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Introduction: A positive childbirth experience promotes women's health, both during and beyond the perinatal period. Understanding what constitutes a positive childbirth experience is thus critical to providing high‐quality maternity care. Currently, there is no clear, inclusive, woman‐centered definition of a positive childbirth experience to guide practice, education, and research. Aim: To formulate an inclusive woman‐centered definition of a positive childbirth experience. Methods: A six‐step process was undertaken: (a) Key concepts associated with a positive childbirth were derived from a rapid literature review; (b) The key concepts were used by interdisciplinary experts in the author group to create a draft definition; (c) The draft definition was presented to clinicians and researchers during a European research meeting on perinatal mental health; (d) The authors integrated the expert feedback to refine the working definition; (e) A revised definition was shared with women from consumer groups in six countries to confirm its face validity; and (f) A final definition was formulated based on the women's feedback (n = 42). Results: The following definition was formulated: "A positive childbirth experience refers to a woman's experience of interactions and events directly related to childbirth that made her feel supported, in control, safe, and respected; a positive childbirth can make women feel joy, confident, and/or accomplished and may have short and/or long‐term positive impacts on a woman's psychosocial well‐being." Conclusions: This inclusive, woman‐centered definition highlights the importance of provider interactions for facilitating a positive childbirth experience. Feeling supported and having a sense of control, safety, and respect are central tenets. This definition could help to identify and validate positive childbirth experience(s), and to inform practice, education, research, advocacy, and policy‐making. [ABSTRACT FROM AUTHOR]

Introduction: Many women experience giving birth as traumatic. Although women's subjective experiences of trauma are considered the most important, currently there is no clear inclusive definition of a traumatic birth to help guide practice, education, and research. Aim: To formulate a woman‐centered, inclusive definition of a traumatic childbirth experience. Methods: After a rapid literature review, a five‐step process was undertaken. First, a draft definition was created based on interdisciplinary experts' views. The definition was then discussed and reformulated with input from over 60 multidisciplinary clinicians and researchers during a perinatal mental health and birth trauma research meeting in Europe. A revised definition was then shared with consumer groups in eight countries to confirm its face validity and adjusted based on their feedback. Results: The stepwise process confirmed that a woman‐centered and inclusive definition was important. The final definition was: "A traumatic childbirth experience refers to a woman's experience of interactions and/or events directly related to childbirth that caused overwhelming distressing emotions and reactions; leading to short and/ or long‐term negative impacts on a woman's health and wellbeing." Conclusions: This definition of a traumatic childbirth experience was developed through consultations with experts and consumer groups. The definition acknowledges that low‐quality provider interactions and obstetric violence can traumatize individuals during childbirth. The women‐centered and inclusive focus could help women to identify and validate their experiences of traumatic birth, offering benefits for practice, education, and research, as well as for policymaking and activism in the fields of perinatal mental health and respectful maternity care. [ABSTRACT FROM AUTHOR]

Background: Implementation of shared decision‐making in antenatal care has had limited exploration. Objective: To assess what is known about shared decision‐making in antenatal care. Search Strategy: Five databases were searched (1997–2022) limited to English language studies from OECD countries. Data Collection and Analysis: A data collection table was constructed with findings from 32 papers. A narrative synthesis was conducted with subsequent thematic analysis of included papers. Main Results: Four areas of decision‐making were identified with six themes revealing enablers and barriers to shared decision‐making in antenatal care. Conclusion: Implementation of shared decision‐making requires continuity, time and personalisation of care. [ABSTRACT FROM AUTHOR]

The article offers information on the issues tackled in the journal which include evaluating the effectiveness of midwifery care as defined by the Quality Maternal and Newborn Care framework.

Background: Increasing numbers of childbearing women with a history of female genital mutilation (FGM) are accessing maternity services in high‐income countries across the world. For many of these women, their first contact with the health services in their host country is when they are pregnant. While the clinical consequences of certain categories of FGM are well documented, how high‐risk maternity services — designed to mitigate the obstetric consequences of FGM — impact upon women's experience of childbearing is less clear. Methods: Using a meta‐synthesis approach, this paper synthesizes 12 qualitative research papers, conducted in 5 high‐income countries, to explore how migrant women with a history of FGM experience maternity care in their host countries. Results: One over‐arching theme and four discrete subthemes of migrant women's experience of the maternity services in their host country were identified: feelings of alienation; fatalism and divine providence, positive and negative feelings about maternity care, different understandings of the birthing process, and feelings about FGM. Conclusions: The findings illustrate that migrant women with a history of FGM frequently encounter negative attitudes when accessing the maternity services in their host countries. Women's experiences suggest a concerning absence of sensitive and empathetic care; a more woman‐centered approach is recommended. [ABSTRACT FROM AUTHOR]

Background: Normal physiologic birth has been shown to result in optimal maternal–infant outcomes, but the concept of physiologic birth is continually evolving. Midwives play an important role in advocating for normal physiologic birth; however, their perceptions of what this approach entails have not been systematically appraised. Objective: In this qualitative review, we aimed to examine midwives' perceived meanings of "normal physiologic birth" and to describe their experiences facilitating such births. Methods: Five electronic databases were searched, and 26 qualitative papers were included, representing a total of 433 midwives from different backgrounds (i.e., independent, home‐based, community‐based, and hospital‐based). Eligible papers were assessed for quality, and then data were coded and synthesized thematically. Results: Four highly connected themes were generated: (1) the midwife: fundamental beliefs; (2) the woman: empowerment and advocacy; (3) the environment: ambience and culture; and (4) the team: need for institutional support and recognition. The fundamental beliefs of midwives, such as their perceived role and definition of normal physiologic birth and their self‐confidence, influence practice styles and contribute to personal and professional development. Midwives often advocate for a person‐centered approach that encouraged women's and other birthing person's autonomy and involvement in shared decision‐making. The midwife–client relationship is also central. Most importantly, a conducive birthing environment and an inclusive workplace culture that encourages interprofessional support, collaboration, and recognizes midwifery practices were identified as crucial in providing optimal conditions for the facilitation of physiologic birth. Conclusions: This review provides healthcare policymakers and institutions fresh impetus to evaluate and revise as needed current workplace policies to be more inclusive and supportive of midwifery practices and physiologic birth. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Healthcare for childbearing women with complex needs demands a multi‐disciplinary approach requiring transitions between care providers, paradigms, and models of care. These transitions may create disconnects between women and the maternity care “system.” Poorly managed care transitions can lead to women becoming hostage to the power struggles between healthcare organizations and the professionals working within them, further increasing the risk of poor outcomes. This paper presents the findings of a study that aimed to better understand how midwives provide woman‐centered care for women with complex needs in the real world of maternity services.A constructivist grounded theory approach, using Clarke's situational analysis to extend critical and feminist perspectives in data analysis. Qualitative data were obtained from two sources: publicly available data, and individual interviews with providers of care (midwives) and recipients of care (women with complex pregnancies).Woman‐centered care is defined as care in which the woman is seen, heard, and known. “The midwifery capabilities theory” describes the process whereby midwives create opportunities to develop women's capabilities. Capabilities are enabled through the midwifery relationship creating space, moments in time, and equalizing power and positionality.Aligning with contemporary theories surrounding the provision of midwifery care, the midwifery capabilities theory recognizes the individual health and social status of women and the rights to self‐determination. This centers care around each individual's needs, which, in addition to improving health and well‐being outcomes, contributes to improved self‐confidence, enhancing engagement through authentic professional relationships. [ABSTRACT FROM AUTHOR]

