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Objective: The study aims to examine maternal care among Hispanic birthing people by primary language and state policy environment. Data Sources and Study Setting: Pooled data from 2016 to 2020 Pregnancy Risk Assessment Monitoring System surveys from 44 states and two jurisdictions. Study Design: Using multivariable logistic regression, we calculated adjusted predicted probabilities of maternal care utilization (visit attendance, timeliness, adequacy) and quality (receipt of guideline‐recommended care components). We examined outcomes by primary language (Spanish, English) and two binary measures of state policy environment: (1) expanded Medicaid eligibility to those <133% Federal Poverty Level, (2) waived five‐year waiting period for pregnant immigrants to access Medicaid. Data Collection/Extraction Methods: Survey responses from 35,779 postpartum individuals with self‐reported Hispanic ethnicity who gave birth during 2016–2020. Principal Findings: Compared to English‐speaking Hispanic people, Spanish‐speaking individuals reported lower preconception care attendance and worse timeliness and adequacy of prenatal care. In states without Medicaid expansion and immigrant Medicaid coverage, Hispanic birthing people had, respectively, 2.3 (95% CI:0.6, 3.9) and 3.1 (95% CI:1.6, 4.6) percentage‐point lower postpartum care attendance and 4.2 (95% CI:2.1, 6.3) and 9.2 (95% CI:7.2, 11.2) percentage‐point lower prenatal care quality than people in states with these policies. In states with these policies, Spanish‐speaking Hispanic people had 3.3 (95% CI:1.3, 5.4) and 3.0 (95% CI:0.9, 5.1) percentage‐point lower prenatal care adequacy, but 1.3 (95% CI:−1.1, 3.6) and 2.7 (95% CI:0.2, 5.1) percentage‐point higher postpartum care quality than English‐speaking Hispanic people. In states without these policies, those same comparisons were 7.3 (95% CI:3.8, 10.8) and 7.9 (95% CI:4.6, 11.1) percentage‐points lower and 9.6 (95% CI:5.5, 13.7) and 5.3 (95% CI:1.8, 8.9) percentage‐points higher. Conclusions: Perinatal care utilization and quality vary among Hispanic birthing people by primary language and state policy environment. States with Medicaid expansion and immigrant Medicaid coverage had greater equity between Spanish‐speaking and English‐speaking Hispanic people in adequate prenatal care and postpartum care quality among those who gave birth. [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]

Objective: To describe changes in attitudes and expectations of labor over the previous six decades, comparing the Iraqi generation who labored at home without medical assistance with their descendants. Study Design: We used semi‐structured telephone interviews with 22 women across three generations of one extended family living and giving birth in Iraq between the 1950s and the 2010s. Qualitative data were analyzed thematically using open, axial, and selective coding. Results: Each generation experienced a paradigm shift in childbirth, from exclusive home births to hospital‐directed maternity care, to a trend that favors planned cesarean birth, driven by generation‐specific changes in outlook. Emerging themes included social influences, changing technology, and medical professionals' recommendations; all of these affected attitudes toward childbirth and pregnancy. There were generational disconnects in perceptions concerning the reasons childbirth has changed over the past 60 years, with the youngest generation citing wider pressures regarding body image and marital relationships as two of the factors affecting preferences in childbirth options. Conclusions: Societal changes and availability of healthcare services affect women's choices and experiences of childbirth. To be successful, efforts to improve women's experiences in labor, as well as maternal and neonatal outcomes, must consider these wider sociocultural issues. [ABSTRACT FROM AUTHOR]

