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The clock occupies a prominent position in many feminist and midwifery critiques of the medicalisation of labour and birth. Concern has long focused on the production of standardised 'progress' during labour via the expectation that once in 'established' labour, birthing people's cervixes should dilate at a particular rate, measurable in centimetres and clock time. In this article we draw on 37 audio‐ or video‐recordings of women labouring in two UK midwife‐led units in NHS hospital settings to develop a more nuanced critique of the way in which times materialise during labour. Mobilising insights from literature that approaches time as relational we suggest that it is helpful to explore the making of times during labour as multiple, uncertain and open‐ended. This moves analysis of time during labour and birth beyond concern with particular forms of time (such as the clock or the body) towards understanding how times are constituted through interactions (for example, between midwives, cervixes, clocks, people in labour and their birth partners), and what they do. [ABSTRACT FROM AUTHOR]

To understand the experience, training, and needs of midwives in their approach to perinatal grief. A descriptive cross-sectional study was carried out using an online questionnaire with 26 questions related to institutional management and individual clinical practices in the care of a perinatal loss was developed by a team of midwives from the Hospital "La Mancha-Centro" of Alcazar de San Juan (Ciudad Real). Strobe checklist was followed. A total of 267 midwives participated. A total of 92.1% (246) of the centers had specific protocols for action, but each professional applied their own criteria. The presence of a perinatal psychology team was nonexistent according to 88% (235) of those surveyed. Regarding their training and professional experience, 16.5% (44) of the midwives had never received training. Only 4.1% (11) of the midwives felt very prepared to care for women with a perinatal loss. Among the factors associated with greater application of recommended practices in the face of perinatal death by midwives were being a woman, having prior training on care during perinatal death, and a greater perception of preparation (p < 0.05). The perception of lack of preparation on the part of midwives in the accompaniment of these families was high. [ABSTRACT FROM AUTHOR]

Background: Globally, cesarean birth rates are rising, and while it can be a lifesaving procedure, cesarean birth is also associated with increased maternal and perinatal risks. This study aims to describe changes over time about the mode of birth and perinatal outcomes in second‐pregnancy women with one previous cesarean birth in the Netherlands over the past 20 years. Methods: We conducted a nationwide, population‐based study using the Dutch perinatal registry. The mode of birth (intended vaginal birth after cesarean (VBAC) compared with planned cesarean birth) was assessed in all women with one previous cesarean birth and no prior vaginal birth who gave birth to a term singleton in cephalic presentation between 2000 and 2019 in the Netherlands (n = 143,146). The reported outcomes include the trend of intended VBAC, VBAC success rate, and adverse perinatal outcomes (perinatal mortality up to 7 days, low Apgar score at 5 min, asphyxia, and neonatal intensive care unit admission ≥24 h). Results: Intended VBAC decreased by 21.5% in women with one previous cesarean birth and no prior vaginal birth, from 77.2% in 2000 to 55.7% in 2019, with a marked deceleration from 2009 onwards. The VBAC success rate dropped gradually, from 71.0% to 65.3%, across the same time period. Overall, the cesarean birth rate (planned and unplanned) increased from 45.2% to 63.6%. Adverse perinatal outcomes were higher in women intending VBAC compared with those planning a cesarean birth. Perinatal mortality initially decreased but remained stable from 2009 onwards, with only minimal differences between both modes of birth. Conclusions: In the Netherlands, the proportion of women intending VBAC after one previous cesarean birth and no prior vaginal birth has decreased markedly. Particularly from 2009 onwards, this decrease was not accompanied by a synchronous reduction in perinatal mortality. [ABSTRACT FROM AUTHOR]

Background: The increasing number of unnecessary cesarean births is a cause for concern and may be addressed by increasing access to midwifery care. The objective of this review was to assess the effect of midwifery care on the likelihood of cesarean births. Methods: We searched five databases from the beginning of records through May 2020. We included observational studies that reported odds ratios or data allowing the calculation of odds ratios of cesarean birth for births with and without midwife involvement in care or presence at the institution. Standard inverse‐variance random‐effects meta‐analysis was used to generate overall odds ratios (ORs). Results: We observed a significantly lower likelihood of cesarean birth in midwife‐led care, midwife‐attended births, among those who received instruction pre‐birth from midwives, and within institutions with a midwifery presence. Conclusions: Care from midwives reduces the likelihood of cesarean birth in all the analyses, perhaps due to their greater preference and skill for physiologic births. Increased use of midwives in maternal care can reduce cesarean births and should be further researched and implemented broadly, potentially as the default modality in maternal care. [ABSTRACT FROM AUTHOR]

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

Purpose: The association between birth order and adverse perinatal outcomes has been well studied in twin pregnancies. However, little is known about the differences in immediate perinatal outcomes as well as long‐term hospitalization of the offspring in triplet pregnancies according to their birth order. As such, we aimed to assess the differences in immediate perinatal outcomes and long‐term hospitalizations among triplets by their birth order. Methods: In a retrospective hospital‐based cohort study, immediate perinatal outcomes and long‐term hospitalizations were compared among triplet siblings according to their birth order. Deliveries occurred between the years 1991 and 2021 in a tertiary medical center. The study groups were followed until 18 years of age for cardiovascular, respiratory, neurological, and infection‐related hospitalizations. Generalized estimation equation (GEE) models were used to control for confounders. Kaplan–Meier survival curves were used to compare cumulative long‐term hospitalization incidences and Cox proportional hazards models were performed to control for confounders. Results: The study included 117 triplet deliveries. Rates of small for gestational age (SGA) infants increased linearly by birth order (6.0%, 7.7%, and 15.4% for the first, second, and third siblings, respectively; p‐value for trends = 0.035). Using a GEE model controlling for maternal age, being born third in a triplet pregnancy was independently associated with SGA (third vs. first sibling, adjusted OR 3.0, 95% CI 1.38–6.59, p = 0.005). No significant differences in cardiovascular, respiratory, neurological, and infection‐related hospitalizations were noted among the first, second, and third siblings. Likewise, using Kaplan–Meier survival analyses, no significant differences in the cumulative incidence of long‐term pediatric hospitalizations were noted between the siblings. In Cox proportional hazards models, controlling for weight and gender, birth order in a triplet pregnancy did not exhibit an association with long‐term hospitalizations of the offspring. Conclusion: Despite the association between birth order and SGA, birth order in triplets does not seem to have an impact on the risk for long‐term offspring hospitalization. [ABSTRACT FROM AUTHOR]

Introduction: Although current recommendations support vaginal breech birth as a reasonable option, access to breech birth in US hospitals is limited. This study explored the experiences of decision‐making and perceptions of access to care in people who transferred out of the hospital system to pursue home breech birth. Methods: We conducted a mixed methods study of people with a singleton, term breech fetus who transferred out of the US hospital system to pursue home breech birth. Twenty‐five people completed an online demographic and psychosocial survey, and 23 (92%) participated in semi‐structured interviews. We used an interpretive description approach informed by situational analysis to analyze qualitative data about participants' experiences and perceived access to care. Results: Of 25 individuals who left the hospital system to pursue a home breech birth, most felt denied informed choice (64%) and threatened or coerced into cesarean (68%). The majority reported low or very low autonomy in decision‐making (n = 20, 80%) and high decisional satisfaction using validated measures. Many participants felt safer in a hospital setting but were not able to access care for planned vaginal breech hospital birth, despite extensive efforts. Participants felt "backed into a corner" and "forced into homebirth," perceiving a lack of access to safe and respectful care in the hospital system. Conclusion: Some service users believe that home birth is their only option when they cannot access hospital‐based care for vaginal breech birth. Current barriers to care for breech birth limit birthing people's autonomy and may be placing them and their infants at increased risk. [ABSTRACT FROM AUTHOR]