Background: In an Australian randomized controlled trial (RCT), two techniques for intrapartum fetal surveillance were compared: ST analysis (STan) as an adjunct to cardiotocography (CTG), compared with CTG alone. The aim was to determine whether CTG + STan could reduce emergency cesarean birth rates while maintaining or improving neonatal outcomes. Secondary aims were to compare clinical, economic, and psychosocial outcomes. The purpose of this paper was to present psychosocial outcomes from one cohort enrolled in the trial. Methods: The study was conducted at one tertiary referral hospital. Participants who had taken part in the trial from the outset were invited to complete a questionnaire between March 2018 and January 2020, approximately 8 weeks after giving birth. Outcomes included depression, psychological distress, health‐related quality of life, and infant feeding practices. Analysis was by intention to treat. Results: N = 207/527 participants completed the questionnaire (n = 113, STan; n = 94, CTG alone). Overall, no statistically significant or clinically meaningful differences were found in the two groups for symptoms of depression, psychological distress, quality of life, or infant feeding. A statistically significant difference was observed for the subscale of pain‐discomfort, where scores were higher on average in the CTG alone arm relative to that in the CTG + STan arm. Conclusions: Although STan as an adjunct to CTG constitutes a different clinical technology from CTG alone, both monitoring types appeared to produce similar results in terms of postnatal psychosocial outcomes for women. Findings from this study provide service users and staff with a comprehensive assessment of STan that can be used to make evidence‐informed decisions about monitoring options should STan become more widely available. [ABSTRACT FROM AUTHOR]

Background: For pregnant and birthing women, maintaining a relationship with the same health care practitioner is critical to establishing a sense of safety. In postsocialist Serbia, where care is fragmented and depersonalized, this continuity is often missing. Patients are frequently handed over to new practitioners, sometimes without even knowing the name of the person overseeing their care. In response, many women turn to the private sector to keep the same practitioner across their prenatal period and their birth by establishing a personal "connection" within the hospital that they believe will shield them from mistreatment during childbirth. Methods: Data presented in this paper were collected through participant observation in one public maternity hospital and one public primary care center in Serbia; semistructured interviews with 14 physicians; and semistructured interviews with 80 women who had given birth in one public maternity hospital in Serbia. Results: Public maternity hospital physicians who supplement their income working in the private sector have the power to blur the distinctions between favors and services. They offer continuity of personalized care to their private clients/patients once they enter the public system, and they themselves obtain social and economic security unavailable to those working in only one sector. At the same time, there is evidence that personalized continuity of care does not actually shield women from mistreatment in hospitals. Conclusions: The private sector is reshaping existing informal strategies and blurring the lines between formal and informal payments. In the postsocialist context, consumer practices are not separate from, but entangled with, informality. Neoliberalism has not brought about empowerment and eliminated informality, but has instead further exacerbated existing inequalities in maternity care in Eastern Europe. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Mothers and infants continue to die at alarming rates throughout the Global South. Evidence suggests that high‐quality midwifery care significantly reduces preventable maternal and neonatal morbidity and mortality. This paper uses a case study approach to describe the social and institutional model at one birth center in Northern Uganda where, in over 20,000 births, there have been no maternal deaths and the neonatal mortality rate is 11/1000—a rate that is lower than many high‐resource countries.This case study combined institutional ethnographic and narrative methods to explore key maternal and neonatal outcomes. The sample included birthing people who intended to or had given birth at the center, as well as the midwives, staff, stakeholders, and community health workers affiliated with the center. Data were collected through individual and small group interviews, participant observation, field notes, data and document reviews. Iterative and systematic analytical steps were followed, and all data were organized and managed with Atlas.ti software.Findings describe the setting, an overview of the birth center's history, how it is situated within the community, its staffing, administration, clinical outcomes, and model of care. A synthesis of contextual variables and key outcomes as they relate to the components of the evidence‐informed Quality Maternal and Newborn Care (QMNC) framework are presented. Three overarching themes were identified: (a) community knowledge and understanding, (b) community integrated care, and (c) quality care that is respectful, accessible, and available.This birth center is an example of care that embodies the findings and anticipated outcomes described in the QMNC framework. Replication of this model in other childbearing settings may help alleviate unnecessary perinatal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Separation at birth due to safeguarding concerns is a deeply distressing and impactful event, with numbers rising across the world, and has devastating outcomes for birth mothers and their children. It is one of the most challenging aspects of contemporary midwifery practice in high‐income countries, although rarely discussed and reflected on during pre‐ and post‐registration midwifery training. Ethnic and racial disparities are prevalent both in child protection and maternity services and can be explained through an intersectional lens, accounting for biases based on race, gender, class, and societal beliefs around motherhood. With this paper, we aim to contribute to the growing body of critical midwifery studies and re‐think the role of midwives in this context. Building on principles of reproductive justice theory, Intersectionality, and Standpoint Midwifery, we argue that midwives play a unique role when supporting women who go through child protection processes and should pursue a shift from passive bystander to active upstander to improve care for this group of mothers. [ABSTRACT FROM AUTHOR]

Effective communication in relation to pregnancy and birth is crucial to quality care. A recent focus in reproductive healthcare on “sexed language” reflects an ideology of unchangeable sex binary and fear of erasure, from both cisgender women and the profession of midwifery. In this paper, we highlight how privileging sexed language causes harm to all who birth—including pregnant trans, gender diverse, and non‐binary people—and is, therefore, unethical and incompatible with the principles of midwifery. We show how this argument, which conflates midwifery with essentialist thinking, is unstable, and perpetuates and misappropriates midwifery's marginalized status. We also explore how sex and gender essentialism can be understood as colonialist, heteropatriarchal, and universalist, and therefore, reinforcing of these harmful principles. Midwifery has both the opportunity and duty to uphold reproductive justice. Midwifery can be a leader in the decolonization of childbirth and in defending the rights of all childbearing people, the majority of whom are cisgender women. As the systemwide use of inclusive language is central to this commitment, we offer guidance in relation to how inclusive language in perinatal and midwifery services may be realized. [ABSTRACT FROM AUTHOR]

This commentary is in response to the Call for Papers put forth by the Critical Midwifery Studies Collective (June 2022). We argue that due to a long and ongoing history of gendered racism, Women of Color are devalued in U.S. society. Devaluing Women of Color leads maternal healthcare practitioners to miss and even dismiss distress in Women of Color. The result is systematic underdiagnosis, undertreatment, and the delivery of poorer care to Women of Color, which negatively affects reproductive outcomes generally and birth outcomes specifically. These compounding effects exacerbate distress in Women of Color leading to greater distress. Stress physiology is ancient and intricately interwoven with healthy pregnancy physiology, and this relationship is a highly conserved reproductive strategy. Thus, where there is disproportionate or excess stress (distress), unsurprisingly, there are disproportionate and excess rates of poorer reproductive outcomes. Stress physiology and reproductive physiology collide with social injustices (i.e., racism, discrimination, and anti‐Blackness), resulting in pernicious racialized maternal health disparities. Accordingly, the interplay between stress and reproduction is a key social justice issue and an important site for theoretical inquiry and birth equity efforts. Fortunately, both stress physiology and pregnancy physiology are highly plastic—responsive to the benefits of increased social support and respectful maternity care. Justice means valuing Women of Color and valuing their right to have a healthy, respected, and safe life. [ABSTRACT FROM AUTHOR]

