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BACKGROUND: Despite research that has shown that the presence of support persons during maternity care is associated with more respectful care, support persons are frequently excluded due to facility practices or negative attitudes of providers. Little quantitative research has examined how integrating support persons in maternity care has implications for the quality of care received by women, a potential pathway for improving maternal and neonatal health outcomes. This study aimed to investigate how integrating support persons in maternity care is associated with multiple dimensions of the quality of maternity care. METHODS: We used facility-based cross-sectional survey data from women (n = 1,138) who gave birth at six high-volume facilities in Nairobi and Kiambu counties in Kenya and their support persons (n = 606) present during the immediate postpartum period. Integration was measured by the Person-Centered Integration of Support Persons (PC-ISP) items. We investigated quality of care outcomes including person-centered care outcomes (i.e., Person-Centered Maternity Care (PCMC) and Satisfaction with care) and clinical outcomes (i.e., Implementation of WHO-recommended clinical practices). We used fractional regression with robust standard errors to estimate associations between PC-ISP and care outcomes. RESULTS: Compared to low integration, high integration (≥four woman-reported PC-ISP experiences vs.

INTRODUCTION: Person-centred care (PCC) is provision of care that is respectful of and responsive to individual patient preferences, needs and values, and ensures that patient values guide all clinical decisions. While there is a large body of evidence on the benefits of PCC in high-income countries, little research exists on PCC in Ghana and Sub-Saharan Africa at large. Most studies on PCC have focused on maternity care as part of the global movement of respectful maternity care. The few studies on patient experiences and health system responsiveness beyond maternal health also highlight gaps in patient experience and satisfaction as well as discrimination in health facilities, which leads to the most vulnerable having the poorest experiences. The protocol for this scoping review aims to systematically map the extent of literature focused on PCC in Ghana by identifying patient expectations and preferences, barriers and facilitators, and interventions. METHODS AND ANALYSIS: The protocol will be guided by the Arksey and OMalley methodological framework and recommendations by Levac et al. A comprehensive search strategy will be used to search for published articles in PubMed, EMBASE, Web of Science and the African Journals Online from their inception to August 2022. Grey literature and reference lists of included studies will also be searched. Two independent reviewers will perform the literature search, eligibility assessments and study selection. Any disagreements will be resolved through discussion with a third reviewer. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram for the scoping reviews will be used to outline the study selection process. Extracted data from the included articles will be synthesised and reported under key concepts derived from the outcomes of the scoping review. ETHICS AND DISSEMINATION: This scoping review does not require ethical approval. The findings will be disseminated through publications and conference presentations. SCOPING REVIEW REGISTRATION: OSF Registration DOI 10.17605/OSF.IO/ZMDH9.

BACKGROUND: Women in South Asia often return to their natal home during pregnancy, for childbirth, and stay through the postpartum period-potentially impacting access to health care and health outcomes in this important period. However, this phenomenon is understudied (and not even named) in the demographic or health literature, nor do we know how it impacts health. OBJECTIVE: The aim of this study is to measure the magnitude, timing, duration, risk factors and impact on care of this phenomenon, which we name Temporary Childbirth Migration. METHODS: Using data from 9,033 pregnant and postpartum women collected in 2019 in two large states of India (Madhya Pradesh and Bihar) we achieve these aims using descriptive statistics and logistic regression models, combined with qualitative data from community health workers about this practice. RESULTS: We find that about one third of women return to their natal home at some point in pregnancy or postpartum, mostly clustered close to the time of delivery. Younger, primiparous, and non-Hindu women were more likely to return to their natal home. Women reported that they went to their natal home because they believed that they would receive better care; this was born out by our analysis in Bihar, but not Madhya Pradesh, for prenatal care. CONCLUSIONS: Temporary childbirth migration is common, and, contrary to expectations, did not lead to disruptions in care, but rather led to more access to care. CONTRIBUTION: We describe a hitherto un-named, underexplored yet common phenomenon that has implications for health care use and potentially health outcomes.

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 developing countries birth asphyxia is a major cause of neonatal morbidity and mortality. Despite the implementation of various strategies and interventions to combat neonatal mortality rates, birth asphyxia remains the main public health concern in Ethiopia. Moreover, limited studies have been conducted, especially in the study area and there are no multicenter analyses available to generate evidence for action. Therefore, this study aimed to assess the burden and associated factors of birth asphyxia among newborns in the selected public hospitals of the Addis Ababa City Administration Health Bureau. Methods: Three hundred forty-three mother-child pairs who used delivery services and gave birth in the selected public hospitals were included in the study, and institution based cross sectional study design was employed. A systematic random sampling technique was used to select the study participants. A pretested, structured interviewer administered questionnaire was used to collect the data. The physician's/health care professionals diagnosis of an Apgar score less than 7 within the first five minutes of life led to the confirmation of the diagnosis of birth asphyxia. SPSS version 24 was used for analysis after the data were exported from Epi Info version 7.2. Multivariate logistic regression analysis included variables which had P-values less than 0.25 in the bivariable logistic regression analysis. The study findings were expressed using adjusted odds ratio with a 95% confidence interval, and P-value less than 0.05 was used to declare the statistical significance. Results: The magnitude of birth asphyxia was found to be 17.1% [95% CI; (13.2–21.5)] at the first 5 min. In the multivariable logistic regression analysis cord accident [AOR = 6.24: 95% CI; (1.24–31.32)], prolonged duration of labor [AOR = 2.49: 95% CI; (1.93–10.89)], and meconium-stained amniotic fluid [AOR = 3.33: 95% CI; (1.73–6.41)] were the predictors of birth asphyxia. Conclusions: The findings of this research indicate that birth asphyxia is a prevalent neonatal problem at the study area. Therefore, the Addis Ababa Health Bureau must prioritize integrated mitigation interventions targeting high-risk pregnancies to achieve national and international commitment to sustainable changes in newborn health. [ABSTRACT FROM AUTHOR]

Background: Exclusive breastfeeding during postpartum hospitalization is very important for ensuring the success of breastfeeding at home. The aim of the study is to determine if the on-site nurse in rooming in improves exclusive breastfeeding ratio. Methods: We conducted a prospective observational cohort study to evaluate exclusive breastfeeding during the first three months of life in two Neonatology Units in the South of Italy with different hospital settings: Ente Ecclesiastico Miulli of Acquaviva delle Fonti with on-site nurse h24 (on-site group) and Policlinico of Bari with nurse available on call h24 from Neonatology Unit (on-call group). Results: A total of 564 mother-baby dyads were admitted from 3 January to 31 March 2018 (299 in on-site group and 265 in on-call group). In the overall population, exclusive breastfeeding rate was 76.4% at 90-days, confirming the role of nurse and rooming in, independently of modality of setting. Considering the way of delivery, in infants from cesarean section there were higher rates for exclusive breastfeeding at 30 and 90 days of life in on-site group. Conclusions: We can assume that the presence of a nurse h24 could better identify breastfeeding problems. Our study suggests the role of on-site nurse during rooming in to encourage exclusive breastfeeding until three months of life in mothers who underwent caesarean section. [ABSTRACT FROM AUTHOR]

Background: Poor person-centered maternal care (PCMC) contributes to high maternal mortality and morbidity, directly and indirectly, through lack of, delayed, inadequate, unnecessary, or harmful care. While evidence on poor PCMC prevalence, as well as inequities, expanded in the last decade, there is still a significant gap in evidence-based interventions to address PCMC. We describe the protocol for a trial to test the effectiveness of the "Caring for Providers to Improve Patient Experience" (CPIPE) intervention, which includes five strategies, targeting provider stress and bias as intermediate factors to improve PCMC and address inequities. Methods: The trial will assess the effect of CPIPE on PCMC, as well as on intermediate and distal outcomes, using a two-arm cluster randomized controlled trial in 40 health facilities in Migori and Homa Bay Counties in Kenya and Upper East and Northeast Regions in Ghana. Twenty facilities in each country will be randomized to 10 intervention and 10 control sites. The primary intervention targets are all healthcare workers who provide maternal health services. The intervention impact will be assessed among healthcare workers in the study health facilities and among women who give birth in the study health facilities. The primary outcome is PCMC measured with the PCMC scale, via multiple cross-sectional surveys of mothers who gave birth in the preceding 12 weeks in study facilities at baseline (prior to the intervention), midline (6 months after intervention start), and endline (12 months post-baseline) (N = 2000 across both countries at each time point). Additionally, 400 providers in the study facilities across both countries will be followed longitudinally at baseline, midline, and endline, to assess intermediate outcomes. The trial incorporates a mixed-methods design; survey data alongside in-depth interviews (IDIs) with healthcare facility leaders, providers, and mothers to qualitatively explore factors influencing the outcomes. Finally, we will collect process and cost data to assess intervention fidelity and cost-effectiveness. Discussion: This trial will be the first to rigorously assess an intervention to improve PCMC that addresses both provider stress and bias and will advance the evidence base for interventions to improve PCMC and contribute to equity in maternal and neonatal health. Trial registration: ClinicalTrials.gov: NCT06085105. Protocol version and date: v2-11-07-23 [ABSTRACT FROM AUTHOR]