Background: Economic evaluations are being conducted with increasing frequency in the maternity care setting, with more randomized controlled trials containing a health economic component. Key emerging criticisms of economic evaluation in maternity care are lack of robust data collection and measurement, inconsistencies in methodology, and lack of adherence to reporting guidelines. Methods: This article provides a guide to the design of economic evaluations alongside clinical trials in maternal health. We include economic concepts and considerations for the maternity setting and provide examples from the UK and Australia. Results: There are many important considerations for the design of economic evaluations alongside clinical trials. To be effective, researchers must select types of economic evaluation, which align with their study objectives; choose an appropriate evaluation perspective, time horizon, and discount rate; and identify accurate ways to measure and evaluate health outcomes and costs. Discussion: This guide is written for noneconomists and can be used for designing economic evaluations to be conducted as a part of clinical trials. We seek to improve the quality, consistency, and transparency of economic evaluations in maternal health. [ABSTRACT FROM AUTHOR]

Background: Poland has one of the highest cesarean birth (CB) rates in Europe. For this study, we used the Robson Ten‐Group Classification System (TGCS) to analyze trends in the induction and CB rates in one hospital in Poland over a period of 11 years. We compare these trends with changes in National Legislative and Medical Guidelines introduced during this time that were aimed at lowering rates of unnecessary medical interventions. Methods: We conducted a retrospective study including all births after 24 weeks' gestation between 2010 and 2020 from one tertiary hospital (n = 66,716 births). After the deletion of records with missing data, 66,678 births were included in the analysis. All births were classified according to the Robson TGCS. The size, CB rate, and contribution of each group for every year were calculated. Linear regression analyses were used to analyze trends over time. Results: The total CB rate varied from 29.6% to 33.0% during the study period, with a linear increase of 0.045 percentage points annually (R2 = 0.021; F(1) = 0.189; p = 0.674). This study was considerably lower than the total CB rate for Poland, which rose from 33.9% in 2010 to 45.1% in 2020, increasing at a rate of 1.13 percentage points per year (R2 = 0.93; F(1) = 61.88; p < 0.001). Induction rates among both nulliparous (R1 + R2) and multiparous (R3 + R4) women at term also increased. Study groups R5 (previous cesarean birth), R2 (nulliparous in induced or prelabor cesarean delivery), and R1 (nulliparous women at term with single cephalic pregnancy in spontaneous labor) were the highest contributors to the overall CB rate. The greatest decrease in the CB rate was detected in group R5b (more than one previous CB). None of the groups showed statistically significant increases in CB rates over the study period. Conclusions: The CB rate in the hospital where the study was conducted was considerably lower than the total CB rate in Poland. When compared with countries with similar CB rates, group R2b (women with nulliparous, prelabor cesarean birth) in our study was considerably larger. More comparisons across different hospital settings in Poland are needed. However, as hospitals are not encouraged to routinely collect the data needed to construct TGCS, such comparisons are very difficult to conduct. [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: Women's dissatisfaction with perinatal health care services is associated with poor postpartum outcomes for the mother and the baby. The Mackey Childbirth Satisfaction Rating Scale is a frequently used measure of women's childbirth satisfaction. However, its factor structure has been inconsistent across investigations. The goal of this study was to evaluate the psychometric properties of the scale (i.e., factor structure and sources of validity evidence). Methods: This study is a descriptive prospective investigation. Participants included 106 pregnant women (mean age = 31.86, SD = 4.12) recruited from a public university hospital situated in South Madrid. Sources of construct validity of the Mackey were explored with the Women's View of Birth Labor Satisfaction Questionnaire. Sources of criterion validity were investigated with measures of pain (labor, delivery, and just after birth) and post‐traumatic stress symptoms. Results: Minor adaptations in item distribution resulted in an adequate fit of the original six‐factor solution of the Mackey scale (i.e., oneself, the partner, the baby, the nurse, the physician, and overall satisfaction). Sources of validity evidence supported the construct and criterion validity of the scale. Conclusions: Obtaining a psychometrically and conceptually sound factor solution is fundamental when validating a scale. With the present study, researchers and clinicians (e.g., midwives) will be able to measure women's childbirth satisfaction in a more robust manner. Both antecedents and consequences of satisfaction were found to correlate with several satisfaction subscales, which might help guide prevention programs in mother care in a more efficient way. [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]

Background: Respectful maternity care (RMC) is a rights‐based approach to childbirth that centers the dignity, autonomy, and well‐being of birthing women. This study aimed to examine factors associated with RMC among women giving birth in Tanzania and to examine whether HIV status was associated with self‐reported RMC. Methods: We enrolled 229 postpartum women in six clinics in the Kilimanjaro Region; of them, 103 were living with HIV. Participants completed a survey within 48 h after birth before being discharged. RMC was measured using a 30‐item scale with three subscales (dignity and respect; supportive care; communication and autonomy), each standardized from 0 to 100. Univariable and multivariable regression models examined factors associated with RMC. Results: The median score of the full RMC score was 74, differing slightly by subscale: 83 for dignity and respect, 76 for supportive care, and 67 for communication and autonomy. RMC did not differ by HIV status (median 67.0 vs. 67.0, p = 0.89). In multivariable linear regression, women who would not recommend the birth facility to their friends and who did not receive breastfeeding education had significantly lower RMC scores on the full RMC scale. In the dignity and respect subscale, variables associated with significantly lower RMC scores were not being able to read and write, delivering in a public facility, and delivering vaginally. Conclusions: Although self‐reported RMC was generally high, we identified areas for improvement. Practitioners need ongoing training on RMC principles and the delivery of equitable care. [ABSTRACT FROM AUTHOR]

Unique service needs exist for expectant or parenting youth with foster care histories (EPY) and their families. Informed by Critical Ecological Systems Theory (CEST), this exploratory qualitative study presents findings from an inductive content analysis of in‐depth interviews and focus groups with EPY and service providers. The study included nine in‐depth face‐to‐face interviews with service providers (n = 5) and EPY (n = 4) as well as five focus groups with service providers (n = 23) and three with EPY (n = 7) to identify the characteristics of service providers, agencies and systems that may act as barriers to service utilization among EPY with a foster care history (n = 10) or juvenile justice history (n = 1). Service provider characteristics included negative attitudes towards EPY and/or those with child welfare experiences. Agency characteristics included a lack of workforce diversity, employee turnover, lack of training about diverse communities, restrictive enrolment processes and eligibility requirements, lack of childcare and transportation and limited accessibility of services. System characteristics included a lack of up‐to‐date information about existing services, territorialism, funding sources that do not prioritize interagency collaboration and a lack of communication/coordination among agencies. Implications include hiring and retaining a diverse workforce, providing training about diverse communities and implicit biases concerning young parents, developing navigation services specifically for EPY and developing processes for sharing data and communicating across systems that interact with EPY. [ABSTRACT FROM AUTHOR]

