reports of adverse action against a nurse-midwife can be submitted to the NPDB by a state licensure board, a governmental agency, hospitals, health maintenance organizations, or other health care organizations. Reporting of licensing actions and clinical privilege actions are not required, although these may be voluntarily reported. The NPDB received 484 reports about nurse-midwives from September 1, 1999, to March 31, 2005. Of the 484 reports, 375 have an obstetric malpractice code. The median claim payment made on behalf of nurse-midwives during this period is $225,000. Although limited, the NPDB is the only systematic national source of nurse-midwifery malpractice data collection. [Copyright &y& Elsevier]

Shoulder dystocia and brachial plexus injury occur in 0.5% to 1.5% of all births. Risk factors for both include maternal obesity, excessive prenatal weight gain, maternal diabetes, protracted labor, and fetal macrosomia. These factors are involved in only about 50% of births complicated by shoulder dystocia or brachial plexus injury. Shoulder dystocia has a low recurrence rate (9.8%–16.7%), although history of previous shoulder dystocia is the most reliable predictor of occurrence. Brachial plexus injury is the most common morbidity associated with shoulder dystocia, but 50% of newborns who present with this injury were not subject to shoulder dystocia at birth. Most brachial plexus injuries are transient, although 5% to 22% become permanent. Shoulder dystocia followed by permanent brachial plexus injury or mental impairment is one of the leading causes of malpractice allegations. Prompt assessment and management of shoulder dystocia and preparation to maximize the efficiency of shoulder dystocia maneuvers are critical. Documentation of the appropriate use of maneuvers to relieve shoulder dystocia demonstrates standard of care practice, thereby decreasing the potential for successful malpractice allegations. [Copyright &y& Elsevier]

Body mass index (BMI) should be assessed at every health care visit. Overweight and obesity are associated with higher risks of hypertension, type 2 diabetes, irregular ovulation, infertility, and pregnancy and birth complications. Family planning and annual gynecology examinations give primary care providers the opportunity to share basic weight management guidelines with women. Weight management to normalize BMI or reduce overweight and obesity is vital to reduce future comorbidities. This article demonstrates integration of basic weight management into gynecologic care. [Copyright &y& Elsevier]

An anonymous survey was mailed to 499 CNMs in Florida in May 2001 to examine the impact of CNM retirement on the Florida women''s health provider workforce and to estimate the replacement demand for CNMs. The survey also investigated where Florida''s CNMs studied midwifery, reasons for choosing education programs, reasons for moving to Florida, and causes of underemployment of CNMs. Two hundred eighty respondents returned the survey. Thirty-nine percent of respondents received their midwifery education in Florida. Eighty-one percent of respondents were working as CNMs. From 2010 through 2025, an average of 11 CNMs in Florida will reach age 65 each year. These data indicate that retirement will generate demand for new CNMs in the next two decades. These data, along with future research tracking midwifery education, employment, and retirement, could be used to plan program funding, clinical site needs, and legislative support of midwifery. [Copyright &y& Elsevier]