Background Methods Results Discussion Prenatal ultrasounds form an important part of routine maternity care in Australia and indeed internationally. The COVID‐19 pandemic necessitated rapid changes in society and healthcare to curb transmission, with evidence demonstrating detrimental impacts on childbearing women associated with these restrictions. However, experiences with pandemic restrictions for prenatal ultrasounds in relation to distress, patient expectations, and satisfaction are largely unknown. This study aimed to explore the experiences of pregnant women attending prenatal ultrasound during the pandemic in Australia.A cross‐sectional online survey of people in Australia who had undergone at least one prenatal ultrasound during the period of maternity care restrictions was performed. The survey included validated tools for assessing post‐traumatic stress, satisfaction, and expectations with maternity care.A total of 1280 responses were obtained. Almost 37% of respondents returned a PCL‐C score consistent with probable post‐traumatic stress disorder. Unexpected ultrasound findings or a high PCL‐C score were more likely to have higher expectations and lower levels of satisfaction with their maternity care experience. Having an ultrasound for pregnancy loss, fetal abnormality, and/or a prior post‐traumatic stress disorder diagnosis were the strongest factors correlating with a high PCL‐C score.The prevalence of post‐traumatic stress symptoms in the study population is concerning and elucidates the distress experienced in association with prenatal ultrasounds during pandemic restrictions in Australia. Maternity services should acknowledge the high levels of service consumers with post‐trauma symptoms and consider trauma‐responsive maternity care adaptations in response to adverse perinatal outcomes for those afflicted with post‐trauma and distress‐related symptoms. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of obstructed labour, associated risk factors and outcomes across a network of referral hospitals in Nigeria. Design: Retrospective observational study. Setting: A total of 54 referral‐level hospitals across the six geopolitical regions of Nigeria. Population: Pregnant women who were diagnosed with obstructed labour during childbirth and subsequently underwent an emergency caesarean section between 1 September 2019 and 31 August 2020. Methods: Secondary analysis of routine maternity care data sets. Random‐effects multivariable logistic regression was used to ascertain the factors associated with obstructed labour. Main outcome measures: Risk factors for obstructed labour and related postpartum complications, including intrapartum stillbirth, maternal death, uterine rupture, postpartum haemorrhage and sepsis. Results: Obstructed labour was diagnosed in 1186 (1.7%) women. Among these women, 31 (2.6%) cases resulted in maternal death and 199 (16.8%) cases resulted in postpartum complications. Women under 20 years of age (OR 2.03, 95% CI 1.50–2.75), who lacked formal education (OR 1.88, 95% CI 1.55–2.30), were unemployed (OR 1.94, 95% CI 1.57–2.41), were nulliparous (OR 2.11, 95% CI 1.83–2.43), did not receive antenatal care (OR 3.34, 95% CI 2.53–4.41) or received antenatal care in an informal healthcare setting (OR 8.18, 95% CI 4.41–15.14) were more likely to experience obstructed labour. Ineffective referral systems were identified as a major contributor to maternal death. Conclusions: Modifiable factors contributing to the prevalence of obstructed labour and associated adverse outcomes in Nigeria can be addressed through targeted policies and clinical interventions. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to explore inequalities in antenatal care (ANC) in South Korea. Based on the guidelines of the WHO, we categorized less than eight visits to an obstetrical facility as insufficient ANC. We examined ANC inequalities associated with age, disability, nationality, income, and geographic accessibility. Methods: We extracted delivery event claimed from 2013 to 2022 from the National Health Insurance Service database. By tracing back 270 days from the delivery date, we counted the number of antenatal visits for each childbirth and calculated the proportion of women with insufficient ANC and assessed both absolute and relative inequalities for each population group. The logistic regression analysis for both underuse and overuse of ANC were conducted. Results: Out of 3 416 517 childbirths, 104 109 women (3.0%) had fewer than eight ANC visits. Although the average number of ANC visits reached 18.7 in 2022, significant inequalities persisted across different population groups. The insufficient ANC rate was 28.1% for teenage women, 6.4% for disabled women, 10.7% for non‐Korean women, and 15.2% for dependents of medical aid households. Women with low income and those living in obstetric care underserved areas also exhibited higher ANC insufficiency. From 2021 to 2022, sufficiency in ANC decreased for teenage, disabled, and non‐Korean women, highlighting the effects of the COVID‐19 pandemic. Conclusion: Antenatal care inequalities are evident in South Korea's well‐resourced health system. There is a need for further investigation into these disparities and the qualitative aspects of maternity care services. Synopsis: Despite South Korea's well‐equipped health system, significant antenatal care inequalities exist, necessitating further exploration and qualitative analysis of maternity care gaps. [ABSTRACT FROM AUTHOR]