The quest to ensure maternal health has long been in focus, mainly since the Safe Motherhood Initiative of the 1980s. Maternal health is contingent, among other things, on the availability of maternal health care services and the context in which the services are available. Therefore, we conducted rapid ethnographic research at four public hospitals in Southwest Ethiopia to gain anthropological insights into maternal health, maternal health‐seeking behavior, and healthcare services. We collected data from maternal near‐miss patients, patients with obstetric fistula, and health professionals working in maternity and labor wards. Our data reveal that there has been a huge effort to promote institutional delivery and ensure maternal health in the study area. However, failure to consider socioculturally embedded issues undermined the outcome of these efforts. We suggest that maternal health‐seeking for institutional delivery and, hence, ensuring maternal health should be understood as a process that should take into account these socioculturally embedded issues. [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]

Objective: This systematic review and meta‐analysis aimed to evaluate the performance of existing externally validated prediction models for pre‐eclampsia (PE) (specifically, any‐onset, early‐onset, late‐onset and preterm PE). Methods: A systematic search was conducted in five databases (MEDLINE, EMBASE, Emcare, CINAHL and Maternity & Infant Care Database) and using Google Scholar/reference search to identify studies based on the Population, Index prediction model, Comparator, Outcome, Timing and Setting (PICOTS) approach until 20 May 2023. We extracted data using the CHARMS checklist and appraised the risk of bias using the PROBAST tool. A meta‐analysis of discrimination and calibration performance was conducted when appropriate. Results: Twenty‐three studies reported 52 externally validated prediction models for PE (one preterm, 20 any‐onset, 17 early‐onset and 14 late‐onset PE models). No model had the same set of predictors. Fifteen any‐onset PE models were validated externally once, two were validated twice and three were validated three times, while the Fetal Medicine Foundation (FMF) competing‐risks model for preterm PE prediction was validated widely in 16 different settings. The most common predictors were maternal characteristics (prepregnancy body mass index, prior PE, family history of PE, chronic medical conditions and ethnicity) and biomarkers (uterine artery pulsatility index and pregnancy‐associated plasma protein‐A). The FMF model for preterm PE (triple test plus maternal factors) had the best performance, with a pooled area under the receiver‐operating‐characteristics curve (AUC) of 0.90 (95% prediction interval (PI), 0.76–0.96), and was well calibrated. The other models generally had poor‐to‐good discrimination performance (median AUC, 0.66 (range, 0.53–0.77)) and were overfitted on external validation. Apart from the FMF model, only two models that were validated multiple times for any‐onset PE prediction, which were based on maternal characteristics only, produced reasonable pooled AUCs of 0.71 (95% PI, 0.66–0.76) and 0.73 (95% PI, 0.55–0.86). Conclusions: Existing externally validated prediction models for any‐, early‐ and late‐onset PE have limited discrimination and calibration performance, and include inconsistent input variables. The triple‐test FMF model had outstanding discrimination performance in predicting preterm PE in numerous settings, but the inclusion of specialized biomarkers may limit feasibility and implementation outside of high‐resource settings. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: Surgery for obstetric fistula is a highly effective treatment to restore continence and improve quality of life. However, a lack of data on the cost‐effectiveness of this procedure limits prioritization of this essential treatment. This study measures the effectiveness of fistula surgeries using disability‐adjusted life years (DALYs) averted. Methods: In 2021 and 2022, the Fistula Foundation funded 20 179 fistula surgeries and related procedures at 143 hospitals among 27 countries. We calculated DALYs averted specifically for vesicovaginal fistula and rectovaginal fistula procedure types (n = 13 235 surgeries) by using disability weights from the 2019 Global Burden of Disease study. We based cost calculations on direct treatment expenses, including medical supplies, health provider fees, and preoperative and postoperative care. We measured effectiveness using data on the risk of permanent disability, country‐specific average life spans, and treatment outcomes. Results: The total treatment cost was $7.6 million, and a total of 131 433 DALYs were averted. Thus, the cost per DALY averted—the cost to restore 1 year of healthy life—was $58. For this analysis, we took a cautious approach and weighted only surgeries that resulted in a closed fistula with restored continence. We calculated DALYs averted by country. Limitations of the study include data entry errors inherent in patient logs and lack of long‐term outcomes. Conclusion: The current study demonstrates that obstetric fistula surgery, along with having a significant positive impact on maternal health outcomes, is highly cost‐effective in comparison with other interventions. The study therefore highlights the benefits of prioritizing fistula treatment as part of the global agenda for maternal health care. Synopsis: Obstetric fistula treatment is highly cost‐effective. The current study highlights the benefits of prioritizing fistula treatment as part of the global agenda for maternal health care. [ABSTRACT FROM AUTHOR]

Maternal reports of decreased fetal movement (DFM) are a common reason to present to maternity care and are associated with stillbirth and other adverse outcomes. Promoting awareness of fetal movements and prompt assessment of DFM has been recommended to reduce stillbirths. However, evidence to guide clinical management of such presentations is limited. Educational approaches to increasing awareness of fetal movements in pregnant women and maternity care providers with the aim of reducing stillbirths have recently been evaluated in a several large clinical trials internationally. The International Stillbirth Alliance Virtual Conference in Sydney 2021 provided an opportunity for international experts in fetal movements to share reports on the findings of fetal movement awareness trials, consider evidence for biological mechanisms linking DFM and fetal death, appraise approaches to clinical assessment of DFM, and highlight research priorities in this area. Following this workshop summaries of the sessions prepared by the authors provide an overview of understandings of fetal movements in maternity care at the current time and highlights future directions in fetal movement research. Synopsis: This conference workshop report provides an overview of contemporary understandings of decreased fetal movements in maternity care highlighting future directions in fetal movement research. [ABSTRACT FROM AUTHOR]

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]

Background: We aimed to examine the effects of endometriosis on the rate of abnormal placentation by comparing the data of pregnant women with and without endometriosis. Methods: A case–control study was conducted to compare the perinatal outcomes between women with and without endometriosis. In the subgroup analysis, magnetic resonance imaging (MRI) scans of pregnant women with placenta previa were used to measure the cervical angle and its relationship with endometriosis. The cervical angle was measured as the angle between the cervical glands and the line perpendicular to the spinal column in each sagittal MRI section. Results: We retrospectively analyzed data from 3453 cases of singleton deliveries between 2015 and 2019 at two study facilities. Among them, 159 had clinically or surgically confirmed endometriosis. The odds ratio (OR) for abnormal placental position was significantly higher in pregnant women with endometriosis (OR. 2.82; 95% confidence interval [CI], 1.58–5.04). The OR was 3.21 (95% CI, 1.57–6.55) in the endometriosis‐surgery group (91 patients) and 2.32 (95% CI, 0.91–5.88) in the non‐surgery group (68 patients). Furthermore, 44 women who underwent pelvic MRI after 30 weeks of gestation were included to examine the cervical angle. Then, we compared the date of pregnant women with (n = 6) and without endometriosis (n = 38). Regardless of placental attachment position, the cervical angle was significantly lower in the group with than in the group without a history of endometriosis. Conclusion: Pregnant women with a history of endometriosis may have stronger uterine retroversion, which could potentially contribute to abnormal placental positioning. [ABSTRACT FROM AUTHOR]

Key content: In obstetrics and gynaecology, things often 'go well' because clinicians make sensible adaptations in response to situations to ensure safety, often within a highly pressurised environment.The adaptations and performance variables that are made under these complex circumstances are not explicitly understood.Understanding the performance variability of clinicians as well as the environmental context that enables good or successful outcomes may bring awareness of how to build adaptive capacities and capabilities in clinicians when working in unpredictable and unanticipated highly pressurised environments. Learning objectives: To be aware of the current research in safety‐II and the concept of resilience engineering in illustrating the nature of adaptations that happen in complex clinical contexts.To understand the concept of capability mindfulness, which can help clinicians to focus on their environment and to be alert and aware of correcting errors before they occur.To be aware of these concepts (behaviour and skills) through the lens of 'what went well' in clinicians' responses to unforeseen and unpredictable situations. [ABSTRACT FROM AUTHOR]