Introduction: In the United States, adverse birth outcomes are most prevalent among Black women and birthing people, who are known to experience increased mistreatment and disrespect in care. The purpose of this paper is to describe findings from a study that used two validated scales to examine factors associated with experiences of person‐centered care during pregnancy and birth among Black birthing people in California. Methods: We used data from 234 Black women and birthing people who were recruited between January and September 2020 as part of a validation study for the Person‐Centered Prenatal Care (PCPC) and the Person‐Centered Maternity Care (PCMC‐US) scales. Bivariate and multivariate analyses were conducted to examine the associations between PCPC and PCMC‐US scores and sociodemographic, health‐related, and care‐related factors. Results: The factors associated with lower PCPC scores were having foreign‐born parents, having public or no insurance, part‐time employment, unstable housing, late start of prenatal care (in the second or third trimester), poorer self‐rated health (less than very good), and lack of continuity of care with prenatal providers. Factors associated with lower PCMC‐US scores were having public insurance, late start of prenatal care, longer length of stay in facility following birth, poorer self‐rated health, lack of continuity of care between prenatal care and birth providers, and racial discordance with birth provider. Conclusions: Our analysis highlights the contributions of intersecting identities as well as health‐related and care‐related factors to Black birthing people's experiences of care in California. Continuity of care and provider racial concordance, in particular, were shown to improve pregnancy and birth experiences. [ABSTRACT FROM AUTHOR]

Background: In Canada, Ontario midwives provide care to sexual and gender minority (SGM) people. Published literature shows how midwives' attitudes shape the experiences of lesbians, but research examining midwives' attitudes toward SGM people is lacking. Our study measured the attitudes of Ontario midwives toward SGM clients, hypothesizing that attitudes would be positive overall and that there would be no difference in attitudes across practice settings. Methods: Paper surveys (n = 926) with an option to respond online were sent to Ontario midwifery practices. We measured midwives' attitudes toward sexual minorities (11 questions, scores ranged from 11 to 55) and gender minorities (9 questions, scores ranged from 9 to 45), with higher scores indicating more positive attitudes. Overall and subgroup analyses were performed. Results: The 268 completed surveys indicated that midwives' attitudes were positive toward both sexual (mean score 49.2, maximum possible score of 55, ie, 89.4%) and gender minorities (mean score 38.9, maximum possible score of 45, ie, 86.4%). Analyses showed that attitudes toward SGM were associated with midwives' sexual identity and route of entry into the profession (ie, university‐based vs bridging programs), but not practice setting. Conclusions: Although attitudes of this subset of midwives toward SGM clients were positive, volunteer bias could account for this finding since 32.6% of respondents identified as sexual minorities. Since the attitudes of midwives who entered the profession through the university‐based education program were significantly more positive than those who entered through international bridging programs, future research should examine how SGM‐related content is integrated into midwifery education and training curricula. [ABSTRACT FROM AUTHOR]

Background: The objective of this paper was to identify predictors of a vaginal birth in individuals with singleton pregnancies and a Bishop Score <4, following Induction of Labor (IoL) using dinoprostone vaginal insert (DVI). Secondarily, we sought to understand the association between oxytocin use for labor augmentation and IoL outcomes. Methods: We developed and internally validated a multivariate prediction model using machine learning (ML) applied to data from two Phase‐III randomized controlled double‐blind trials (NCT01127581, NCT00308711). The model was internally validated using 10‐fold cross‐validation. Results: This study included 1107 participants. Despite unfavorable cervical status and inclusion of high‐risk pregnancies, 72% of participants had vaginal births. The model's area under receiver operating characteristic curve was 0.73. The following factors increased the chance of vaginal birth: being parous; being between 37 and 41 weeks of gestation; having a lower Body Mass Index; having a lower maternal age; having fewer maternal comorbidities; and having a higher Bishop score. Parity alone correctly predicted the outcome in ~50% of cases, at a ~10% false‐negative rate. Participants whose labors progressed without requiring oxytocin had a higher probability of vaginal birth than those requiring oxytocin for either induction or augmentation (81% vs 70% vs 77%, respectively). Discussion: Even in high‐risk pregnancies and with low Bishop scores, the use of DVI results in a high chance of vaginal birth. Parity is a critical predictor of success. The judicious use of oxytocin for labor induction or augmentation can increase the chance of vaginal birth. Our study validates the use of ML and predictive modeling for treatment response prediction when considering IoL. [ABSTRACT FROM AUTHOR]

Background: The Quality Maternal and Newborn Care (QMNC) Framework describes the care that childbearing women and newborn infants need in all settings. It comprises five components and was designed for use in planning, workforce development, and resource allocation, aimed at improving the quality and cost effectiveness of maternal and newborn care globally. The purpose of this paper is to describe the first phase of a project designed to transform the Framework into a quantitative tool for service user assessment of the quality of maternity care. Methods: Each component of the original Framework content was developed into a draft service user questionnaire and distributed to an expert panel, drawn from a range of low‐, middle‐, and high‐resource countries. The panel consisted of five Framework authors, nine midwife researchers, six midwives, and five service user (consumer) advocates. Two rounds of discussion and revision were undertaken with the expert panel who commented on the importance, relevance and clarity of questions, and then on their necessity, wording, and order. A third round involved two experts in survey design. Results: Following 24 responses in the first round, the questions were refined and returned to the panel. After incorporating the second‐round comments from 16 experts, the survey was then sent to two experts in questionnaire design and construction. Face validity was affirmed through this consultative process. Conclusions: Despite Covid‐19 pandemic‐related restrictions, this robust iterative consultative process with an international expert panel has resulted in the prototype QMNC Framework index (QMNCFi)—a questionnaire designed for use in diverse settings to assess the quality of maternity care. The QMNCFi's psychometric properties are now being tested in an international online survey. [ABSTRACT FROM AUTHOR]

Background: Female genital mutilation (FGM) is a cultural practice defined as the partial or total removal of the external female genitalia for nontherapeutic indications. Due to changing patterns of migration, clinicians in high‐income countries are seeing more women from countries where the practice is prevalent. This review aims to understand the sociocultural and health needs of these women and identify opportunities to improve the quality of maternity care for women with FGM. Methods: We undertook a systematic review and meta‐synthesis of peer‐reviewed primary qualitative research to explore the experience and needs of migrant women with FGM receiving maternity care. A structured search of nine databases was undertaken, screened papers appraised, and a thematic analysis undertaken on data extracted from the findings and discussion sections of included papers. Results: Sixteen peer‐reviewed studies were included in the systematic review. Four major themes were revealed: Living with fear, stigma, and anxiety; Feelings of vulnerability, distrust, and discrimination; Dealing with past and present ways of life after resettlement; and Seeking support and involvement in health care. Conclusions: The findings suggest that future actions for improving maternity care quality should be focused on woman‐centered practice, demonstrating cultural safety and developing mutual trust between a woman and her care providers. Meaningful consultation with women affected by FGM in high‐income settings requires cultural sensitivity and acknowledgment of their specific circumstances. This can be achieved by engaging women affected by FGM in service design to provide quality care and ensure woman‐focused policy is developed and implemented. [ABSTRACT FROM AUTHOR]

Background Methods Results Discussion Evidence suggests that transgender and gender‐expansive people are more likely to have suboptimal pregnancy outcomes compared with cisgender people. The aim of this study was to gain a deeper understanding of the role of midwifery in these inequities by analyzing the pregnancy experiences of transgender and gender‐expansive people from a critical midwifery perspective.We conducted a systematic scoping review. We included 15 papers published since 2010 that reported on pregnancy experiences of people who had experienced gestational pregnancy at least once, and were transgender, nonbinary, or had other gender‐expansive identities.Three themes emerged from our analysis: “Navigating identity during pregnancy,” “Experiences with mental health and wellbeing,” and “Encounters in the maternal and newborn care system.” Although across studies respondents reported positive experiences, both within healthcare and social settings, access to gender‐affirmative (midwifery) care and daily social realities were often shaped by trans‐negativity and transphobia.To improve care outcomes of transgender and gender‐expansive people, it is necessary to counter anti‐trans ideologies by “fixing the knowledge” of midwifery curricula. This requires challenging dominant cultural norms and images around pregnancy, reconsidering the way in which the relationship among “sex,” “gender,” and “pregnancy” is understood and given meaning to in midwifery, and applying an intersectional lens to investigate the relationship between gender inequality and reproductive inequity of people with multiple, intersecting marginalized identities who may experience the accumulated impacts of racism, ageism, and classism. Future research should identify pedagogical frameworks that are suitable for guiding implementation efforts. [ABSTRACT FROM AUTHOR]