It is estimated that over 1 billion people worldwide have a disability. In Australia, 9% of women of childbearing age have a disability, but data on disability status for women accessing maternity services are not routinely collected and data collection processes are inconsistent. Maternal disability may affect perinatal outcomes, but to understand what factors might be amenable to interventions to improve outcomes, accurate data collection on disability status is essential. This opinion piece reflects on disability identification within maternity services in Australia, identifying areas for policy and practice change. [ABSTRACT FROM AUTHOR]

Background: Recent years have brought substantial declines in geographic access to abortion facilities and maternity care across the US. The purpose of this study was to identify the reproductive health consequences of living in a county without access to comprehensive reproductive health care services. Methods: We analyzed National Center for Health Statistics data on all live births occurring in the US in 2020. We used data on locations of abortion facilities and availability of maternity care in order to classify counties by level of access to comprehensive reproductive health care services and defined comprehensive reproductive health care deserts as counties that did not have an abortion facility in the county or in any neighboring county and did not have any maternity care practitioners. We fit modified Poisson regression models with generalized estimating equations to estimate the degree to which living in a comprehensive reproductive health care desert was associated with receipt of timely and adequate prenatal care and risk of preterm birth, controlling for individual‐level and county‐level characteristics. Results: In 2020, one third of counties in the US were comprehensive reproductive health care deserts (n = 1082), and 136,272 births occurred in these counties. In adjusted models, there was no difference in prenatal health care use (timeliness or adequacy of care) between persons in comprehensive reproductive health care deserts and those with full access to care, but the risk of preterm birth was significantly elevated (aRR =1.09, 95% CI = 1.06, 1.13). Conclusions: Lack of access to comprehensive reproductive health care services may increase the incidence of preterm birth. [ABSTRACT FROM AUTHOR]

Background: The high maternal and neonatal mortality rate in sub‐Saharan Africa could be reduced by using navigation by means of mobile devices to increase the number of women who choose to give birth in a health center (HC) with a skilled healthcare practitioner. Methods: A quasi‐experimental design was used to test a midwife‐delivered navigation by means of mobile phone. A total of 208 women were randomized to two groups (intervention and control). Women in the intervention group received up to three navigation calls from midwives. Women in the control group received usual antenatal education during prenatal visits. Data were collected using semistructured questionnaires. Childbirth location was determined through medical records. Results: Overall, 180 (87%) women gave birth in a HC with a 3% advantage for the intervention group. A total of 86% (88/102) of the control group gave birth in a HC versus 89% (92/103) for the intervention group (Χ2 = 0.44, p‐value = 0.51), with an unadjusted odds ratio of 1.33 (95% CI: 0.57, 3.09). Among those with personal phones, 91% (138/152) had a birth in a HC versus 79% (42/53) in those without a personal phone (Χ2 = 4.89, p‐value = 0.03). Conclusions: The results of this study indicate that it is feasible to deliver phone‐based navigation to support birth in a HC; personal phone ownership may be a factor in the success of this strategy. [ABSTRACT FROM AUTHOR]

Introduction: Preeclampsia (PE) is a major maternal and fetal threat. Previous risk‐scoring methods in guidelines lacked precision. The Fetal Medicine Foundation (FMF) proposed a first‐trimester PE screening model using Bayes' theorem. PE Prediction Model: FMF prediction model combines maternal characteristics and medical/obstetrical history to determine prior risk and further incorporate maternal blood pressure, maternal serum biomarkers, and uterine Doppler pulsatility index expressed as multiples of the median (MoM) to estimate posterior risk. Low‐Dose Aspirin Prevention: Low‐dose aspirin is one of the potential PE prevention strategies. Initiating it before 16 weeks is crucial. Aspirin's antiplatelet and anti‐inflammatory properties align with PE's pathophysiology. Dosing and resistance warrant further study, but a standard regimen of 150 mg nightly, starting before 16 weeks, is widely supported. PE Prevention in Practice: Clinical trials, including ASPRE, affirm aspirin's role in PE prevention. Starting aspirin based on FMF screening significantly reduces preterm PE and associated complications. Advancements and Prospects: Emerging research explores predictors like maternal ophthalmic arterial waveform. Regional variations, especially in Asian populations, are considered. Machine learning and AI show promise, but examiner expertise remains essential for accurate prediction. In conclusion, integrating FMF's first‐trimester PE screening with low‐dose aspirin offers a promising strategy. Further advancements may enhance precision and broaden prevention efforts. [ABSTRACT FROM AUTHOR]