Introduction: Transitioning into the role of a mother encompasses many physical and psychosocial changes, affecting the way a woman may function. Maternal health is an emerging area of practice for occupational therapists, and therefore, screening and assessment tools to support work in this area are needed. The Barkin Index of Maternal Functioning (BIMF) is a quantitative outcome measure that is used by health professionals to assess maternal functioning. Currently, its ability to measure occupational performance is unclear. Methods: Utilising a mixed methods design, this study analysed the extent to which the BIMF assesses maternal function from an occupational perspective. Thirteen first‐time mothers with a baby 12 months of age or younger participated in the study. Results from the BIMF were compared with themes developed from semi‐structured qualitative interviews that explored the occupational experiences of first‐time mothers. Findings: Seven themes were developed from the interviews. The BIMF addressed three themes, including changes to engagement in basic activities of daily living and leisure, transitioning into motherhood, emotions, self‐efficacy, and social support. However, four themes were not captured by the BIMF, including changes to partner relationships, identity shift, influence of 'person' factors, and changes to social experiences in early motherhood. Conclusion: Findings suggest that a new tool with a holistic perspective of mothers as occupational beings is needed to be able to identify occupational performance issues and the potential need for occupational therapy support. This study identified key experiences of occupational performance for new mothers. [ABSTRACT FROM AUTHOR]

Adverse outcomes associated with pregnancy, including severe acute maternal morbidity (SAMM) and mortality, are internationally regarded as important indicators of quality of maternity services. Varied definitions and processes are barriers for SAMM recording, reporting and review. Identifying and documenting these cases of SAMM is a critical first step. Case reviews allow exploration of factors contributing to SAMM. Translation of the lessons learnt into practice improvement strategies and dissemination of this knowledge is essential for continual quality improvement. This review will outline the current status of SAMM review internationally and in Australia. [ABSTRACT FROM AUTHOR]

Background: The pain that women experience during labor and childbirth is the central feature of parturition in humans. Despite improvement in the development of standards for pain assessment and treatment, labor pain is mostly ignored especially in low‐ and middle‐income countries resulting in unmeasured suffering from childbirth for mothers. Objectives: We aimed to provide a comprehensive estimation of the pooled magnitude and associated factors of labor pain management practices in Ethiopian public health facilities. Search Strategy: A systematic review and meta‐analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analysis statement. Electronic databases including Google Scholar, Web of Science, Excerpta Medica Database (EMBASE), PubMed/MEDLINE, and Scopus were searched from database inception to June 30, 2023. Selection Criteria: The inclusion criteria were established prior to article review and follows the population, intervention, comparison and outcome criterions. Data Collection and Analysis: We evaluated publication bias by means of funnel plots and Egger's test. Heterogeneity between studies was assessed using I2 statistics. For each associated factors in meta‐regressions, the pooled odds ratio (OR) and its 95% confidence interval (CI) were extracted. A P value of 0.05 was used to determine the significance of the small study effect. Main Results: Our search terms yielded 17 studies with 5735 participants. The pooled prevalence of labor pain management practices in Ethiopia was 45.73% (95% CI: 39.13, 52.32; I2 = 96.4). Having adequate knowledge regarding labor pain management (OR: 3.74; 95% CI: 2.74, 5.11; I2 = 53.8%), a favorable attitude toward labor pain management (OR: 2.90; 95% CI: 2.03, 4.14; I2 = 63.8%), availability of labor analgesics (OR: 3.23; 95% CI: 2.18, 4.79; I2 = 46.2%), and clinical experience of 10 or more years (OR: 3.45; 95% CI: 2.06, 5.78; I2 = 19.0%) were factors that were statistically associated with the use of labor pain management practices. Conclusion: We concluded that the routine practices of labor pain management by obstetric health providers in Ethiopia are still low. Therefore, it remains important to call for holistic and inclusive interventions targeting maternity health providers and hospital officials to update their long‐standing practices. Registration: Registered in PROSPERO under protocol number CRD42023429140. Synopsis: Labor pain management practice in Ethiopia is still low. Formulating a systematic approach to implement pain management guidelines would be valuable across the maternity care pathways. [ABSTRACT FROM AUTHOR]

Despite significant progress made previously and the recognized health benefits of optimal feeding practices, ensuring a minimum acceptable diet in developing countries like Ethiopia remains a formidable challenge. Additionally, there is a scarcity of data in this area. Therefore, our study aims to identify predictors of a minimum acceptable diet using a powerful tool called complementary log‐log regression analysis. Thus, it contributes to accelerating the pathway of ending child undernutrition thereby promoting optimal child health. A multilevel analysis was conducted among a weighted sample of 1427 children aged 6‐23 months using the 2019 Ethiopian Demographic Health Survey (EDHS). The EDHS sample was stratified and selected in two stages. A minimum acceptable diet is defined as a composite of children fed with both minimum dietary diversity and minimum meal frequency. Data extraction took place between August 1 and 30, 2023. We used STATA software version 17 for data analysis. A complementary log‐log regression model was fitted to identify significant predictors of the minimum acceptable diet. A p‐value of ≤0.05 was used to declare statistically significant predictors. Only 10.44% (95CI: 8.90‐12.15) of the children meet the minimum acceptable diet. Child aged (18‐23 month) (AOR = 1.78, 95CI:1.14‐2.78)], mother's educational level (secondary and above education) (AOR = 279,95CI: 1.51‐5.15), number of children three and above [(AOR = 0.78,95CI: 0.53‐0.94], institutional delivery [AOR = 1.77,95CI: 1.11‐3.11], having postnatal‐check‐up [AOR = 2.33,95CI: 1.59‐3.41] and high community poverty level (AOR = 0.49,95CI: 0.29‐0.85) were found to be predictors of minimum acceptable diet. In Ethiopia, only one in ten children achieve a minimum acceptable diet. Which is lower than the global report findings (16%). Enhancing maternal education programs and promoting family planning strategies to reduce household size are essential. Besides, encouraging institutional deliveries and postnatal check‐ups are also recommended. It is necessary to implement targeted interventions for poverty reduction in communities to ensure that families can afford nutritious diets for their children. Key messages: This study aimed to identify predictors of a minimum acceptable diet among children aged 6‐23 months.Analysis revealed that only 10.44% of children met the minimum acceptable diet criteria.Factors such as child age, mother's educational level, number of children in the household, place of delivery, postnatal checkup 2 months after delivery, and community poverty level emerged as significant predictors of achieving a minimum acceptable diet.These findings underscore the multifactorial nature of dietary adequacy in early childhood and highlight the importance of targeted interventions to improve nutritional outcomes for young children. [ABSTRACT FROM AUTHOR]