Background: Despite strong evidence supporting the expansion of midwife‐led unit provision, as a result of optimal maternal and perinatal outcomes, cost‐effectiveness, and positive service user and staff experiences, scaling‐up has been slow. Systemic barriers associated with gender, professional, economic, cultural, and social factors continue to constrain the expansion of midwifery as a public health intervention globally. This article aimed to explore relationships and trust as key components of a well‐functioning freestanding midwifery unit (FMU). Method(s): A critical realist ethnographic study of an FMU located in East London, England, was conducted over a period of 15 months. Recruitment of the 82 participants was purposive. Data collection included participant observation and semi‐structured interviews, and data were analyzed thematically along with relevant local guidelines and documents. Results: Twelve themes emerged. Relationships and Trust were identified as a core theme. The other 11 themes were grouped into six families, three of which: Ownership, Autonomy, and Continuous Learning; Team Spirit, Interdependency, and Power Relations; and Salutogenesis will be covered in this paper. The remaining three families: Friendly Environment; Having Time and Mindfulness; and Social Capital, will be covered in a separate paper. Conclusions: A relationship‐based model of care was crucial for both the functioning of the FMU and service users' satisfaction and may offer a compelling response to high levels of stress and burnout among midwives. [ABSTRACT FROM AUTHOR]

Background: Rheumatic heart disease (RHD) is a preventable cardiac condition that escalates risk in pregnancy. Models of care informed by evidence‐based clinical guidelines are essential to optimal health outcomes. There are no published reviews that systematically explore approaches to care provision for pregnant women with RHD and examine reported measures. The review objective was to improve understanding of how attributes of care for these women are reported and how they align with guidelines. Methods: A search of 13 databases was supported by hand‐searching. Papers that met inclusion criteria were appraised using CASP/JBI checklists. A content analysis of extracted data from the findings sections of included papers was undertaken, informed by attributes of quality care identified previously from existing guidelines. Results: The 43 included studies were predominantly conducted in tertiary care centers of low‐income and middle‐income countries. Cardiac guidelines were referred to in 25 of 43 studies. Poorer outcomes were associated with higher risk scores (detailed in 36 of 41 quantitative studies). Indicators associated with increased risk include anticoagulation during pregnancy (28 of 41 reported) and late booking (gestation documented in 15 of 41 studies). Limited access to cardiac interventions was discussed (19 of 43) in the context of poorer outcomes. Conversely, early assessment and access to regular multidisciplinary care were emphasized in promoting optimal outcomes for women and their babies. Conclusions: Despite often complex care requirements in challenging environments, pregnancy provides an opportunity to strengthen health system responses and address whole‐of‐life health for women with RHD. A standard set of core indicators is proposed to more accurately benchmark care pathways, outcomes, and burden. [ABSTRACT FROM AUTHOR]

Background: Birth companions can have a positive effect on women's experiences in labor. However, companions can feel unprepared and need professional guidance to help them feel involved and provide effective support. Methods: A convergent segregated mixed‐methods systematic review was conducted to explore women's, companions', and midwives' experiences of birth companion support and identify ways to improve the experience for women and companions. A thematic synthesis of qualitative data and a narrative summary of quantitative data were conducted followed by integration of the findings. Results: Companions who cope well in labor reported feeling involved, able to preserve women's internal focus and have a defined role, providing physical or emotional support. LBGTQ+ partners faced barriers to inclusion due to "forefronting" of their sexuality by staff and a lack of recognition in the language and processes used. The experience of birth companions can be enhanced by promoting their role as co‐parent, guardian, and coach, provision of timely information and developing a trusting relationship with care providers. Only two papers reported midwives' views on birth companions in labor. Conclusions: Women's and companions' satisfaction with birth is increased when companions can support the mother, feel supported themselves, and valued as a co‐parent. The midwives' role in information provision and guidance can maximize birth companions' experience and ability to provide positive support. LBGTQ+ families need more support to feel included and recognized. [ABSTRACT FROM AUTHOR]

Background: Cesarean birth (CB) rates have increased over recent years with concerns over differences between these rates in migrant communities compared with the rates among women in their receiving country. This review aimed at summarizing the available literature regarding the incidence of CB among migrants in Europe. Methods: A systematic search of four electronic databases was carried out, including CINAHL, MEDLINE, Scopus, and Maternity and Infant Care. Identified studies were screened and their quality assessed. Meta‐analysis was undertaken using Rev Man 5.4 where sufficient data were available. Otherwise, data were synthesized narratively. Results: From the 435 records identified in searches, 21 papers were included. Analysis shows that overall CB rates were significantly lower for Syrian refugee women compared with women in their receiving country (Turkey) and higher for Iranian migrants than women in their host country. Emergency CB rates were significantly higher for migrant women from "Sub Saharan Africa" and the "South East Asia, Asia and Pacific" region than rates in the receiving country. Statistical significance was not found between other populations. Conclusions: This review highlights differences between CB rates in certain migrant groups in comparison with women native to their host country, which merits further investigation for potential explanations. We also identified a need to standardize definitions and population groupings to enable more meaningful analysis. This review also highlights a substantial lack of data on CB rates between different population groups that could negatively impact the provision of care. [ABSTRACT FROM AUTHOR]

As two academics researching in the area of maternal health, we are increasingly concerned with what we see as a positivist turn in midwifery research. In this paper, we examine this idea of the quantification of midwifery research, using as an example the current esteem given to the systematic literature review, and its creep into other methodologies. We argue that the current favor toward quantitative research and expertise in midwifery academia risks the future of midwifery research by the lack of equal development of qualitative experts, diluting qualitative research rigor within the profession, and limiting the kinds of questions asked. We identify the similarity between the current prominence of quantitative research and medical dominance in midwifery and maintain that it is of vital importance to the profession (research and practice) that the proper attention, contemplation, and merit are given to qualitative research methods. [ABSTRACT FROM AUTHOR]

Background: Contrary to social constructions of new motherhood as a joyous time, mothers may experience postnatal depression and anger. Although postnatal depression has been thoroughly studied, the expression of maternal anger in the context of postnatal depression is conceptually unclear. This integrative review investigated the framing of anger in the context of postnatal depression. Methods: After undertaking a search of CINAHL, Ovid‐Medline, PsycInfo, and Web of Science, we identified qualitative (n = 7) and quantitative (n = 17) papers that addressed maternal anger and postnatal depression. We analyzed the data by developing themes. Results: Our review indicated that anger was a salient mood disturbance for some postnatally depressed women with themes integrated as: (i) anger accompanying depression, (ii) powerlessness as a component of depression and anger, and (iii) anger occurring as a result of expectations being violated. CONCLUSIONS: Our findings indicate that anger can coexist with women's postnatal depression. Anger can be expressed toward the self and toward children and family members with negative relationship effects. We recommend that health care providers and researchers consider anger in the context of postnatal mood disturbances. [ABSTRACT FROM AUTHOR]