Background Aim Materials and methods Results Conclusions Miscarriage is a common medical occurrence which can be associated with significant psychological distress. Patients and partners are frequently disappointed by aspects of their care, especially with regard to emotional support. Although most published studies investigated the experiences of patients and partners in emergency departments (EDs) of public hospitals, miscarriage is also frequently diagnosed in non‐emergency settings, such as during sonography or antenatal appointments, and approximately 25% of Australian women receive maternity care in private hospitals.Because the experience of miscarriage is known to be setting‐dependent, it is important to understand how patients and partners experience care outside the ED. Here, we addressed this gap by investigating the experiences of patients and partners who attended a private maternity hospital for miscarriage using a mixed‐methods approach.Eighteen patients and six partners who had recently experienced a miscarriage were recruited at a private maternity hospital to take part in both semi‐structured interviews and online surveys.Overall, patients and partners were highly satisfied with the emotional care they received. Thematic analysis of semi‐structured interviews allowed us to identify a total of ten themes that contributed to satisfaction with emotional care.We provide the first specific insights into the experiences of women and partners who received care for miscarriage in an Australian private hospital setting, and the first example of a healthcare setting that achieves high satisfaction with emotional care around miscarriage. The ten themes we identify provide a framework for improving satisfaction with care also in other settings. [ABSTRACT FROM AUTHOR]

Objective To perform a systematic review of screening tools and interventions focused on reducing adverse health outcomes associated with intimate partner violence (IPV) at abortion-related visits. Study Design Studies were eligible if they included individuals seeking pregnancy options health care services in the United States, screening for or implementation of an intervention for IPV, and were published in English after the year 2000. The primary outcomes were to summarize screening tools, interventions studied, and if interventions led to individuals being connected to IPV-related resources. Secondary outcomes included patient responses to the IPV-related interventions and any other outcomes reported by the studies (PROSPERO #42021252199). Results Among 4,205 abstracts identified, nine studies met inclusion criteria. The majority (n = 6) employed the ARCHES (Addressing Reproductive Coercion in Health Settings) tool for identification of IPV. Interventions included provider-facilitated discussions of IPV, a safety card with information about IPV and community-based resources, and referral pathways to directly connect patients with support services. For the primary outcome, IPV-related interventions were shown to better inform patients of available IPV-related resources as compared to no intervention at all. For the secondary outcomes, screening and intervening on IPV were associated with improvements in patient perception of provider empathy (i.e., caring about safety) and safer responses by patients to unhealthy relationships. Conclusion Screening for and intervening on IPV at abortion-related visits are associated with positive outcomes for patient safety and the patient–provider relationship. However, data on effective tools for identifying and supporting these patients are extremely limited. This review emphasizes the unmet need for implementation and evaluation of IPV-specific interventions during abortion-related clinical encounters. Key Points The abortion visit offers a crucial setting to address IPV among a highly affected population. This study reviews others that analyzed interventions and associated outcomes for IPV at abortion-related visits. Appropriate interventions for IPV can improve patient-provider relationships and connect patients to essential resources. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic contact restrictions considerably changed maternal visiting contacts during the time in which breastfeeding is initiated. We wanted to know how maternity ward staff and mothers rated the conditions of starting breastfeeding under contact restrictions. Methods: In the Breastfeeding in North Rhine-Westphalia (SINA) study, Germany, 2021/22, chief physicians as well as ward staff from 41 (out of 131) maternity hospitals (82 members of the healthcare sector in total) were surveyed by telephone concerning structural and practical conditions for breastfeeding support before and during the pandemic; 192 (out of 426 eligible) mothers answered an online-questionnaire about their breastfeeding experiences at 2 weeks and 2 months after birth. Results: In almost all of the hospitals, visits were restricted due to the pandemic, with the exception of the primary support person. After more than one year of pandemic experience, the ward staff were convinced that the restrictions were mostly positive for the mothers (97.6%) and for the ward staff themselves (78.0%). A total of 80.5% of the ward staff would maintain the restrictions beyond the pandemic. The mothers themselves mostly rated the restrictions in the hospital as being just right; moreover, many mothers voluntarily maintained the restrictions at home, at least in part. Conclusions: The unprecedented visiting restrictions in hospitals during the pandemic were like an "experiment" born out of necessity. Restricting visiting arrangements may be an underestimated beneficial component for the development of the mother-infant dyad in perinatal breastfeeding care, particularly in healthcare systems where almost all births occur in the maternity hospital. Trial registration: German Clinical Trials Register (DRKS) (DRKS00027975). [ABSTRACT FROM AUTHOR]

Background: Findings from research and recommendations from the World Health Organization favor restrictive use of episiotomy, but whether this guidance is being followed in India, and factors associated with its use, are not known. This study sought to document trends in use of episiotomy over a five-year period (2014–2018); to examine its relationship to maternal, pregnancy, and health-system characteristics; and to investigate its association with other obstetric interventions. Methods: We conducted a secondary analysis of data collected by the Maternal Newborn Health Registry, a prospective population-based pregnancy registry established in Central India (Nagpur, Eastern Maharashtra). We examined type of birth and use of episiotomy in vaginal deliveries from 2014 to 2018, as well as maternal and birth characteristics, health systems factors, and concurrent obstetric interventions associations with its use with multivariable Poisson regression models. Results: During the five-year interval, the rate of episiotomy in vaginal birth rose from 13 to 31% despite a decline in assisted vaginal birth. Associations with episiotomy were found for the following factors: prior birth, multiple gestations, seven or more years of maternal education, higher gestational age, higher birthweight, delivery by an obstetrician (as compared to midwife or general physician), and birth in hospital (as compared to clinic or health center). After adjusting for these factors, year over year rise in episiotomy was significant with an adjusted incidence rate ratio (AIRR) of 1.10 [95% confidence interval (CI) 1.08–1.12; p = 0.002]. We found an association between episiotomy and several other obstetric interventions, with the strongest relationship for maternal treatment with antibiotics (AIRR 4.23, 95% CI 3.12–5.73; p = 0.001). Conclusions: Episiotomy in this population-based sample from central India steadily rose from 2014 to 2018. This increase over time was observed even after adjusting for patient characteristics, obstetric risk factors, and health system features, such as specialty of the birthing provider. Our findings have important implications for maternal-child health and respectful maternity care given that most women prefer to avoid episiotomy; they also highlight a potential target for antibiotic stewardship as part of global efforts to combat antimicrobial resistance. Trial Registration: The study was registered at ClinicalTrials.gov under reference number NCT01073475. Plain English summary: Episiotomy is a surgical procedure to widen the vaginal opening for childbirth. It was once commonly used worldwide. However, because the procedure can cause pain to mothers and place them at risk for infections and serious tears to the vagina—especially when the cut is directly downward—research suggests it should be used sparingly. As such, it is now less often practiced in high-income countries, but whether the same is true in India is not known. To answer this question, we used a large population-based pregnancy registry, the Maternal Newborn Health Registry, from Central India (Nagpur) to assess the frequency of episiotomy use between 2014 and 2018 and if there were certain maternal characteristics, features of the health care system, and other pregnancy interventions that were related with its use. Over this five-year period, the use of episiotomy during vaginal birth rose more than two-fold. It was more often used on women who had never delivered a baby before, were further along in pregnancy, had higher levels of education, had heavier babies, or were carrying more than one baby. Obstetricians were more likely to perform episiotomy than midwives or general physicians and it was more likely to be performed in hospitals than in clinics or primary health centers. This rise during the five-year interval was significant even when accounting for these patient and provider characteristics, suggesting a shift in medical practice. Because this was an observational study more research is needed to determine if the associations we found are causal. [ABSTRACT FROM AUTHOR]

Background: Retaining midwives and registered nurses in the Obstetrics and Gynecology department/unit (OB/GYN) is not just a matter of organizational effectiveness and financial wellness. It's a crucial aspect of ensuring quality healthcare delivery. This study aimed to discuss the degree to which midwives and nurses in OB/GYN departments are structurally empowered, resilient, and committed to remaining at the organizations and to examine whether nurses' and midwives'sense of structural empowerment and resilience is a good predictor of their decision to stay with the organization. Methods: This study employed a unique convergent parallel mixed methods approach. The research was conducted in two distinct phases. The first phase involved a cross-sectional quantitative survey with a convenience sample of 200 midwives and nurses in OB/GYN departments. The second phase was a qualitative study utilizing semi-structured, open-ended interviews. Eighteen nurses and midwives, specifically chosen as the target population, were invited to participate in individual interviews. The data collection took place at three major hospitals in Saudi Arabia, starting in January 2023 and concluding in February 2023. Results: The study results revealed that structural empowerment and resilience were statistically significant predictors of the intent to stay in the organization (F = 35.216, p < 0.001), with 26.3% variation, the structural empowerment is higher predictor (β = 0.486, p < 0.000) to intent to stay if compared to resilience (β = 0.215, p < 0.008). Five major themes emerged from the narratives of the nurses and midwives: the nurturing of the physical and physiological, the development of the psychological, the managing finances, the restructuring of the organization, and the enrichment of the professional and occupational. Conclusion: The study's findings have significant implications for healthcare organizations. They highlight the importance of cultivating a culture of empowerment and resilience, which can serve as a powerful tool to encourage registered nurses and midwives to remain in their organizations. This insight empowers healthcare administrators, human resource managers, and obstetrics and gynecology professionals to take proactive steps toward improving retention rates. [ABSTRACT FROM AUTHOR]