Background: Perinatal mental health disorders affect up to 20% of all women. Women of refugee background are likely to be at increased risk, yet little research has explored this. This study aimed to assess if women of refugee background are more likely to screen risk positive for depression and anxiety than non‐refugee women, using the Edinburgh Postnatal Depression Scale (EPDS); and if screening in pregnancy using the EPDS enables better detection of depression and anxiety symptoms in women of refugee background than routine care. Methods: This implementation study was conducted at an antenatal clinic in Melbourne, Australia. Women of refugee and non‐refugee backgrounds were screened for depression using English or translated versions of the EPDS and a psychosocial assessment on a digital platform. The psychosocial assessment records of 34 women of refugee background receiving routine care (no screening) were audited. Results: Overall, 274 women completed the EPDS; 43% of refugee background. A similar proportion of women of refugee and non‐refugee backgrounds had EPDS scores of ≥9 (39% vs. 40% p = 0.93). Women receiving the combined EPDS and psychosocial screening were more likely to receive a referral for further support than women receiving routine care (41% vs. 18%, p = 0.012). Conclusion: Similarly, high proportions of women of refugee and non‐refugee backgrounds were at increased risk of experiencing a current depressive disorder in early pregnancy, suggesting pregnancy care systems should acknowledge and respond to the mental health needs of these women. Screening appeared to facilitate the identification and referral of women compared to routine care. [ABSTRACT FROM AUTHOR]

Aim: To analyze the characteristics and trends in published research on perinatal depression between 1920 and 2020. Methods: A search strategy in Web of Science identified all published literature on perinatal depression between January 1, 1920, and December 31, 2020. Output from Web of Science was used to analyze bibliometric information, and VOSViewer was used to visualize the networks of linkages between identified publications. Results: There were 16,961 publications identified. Among these publications, there were 82,726 unique authors and 140 countries represented. The United States had the highest frequency of publications (44.6%). Most publications (69.8%) occurred between 2011 and 2020, with the first publication identified in 1928. There were 2197 unique journals identified, with over half publishing only one (n = 948, 43.2%) or two relevant publications (n = 314, 14.3%). Authors with the largest number of publications were Wisner (n = 115), Dennis (n = 95), and Murray (n = 92), while authors with the largest number of citations were Cox (n = 7225), Murray (n = 2755), and O'Hara (n = 2069). Limitations: While the Web of Science is a representative database identifying the greatest number of relevant articles, it may be unrepresentative of all published literature. Conclusion: This is the first study mapping publications on perinatal depression between 1920 and 2020. The rate of publication on perinatal depression has been steadily increasing in recent years with a wide variety of authors, countries, and journals represented. As the field continues to grow, trends may shift as early career researchers emerge and the importance of mental health in low‐income countries is prioritized. [ABSTRACT FROM AUTHOR]

Background: In order to evaluate interventions aimed at reducing cesarean births, care practitioners' attitudes are important to measure. The Labor Culture Survey (LCS) is a scale that measures individual and unit attitudes towards supporting vaginal birth. As no equivalent scale exists in Sweden, the aim was to translate, adapt, and validate the LCS and to investigate whether there were differences in attitudes toward supporting vaginal birth between maternity care practitioners. Methods: A cross‐sectional study including midwives, physicians, and nurse assistants working with intrapartum care in five labor wards in Sweden. The original LCS was translated into Swedish, and six context‐specific items were developed for the Swedish setting (SLCS). The translation was tested for face validity. Psychometric analysis was conducted using exploratory factor analysis with principal component analysis, parallel analysis, and principal axis factoring. Reliability was estimated using Cronbach's alpha. One‐way ANOVA and Tukey HSD were calculated to analyze differences in attitudes between professions on the subscales of the S‐LCS. Results: A total of 539 midwives, physicians, and nurse assistants participated. The final S‐LCS showed a five‐factor solution with the following subscales: Best Practices to reduce cesarean overuse, Unpredictability of vaginal birth, Unit Microculture, Maternal Agency, and Organizational Oversight. Chronbach alpha values varied from 0.60 to 0.83. Midwives were more supportive towards vaginal birth and less fearful of potential consequences of vaginal birth compared with physicians. Conclusions: The S‐LCS demonstrated satisfactory psychometric properties for use in Swedish maternity care. Further work to improve the scale should include additional items reflecting the subscale Maternal Agency. [ABSTRACT FROM AUTHOR]

Background: In 2014, the National University Hospital of Iceland (NUHI) merged a mixed‐risk birth unit and a midwifery‐led low‐risk unit into one mixed‐risk unit. Interprofessional preventative and mitigating measures were implemented since there was a known threat of cultural contamination between mixed‐risk and low‐risk birth environments. The aim of the study was to assess whether the NUHI's goal of protecting the rates of birth without intervention had been achieved and to support further development of labor services. Methods: A retrospective cohort study of all women who had singleton births at NUHI birth units in two 2‐year periods, 2012–2013 and 2015–2016. The primary outcome variables, birth without intervention, with or without artificial rupture of membranes (AROM), were adjusted for confounding variables using logistic regression analysis. Secondary outcome variables (individual interventions and maternal and neonatal complications) were analyzed using descriptive statistics, t test, and Chi‐square test. Results: The rate of births without interventions, both with and without AROM, increased significantly after the unit merger and accompanying preventative measures. The rates of AROM, oxytocin augmentation, episiotomies, and epidural analgesia decreased significantly. The rate of induction increased significantly. There were no significant differences in maternal or neonatal complication rates. Conclusions: Interprofessional preventative measures, implemented alongside a mixed‐risk and low‐risk birth unit merger, can increase rates of births without interventions in a mixed‐risk hospital setting. However, it is necessary to maintain awareness of the possible effects of a mixed‐risk birth environment on the use of childbirth interventions and examine the long‐term effects of preventative measures. [ABSTRACT FROM AUTHOR]

Background: Traumatic childbirth experiences are common in the United States – affecting a third to a fourth of mothers – with significant negative impacts on maternal health. Yet most research on traumatic childbirth focuses on white mothers' experiences. Drawing on a racially and ethnically diverse sample of mothers who experienced traumatic childbirth, this exploratory qualitative study examined Black, Latina, and Asian mothers' traumatic birth experiences and the role of obstetric racism in shaping these experiences. Methods: In‐depth, semi‐structured interviews were conducted in 2019–2020 with 30 mothers who identified as women of color (37% Black, 40% Latina, and 23% Asian) who gave birth in the US and self‐identified as having experienced a traumatic childbirth. Data were analyzed using qualitative content analysis. Results: Mothers reported obstetric racism as core to their traumatic birth experiences. This racism manifested through practitioners' use of gendered and racialized stereotypes, denying and delegitimizing mothers' needs. Mothers shared key consequences of the obstetric racism they experienced, including postpartum anxiety and depression, increased medical mistrust, and decreased desire for future children. Conclusions: Mothers' reports suggest that obstetric racism played a role in their traumatic birth experiences. Particularly, practitioners' deployment of gendered and racialized stereotypes influenced mothers' treatment during birth. These findings point to opportunities to address obstetric racism during childbirth and improve patients' experiences through enhancing their agency and empowerment. The findings, in addition, highlight the need for increased practitioner training in anti‐racist practice and cultural humility. [ABSTRACT FROM AUTHOR]