Background: Midwifery continuity of care models are the only health system intervention associated with both a reduction in preterm birth (PTB) and an improvement in perinatal survival; however, questions remain about the mechanisms by which such positive outcomes are achieved. We aimed to uncover theories of change by which we can postulate how and why continuity of midwifery care models might affect PTB. Methods: We followed Pawson's guidance for conducting a realist review and performed a comprehensive search to identify existing literature exploring the impact of continuity models on PTB in all pregnant women. A realist methodology was used to uncover the context (C), mechanisms (M), and outcomes (O) and to develop a group of CMO configurations to illuminate middle‐range theories. Results: Eleven papers were included from a wide variety of settings in the United Kingdom, Australia, and the United States. The majority of study participants had low socioeconomic status or social risk factors and received diverse models of midwifery continuity of care. Three themes—woman‐midwife partnership, maternity pathways and processes, and system resources—encompassed ten CMO configurations. Building relationships, trust, confidence, and advocacy resulted in women feeling safer, less stressed, and more secure and respected, and encouraged them to access and engage in antenatal care with more opportunities for early prevention and diagnosis of complications, which facilitated effective management when compliance to guidelines was ensured. Organizational infrastructure, innovative partnerships, and robust community systems are crucial to overcome barriers, address women's complex needs, ensure quality of care, and reduce PTB risk. Conclusions: Pregnant women living in different contexts in the United Kingdom, Australia, and the United States at low and mixed risk of complications and with low socioeconomic status or social risk factors experienced continuity models in similar ways, and similar underlying mechanisms may have influenced PTB outcomes. Further research is required to understand how continuity models may influence behavioral change, physiological stress levels, ethnic disparities in PTB and care coordination, and navigation of health services. [ABSTRACT FROM AUTHOR]

The article presents the discussion on providing a forum for evidence-based research challenging the status quo in maternity care. Topics include adding Marian as a collaborator on a series of studies on rising cesarean rates; and accessing to having great skill at analyzing national birth certificate and infant death data, most of the work involving the production of government reports.

Abstract: Despite decades of considerable economic investment in improving the health of families and newborns world‐wide, aspirations for maternal and newborn health have yet to be attained in many regions. The global turn toward recognizing the importance of positive experiences of pregnancy, intrapartum and postnatal care, and care in the first weeks of life, while continuing to work to minimize adverse outcomes, signals a critical change in the maternal and newborn health care conversation and research prioritization. This paper presents “different research questions” drawing on evidence presented in the 2014 Lancet Series on Midwifery and a research prioritization study conducted with the World Health Organization. The results indicated that future research investment in maternal and newborn health should be on “right care,” which is quality care that is tailored to individuals, weighs benefits and harms, is person‐centered, works across the whole continuum of care, advances equity, and is informed by evidence, including cost‐effectiveness. Three inter‐related research themes were identified: examination and implementation of models of care that enhance both well‐being and safety; investigating and optimizing physiological, psychological, and social processes in pregnancy, childbirth, and the postnatal period; and development and validation of outcome measures that capture short and longer term well‐being. New, transformative research approaches should account for the underlying social and political‐economic mechanisms that enhance or constrain the well‐being of women, newborns, families, and societies. Investment in research capacity and capability building across all settings is critical, but especially in those countries that bear the greatest burden of poor outcomes. We believe this call to action for investment in the three research priorities identified in this paper has the potential to achieve these benefits and to realize the ambitions of Sustainable Development Goal Three of good health and well‐being for all. [ABSTRACT FROM AUTHOR]

Background: The Birthing on Noongar Boodjar project (NHMRC Partnership Project #GNT1076873) investigated Australian Aboriginal women and midwives' views of culturally safe care during childbearing. This paper reports on midwifery knowledge of Aboriginal women's cultural needs, their perceptions of health systems issues, and their ability to provide equitable and culturally safe care. Method: A qualitative study framed by an Indigenous methodology and methods which supported inductive, multilayered analyses and consensus‐driven interpretations for two clinical midwife data groups (n = 61) drawn from a larger project data set (n = 145) comprising Aboriginal women and midwives. Findings: Midwives demonstrated limited knowledge of Aboriginal women's cultural childbearing requirements, reported inadequate access to cultural education, substituted references to women‐centered care in the absence of culturally relevant knowledge and consistently expressed racialized assumptions. Factors identified by midwives as likely to influence the midwifery workforce enabling them to provide culturally safe care for Aboriginal women included more professional development focused on improving understandings of cultural birth practices and health system changes which create safer maternal health care environments for Aboriginal women. Conclusions: Individual, workforce, and health systems issues impact midwives' capability to meet Aboriginal women's cultural needs. An imperative exists for effective cultural education and improved professional accountability regarding Aboriginal women's perinatal requirements and significant changes in health systems to embed culturally safe woman‐centered care models as a means of addressing racism in health care. [ABSTRACT FROM AUTHOR]

Background: Postpartum anemia can negatively affect maternal health and interfere with early parenting. Thus, it is important to have clear, evidence‐informed recommendations on its diagnosis and treatment. Objective: To compare global recommendations regarding the appropriate management of postpartum anemia and to highlight similarities and differences. Methods: Systematic searches were conducted in the databases PubMed, CINAHL, LILACS, TRIP database, and Scopus, and in the websites of health institutions and scientific societies. Search terms were related to anemia and the postpartum period. Two hundred and eighty papers were identified; the full texts of 30 sets of guidelines were reviewed, with seven being included in the final analysis. Recommendations were extracted through an evaluation of the evidence on the definition, screening, and diagnosis of anemia. The quality of the guidelines was assessed using the AGREE II instrument. Results: Two sets of guidelines have been elaborated by international organizations, and the rest were produced by professional associations within high‐resource countries. The discrepancies found in the guidelines are important and affect the definition of anemia, the criteria for screening asymptomatic women, or the criteria guiding treatment. The quality of the guidelines commonly scored between 4 and 6 on a scale of 0 to 7. Recommendations with poor‐quality evidence predominated over recommendations with high‐quality evidence. Conclusions: This review highlights the need to reach a consensus on the definition of postpartum anemia, to agree on what constitutes a problem for maternal health, and to provide recommendations that reach greater consensus on its diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background The Supporting breastfeeding In Local Communities (SILC) cluster randomized controlled trial evaluated whether a home visit focussed on infant feeding early in the postpartum period increased the percentage of infants breastfeeding at 4 months in low socioeconomic areas of Victoria, Australia. The visits were offered to women identified as at risk of early breastfeeding cessation after discharge home with a new baby. This paper describes the content of the home visits. Methods SILC visited 1,043 women from September 2012 to March 2013, and completed a data sheet for each visit documenting topics discussed, as well as what support and resources were offered. Frequencies and percentages are presented. Results Home visits most commonly included the provision of reassurance to women (91%). Topics discussed included general breastfeeding information (83%), supply and demand (83%), positioning (79%), and feeding frequency (78%). Newborn feeding/behavior (57%), expression of breastmilk (54%), nipple pain (41%), low breastmilk supply (41%), and the use of nipple shields (18%) were also prominent topics. The issues and support needs of women were similar across locations (rural, regional or metropolitan) and regardless of maternal parity or age. There was some variation in the resources suggested in different localities. Conclusions New mothers require help and reassurance independent of whether this is their first or subsequent child, reinforcing the need for support, breastfeeding information, and education about normal neonatal behavior. Key aspects of support are reassurance, normalization of infant behavior, and education. [ABSTRACT FROM AUTHOR]

Background: A physiological breech birth is one in which the woman is encouraged to remain active throughout her labor and able to assume the position of her choice for the birth. Use of this strategy within the United Kingdom National Health Service has led to the use of innovative maneuvers to relieve obstruction when women give birth in upright positions, for example, kneeling or standing. This includes use of the face‐to‐pubes rotational maneuver to relieve extended nuchal arm(s). In this paper, we report a case where the face‐to‐pubes rotational maneuver was used to relieve bilateral nuchal arm entrapment in a breech birth. Methods: Single‐case study. We aimed to generate an in‐depth understanding of how this maneuver works and how professionals decide to use it by exploring its use in a real‐life context. Results: The face‐to‐pubes rotational maneuver appears to be an effective method of relieving nuchal arm entrapment when used by experienced hands. In cases of bilateral nuchal arm entrapment, elevation to a higher station may be necessary to dis‐impact the arms above the pelvic inlet before the fetus can be rotated. After face‐to‐pubes rotation and release of arms, the head should be realigned in an occiput anterior position for delivery. Conclusion: The face‐to‐pubes rotational maneuver can be taught for resolution of nuchal arms in an upright position. Parents should be informed of the availability or not of a specialist midwife trained in physiological breech birth, as this may be important to their decision‐making. [ABSTRACT FROM AUTHOR]