Background: There has been a growing concern regarding research waste and the mismatch between conducted research and the research needs of knowledge users. The Needs Led Research (NLR) approach is proposed as an effective method to ensure that research address actual evidence gaps that are relevant to the users of the knowledge. By search and reviewing literature and involving knowledge users, NLR aims to identify, verify, and prioritize research needs. This paper describes and compares the implementation of the NLR approach in two separate PhD projects within maternity care, and addresses the challenges encountered throughout the processes, aiming to offer valuable insights for future NLR initiatives. Methods: The NLR processes consisted of four phases: (1) defining the scope (2) identifying and verifying research needs (3) prioritizing research needs and (4) designing the PhD projects. Literature searches were conducted during Phase 2, while knowledge user involvement took place in Phases 2 and 3. The knowledge user involvement, at a co-thinker and advocatory level, included knowledge user groups and surveys. Project groups, who were responsible for all decision-making, conducted Phases 1 and 4. The scopes of the PhD projects were labor induction (NLR-LINO) and fetal monitoring in low-risk deliveries (NLR-LISTEN). Results: In NLR-LINO, 17 research needs were identified and verified as actual evidence gaps relevant for the knowledge users. Among these, ten were rated as "very important" by a majority of the 322 survey respondents. The aim of the PhD LINO project was defined as "To investigate whether outpatient induction of labor is beneficial in a Norwegian setting." In NLR-LISTEN, seven research needs were identified and verified as actual evidence gaps relevant for the knowledge users. These were prioritized by 466 survey respondents, and the aim of the PhD LISTEN project was defined as "To investigate the methods used for fetal monitoring in low-risk deliveries in Norway and evaluate adherence to evidence-based practice while also exploring potential reasons for any deviations." Conclusions: This paper shows that the NLR is a viable approach for prioritizing research. The findings highlight the impact of the initial scope on subsequent phases and emphasize the importance of pragmatic decision-making throughout the process. However, it is crucial to acknowledge that NLR requires dedicated resources, and if integrated into PhD projects, additional time and training should be allocated accordingly. Plain English summary: This paper addresses the issue of research waste and the mismatch between conducted research and the actual needs of the users of the knowledge. The Needs Led Research (NLR) approach is proposed as an effective method for identifying and prioritizing research needs that are relevant to knowledge users and have not been adequately addressed by existing research. The paper specifically examines the implementation of the NLR approach in two separate PhD projects within the field of maternity care, aiming to provide valuable insights for future NLR initiatives. The NLR process consists of four phases: defining the scope, identifying and verifying research needs, prioritizing those needs, and designing the PhD projects. Literature searches were conducted during Phase 2 to identify existing evidence gaps in the research literature. Knowledge users were involved in both the identification and prioritization of research needs in Phases 2 and 3 through surveys and group discussions. In conclusion, this paper shows that NLR is a viable approach for prioritizing research and ensuring its relevance to the users of the knowledge. It emphasizes the importance of defining a clear scope and making pragmatic decisions throughout the process. However, it also highlights the need for dedicated resources and additional time and training when integrating the NLR approach into PhD projects. [ABSTRACT FROM AUTHOR]

Background: Due to changes in Swedish maternity care during the COVID-19 pandemic, partners were often excluded from antenatal and postnatal care. Aim: To explore partners' experiences of pregnancy, labour, and postnatal care in relation to the COVID-19 pandemic restrictions. Methods: A descriptive qualitative interview study with 15 partners of women who gave birth from March 2020 to March 2022. Data was collected from April to November 2022, and analysed using inductive thematic analysis. Findings: Two themes and six subthemes were identified. The first theme, Feelings of loss and exclusion, emphasises the expectation and desire to share the journey of becoming a parent together with the pregnant partner. When excluded from maternity care, a feeling of missing out was described which could create a sense of distance from the unborn child. The second theme, Dealing with powerlessness, relates to the fear of infection and not being able to participate during the birth, and life being adapted to restrictions. Mixed feelings regarding the restrictions were described since the reasons behind were not always perceived as clear and logical. Discussion: Sweden prides itself on gender equality, where partners normally are a natural part of maternity care. This likely contributed to strong feelings of exclusion when partners were prevented from participating in maternity care during the COVID-19 pandemic. Conclusion: Partners of women giving birth during the COVID-19 pandemic were substantially affected by the restrictions within maternity care. Partners wish to be involved in pregnancy and birth and want to receive clear information as part of their preparation for parenthood. Society–including maternity care–must decide how to address these needs. [ABSTRACT FROM AUTHOR]

Job satisfactions have impacts on productivity and essentials provision of care for maternal and child health in the rural area. Despite Health extension workers (HEWs) have pivotal role towards improvement of maternal and child health outcome, there is scarcity of data regarding their job satisfaction, hence this study was employed to assess the level of job satisfaction and associated factors among rural HEW in Buno Bedele Zone, Southwest Ethiopia. A Facility based cross-sectional study design was conducted among 393 randomly selected HEW from May to June, 2023. A pretested; questionnaire was used to collect the data. SPSS version 25 was used for statistical analysis. Logistic regression analysis with odds ratio (OR), a 95% CI and P < 0.05 were used to declare statistical significance. The overall satisfaction of health extension workers was 45.5%, [95% Confidence interval CI 44.0–46.09]. Availability of residence [AOR = 2.349, 95% CI 1.352, 4.083], transfer between kebeles [AOR = 0.267, 95% CI 0.132, 0.540], availability of medical supply [AOR = 2.853, 95% CI 1.474, 5.523], Good working environment [AOR = 3.395, 95% CI 2.017, 5.717], Getting technical support during work from their supervisor [AOR = 3.656, 95% CI 1.851, 7.219] were significantly associated factors with HEW job satisfaction. More than half of the health extension workers were dissatisfied with their jobs. Availability of living home, Transfer, medical supply, Environment, Support was predictor of job satisfaction. It is crucial to encourage intervention mode that may enhance their satisfaction and motivation of HEWs to improve service provision. [ABSTRACT FROM AUTHOR]

Background: Ethiopia has made strides in reducing maternal mortality, but significant discrepancies in maternal health service utilization exist across socioeconomic levels. According to studies, women from higher-income households are far more likely to use essential services such as antenatal care, delivery care, and postnatal care than poorer women. This wealth disparity is a primary contributor to persistently high maternal mortality, particularly among poor populations. The study's goal was to assess wealth disparities in maternal health service uptake and identify contributing factors. Methods and materials: We used the Ethiopian Mini Demographic Health Survey (EMDHS), conducted in 2019 on women aged 15–49 living in selected census areas, with a weighted sample size of 3,909. The Erreygers Concentration Index (ECI) was used to measure wealth inequalities in maternal health care, and the ECI decomposition was used to identify factors contributing to inequality in maternal health services. Results: Maternal health service utilization was pro-rich among women in Ethiopia. The prevalence of antenatal care service (ANC), delivery, and postnatal care (PNC) service utilization showed a pro-rich distribution among Ethiopian women, with ECI = 0.115 (95% CI: 0.091–0.137), ECI = 0.223 (95% CI: 0.191–0.276), and ECI = 0.121 (95% CI: 0.041-0.200), respectively. The ECI indices were decomposed to examine the contributing factors to disparities in maternal service utilization in Ethiopia. Mother's current age, household family size, region, birth order, and parity were contributors to maternal health service utilization. Conclusion: The ANC service, delivery service and PNC service utilization showed a pro-rich distribution among Ethiopian women. Mother's current age, household family size, region, birth order, and parity are important contributors of maternal health service inequality. To improve access and usage among low-income women, policymakers can develop programs including increasing the number of free or subsidized services and providing transportation. [ABSTRACT FROM AUTHOR]