Background: Late preterm and full‐term infants comprise the majority of births in our hospital which serves a multicultural lower socioeconomic community. Patients give birth vaginally (normal birth, NB) or by cesarean birth (CB), and the majority of neonates are exclusively breastmilk fed until discharge. In this study we examined what factors within these two birth modes and feeding regimes of exclusive breast milk were associated with early postnatal readmission. Ideally, findings will aid initiatives to decrease readmission rates. Methods: A retrospective cohort study was performed on maternal–infant pairs. All neonates from 2016 to 2018, exclusively breastmilk fed at discharge, born by NB (n = 4245) or CB (n = 1691), were grouped as non‐Readmitted (Reference) or Readmitted within 30 days of discharge. Readmission reason was determined, and potential associations were identified using univariate analysis and multivariable logistic regression. Results: Rates of readmission were similar for both NB and CB infants (6.8% vs. 7.3%). In order, NB concerns were jaundice, infection, and feeding—this was reversed for the CB Group. NB readmission bilirubin levels were higher (293 ± 75 vs. 236 ± 112, μmol/L, NB:CB, p < 0.001). Factors associated with readmission for both groups were similar to previously published studies. Edinburgh Postnatal Depression Score (EPDS) was higher for Readmitted infant mothers. Importantly, for non‐jaundice readmission EDPS categories indicated that both CB and NB mothers were more likely to have depression. Conclusion: Early readmission of exclusively breastmilk‐fed infants born by means of NB or CB is multifactorial. Early pregnancy mental health issues are associated with readmission, highlighting the potential effects of perinatal depression on neonatal health. [ABSTRACT FROM AUTHOR]

Background: Over one‐third of nulliparae planning births either at home or in freestanding midwife‐led birthing centers (community births) in high‐income countries are transferred during labor. Perinatal data are reported each year in Germany for women planning community birth. So far, data sets have not been linked to describe time‐related factors associated with nulliparous transfer to hospital. Objectives: To describe the prevalence of referral for nulliparae and assess maternal and labor characteristics associated with intrapartum transfer. Methods: Perinatal data from 2010 to 2015 were linked (n = 26,115). Women were reviewed with respect to international eligibility criteria for community birth; 1997 women were excluded (7.6%). Descriptive statistics were reported; unadjusted and adjusted odds ratios with 95% confidence intervals (CI) tested the predictive effect of demographic and labor factors on rates of intrapartum transfer. Results: One in three nulliparous women (30.6%) were transferred to hospital. Compared with community births, transferred women were significantly more likely to experience longer time intervals during labor: from rupture of membranes (ROM) until birth lasting 5 to 18 h (OR 6.05, CI 5.53–6.61) and 19 to 24 h (OR 10.83, CI 9.45–12.41) compared to one to 4 h; and from onset of labor until birth 11 to 24 h (OR 6.72, CI 6.24–7.23) and 25 to 29 h (OR 26.62, CI 22.77–31.11) compared to one to 10 h. When entering all factors into the model, we found the strongest predictors of transfer to be fetal distress, longer time intervals between ROM until birth and onset of labor until birth. Conclusions: Nulliparous transfer rates were similar to rates in other high‐income countries; 94% of referrals were non‐urgent. Time was found to be an independent risk factor for the transfer of nulliparae planning community birth. [ABSTRACT FROM AUTHOR]

Background: Woman‐centered maternity service delivery is endorsed by Australian federal health policy. Despite this, little evaluation of maternity care is conducted through the lens of women. We examined the responses of women birthing in Australia to the international Babies Born Better 2018 (Version 2) open‐response survey. Methods: An online international survey was distributed primarily by means of social media for women who had given birth in the last 5 years. In addition to closed‐ended questions to describe the sample, a series of open‐ended questions recorded women's experiences and satisfaction with their maternity care and place of birth. Results: Of 1249 women who reported birthing their most recent baby in Australia and speaking English, 84% responded to at least one open‐ended evaluation question. We thematically analyzed the data to identify three related themes of safety, choice, and respect for women. Women's experiences of these were closely tied to their model of care; those birthing at home with a private midwife more so reported positive experiences than those discussing obstetric care or, to a lesser extent, midwifery‐led care in a hospital. There was a strong preference and need for (1) access to affordable care with a known practitioner from early pregnancy to postpartum, and (2) individualized care with the removal of restrictive hospital policies not aligned with woman‐centered practice. Discussion: This is the first Australian national study of women's maternity experiences and evaluations. Consistent with previous state‐based research, women birthing in Australia continue to report maternity "care" that is physically and emotionally harmful. They also stated a need to address the psychosocial aspects of becoming a mother, in addition to the biological ones. Women and other birthing people must be at the center of defining quality maternity health service delivery, and services must be accountable for preventing and addressing harm, as defined by all birthing people. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the weight gain during pregnancy that minimizes the predicted probability of various perinatal adverse events according to the pre‐pregnancy body mass index (BMI) and make recommendations for optimal weight gain in Japan. Methods: The Japan Society of Obstetrics and Gynecology perinatal database for 2015–2017 was used. From the 719 723 deliveries included in this database, parturients with underlying diseases or missing data were excluded, and 419 114 deliveries were analyzed. A questionnaire survey was also conducted to weigh each perinatal adverse event. For each of the nine outcomes, a restricted cubic spline model was made to estimate the association between the "expected gestational weight gain at 40 weeks" and the outcome risk. Results: Since the classes of medical facilities were generally the same, weights were assigned according to the mean of the questionnaires rather than by the class of the facility. For each pre‐pregnancy BMI, the weight gains during pregnancy that minimized the predicted probability of various adverse perinatal events were 12–15, 10–13, 7–10, and upper limit of 5 kg for the underweight, normal‐weight, obese 1, and obese ≥2 groups, respectively. Conclusions: The weight gain during pregnancy that minimizes the predicted probability of various perinatal adverse events according to the pre‐pregnancy BMI was established. [ABSTRACT FROM AUTHOR]

Aim: Prediction of labor progression is important for maternal and fetal health, as improved accuracy can lead to more timely intervention and improved outcomes. This review aims to outline the importance of predicting the progression of spontaneous parturition, detail the various methods employed to enhance this prediction and provide recommendations for future research. Methods: We searched articles relating to labor progression and systematic review articles on Artificial Inteligence (AI) in childbirth management using PubMed. To supplement, Google Scholar was used to find recent guidelines and related documents. Results: Traditional methods like vaginal examinations, criticized for subjectivity and inaccuracy, are gradually being replaced by ultrasound, considered a more objective and accurate approach. Further advancements have been observed with machine learning and artificial intelligence techniques, which promise to surpass the accuracies of conventional methods. The Friedman curve, developed in 1954, is the standard for assessing labor progress, but its application to Asian women, in particular, remains controversial, and various studies have reported that the actual rate of labor was slower than that indicated by the Friedman curve. Conclusion: There is a need to innovate methodologies for predicting delivery tailored to modern pregnant women, especially when they have different genetic and cultural backgrounds than their Western counterparts, such as Asians. Future research should develop predictive models of labor progression that aim to enhance medical intervention and improve the safety and well‐being of both mother and child. [ABSTRACT FROM AUTHOR]

Background: Preterm children are at increased risk of cognitive and language delay compared with term‐born children. While many perinatal factors associated with prematurity are well established, there is limited research concerning the influence of the socio‐familial environment on the development of preterm children. This study aims to assess the relative impact of perinatal and socio‐familial risk factors on cognitive and language development at 2 years corrected age (CA). Method: This retrospective cross‐sectional study included preterm infants with a gestational age <32 weeks and/or a birth weight <1500 g, who underwent neurodevelopmental assessment at 2 years CA. Cognitive and language scores were assessed using the Bayley Scales of Infant–Toddler Development, third edition. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated using a multivariable model to examine the relationship between developmental delays and perinatal and socio‐familial factors. Result: The prevalence of language delay was negatively associated with daycare attendance (aOR: 0.25, 95% CI: 0.07–0.85, p < 0.05) and high maternal educational levels (aOR: 0.24, 95% CI: 0.05–0.93, p < 0.05) and positively associated with bilingual environments (aOR: 5.62, 95% CI: 1.46–24.3, p < 0.05). Perinatal and postnatal risk factors did not show a significant impact on cognitive or language development. Conclusion: The development of language appears to be more influenced by the socio‐familial environment than by early perinatal and postnatal factors associated with prematurity. These findings highlight the importance of considering socio‐familial factors in the early identification and intervention of language delay among preterm children. [ABSTRACT FROM AUTHOR]