Background: This study investigated the surrogates' birth experiences, their levels of emotional struggle at relinquishment, how often they thought about the surrogacy children, and the surrogate–parent relationship dynamics during pregnancy and post‐birth. Methods: Data were collected from 06/2016 to 02/2017 using an anonymous questionnaire. Participants were Canadian gestational surrogates who had completed the process with or without a successful live birth, and who were at various stages of an ongoing surrogacy. For this paper, only a subgroup of cases with a successful live birth was selected for analysis. Results: The data set included 131 births involving 90 surrogates who delivered 157 babies (105 singletons and 26 sets of twins). Their mean age at the time of surrogacy was 31.7 ± 5 years (range: 21‐47y). More than one‐third (37.4%) of the cases were for intended parents who were same‐sex male couples and single men. Surrogates assisting Canadian‐resident intended parents had an overall better birthing experience compared with those assisting nonresidents. There was none or very little struggle with the relinquishment of the baby in 96.9% of cases. Continued contact with parents after the births was reported in 93.0% of cases. Surrogates were significantly more likely to have frequent post‐birth contact with same‐sex and single fathers compared with heterosexual parents and single mothers (76.6% vs 54.3%). Conclusions: Same‐sex male couples and single men can develop a long‐lasting relationship with their surrogates even when no intended female partners are involved. The development of institutional practice guidelines in standardizing surrogacy birth practice is paramount in optimizing surrogates' care. [ABSTRACT FROM AUTHOR]

Background: Umbilical cord clamp timing has implications for newborn health, which include increased iron stores up to 6 months of age. National and International cord clamping guidelines differ as do health professionals' practices. The rationale for differences in cord clamping practice is unclear. Aims and objective: Studies on the knowledge, attitudes, and practices of maternity health care professionals about cord clamp timing were synthesized. Similarities and differences between professional groups and understanding of the optimal timing of cord clamp timing for term newborns were compared. Methods: An integrative review was undertaken. PubMed, Scopus, MIDIRS, CINAHL, and Google Scholar were searched. Publication date limits were set between January 2007 and December 2020. Quality appraisal was undertaken using the Critical Appraisal Skills Program (CASP) tools. Results: Eighteen studies met inclusion criteria, as they included primary research studies that investigated maternity health care professionals' knowledge, attitudes, and practices about umbilical cord clamping, and were written in English. Four main subject areas were identified: a) knowledge of optimal cord clamp timing; b) attitudes and perceptions of early vs deferred cord clamping; c) cord clamping practice; and d) rationale for cord clamping practice. Conclusions: Different attitudes and practices were identified between midwifery and medical professionals in relation to cord clamp timing together with health professional knowledge and practice gaps pertaining to optimal cord clamp timing. Contemporary evidence should inform guidelines for clinical practice and be embedded into maternity health professional curricula and professional development programs. [ABSTRACT FROM AUTHOR]

Background: Echoing international trends, the most recent United Kingdom reports of infant and maternal mortality found that pregnancies to women with social risk factors are over 50% more likely to end in stillbirth or neonatal death and carry an increased risk of premature birth and maternal death. The aim of this realist synthesis was to uncover the mechanisms that affect women's experiences of maternity care. Methods: Using realist methodology, 22 papers exploring how women with a wide range of social risk factors experience maternity care in the United Kingdom were included. The data extraction process identified contexts (C), mechanisms (M), and outcomes (0). Results: Three themes, Resources, Relationships, and Candidacy, overarched eight CMO configurations. Access to services, appropriate education, interpreters, practical support, and continuity of care were particularly relevant for women who are unfamiliar with the United Kingdom system and those living chaotic lives. For women with experience of trauma, or those who lack a sense of control, a trusting relationship with a health care professional was key to regaining trust. Many women who have social care involvement during their pregnancy perceive health care services as a system of surveillance rather than support, impacting on their engagement. This, as well as experiences of paternalistic care and discrimination, could be mitigated through the ability to develop trusting relationships. Conclusions: The findings provide underlying theory and practical guidance on how to develop safe services that aim to reduce inequalities in women's experiences and birth outcomes. [ABSTRACT FROM AUTHOR]

Background: A recent Center for Medicare and Medicaid Innovation report evaluated the four‐year Strong Start for Mothers and Newborns Initiative, which sought to improve maternal and newborn outcomes through exploration of three enhanced, evidence‐based care models. This paper reports the socio‐demographic characteristics, care processes, and outcomes for mothers and newborns engaged in care with American Association of Birth Centers (AABC) sites. Methods: The authors examined data for 6424 Medicaid or Children's Health Insurance Program (CHIP) beneficiaries in birth center care who gave birth between 2013 and 2017. Using data from the AABC Perinatal Data Registry™, descriptive statistics were used to evaluate socio‐behavioral and medical risks, and core perinatal quality outcomes. Comparisons are made between outcomes in the AABC sample and national data during the study period. Results: Childbearing mothers enrolled at AABC sites had diverse socio‐behavioral risk factors similar to the national profile. The AABC sites exceeded national quality benchmarks for low birthweight (3.28%), preterm birth (4.42%), and primary cesarean birth (8.56%). Racial disparities in perinatal indicators were present within the Strong Start sample; however, they were at narrower margins than in national data. The enhanced model of care was notable for use of midwifery‐led prenatal, labor, and birth care and decreased hospital admission. Conclusions: Birth center care improves population health, patient experience, and value. The model demonstrates the potential to decrease racial disparity and improve population health. Reduction of regulatory barriers and implementation of sustainable reimbursement are warranted to move the model to scale for Medicaid beneficiaries nationwide. [ABSTRACT FROM AUTHOR]

Background In 2009 there were an estimated 2.6 million stillbirths worldwide. In the United States, a 2007 systematic review found little consensus about professional behaviors perceived by parents to be most helpful or most distressing. In the United Kingdom, a bereaved parents' organization has highlighted discordance between parental views and clinical guidelines that recommend clinicians do not encourage parents to see and hold their baby. The objective of this review was to identify and synthesize available research reporting parental outcomes relating to seeing and holding. Methods We undertook a systematic review. We included studies of any design, reporting parental experiences and outcomes. Electronic searches (PubMed and Psych INFO) were conducted in January 2014. Three authors independently screened and assessed the quality of the studies before abstracting data and undertaking thematic analysis. Results We reviewed 741 records and included 23 studies (10 quantitative, 12 qualitative, and 1 mixed-method). Twenty-one studies suggested positive outcomes for parents who saw or held their baby. Increased psychological morbidity was associated with current pregnancy, choice not to see their baby, lack of time with their baby and/or insufficient mementos. Three themes were formulated 'positive effects of contact within a traumatic life event,' 'importance of role of health professionals,' and 'impact on mothers and fathers: similarities and differences.' Conclusions Stillbirth is a risk factor for increased psychological morbidity. Parents seeing and holding their stillborn baby can be beneficial to their future well-being. Since 2007, there has been a proliferation of studies that challenge clinical guidelines recommending that clinicians do not encourage parental contact. [ABSTRACT FROM AUTHOR]