Background: Labor pain is the nastiest conceivable pain women are involved in during labor and delivery. In this way, the end of labor pain is frequently outlined by myths and equivocalness. Hence, giving a compelling absence of pain in labor remained a challenge specifically in developing countries including Ethiopia. Objectives: This systematic review and meta-analysis aimed to explore the pooled prevalence of labor analgesia and associated factors to pregnant women in Ethiopia. Design: A systematic review and meta-analysis were utilized in agreement with the Preferred Reporting Items for Systematic Reviews. Data Sources: PubMed/Medline, SCOPUS, EMBASE, Web of Science, Google Scholars, and the Cochrane Library and supplemented it with manual were deliberately looked at until January 1–30, 2024. Methods: Two authors independently extricated all principal information utilizing standardized data extraction designs, and the analysis was done utilizing STATA version 17. Heterogeneity over the studies was evaluated utilizing I 2 measurement. The funnel plot and Egger's weighted regression tests were utilized to assess subjective and objective publication biases respectively. Also, the pooled effect of labor pain management and the associations were evaluated utilizing a random-effects model. Results: The general pooled prevalence of labor analgesia in the present study was 23.3% with a (95% confidence interval (CI): 13.5, 33.1). Maternal age (odds ratio (OR): 1.91; 95% CI: 1.11, 2.77), parity of the mother (OR: 0.28; 95% CI: 0.06, 0.63), history of pregnancy misfortune (OR: 0.12; 95% CI: 0.11, 0.36), length of labor (OR: 2.09; 95% CI: 1.06, 3.13), and awareness about labor analgesia (OR: 1.91; 95% CI: 0.34, 3.49) were significantly related with labor analgesia among pregnant women in Ethiopia. Conclusions: The generally pooled prevalence of labor analgesia among pregnant women in Ethiopia was low. Maternal age, parity of the mother, history of pregnancy loss, length of labor, and awareness of labor analgesia were factors influencing labor analgesia among pregnant women in Ethiopia. This finding proposes exceptional consideration to make laboring mothers free of pain by scaling up the strategies and utilizing labor pain administration in a way that universally recognized standards are met. Registration number: PROSPERO CRD: 42024525636 [ABSTRACT FROM AUTHOR]

Background: As the Sustainable Development Goal 3.2.1 deadline (2030) approaches, rapidly reducing under-5 mortality (U5M) gains more prominence. However, initiatives or interventions that aided Bangladesh in achieving Millennium Development Goal 4 showed varied effectiveness in reducing certain cause-specific U5M. Therefore, this study aimed to examine the predictors of the key cause-specific mortalities. Methods: This cross-sectional study was conducted using the Bangladesh Demographic and Health Survey 2011 and 2017-18 data. Cause-specific U5M was examined using multilevel multinomial mixed-effects analyses, and overall/all-cause U5M was examined using multilevel mixed-effects analyses. The respective estimates were compared. Results: The cause-specific analysis revealed that pneumonia and prematurity-related U5M were significantly associated with antenatal care and postnatal care, respectively. However, analysis of overall/all-cause U5M did not reveal any significant association with health services. Twins or multiples had a greater risk of mortality from preterm-related conditions (adjusted Relative Risk Ratio (aRRR): 38.01, 95% CI: 19.08–75.7, p <.001), birth asphyxia (aRRR: 6.52, 95% CI: 2.51–16.91, p <.001), and possible serious infections (aRRR: 11.12, 95% CI: 4.52–27.36, p <.001) than singletons. Children born to mothers 18 years or younger also exhibited a greater risk of mortality from these three causes than children born to older mothers. This study also revealed an increase in the predicted risk of prematurity-related mortality in the 2017-18 survey among children born to mothers 18 years or younger, children born to mothers without any formal education, twins or multiples and children who did not receive postnatal care. Conclusions: This research provides valuable insights into accelerating U5M reduction; a higher risk of preterm-related death among twins underscores the importance of careful monitoring of mothers pregnant with twins or multiples through the continuum of care; elevated risk of death among children who did not receive postnatal care, or whose mothers did not receive antenatal care stresses the need to strengthen the coverage and quality of maternal and neonatal health care; furthermore, higher risks of preterm-related deaths among the children of mothers with low formal education or children born to mothers 18 years or younger highlight the importance of more comprehensive initiatives to promote maternal education and prevent adolescent pregnancy. [ABSTRACT FROM AUTHOR]

The United States (US) is experiencing a maternal health crisis, with high rates of maternal morbidity and mortality. The US has the highest rates of pregnancy-related mortality among industrialized nations. Maternal mortality has more than quadrupled over the last decades. Rural areas and minoritized populations are disproportionately affected. Increased pregnancy-care workforce with greater participation from family medicine, greater collaborative care, and adequate postpartum care could prevent many maternal deaths. However, more than 40% of birthing people in the US receive no postpartum care. No singular solutions can address the complex contributors to the current situation, and efforts to address the crisis must address workforce shortages and improve care during and after pregnancy. This essay explores the role family medicine (FM) can play in addressing the crisis. We discuss pregnancy care training in FM residencies as well as the threats posed by financial and medico-legal climates to the maternal health workforce. We explore how collaborative care models and comprehensive postpartum care may impact the maternal health workforce. Efforts and resources devoted to high impact solutions for which FM has considerable autonomy, including collaborative and postpartum care, are likely to have greatest impact. [ABSTRACT FROM AUTHOR]

Postpartum depression (PPD) is a mental health disorder that affects 10%–15% women globally. Longitudinal and meta-analyses have consistently demonstrated the negative impacts of PPD on both the affected mothers and subsequent infant development. Given the consideration that antidepressant side effects in breastfeeding infants and the cost-effectiveness considerations of psychotherapies, attention has been paid towards the promising role of social support interventions in order to prevent and reduce the PPD symptoms. Confirming the assertion, this narrative review examines the potential of five social support interventions to ameliorate PPD-related maternal and infant outcomes. The wide implications of psychoeducational strategy, nurses' supportive and non-directive counselling and home-visiting approach are outlined. Furthermore, the evidence underlying the role of peer support, culturally tailored intervention and community-based participatory approach in PPD is elucidated. In clinical practice, this review reinforce the roles of discharge educational intervention led by the experienced nurse during the postpartum stay, in order to maintain psychological mental health among the postpartum mothers. More importantly, the skilled and competence public health nurses act as valuable assets in treating PPD, and this effective treatment alternative should be considered by healthcare planners. In future, major investigations will be strategized to discover the synergistic effects of combined social support approaches to yield a better outcome in the prevention and treatment of PPD. [ABSTRACT FROM AUTHOR]

Background: The continuum of care (CoC) in maternal health refers to the continuity of individual reproductive health care across the antenatal, intrapartum, and postnatal periods. The CoC is an indicator of the quality of maternal and newborn health outcomes and women's empowerment is crucial to improving maternal and neonatal health service access and utilisation. Objective: To examine the spatial patterns of continuum of care use for maternal and neonatal health services and its correlation with women's empowerment. Methods: We analysed data from the Ethiopian Demographic and Health Surveys (EDHS) of 2011 and 2016. All women aged 15–49 who had live births in the preceding five years of the DHS surveys were included in the analysis. We measured the continuum of care using the modified co-coverage index (CoCI), which consisted of six indicators. Women's empowerment was assessed using a validated survey-based Women's Empowerment (SWPER) index. We used the Getis-Ord-Gi* spatial analysis tool to portray locations with clusters of CoC service use and spatial correlations between CoC use and women empowerment. Results: None of the newborn-mother pairs in the 2011 survey received the entire continuum of care and only 2.5% of newborn-mother pairs received the full range of continuum of care services in the 2016 survey. In 2016, 6.9% of mother-newborn pairs received the basic CoC services (four or more antenatal care [ANC] visits, skilled birth attendance [SBA], and postnatal care [PNC]), and no mother-newborn pair received all three services at the same time in 2011. The Amhara, Afar, and Somali regional states had the least CoC service use in both surveys. There was a positive spatial correlation between CoC use and women's empowerment domains. Conclusion: Our analysis showed that the use of four or more ANC visits, SBS, newborn PNC, Bacillus Calmette-Guérin (BCG) vaccine uptake, and tetanus toxoid protection at birth were low in Ethiopia. Women empowerment domains were found to have a positive spatial correlation with CoC services use. To improve and preserve continuity of care, it is critical to leverage every maternal health facility encounter to encourage sustained service usage at each step of the continuum. Government policies should prioritise women's empowerment and raise public awareness of maternity services. [ABSTRACT FROM AUTHOR]