Objective: Screening for intimate partner violence in the home is often challenging due to the lack of privacy. The aim of this study was to compare two different screening methods (paper‐pencil vs. tablet) for identifying intimate partner violence during perinatal home visits. Design: Randomized control trial. Sample: Pregnant women (N = 416) in perinatal home visiting programs were randomized to either paper‐pencil or computer assisted, intimate partner violence screening. Measurements: The Abuse Assessment Screen was used to screen for physical and sexual IPV and Women's Experiences with Battering for emotional intimate partner violence. Results: No significant differences in prevalence were found between the screening methods. Intimate partner violence prevalence rates for the year before and/or during pregnancy using paper‐pencil was 21.8% versus 24.5% using tablets (p =.507). There were significant differences in prevalence among the three race/ethnic groups (Caucasian, 36.9%; African American, 26.7%; Hispanics, 10.6%; p <.001) and significant differences in rates across three geographical areas: urban 16.0%; rural 27.6%, suburban women 32.3% (p <.001). Conclusions: This study provides evidence that both methods are useful for identifying intimate partner violence during perinatal home visits. [ABSTRACT FROM AUTHOR]

Aim: To use co‐design principles to design a nationwide maternity experiences survey and to distribute the survey through social media. Design: A co‐designed, cross sectional, and national online survey. Methods: Using co‐design principles from study design and throughout the research process a cross‐sectional, online, national survey of Australian women's experiences of maternity care was designed. Four validated survey instruments were included in the survey design. Results: An extensive social media strategy was utilized, which included paid advertising, resulting in 8804 surveys for analysis and 54,896 comments responding to open text questions. Discussion: The inclusion of co‐design principles contributed to a well‐designed survey and consumer involvement in distribution and support of the online survey. The social media distribution strategy contributed to high participation rates with overall low marketing costs. Clinical Relevance: Maternity services should be designed to provide woman‐centered, individualized care. This survey was co‐designed with maternity users and maternity organizations to explore women's recent experiences of maternity care in Australia. The outcomes of this study will highlight the factors that contribute to positive and negative experiences in maternity services. Patient or Public Contribution: As a co‐designed study, there was consumer engagement from the design of the study, throughout the research process. [ABSTRACT FROM AUTHOR]

Aim: Improved identification and treatment of infants at risk of hypoglycaemia using evidence‐based guidelines. Methods: Design: Prospective, multidisciplinary quality improvement project (QIP). Setting: Tertiary maternity hospital, Dublin (2016–2023). Subjects: Infants at risk for neonatal hypoglycaemia. Intervention: Plan‐Do‐Study‐Act methodology. A hospital‐wide survey and ongoing audit informed our initiatives including staff education, antenatal maternal education and standardisation of equipment. Our guidelines were continually evaluated and updated based on emerging evidence. Main outcome measures: Neonatal unit (NNU) admissions, adherence to guidelines and use of glucose gel. Results: NNU admissions decreased by 70%, from 3% (118/3883) to 0.9% (34/3806 infants). The number requiring an IV glucose bolus reduced from 25% (29/118) to 6% (2/34). Improved antenatal education, antenatal expression of colostrum and early and frequent feeding also contributed to a reduction in glucose gel use of 94% (1009 tubes in 2018‐v‐62 in 2022). There were no adverse side effects related to hypoglycaemia. Conclusion: Our QIP resulted in a significant reduction in NNU admissions leading to significant cost reductions and NNU workload. More importantly, this resulted in less maternal–infant separation and potentially less parental anxiety and a more supportive environment for breastfeeding. These low‐cost initiatives can be implemented in other tertiary maternity hospitals to improve maternity and newborn care. [ABSTRACT FROM AUTHOR]

Policy PointsPregnancy and childhood are periods of heightened economic vulnerability, but current policies for addressing health‐related social needs, including screening and referral programs, may be insufficient because of persistent gaps, incomplete follow‐up, administrative burden, and limited take‐up.To bridge gaps in the social safety net, direct provision of cash transfers to low‐income families experiencing health challenges during pregnancy, infancy, and early childhood could provide families with the flexibility and support to enable caregiving, increase access to health care, and improve health outcomes. [ABSTRACT FROM AUTHOR]

Social support is an important factor in reducing fear of childbirth (FOC). Recently, the Internet and Social Networking Services (SNS) have become new forms of social support. However, it is unclear whether such support can reduce pregnant women's fear. This study aimed to investigate the association between FOC and social support through the Internet and SNS in pregnant women. A cross-sectional study using a web-based questionnaire including questions about FOC, social support, the Internet and SNS usage, psychological variables, and sociodemographic variables was conducted. Data from 111 participants were analyzed. A greater number of social support from people who are often seen during pregnancy, and becoming relieved by interaction with others through the Internet and SNS were negatively associated with FOC. This study showed that face-to-face social support was associated with lower FOC, while social support through the Internet and SNS was not. Further research is needed on how to use Internet and SNS to reduce FOC in pregnant women. [ABSTRACT FROM AUTHOR]

Obstetric fistula is a life transforming event resulting in embodied biographical disruption. Survivors suffer myriad long‐term physical and emotional consequences. This paper is an account of a narrative inquiry, conducted with 15 fistula survivors in North‐central, Nigeria, who described how their identities had been transformed by their condition. A narrative therapeutic approach, using Frank's 'chaos, restitution and quest' typology, was used to map their recovery narratives. 'Chaos', described by Frank as the opposite of restitution, dominated, with women losing hope of recovery. Women's shift towards 'restitution' began with treatment, but inadequate health‐care access often delayed this process. In their quest narratives, women's life and identify changes enabled them to derive meaning from their experience of obstetric fistula within the context of their own lives. The findings highlight socio‐structural factors raising the risk of obstetric fistula, which in turn causes biographical disruption and hampers sufferers' treatment and recovery. Rehabilitation should include income‐generating skills to bring succour to survivors, particularly those whose incontinence persists after repairs. [ABSTRACT FROM AUTHOR]