This article discusses the implementation of a Plan-Do-Study-Act (PDSA) intervention to improve the practice of birth companionship at St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia. The study found that the introduction of the PDSA intervention significantly increased the practice of birth companionship, with the percentage of mothers utilizing the service rising from less than 2% to 94.7%. The findings suggest that a stepwise PDSA intervention can effectively improve the practice of birth companionship and contribute to the realization of effective implementation of birth companions for all mothers during labor and delivery. [Extracted from the article]

Aim: To clarify the factor structure of "expectant mothers of concern" for whom midwives anticipate difficulties in future childrearing. Methods: The participants were 2633 midwives working at hospitals and clinics in Japan. Data were collected using a 108‐item, five‐point Likert scale questionnaire about the behaviors, appearance, and family relationships of the expectant mothers of concern to the nurses. Items with a mean equal to or greater than 4.0 were selected as items considered relevant to expectant mothers of concern by midwives. Exploratory factor analysis, confirmatory factor analysis, and further secondary factor analysis were conducted. Results: The factor structure of the expectant mothers of concern as perceived by midwives comprised seven factors, including 23 items: "Suspected of being a victim of intimate partner violence," "Uneasy feeling about the expectant mother's marital relationship," "Perception that the expectant mother is conflicted about her pregnancy," "Uneasy feeling about the expectant mother's actions/behaviors concerning her medical checkups," "Engages in physically risky actions and behaviors," "Does not appear to be able to build relationships with children," and "Makes remarks that indicate possible bonding disorder" (goodness‐of‐fit index = 0.910, adjusted goodness‐of‐fit index = 0.879, comparative fit index = 0.939, and root mean square error of approximation = 0.070). Further, a secondary factor, "Expectant mothers who must urgently be connected to support," was extracted. Conclusions: The elucidation of the factor structure of the expectant mothers of concern could help midwives identify expectant mothers who may face difficulties in future childrearing. [ABSTRACT FROM AUTHOR]

A study published in the journal Paediatric & Perinatal Epidemiology reveals that one in four women enter pregnancy with a pre-existing condition. The study, conducted in British Columbia, Canada, over a 20-year period, found that the most common pre-existing conditions were depressive disorders, anxiety disorders, bipolar disorder, chronic hypertension, and diabetes mellitus. The prevalence of psychiatric disorders, particularly in women born after 1985, has been increasing. The study highlights the need for robust preconception care strategies and multidisciplinary, patient-centered care approaches to improve outcomes for pregnant women with pre-existing conditions. [Extracted from the article]

This article describes the successful implementation of a population-based screening and assessment service for pregnant women in a remote healthcare setting in Australia. The service, called the Initial Maternity Assessment and Planning (IMAP) service, was expanded to include a remote Australian maternity healthcare setting using a co-design approach and implementation science methodology. Since its establishment in 2023, over 200 women have been seen through the service, resulting in an increase in the proportion of local women accessing first trimester ultrasound and a decrease in the number of local women not attending for antenatal care within the first trimester. This study demonstrates the feasibility of scaling up a service to improve equity of care for women in regional and remote areas. [Extracted from the article]

This article describes the establishment of the Initial Maternity Assessment and Planning Service (IMAP) in Australia, which aims to provide comprehensive and early antenatal care for women planning public maternity care. The service includes a comprehensive ultrasound assessment, screening for aneuploidy and pre-eclampsia, and a review of obstetric, medical, and personal history with a dedicated midwife. The information is collated by an obstetrician to provide early pregnancy risk stratification. This study confirms the feasibility of a redesigned approach to first trimester specialist maternity care. [Extracted from the article]

This article discusses the implementation outcomes of the Initial Maternity Assessment and Planning (IMAP) service in Australia. The IMAP service is a first trimester population-based screening and assessment service that aims to improve antenatal care. The study found that a majority of eligible women accessed the service within the recommended gestational window, and a significant proportion were allocated to low-risk community-based models of care. The findings suggest that the IMAP service has successfully improved the provision of early pregnancy care and highlights the potential benefits of a redesigned approach to first trimester specialist maternity care. [Extracted from the article]