Background: Brazil is one of the countries with the highest rates of caesarean sections (CS), reaching almost 90% of births in the private sector. A quality improvement project called "Adequate Childbirth Project (PPA)" was conceived to reduce CS in the private sector. This project consisted of four primary components: "Governance", "Participation of Women", "Reorganization of Care" and "Monitoring". This paper aims to evaluate: (1) which specific activities of the PPA had the largest effect on the probability of a woman having a vaginal delivery; (2) which primary component of the PPA had the largest effect on the probability of vaginal delivery and (3) which scenarios combining the implementation of different activities planned in the PPA had a higher effect on the probability of vaginal delivery. Methods: A sample of 12 private hospitals participating in the PPA was evaluated. We used a Bayesian Network (BN) to capture both non-linearities and complex cause-effect relations. The BN integrated knowledge from experts and data from women to estimate 26 model parameters. The PPA was evaluated in 2473 women belonging to groups 1–4 of the Robson classification, who were divided into two groups: those participating or not participating in the PPA. Results: The probability of a woman having a vaginal delivery was 37.7% higher in women participating in the PPA. The most important component of the project that led to an increase in the probability of vaginal delivery was "Reorganization of Care", leading to a 73% probability of vaginal delivery among women in labor. The activity that had the greatest effect on the type of delivery was access to best practices during labor, with a 72% probability of vaginal delivery. Considering the 12 scenarios combining the different activities of the PPA, the best scenarios included: a non-scheduled delivery, access to information about best practices, access to at least 4 best practices during labor and respect of the birth plan, with an 80% probability of vaginal delivery in the best combinations. Conclusion: PPA has been shown to be an effective quality improvement program, increasing the likelihood of vaginal delivery in private Brazilian hospitals. Plain English Summary: Introduction: Brazil boasts one of the highest rates of caesarean sections (CS) globally, with nearly 90% of births in private facilities being delivered via CS. In response, the 'Adequate Childbirth Project – PPA' was launched as a quality improvement initiative aimed at curbing CS rates in private healthcare. Its goal is to improve the quality of childbirth and reduce the number of CS in private healthcare. The project has four main parts: 'Governance', 'Participation of Women', 'Reorganization of Care', and 'Monitoring'. Method: an evaluative study was conducted across 12 private hospitals involved in the PPA, involving 2473 women who were categorized into PPA participants and non-participants. They used a method called a cause-effect network to see which parts of the PPA helped more women have vaginal deliveries. Results: They found that women in the PPA were 37.7% more likely to have a vaginal delivery. Giving women access to good practices during labor and birth was really important. Also, 'Reorganization of Care' was the most important part of the project. It led to a 73% chance of vaginal delivery for women in labor. Conclusion: The PPA is effective in helping more women in private hospitals have vaginal deliveries. This means it's a good program for improving childbirth in Brazil's private hospitals. [ABSTRACT FROM AUTHOR]

Background: Worldwide, 10% of postpartum women experience postpartum depression, which can lead to diverse sequalae at individual, family, and societal levels. In sub-Saharan Africa, it is estimated that 17% of women experience depression in the postpartum period, which could be an underestimate as 48% of women in the region do not receive postnatal care (81% in Ethiopia and 51% in Guinea) and a large share of postpartum depression remains undiagnosed and untreated as a result. Globally, despite a critical evidence gap, there are growing reports of postpartum depression among women mistreated (disrespected and abused) during childbirth in health facilities, making a strong case to examine the association between mistreatment and postpartum depression. This study in Addis Ababa (Ethiopia) and Conakry (Guinea) uses a mixed methods design to 1) examine the link between mistreatment and postpartum depression, 2) explore the health system capacity to provide respectful maternity care and maternal mental health services, and 3) explore the experiences of women in accessing care and support for postpartum depression. Methods: We will conduct a prospective longitudinal survey of women (434 in Addis Ababa and 408 in Conakry) from the third trimester of pregnancy to eight weeks postpartum and carry out in-depth interviews with key health system informants (20–25 in each city) and women who recovered from a clinically confirmed episode of postpartum depression (15–25 in each city). Quantitative data from the women's survey will be analysed using a multilevel mixed-effects model; qualitative data from key-informants will be analysed by using a hybrid thematic analysis approach, whereas data from women's in-depth interviews will be analysed using the phenomenological approach. The inclusion of two different settings in our study (Addis Ababa and Conakry) will enable us to apply a comparative health systems lens to explore the dynamics of respectful maternity care and maternal mental health services within the broader health systems of the two countries (Ethiopia and Guinea). Discussion: The findings from this study will inform actions aimed at mitigating the mistreatment of women in maternity settings and improving promotive, preventive, and treatment interventions for postpartum depression in Ethiopia and Guinea. The findings can also be extrapolated to other low-resource settings. [ABSTRACT FROM AUTHOR]

Background: Improving maternal healthcare services is crucial to achieving the Sustainable Development Goal (SDG-3), which aims to reduce maternal mortality and morbidity. There is a consensus among different researchers that proper utilization of maternal healthcare services can improve the reproductive health of women, and this can be achieved by providing Antenatal Care (ANC) during pregnancy, Health Facility Delivery (HFD), and Postnatal Care (PNC) to all pregnant women. The main aim of this study was to investigate the utilization and factors associated with maternal and child healthcare services among women of reproductive age in the pastoralist communities in Kenya. Methods: A cross-sectional survey was conducted among 180 pastoralist women who gave birth in the past two years across ten mobile villages in Marsabit County between 2nd January and 29th February 2019. Three key outcomes were analyzed, whether they attended ANC 4+ visits, delivered at HF, and received PNC. Pearson χ2 test and multivariate logistic regression analysis were conducted by IBM SPSS27.0 following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The significance level was set at p < 0.05. Results: Of the 180 eligible pastoralist women (mean age 27.44 ± 5.13 years), 92.2% were illiterate, 93.9% were married, 33.3% were in polygamy, and 14.4% had mobile phones. The median commuting distance was 15.00 (10–74) km, 41.7% attended ANC 4+, 33.3% HFD, and 42.8% PNC. Those women residing close (≤ 15 km) to a health facility had a threefold higher ANC 4+ (OR 3.10, 95% CI 1.47–6.53), 2.8-fold higher HFD (OR 2.80, 95% CI 1.34–5.84), and 2.5-fold higher PNC (OR 2.49, 95% CI 1.19–5.22) probability. The likelihood was 30-fold higher for ANC 4+ (OR 29.88, 95% CI 6.68–133.62), 2.5-fold higher for HFD (OR 2.56, 95% CI 0.99–6.63), and 60-fold higher for PNC (OR 60.46, 95% CI 10.43–350.55) in women with mobile phones. A monogamous marriage meant a fivefold higher ANC 4+ (OR 5.17, 95% CI 1.88–14.23), 1.6-fold higher HFD (OR 1.67, 95% CI 0.77–3.62), and a sevenfold higher PNC (OR 7.05, 95% CI 2.35–21.19) likelihood. Hosmer Lemeshow test indicated a good-fitting model for ANC 4+, HFD, and PNC (p = 0.790, p = 0.441, p = 0.937, respectively). Conclusion: In conclusion, the utilization of three essential maternal health services is low. Geographic proximity, monogamous marriage, and possession of mobile phones were significant predictors. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community by providing mobile health outreach and health education. Plain Language Summary: Attending maternal healthcare clinics is essential to reduce maternal deaths and infections. This can be achieved by receiving antenatal care, delivering at health facilities, and checkups after delivery. We investigated the utilization and factors associated with maternal and child healthcare services among pastoralist women of reproductive age who have given birth in the past two years. Of one hundred and eighty women who participated, most of them were illiterate; the majority were married, of which almost a quarter were in polygamous marriages. This population's uptake of antenatal care, delivery in health facilities, and checkups after delivery is low. This means, that walking distance to the health facility was more than 15 km, almost half of women attended antenatal care and received checkups after delivery but only thirty-three percent delivered at a health facility. Geographic proximity, monogamy, and possession of mobile phones for communication were significant in determining the usage of maternal health care. Living close to a health facility means almost three times more antenatal care, two times more health facility delivery, and checkups after delivery. Women with mobile phones showed twenty-seven more times chances to attend antenatal care, more than four times chances to deliver in a health facility and sixty times more chances of having checkups after delivery. Monogamous marriage showed five times higher odds to attend ANC 4+ visits, and seven times having checkups after delivery. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community. [ABSTRACT FROM AUTHOR]

Introduction: Extra-uterine life support technology could provide a more physiologic alternative for the treatment of extremely premature infants, as it allows further fetal growth and development ex utero. Animal studies have been carried out which involved placing fetuses in a liquid-filled incubator, with oxygen supplied through an oxygenator connected to the umbilical vessels. Hence, by delaying lung exposure to air, further lung development and maturation can take place. This medical intervention requires adjustments to current obstetric procedures to maintain liquid-filled lungs through a so-called transfer procedure. Methods: Our objective was to develop obstetric device prototypes that allow clinicians to simulate this birth procedure to safely transfer the infant from the mother’s uterus to an extra-uterine life support system. To facilitate a usercentered design, implementation of medical simulation during early phase design of the prototype development was used. First, the requirements for the procedure and devices were established, by reviewing the literature and through interviewing direct stakeholders. The initial transfer device prototypes were tested on maternal and fetal manikins in participatory simulations with clinicians. Results & discussion: Through analysis of recordings of the simulations, the prototypes were evaluated on effectiveness, safety and usability with latent conditions being identified and improved. This medical simulation-based design process resulted in the development of a set of surgical prototypes and allowed for knowledge building on obstetric care in an extra-uterine life support context. [ABSTRACT FROM AUTHOR]