Background In studies investigating predictors of breastfeeding behaviors, it is not uncommon for researchers to adjust for participants' having been breastfed as an infant. This assumes an intergenerational effect of breastfeeding continuity. Our aim was to investigate the veracity of that assumption. Specifically, we sought to summarize and evaluate evidence of associations between breastfeeding in one generation and breastfeeding intentions and behaviors in the second generation. Methods A systematic search of psychological, nursing, and medical databases was conducted for studies examining 'having been breastfed' as a factor in breastfeeding intention, initiation, or duration. Quality indicators were assessed and limitations reported. Effects were explored according to outcomes of intention, initiation, and duration. Results Fifteen papers were found to be eligible for the review. Having been breastfed as an infant was consistently correlated with breastfeeding intention, initiation, and duration. Effect sizes differed depending on methodology. Men's infant-feeding status was also related to later intentions to support or encourage a partner to breastfeed. Conclusions Robust evidence for intergenerational breastfeeding continuity is present; however, mechanisms that explain this association were not considered in the studies reviewed and would best be explored within longitudinal cohort studies. [ABSTRACT FROM AUTHOR]

Abstract: Background: The purpose of this study was to develop assessment criteria that could be used to examine the level of integration of home birth within larger health care systems in developed countries across 11 international jurisdictions. Methods: An expert panel developed criteria and a definition to assess home birth integration within health care systems. We selected jurisdictions based on the publications that were eligible for inclusion in our systematic review and meta‐analysis on planned place of birth. We sent the authors of the included publications a questionnaire about home birth practitioners and practices in their respective health care system at the time of their studies. We searched published peer‐reviewed, non–peer‐reviewed, and gray literature, and the websites of professional bodies to document information about home birth integration in each jurisdiction based on our criteria. Where information was lacking, we contacted experts in the field from the relevant jurisdiction. Results: Home birth is well integrated into the health care system in British Columbia (Canada), England, Iceland, the Netherlands, New Zealand, Ontario (Canada), and Washington State (USA). Home birth is less well integrated into the health care system in Australia, Japan, Norway, and Sweden. Conclusions: This paper is the first to propose criteria for the evaluation of home birth integration within larger maternity care systems. Application of these criteria across 11 international jurisdictions indicates differences in the recognition and training of home birth practitioners, in access to hospital facilities, and in the supplies and equipment available at home births, which give rise to variation in the level of integration across different settings. Standardized criteria for the evaluation of systems integration are essential for interpreting planned home birth outcomes that emerge from contextual differences. [ABSTRACT FROM AUTHOR]

The article offers the authors's response to comments by A. Farr and colleagues on their article on placentophagy. They outline the four points raised by Farr and colleagues including biased data set, insufficient acknowledgment of the lack of evidence supporting the efficacy in placentophagy, and unprofessional recommendations for maternity care providers.

Background This paper examines the separate effects of the perceived amount, source, and quality of support during labor and delivery on women's positive and negative evaluations of their birth experiences. Methods Data come from the Listening to Mothers I and II (LTM) surveys ( n = 2,765). Women's perception of support was regressed separately onto indices of positive and negative words that women associated with their labor and delivery. Results The total number of support sources, type of support person, and quality of support all impacted women's birth evaluations across different regression models, controlling for demographics, birth interventions, and other birth characteristics. Support overall had a greater effect on increasing women's positive evaluations, but was not as protective against negative evaluations. Support from medical and birth professionals (doctors, nurses, doulas) had the greatest effect on women's positive evaluations. Good partner support was complexly related: it was associated with less positive evaluations but also appeared to have a protective effect against negative birth evaluations. Discussion Support in childbirth is a complex concept with multiple dimensions that matter for women's birth evaluations. Support from nursing staff, doctors, and doulas is important for enabling positive evaluations while support from partners is more complexly related to women's evaluations. Research on support for laboring women should more extensively address the division of labor between different sources of support. [ABSTRACT FROM AUTHOR]

Introduction: Continuity of midwifery carer improves outcomes, but there is significant variation in how such schemes are implemented and evaluated cross‐culturally. The Angus home birth scheme in Scotland incorporates continuity of carer throughout pregnancy, labor, birth, and the postnatal period. Methods: Manual maternity case note review to evaluate the 80% continuity of carer and 3% planned home birth rate targets. Results: Of 1466 women booking for maternity care, 69 joined the scheme. Forty‐four had a planned home birth (3% overall), of whom seven were originally deemed ineligible. Of the 44, eight (18%) also achieved 80% continuity of carer with the primary midwife; by including a home birth team colleague, the continuity rate rose to 73%. Women whose care achieved home birth and continuity targets had lower deprivation scores. Eligibility issues, women's changing circumstances, and data recording lapses were complicating issues. Conclusions: Targets must be both feasible and meaningful and should be complemented by assessing a broad range of outcomes while viewing the scheme holistically. By expanding eligibility criteria, the home birth rate target was met; including input from a home birth team colleague in the calculation meant the continuity target was nearly met. With dedicated and competent staff, adequate resource and political support, and when considered in the round, the scheme's viability within local services was confirmed. Other generalizable learning points included the need to standardize definitions and data recording methods. Comparability across schemes helps grow the evidence base so that the links between processes and outcomes can be identified. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "Birth includes us: Development of a community-led survey to capture experiences of pregnancy care among LGBTQ2S+ families" which appeared in the previous issue of 2023.

Background: The objective of this study was to assess the preliminary efficacy and safety of conservative management compared with systematic suture in isolated vaginal or first‐degree perineal tears after birth. Methods: We conducted a preliminary efficacy, open‐label, randomized, controlled, and prospective trial. This study implemented Simon's 2‐step plan (interim analysis and final analysis) to test the success rate of the digital compression strategy group. Primiparous women aged ≥18 years with isolated vaginal or first‐degree perineal tears after spontaneous vaginal birth of a cephalic presenting term (≥37 weeks) neonate were randomly allocated to the conservative management (CM) group (digital compression if bleeding followed by suture if persistent bleeding) or a systematic suture (SS) group. The primary outcome was the success of the intervention 10 days after delivery, defined by pain as evaluated using a visual analog scale < 3, satisfactory healing defined by a REEDA score ≤ 2, and no bleeding or infection. Sexual well‐being was assessed at 2 and 6 months postpartum. Results: Among 861/2209 eligible women, 143 consenting women with a superficial perineal tear were randomized: 72 in the systematic suture group and 71 in the conservative management group. Success rate was 87.8% (90% CI [70.5‐93.54]) (42/55) in the systematic suture group vs 90% (90% CI [78.3‐93.8]) (53/61) in the conservative management group. The REEDA score was significantly higher in the systematic suture group (1.4 vs 0.9; P = 0.036). Perineal pain was significantly higher at day 1 in the systematic suture group (2.38 vs 1.69; P = 0.034). For the Female Sexual Functional Index score, no significant difference was found between the two groups at inclusion or at 2 and 6 months postpartum. Conclusions: Conservative management of superficial perineal tears shows an efficacy rate ≥90%. Women in the conservative management group had less pain at the 1st day follow‐up and lower REEDA scores at the 10th day follow‐up. [ABSTRACT FROM AUTHOR]

Control measures for the COVID‐19 pandemic brought unprecedented challenges to health care delivery. Some countries in sub‐Saharan Africa (SSA) stopped the provision of essential health care except for those services that were deemed emergencies or life‐threatening. A rapid review was conducted on March 18, 2022, on the accessibility and utilization of antenatal care services in sub‐Saharan Africa during the COVID‐19 pandemic. PubMed, Google Scholar, SCOPUS, and the World Health Organization library databases were searched for relevant studies. A modified Population, Intervention, Control, and Outcomes (PICO) framework informed the development of the search strategy. The review included studies conducted within Africa that described the availability, access, and utilization of antenatal services during the COVID‐19 pandemic. Eighteen studies met the inclusion criteria. This review revealed a reduction in access to ANC services, an increase in the number of home deliveries, and a reduction in the number of women attending ANC visits during the COVID‐19 pandemic. A decrease in ANC service utilization was reported in some studies in the review. Barriers to ANC access and utilization during the COVID‐19 pandemic included movement restrictions, limited transport access, fear of contracting COVID‐19 at the health facilities, and facility barriers. The use of telemedicine needs to be improved in African countries to allow for the continued provision of health services during pandemics. In addition, there should strengthening of community involvement in the provision of maternal health services post‐COVID‐19 so that services may be able to better withstand future public health emergencies. [ABSTRACT FROM AUTHOR]