Aim: This qualitative study aimed to explore nurses' perspectives regarding the challenges of providing perinatal/neonatal end-of-life care in a regional hospital. Methods: This exploratory qualitative study was conducted with 20 nurses working in Turkey. Study data were collected through in-depth and semi-structured individual interviews. The interviews were then submitted to thematic analysis. Results: Three themes emerged from analyses of the interviews: (1) inadequate support for delivery of palliative care, (2) perceptions of family readiness, and (3) providing information/education to the family. The most prominent difficulties experienced by nurses were inadequacy of unit and equipment and lack of trained personnel. Another important issue that stood out was families' not accepting the end-of-life care decision for the fetus or the neonate and their having unrealistic expectations. Conclusion: Study results have provided important considerations for regional isolated neonatal and perinatal units, and they will be used to inform clinical practice improvements, staff education support, policies/procedures, family support, and further research relating to end-of-life care provision for the most vulnerable babies and their families. [ABSTRACT FROM AUTHOR]

This article provides an account of using reflexive participatory methods including study advisory group membership to evaluate a perinatal wellbeing service in an economically deprived area of Scotland. There is little qualitative research that explores the experiences of women accessing perinatal mental health services. This article draws on feminist values and narrative theory to explore the practice, process and ethics of using participatory methods with women in the perinatal period. We explore the blurring of intervention and research group boundaries to consider the service and study advisory group as a space which provided the conditions for collective care and re-storying the self. We explore the study advisory group as an extension of the intervention itself, highlighting the role of community in research practices and in interventions, for women who experience perinatal mental health difficulties. We reflect on the 'sticky' practice of navigating epistemic and decision-making power in participatory research, including the dual positionalities of being two academic researchers who come to research with therapeutic training in counselling, psychotherapy and social work. We call for reflexive, community-oriented and flexible approaches when using participatory methods with populations that might be considered vulnerable, marginalised or stigmatised. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this research was to examine the association between perceived quality of care during the COVID-19 pandemic and the modality of maternity care visits, virtual or in-person. Methods: This study utilized an online nationwide survey about experiences in prenatal and postpartum care between 18 April and 6 August 2020. Perceived quality of care was categorized into worse care, better, or the same care as compared to before the pandemic. Barriers were categorized into five groups: (1) concern for the privacy of health information, (2) not having a private or quiet place, (3) lack of physical exam or measurements, (4) quality of care, and (5) technology issues. Data analyses included bivariate analyses and multivariate logistic regression. Results: The majority (75.3%) of modified visits utilized telemedicine. Over half of the women took at-home measurements and the majority were successful. Barriers to care included a lack of a quiet or private space to conduct their visit. Women expressed concerns about a lack of measurements and a lower quality of care. Women who received telemedicine visits perceived worse care as compared to women who received in-person care visits (OR = 5.62; 95% CI 5.01–6.31). Discussion: Previous studies have shown that pregnant patients are generally satisfied with virtual care during the pandemic. This study provides insight from a large nationwide sample of women and geographic variation in satisfaction and perceived quality. These findings highlight barriers and potential solutions to improving patients' perceived quality of virtual maternity care, and thus future uptake of high-quality, virtual care. [ABSTRACT FROM AUTHOR]

This series of three articles will explore the fundamentals related to anatomy, physiology and pathophysiology in relation to three important topics: the cardiac system, the respiratory system and the endocrine system. The series is intended to provide an informative and evidence-based summary of each topic for both students and clinicians. This first article explores the maternal cardiovascular system, outlining its anatomy and the key physiological adaptations of pregnancy, and summarising pathophysiological conditions that may occur. [ABSTRACT FROM AUTHOR]

Diabetes mellitus and gestational diabetes mellitus significantly affect pregnant women, their fetuses and neonates. Midwives need to be aware of their vital role in the care of women with diabetes and keep up to date with the latest evidence and guidelines. However, midwives have reported a deficit in their knowledge regarding postnatal care of women with diabetes. In this article, the challenges of maternity care for women with diabetes are highlighted, and the specific midwifery role in some aspects of postnatal care is discussed. The provision of woman-centred care by midwives, together with the expert knowledge of the diabetic team, can reduce postnatal diabetic complications. [ABSTRACT FROM AUTHOR]

The objective of this study was to gain knowledge and ascertain challenges about periviability counseling among obstetricians to inform curricular development. Focus groups were utilized. A series of open-ended questions was posed to each group of obstetricians; responses were audio recorded and transcribed. Transcriptions were analyzed by two coders using thematic analysis. Four focus groups were convened. Prominent themes included: (1) Obstetrician knowledge about neonatal outcomes is limited, (2) Periviability counseling is both time intensive and time-challenged, (3) Patient processing of information relies on the content, delivery and patient readiness, and (4) Obstetrician bias is toward advocating for maternal safety, which may run counter to parental instinct to "do everything." The last theme was specifically focused on the role of cesarean delivery. Curricula focused on improving obstetrician periviability counseling should focus on neonatal outcomes, the role of cesarean delivery, and utilization of shared decision-making. [ABSTRACT FROM AUTHOR]

Objective To develop a framework and index for measuring universal health coverage (UHC) at the district level in India and to assess progress towards UHC in the districts. Methods We adapted the framework of the World Health Organization and World Bank to develop a district-level UHC index (UHCd). We used routinely collected health survey and programme data in India to calculate UHCd for 687 districts from geometric means of 24 tracer indicators in five tracer domains: reproductive, maternal, newborn and child health; infectious diseases; noncommunicable diseases; service capacity and access; and financial risk protection. UHCd is on a scale of 0% to 100%, with higher scores indicating better performance. We also assessed the degree of inequality within districts using a subset of 14 tracer indicators. The disadvantaged subgroups were based on four inequality dimensions: wealth quintile, urban--rural location, religion and social group. Findings The median UHCd was 43.9% (range: 26.4 to 69.4). Substantial geographical differences existed, with districts in southern states having higher UHCd than elsewhere in India. Service coverage indicator levels were greater than 60%, except for noncommunicable diseases and for service capacity and access. Health insurance coverage was limited, with about 10% of the population facing catastrophic and impoverishing health expenditure. Substantial wealth-based disparities in UHC were seen within districts. Conclusion Our study shows that UHC can be measured at the local level and can help national and subnational government develop prioritization frameworks by identifying health-care delivery and geographic hotspots where limited progress towards UHC is being made. [ABSTRACT FROM AUTHOR]

Background: ICP is a liver condition specific to pregnancy affecting 0.5–0.6% of pregnancies in Australia. Aims: to review the SOMANZ guidelines and extrapolate information relevant to midwives proving care for women with ICP. Findings: Multidisciplinary input is essential in caring for women with ICP and their families. Non-fasting TSBA samples ≥19 µmol/L are diagnostic in the presence of pruritus. Peak TSBA denotes the severity of the disease. Increased risk of stillbirth is small when peak TSBA ≥100 µmol/L. Conclusion: Midwives play an essential role in supporting women with ICP helping them navigate complex appointments and manage the pruritus and concomitant issues. [ABSTRACT FROM AUTHOR]

Medicaid coverage of doula services is increasing as a policy strategy to reduce maternal health inequities in the United States. However, early adopter states struggled to offer accessible, equitable Medicaid doula benefits when implementation began. California began covering doula services through its Medicaid program, Medi-Cal, in 2023. Managed care plans (MCPs) and risk-bearing organizations (RBOs) play an important role in ensuring pregnant and birthing people can access doula support through Medicaid benefits. Between 2021 and 2022, we conducted 14 interviews with MCP and RBO staff (n = 20) representing a total of 14 MCPs and RBOs. Data were analyzed in two stages: 1) rapid assessment process and 2) using the Consolidated Framework for Implementation Research (CFIR) to identify specific facilitators and barriers to Medi-Cal doula benefit implementation. We identified 10 facilitators and 16 barriers across the five CFIR domains. Results indicate a general lack of familiarity with doula care and highlight the importance of relationship building with doulas and collaboration among plans. In California, these findings can help guide improvements to emerging implementation challenges and evaluation efforts. Our findings can also help other states in the planning and Medicaid doula benefit design process. [ABSTRACT FROM AUTHOR]

Perinatal mental and anxiety disorders (PMADs) contribute to adverse health outcomes, though they are underrecognized and undertreated. Inpatient obstetric settings represent a unique opportunity for behavioral health engagement, including screening, brief treatment, and referrals for outpatient care. The proactive consultation-liaison (CL) model has proven effective in general hospital settings but is not well-studied in obstetric settings. This article describes the implementation and evaluation of a proactive CL model in an inpatient obstetric unit within a tertiary medical center. We implemented a multidisciplinary, proactive CL model in an inpatient obstetric unit with the purpose of identifying patients at risk for or experiencing PMADs and providing intervention and/or referral to treatment. Systematic screening of 7322 admitted patients was performed over a 17-month period to identify eligible patients for behavioral health consultation. Consultation data was retrospectively extracted from the electronic medical record. Key implementation outcomes were assessed using a RE-AIM measures (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. 1589 initial consults were conducted by the multidisciplinary team, yielding a consult rate of 21.7 %. The majority of consults (94 %) were completed by a social worker or psychologist, with most patients identified for consultation at multidisciplinary rounds (60.7 %). The most common indications for consultation with a psychiatrist included medication management, history of bipolar disorder, and history of anxiety. All invited staff and providers participated in the model. Alternative funding sources agreed to cover the salaries of the multidisciplinary team following conclusion of pilot grant funding. A proactive CL model implemented in an inpatient obstetric unit led to a higher consult rate (21.7 %) than is observed with traditional CL services. A multidisciplinary proactive CL model shows promise in identifying people at-risk for PMADs and providing targeted interventions to prevent PMADs and treat those with active symptoms. • The proactive CL model increases the consult rate in inpatient obstetric settings. • Team presence at interdisciplinary rounds leads to identification of most consults. • Many consults can reasonably be seen by a social worker or psychologist. • An interdisciplinary team facilitates targeted use of a psychiatrist for complex cases. [ABSTRACT FROM AUTHOR]

The connection between community healthcare providers and available community‐based programs is often weak. For community members to be connected with services, a strong referral link between providers and programs is paramount. The Referral Express and Central Hub (REACH) project was born out of this need for Nurse–Family Partnership (NFP) program sites in the Denver Metro area of Colorado to be better connected and coordinated with local referral sources. The objective of the REACH pilot was to create a centralized referral system and determine its feasibility in practice. After a 12‐month pilot, this innovative referral system supported the increase in a number of referral partners to Denver Metro area sites, an increase in clients served across the Denver Metro area, as well as an increase in the "refer to enroll" rate which increased by 37%. The success of the pilot of REACH led the developers to test the process on a second program, Child First, which was also successful. REACH has proved to be sustainable and continues to operate for both programs. Additionally, REACH acts as a consultant to NFP sites outside the Denver Metro area, in the state of Colorado, as each site works to increase its relationships with referral partners. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic caused unprecedented levels of stress amongst pregnant women and new mothers. The current qualitative study explored the ways in which perinatal women made meaning of their experiences during the COVID-19 pandemic. Methods: Data came from a parent study in which 54 perinatal (pregnant and postpartum) women in the United States completed semi-structured interviews from October 2021 to January 2022 describing their experiences during the COVID-19 pandemic. The data was interpreted using a hermeneutic, phenomenological approach to delve deeply into the concept of meaning-making. Results: Despite high levels of stress and challenging circumstances, participants reported engaging in meaning-making through finding connection, focusing on gratitude, and identifying openings for change. Unique forms of meaning-making amongst this population include a sense of connection to women throughout history, connection to their baby, and recognition of the need for systemic change for perinatal women. Conclusions: Perinatal women coped with the stress of the COVID-19 pandemic by making meaning from their experiences. Future research should further explore the importance of these aspects of meaning-making to perinatal women and implement these findings to adapt prevention and treatment approaches to address perinatal stress, especially during times of crisis. [ABSTRACT FROM AUTHOR]

Care provider communication with Black birthing families is impactful. This cross-sectional study asked 216 Black fathers to recall treatment by birthing care providers and tested variables contributing to birth satisfaction and fathering identity salience. Most fathers reported that care providers were respectful resulting in a positive birthing experience; however, 15% reported negative experiences with care providers. Perceived social support was shown to be a mediator between disrespect, mistreatment, inclusive communication, trust, and positive emotion with birth satisfaction and fathering identity salience. Care provider disrespect served as a "spoiler" of the birthing experience and subsequently diminished positive fathering identity salience. Analysis of open-ended comments showed that contrary to stereotypes about absent, disengaged Black fathers, fathers in this study were caring toward their newborns, present for them, and engaged in fathering. More work needs to be done with care provider communication to make every birth a positive and inclusive experience for Black fathers and their partners. [ABSTRACT FROM AUTHOR]

Anthropological enquiry into brokers and brokerage practice provides a prime entry point for making sense of social change. This article tends to the ways in which the trope of the broker and the everyday practice of those identified as enacting brokerage act as linchpins in broader moral grappling during a period of rapid social change. It draws from the ethnographic context of brokerage discursively constituted and enacted within maternal health markets in Bangladesh, focusing on the trope and actual practice of those identified as morally compromised dalals: brokers bringing women and families from public to private health institutions. It argues that the trope of the dalal operates as a metaphor for immorality ascribed to morally ambiguous spaces of the private health sector, a way for people to contend with a moral discomfort integral to applying market logics to health services enacted largely outside the jurisdiction of formal regulatory mechanisms. The practice of those identified as embodying dalals, in contrast, while flourishing in these conditions, is rooted in economic precarity, primarily of young men with limited power waiting for better opportunities, who negotiate and balance moral and economic imperatives in their line of work. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore the experiences of women with moderate‐to‐severe mental health difficulties during pregnancy, with a focus on establishing their psychological needs. Psychological distress caused by mental health difficulties during pregnancy is common and can significantly impact women and their babies. However, women's subjective experiences of difficulties with their mental health throughout pregnancy, alongside their experiences of staff, services and treatments are less well understood. Design: In this qualitative study, an Interpretive Phenomenological Analysis (IPA) approach was used. Methods: Semi‐structured interviews were conducted with participants recruited via a regional Perinatal Mental Health Service. Interviews were transcribed and analysed following the IPA methodology. Results: Five superordinate themes were identified which represented the lived experiences of the 11 participants on their journey through pregnancy whilst living with mental health difficulties and subsequent psychological distress: (i) Feeling the 'wrong' feelings, (ii) Societal pressures and a desire for greater acceptance, (iii) Searching for answers despite a lack of resources, (iv) What made a difference and (v) Experiences and expectations of service provision. Within these themes, 13 subordinate themes were also identified. Conclusions: These themes highlight the need for greater awareness and acceptance of mental health difficulties during pregnancy as well as postnatally. While perinatal mental health services are evolving, there is still an urgent requirement for services to continue to develop to meet women's needs, as well as to develop the role of clinicians as facilitators of engagement with needs‐matched care. [ABSTRACT FROM AUTHOR]

The global challenge of preterm birth persists with little or no progress being made to reduce its prevalence or mitigate its consequences, especially in low‐resource settings where health systems are less well developed. Improved delivery of respectful person‐centered care employing effective care models delivered by skilled healthcare professionals is essential for addressing these needs. These FIGO good practice recommendations provide an overview of the evidence regarding the effectiveness of the various care models for preventing and managing preterm birth across global contexts. We also highlight that continuity of care within existing, context‐appropriate care models (such as midwifery‐led care and group care), in primary as well as secondary care, is pivotal to delivering high quality care across the pregnancy continuum—prior to conception, through pregnancy and birth, and preparation for a subsequent pregnancy—to improve care to prevent and manage preterm birth. Synopsis: To mitigate preterm birth and its consequences, maternity models of care in all contexts should prioritize consistency and continuity of care and carer(s). [ABSTRACT FROM AUTHOR]

Objective: In the Netherlands, antenatal cardiotocography (aCTG) to assess fetal well‐being is performed in obstetrician‐led care. An innovative initiative was started to evaluate whether aCTG for specific indications—reduced fetal movements, external cephalic version, or postdate pregnancy—is feasible in non‐obstetrician‐led care settings by independent primary care midwives. Quality assessment is essential when reorganizing and shifting tasks and responsibilities. Therefore, we aimed to assess the inter‐ and intraobserver agreement for aCTG assessments between and within four professional groups involved in Dutch maternity care regarding the overall classification and assessment of the various components of aCTG. Method: This was a prospective study among 47 Dutch primary care midwives, hospital‐based midwives, residents, and obstetricians. Ten aCTG traces were assessed twice at a 1 month interval. To ensure a representative sample, we used two different sets of 10 aCTG traces each. We calculated the degree of agreement using the proportions of agreement. Results: The proportions of agreement for interobserver agreement on the classification of aCTG between and within the four professional groups varied from 0.82 to 0.94. The proportions of agreement for each professional group were slightly higher for intraobserver (0.86–0.94) than for interobserver agreement. For the various aCTG components, the proportions of agreement for interobserver agreement varied from 0.64 (presence of contractions) to 0.98 (baseline heart frequency). Conclusion: The proportion of agreement levels between and within the maternity care professionals in the classification of aCTG traces among healthy women were comparable. This means that these professional groups are equally well able to classify aCTGs in healthy pregnant women. Synopsis: The proportion of agreement levels between and within professionals in midwife‐led and obstetrician‐led care in the classification of antenatal cardiotocography traces among healthy women are comparable. [ABSTRACT FROM AUTHOR]