Background: This quality improvement project aimed to create a decision aid for labor induction in healthy pregnancies at or beyond 39 weeks that met the needs of pregnant people least likely to experience shared decision‐making and to identify and test implementation strategies to support its use in prenatal care. Methods: We used quality improvement and qualitative methods to develop, test, and refine a patient decision aid. The decision aid was tested in three languages by providers across obstetrics, family medicine, and midwifery practices at a tertiary care hospital and two community health centers. Outcomes included patients' understanding of their choices, pros and cons of choices, and the decision being theirs or a shared one with their provider. Results: Patient interview data indicated that shared decision‐making on labor induction was achieved. Across three Plan‐Do‐Study‐Act cycles, we interviewed a diverse group of 24 pregnant people: 20 were people of color, 16 were publicly insured, and 15 were born outside the United States. All but one (23/24) reported feeling the decision was theirs or a shared one with their provider. The majority could name induction choices they had along with pros and cons. Interviewees described the decision‐making experience as empowering and positive. Nine medical providers tested the decision aid and gave feedback. Providers stated the tool helped improve the quality of their counseling and reduce bias. Conclusion: This project suggests that using an evidence‐based and well‐tested decision aid can help achieve shared decision‐making on labor induction for a diverse group of pregnant people. [ABSTRACT FROM AUTHOR]

Backgrounds: Outpatient induction of labor (IOL) is an alternative choice offered to pregnant women requiring cervical ripening. Outpatient IOL can provide solutions in terms of women empowerment, but most importantly promotes as normal labor as possible, within the medical context of the IOL. The objectives of this systematic review were to assess safety and effectiveness of cervical ripening performed with a slow‐release dinoprostone vaginal insert in term pregnancies in two settings: the outpatient (home) versus the inpatient (hospital). Methods: The electronic databases Cinahl, Embase, Medline and Maternity and Infant Care were searched to detect studies that met the inclusion criteria. Both reviewers collected the data and assessed the quality of the studies and assessed the pooled odds ratio using a 95% confidence interval and a random‐effects model. Primary outcomes were linked to maternal and neonatal morbidity. Secondary outcomes were related to birth outcomes. Results: No statistical difference was seen between the outpatient and inpatient setting in terms of maternal complications, neonatal morbidity, cesarean section, and labor onset <24 h. Women in the outpatient setting were significantly less likely to experience uterine hyperstimulation, and they were also significantly more likely to require oxytocin to augment or induce their labor than the women in the inpatient setting. Women in the outpatient setting were more satisfied with the cervical ripening experience. Conclusions: Cervical ripening with a slow‐release dinoprostone vaginal insert in term pregnancies in the outpatient setting appears as safe as the inpatient setting in terms of maternal, neonatal, and birth outcomes. [ABSTRACT FROM AUTHOR]

Background: We assessed the change in obstetric management after implementation of a quality improvement intervention, the Nepal Perinatal Quality Improvement Package (NePeriQIP). Methods: The Nepal Perinatal Quality Improvement Package was a stepped‐wedge cluster‐randomized controlled trial conducted in 12 public hospitals in Nepal between April 2017 and October 2018. In this study, three hospitals allocated at different time points to the intervention were selected for a nested before–after analysis. We used bivariate and multivariate analyses to compare obstetric management in the control vs intervention group. Results: There were 25 977 deliveries in the three hospitals during the study period: 10 207 (39%) in the control and 15 770 (61%) in the intervention group. After adjusting for maternal age, ethnicity, education, gestational age, stage of labor at admission, complications during labor, and birthweight, the intervention group had a higher proportion of fetal heart rate monitoring performed as per protocol (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.12–1.27), shorter time intervals between each fetal heart rate monitoring (aOR 2.09, 95% CI 1.96–2.23), a higher likelihood of abnormal fetal heart rate being detected (aOR 1.53, 95% CI 1.25–1.68), progress of labor more often being recorded immediately after per vaginal examination (aOR 2.73, 95% CI 2.55–2.93), and partograph filled as per standards (aOR 3.18, 95% CI 2.98–3.50). The cesarean birth rate was 2.5% in the control group and 8.2% in the intervention group (aOR 3.12, 95% CI 2.64–3.68). Conclusions: The NePeriQIP intervention has potential to improve obstetric care, especially intrapartum fetal surveillance, in similar low‐resource settings. [ABSTRACT FROM AUTHOR]

Background: Attendance of skilled and experienced professionals at breech births has been associated with a reduction in adverse perinatal outcomes. We aimed to determine whether United Kingdom National Health Service (NHS) sites could reliably provide attendants with OptiBreech training and/or advanced proficiency (intervention feasibility) and consistent care (fidelity) that meets women's needs (acceptability), with low neonatal admission rates (safety) and recruitment adequate to support a clinical trial (trial feasibility). Methods: Mixed methods implementation evaluation was used. Settings were 13 services in England and Wales. Participants were 82 women requesting support for a vaginal breech birth (VBB) at term. Outcomes were descriptively analyzed. Twenty‐one women were interviewed, and transcripts were analyzed using the Theoretical Framework of Acceptability. Iterative analysis informed subsequent interviews and the ongoing process of implementation across sites. Results: Although we initially suggested multidisciplinary teams, actively recruiting Trusts yielded services where VBB care was provided through a dedicated clinic, organized and delivered primarily by a lead midwife who functioned as a specialist. This model achieved 87.5% fidelity with the intervention's goal of ensuring the attendance of OptiBreech‐trained professionals. Neonatal outcomes remained stable, with an admission rate of 5.5%. Women reported care from specialist midwives as highly acceptable, but the model is vulnerable without a strategic effort to develop additional proficient team members. Conclusions: Dedicated clinics coordinated by specialist midwives appear to be an acceptable and feasible implementation strategy to test the safety and effectiveness of proficient team care for VBB in a clinical trial. Back‐up arrangements should be maintained while additional members of the team develop proficiency. [ABSTRACT FROM AUTHOR]

Background: The interprofessional education collaborative (IPEC) core competencies (CCs) describe standards for effective interprofessional health care practice and education; these standards are updated periodically based on stakeholder feedback. The purpose of this project was to use a qualitative case study approach to describe one multiparous birth trauma survivor's fifth birth experience with an interprofessional birth care team (IBCT) and to juxtapose her experiences and perspectives with the IPEC core competencies (IPEC CCs). This approach enabled us to identify strengths and gaps in the standards for interprofessional health care education and practice specific to perinatal care. Methods: One in‐depth, open‐ended, semi‐structured interview was conducted to elicit the participant's fifth birth experience. Information from her previous births and the IPEC CCs was used to design the interview guide, and we used independent, deductive, consensus coding to identify themes from verbatim transcripts. Results: Three themes were identified: (a) Establishing a therapeutic patient‐provider relationship; (b) Prioritizing communication, respect, and knowledge in person‐centered care; and (c) Shared decision‐making as the crux of collaborative care. The participant's narrative elevated person‐centered, trauma‐informed care (TIC) principles as critical to effective interprofessional birth care and as essential threads for the IPEC CCs. Conclusions: One survivor's positive experience after prior birth trauma illustrates the critical role IPEC CCs may play in collaborative perinatal care provided by IBCTs. In our analysis, we also identify the need to explicitly incorporate TIC principles and person‐centered language in health care competencies that support the standards for perinatal health care education and practice. [ABSTRACT FROM AUTHOR]