Objectives: The study explored the association between maternal transport modes and childhood mortalities in Nigeria. Method: Utilizing data and definitions from the 2018 Nigeria Demographic and Health Survey report, the ten-year early mortality rates of the five childhood mortalities and the percentage of live births in the 5 years before the survey, transported by eight identified means of transportation, were statistically correlated for each of Nigeria's 36 states and the federal capital territory (FCT) in the R environment at a significance level of α < 0.05. Results: In the spatial distribution of the five childhood mortalities, a notable north-south dichotomy was observed, contrasting with the spatial spread of maternal transport modes. The five childhood mortalities exhibited a significant, moderately positive correlation with transportation by Private Car or Truck, while their associations with Public Transport or Bus and Walking were notably moderate but negative. Conclusion for Practice: While the use of private cars or trucks should be encouraged as a means of maternal transport, public transport should be better organized to provide efficient services to women who need such services for maternal and child healthcare. Additionally, steps should be taken to reduce travel distances to health facilities to manageable distances for mothers. Significance: What is Already Known on this Subject?: Maternal- and child mortality remain global health concerns, with sub-Saharan Africa and South Asia bearing the brunt. Transportation has been identified as a significant barrier to healthcare accessibility for women and children in the region, especially in rural areas. What this Study adds?: Maternal transport mode is significantly associated with childhood mortalities. Efficient public transport has the potential of reducing child mortality; likewise locating healthcare facilities in a way to make them trekking distances for mothers. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the impact of both maternal psychopathological factors and adaptive psychological changes within the couple on fetal growth, emphasizing the importance of evaluating pregnancy from the perspectives of the couple, the mother, and the fetus collectively. A "couple" in this context refers to heterosexual partners engaged in the pregnancy process together, whether married or in a stable relationship. Methods: We included 189 pregnant women in their first trimester, tracking maternal depression, anxiety, body appreciation, prenatal attachment, and the couple's adjustment level across each trimester. Fetal growth parameters measured include biparietal diameter, femur length, humerus length, abdomen circumference, head circumference, β-HCG, and amniotic fluid levels, with relationships between these variables being modeled accordingly. Results: Our findings indicate stable levels of maternal depression, anxiety, body appreciation, and couple's adjustment throughout the pregnancy, with a significant increase in prenatal attachment levels in each subsequent trimester. Prenatal attachment in the first trimester and maternal depression levels in the second and third trimesters were found to directly influence fetal growth, while other variables exhibited indirect effects. Conclusions: Fetal growth is influenced by a myriad of biopsychosocial factors. Ensuring healthy pregnancy and fetal development necessitates close monitoring and support of the mother's adaptive psychological changes, early identification and treatment of potential psychopathologies, and maintenance of the psychosocial health of the couple. Significance: Although there are studies on the effects of maternal psychopathology on fetal growth, there are few studies that study the effects of adaptive psychological changes during pregnancy and the couple's relationship on fetal growth together with maternal psychopathology. With this study, it was understood that there was only a change in the prenatal attachment levels of the mother during pregnancy, there was no significant change in anxiety, depression, body appreciation and dyadic adjustment, but the mutual interactions of these factors during each trimester had important effects on fetal growth. For a healthy pregnancy and healthy fetal development, it is necessary to closely monitor and support the adaptive psychological changes of the mother, early recognition and appropriate treatment of possible psychopathologies, and the psychosocial health of the couple. [ABSTRACT FROM AUTHOR]

Objectives: Antenatal education (ANE) is part of National Health Service (NHS) care and is recommended by The National Institute for Health and Care Excellence (NICE) to increase birth preparedness and help pregnant women/birthing people develop coping strategies for labour and birth. We aimed to understand antenatal educator views about how current ANE supports preparedness for childbirth, including coping strategy development with the aim of identifying targets for improvement. Methods: A United Kingdom wide, cross-sectional online survey was conducted between October 2019 and May 2020. Antenatal educators including NHS midwives and private providers were purposively sampled. Counts and percentages were calculated for closed responses and thematic analysis used for open text responses. Results: Ninety-nine participants responded, 62% of these did not believe that ANE prepared women for labour and birth. They identified practical barriers to accessing ANE, particularly for marginalised groups, including financial and language barriers. Educators believe class content is medically focused, and teaching is of variable quality with some midwives being ill-prepared to deliver antenatal education. 55% of antenatal educators believe the opportunity to develop coping strategies varies between location and educators and only those women who can pay for non-NHS classes are able to access all the coping strategies that can support them with labour and birth. Conclusions for Practice: Antenatal educators believe current NHS ANE does not adequately prepare women for labour and birth, leading to disparities in birth preparedness for those who cannot access non-NHS classes. To reduce this healthcare inequality, NHS classes need to be standardised, with training for midwives in delivering ANE enhanced. Significance: What is Already Known on this Subject?: There is no detailed national guidance about the content or quantity of antenatal education that should be delivered by the NHS to patients and, how coping strategies are developed within these sessions is unknown. What this Study Adds?: Antenatal educators believe that quality of antenatal education needs to be improved. Access to coping strategies for labour and birth is hindered by the type of class, the educator's approach and socioeconomic status. This study can be used to support an argument for addressing the inequality in access to antenatal preparation, whilst better preparing all women through higher quality of antenatal education provision in the NHS. [ABSTRACT FROM AUTHOR]

Objective: To identify characteristics associated with a higher likelihood of patient-initiated encounters with a health care professional before the scheduled 6-week postpartum visit. Methods: We performed a retrospective cohort study of postpartum persons who received prenatal care and delivered at a single academic level IV maternity care center in 2019. We determined associations between maternal sociodemographic and obstetric characteristics and the likelihood of patient-initiated early postpartum encounters with χ2 tests for categorical variables and Wilcoxon rank sum tests for continuous and ordinal variables. Results: A total of 796 patients were included in our analysis, and 324 (40.7%) initiated an early postpartum encounter. Significantly more postpartum persons who initiated early postpartum encounters were primiparous persons (54.3%) than multiparous (33.8%) persons (P <.001). Postpartum persons who desired breastfeeding or who had prolonged maternal hospitalization, episiotomy, or cesarean or operative vaginal delivery were also significantly more likely to initiate early postpartum encounters (all P≤.002). Of postpartum persons who initiated early encounters, 44 (13.6%) initiated in-person visits, 138 (42.6%) initiated telephone or patient portal communication, and 142 (43.8%) initiated encounters of both types. Specifically, 39.2% of postpartum persons initiated at least one early postpartum encounter for lactation support, and nearly half of early postpartum encounters occurred during the first week after hospital discharge. Conclusion: Early postpartum encounters were more common among primiparas and postpartum persons who were breastfeeding or had prolonged hospitalization, episiotomy, cesarean delivery, or operative vaginal delivery. Future studies should focus on the development of evidence-based guidelines for recommending early postpartum visits. Significance: Most pregnancy-related maternal deaths occur during the postpartum period; therefore, optimization of postpartum care is a priority for obstetric clinicians. Postpartum encounters before 6 weeks are sought most frequently by primiparas or postpartum persons who breastfeed or have prolonged hospitalization, episiotomy, or operative vaginal/cesarean delivery. Understanding who initiates early postpartum encounters, preferred methods of contact, and their most frequently asked questions will allow obstetric health practices to better meet the postpartum needs of patients. [ABSTRACT FROM AUTHOR]

Infectious and Congenital Syphilis rates continue to rise globally. Current recommendations for syphilis screening and treatment may be insufficient, and there is a pressing need for improved programs and services to address the increase in cases. A scoping review was conducted to examine approaches to maternal syphilis screening and treatment. Theoretical underpinnings and the key characteristics of these interventions were studied to identify gaps in the existing literature to guide future research. Developing a modified version of the socio-ecological model to guide data analysis, we included 33 academic studies spanning 31 years, covering a range of interventions, programs, and policies globally. We highlight key facets of interventions aligning with the five levels of the modified model that include: individual, interpersonal, institutional, community and policy. In this review, we provide valuable insights into the characteristics and principles of maternal syphilis screening and treatment interventions. Even with advances in care, there remain many similarities in interventions for the improved treatment and screening of maternal syphilis over the past 30 years. There is a need for meaningful research that engages community members in study and intervention development and considers the social determinants of health in the context of maternal syphilis care. Examining interventions in relation to the socio-ecological model may help guide policymakers, researchers, and clinicians in intervention development. [ABSTRACT FROM AUTHOR]

Background: Pregnant women involved in decisions about their care report better health outcomes for themselves and their children. Shared decision‐making (SDM) is a priority for health services; however, there is limited research on factors that help and hinder SDM in hospital‐based maternity settings. The purpose of this study was to explore barriers and facilitators to SDM in a large tertiary maternity care service from the perspectives of multiple stakeholders. Methods: Qualitative semi‐structured interviews were undertaken with 39 participants including women, clinicians, health service administrators and decision‐makers, and government policymakers. The interview guide and thematic analysis were based on the Theoretical Domains Framework to identify barriers and facilitators to SDM. Results: Women expect to be included in decisions about their care. Health service administrators and decision‐makers, government policymakers, and most clinicians want to include them in decisions. Key barriers to SDM included lack of care continuity, knowledge, and clinician skills, as well as professional role and decision‐making factors. Key facilitators pertained to policy and guideline changes, increased knowledge, professional role factors, and social influences. Conclusion: This study revealed common barriers and facilitators to SDM and highlighted the need to consider perspectives outside the patient–clinician dyad. It adds to the limited literature on barriers and facilitators to SDM in hospital care settings. Organizational‐ and system‐wide changes to service delivery are necessary to facilitate SDM. These changes may be enabled by education and training, changes to policies and guidelines to include and support SDM, and adequately timed information provision to enable SDM conversations. [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]