Introduction: In the past 30 years, 60% of South Australia's rural maternity units have closed. Evidence demonstrates midwifery models of care offer regional Australia sustainable birthing services. Five birthing sites within the York and Northern Region of South Australia, designed in collaboration with key stakeholders, offered a new all‐risk midwifery continuity of care model (MMoC). All pregnant women in the region were allocated to a known midwife once pregnancy was confirmed. In July 2019, the pilot program was implemented and an evaluation undertaken. Objective: The study aimed to evaluate the effectiveness, acceptability, and sustainability of the new midwifery model of care from the perspective of health care providers. Design: The evaluation utilised a mixed methods design using focus groups and surveys to explore experiences of health care providers impacted by the implementation of the MMoC. This paper reports on midwives, doctors and nurses experiences at different time points, to gain insight into the model of care from the care providers impacted by the change to services. Findings: The first round of focus groups included 14 midwives, 6 hospital nurses/midwives and 5 doctors with the overarching theme that the 'MMoC was working well.' The second round of focus groups were undertaken across the five sites with 10 midwives, 9 hospital nurses/midwives and 5 doctors. The overarching theme captured all participants commitment to the MMoC, with agreement that 'there is no other option ‐ it has to work'. Discussion: All participants reported positive outcomes and a strong commitment to navigate the changes required to implement the new model of care. Collaboration and communication was expressed as key elements for success. Specific challenges and complexities were evident including a need to clarify expectations and the workload for midwives, and for nurses who were accustomed to having midwives 24 hours a day in hospitals. Conclusion: This innovative model responds to challenges in providing rural maternity care and offers a sustainable model for maternity services and workforce. There is an overwhelming commitment and consensus that there is 'no other option–it has to work'. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of the Obstetric Simulation Training and Teamwork (OB‐STaT) curriculum on postpartum haemorrhage (PPH) rates and outcomes. Design: Before‐and‐after study. Setting: Maternity care hospitals within the USA. Population: Patients who delivered between February 2018 and November 2019. Methods: Interprofessional obstetric teamwork training (OB‐STaT) conducted at each hospital. Electronic medical records for deliveries were reviewed for 6 months before and after conducting OB‐STaT at participating hospitals. Main outcome measures: The PPH rate (blood loss of ≥1000 ml), uterotonic medications used, tranexamic acid use, blood product transfusion, hysterectomy, length of stay and composite maternal morbidity (postpartum haemorrhage, hysterectomy, transfusion of ≥4 units of blood products and intensive care unit admission for PPH). Results: A total of 9980 deliveries were analysed: 5059 before and 4921 after OB‐STaT. The PPH rates did not change significantly (5.48% before vs 5.14% after, p = 0.46). Composite maternal morbidity decreased significantly by 1.1% (6.35%–5.28%, p = 0.03), massive transfusions decreased by 57% (0.42%–0.18%, p = 0.04) and the mean postpartum length of stay decreased from 2.05 days (1.05 days SD) to 2.01 days (0.91 days SD) (p = 0.04). Following OB‐STaT, haemorrhage medication use increased by 36% (14.8%–51.2%, p = 0.03), the use of tranexamic acid for PPH treatment almost doubled (2.7%–4.8%, p < 0.001) and the rate of hysterectomy significantly increased (0%–0.1%, p = 0.03). Conclusions: Although the PPH rates did not decrease, OB‐STaT significantly improved maternal morbidity, decreased massive transfusions, and improved PPH management by increasing the utilization of uterotonic medications, tranexamic acid and hysterectomy. [ABSTRACT FROM AUTHOR]

Factor XIII deficiency is an extremely rare autosomal recessive genetic disorder, occurring in 1 of 3–5 million people, and is associated with perinatal complications, such as habitual abortion and prolonged bleeding. Although plasma‐derived factor XIII (Fibrogamin®) carries a risk of infection and contains very low concentrated forms of factor XIII (FXIII) used for a pregnant woman with congenital coagulation factor XIII deficiency, recombinant factor XIII (rFXIII, Novo Thirteen®; Tretten®, Novo Nordisk, Bagsværd, Denmark), which has no risk of infection and is highly concentrated, has emerged as a novel formulation. Herein, we report the first case of a Japanese pregnant woman with congenital coagulation factor XIII deficiency successfully managed by rFXIII. She had a good perinatal course without pregnancy‐related complications and transfusion through the perinatal period. [ABSTRACT FROM AUTHOR]

Objective: To determine the proportion of women who experienced disrespect and abuse (D&A) and the type of D&A during labor and postpartum, and to determine the factors significantly associated with D&A. Methods: A cross‐sectional mixed‐methods study undertaken in tertiary care teaching institute South India. After ethical approval, 380 postpartum women within 72 h of delivery were recruited for the study. The determinants of respectful maternity care (RMC) were assessed quantitatively and qualitatively. For quantitative assessment, they were interviewed using questionnaires adopted from the United States Agency for International Development‐ Maternal and Child Health Integrated Program (USAID‐MCHIP) protocol, which has verification criteria for RMC. As a second method for quantitative assessment, they were asked to rate the care from their perspective on a 10‐point score. For the qualitative component, they were asked to identify the healthcare workers associated with D&A by their designation and to answer three open‐ended questions. IBM SPSS Statistics 25 (IBM Corporation, Statistical Package for Social Sciences, version 25) was used for analysis. D&A as per RMC standards I–VII and its severity were expressed as frequencies and percentages with 95% confidence interval. Univariate analysis was used to determine the associated factors, and severity was determined by χ2 test. Results: The prevalence of D&A was high (85%) according to the RMC standards of the USAID‐MCHIP questionnaire, whereas it was only 33% according to women's perspective. The most common type of D&A was non‐dignified care. The factors significantly associated with D&A were women over 25 years, those admitted as an emergency referral, having a recommendation letter, and relatives working at the same healthcare facility. Conclusion: The prevalence of D&A was high as measured by the USAID‐MCHIP questionnaire, and the most common type was non‐dignified care followed by physical abuse. Synopsis: The prevalence of disrespect and abuse during childbirth is high according to the standards of the USAID‐MCHIP, but it is lower from the women's perspective. [ABSTRACT FROM AUTHOR]

Background: Fetal alcohol syndrome (FAS) can have adverse effects on health outcomes throughout the life course. Adults with FAS have an increased risk of chronic and infectious diseases. Although these conditions can affect reproductive health, few have described perinatal outcomes among individuals with an FAS diagnosis. Methods: We analyzed data from the Study of Mothers and Infants, an administrative birth cohort derived from California birth certificates linked with a hospital discharge database. The cohort consisted of 7.3 million singleton, live births between 2005 and 2021. FAS was identified by International Classification of Diseases (ICD) codes in maternal hospital discharge records. Pregnancy and birth outcomes were captured via ICD codes in maternal or infant records. We performed descriptive analyses for pregnancy and birth outcomes by maternal FAS diagnosis. Results: There were 35 babies born to 30 individuals with an FAS diagnosis between 2005 and 2021 (0.5/100,000 live births). The prevalence of births to individuals with an FAS diagnosis increased over the period. Individuals with an FAS diagnosis were more likely to identify as non‐Hispanic White, or "other/multiple" race, and less likely to be Hispanic than those without FAS. They were also more likely to be publicly insured and less than 18 years old. Birthing individuals with FAS were also more likely to use nicotine during pregnancy and to have diagnoses of mental health disorders, epilepsy, substance use disorders, preexisting or gestational hypertension, and sexually transmitted infections or other infections complicating pregnancy. Infants of individuals with FAS were more likely to be born prematurely or small for gestational age and be admitted to the neonatal intensive care unit. Conclusions: These findings highlight the need for improved recognition of FAS among birthing people. The results suggest that individuals with FAS would benefit from early and sustained medical care prior to pregnancy to optimize perinatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To inform policy supporting the retention of family physicians (FPs) in the perinatal care workforce by identifying physician characteristics that are associated with retention. Data Sources and Study Setting: We surveyed FPs who had been in practice for at least 11 years and reported attending deliveries as part of their practice. Study Design: We compared the characteristics of FPs who continue to provide perinatal care to those who have ceased and explored their reasons for no longer attending deliveries. Data Collection/Extraction Methods: We estimated a probit regression with the dependent variable: whether the physician currently delivers babies. Open‐ended survey responses were analyzed and close‐coded using a conceptual content analysis approach. Principle Findings: Of the FPs who received a survey, 1505 (37%) responded. Those who continue attending deliveries were more likely to receive a stipend or be paid per hour/shift in addition to their salary versus those paid a salary (percentage point difference = 13), and less likely to work part‐time versus full‐time (percentage point difference = −20). Those who ceased attending deliveries cite lifestyle (n = 208), call structure (n = 113), and delivery volume (n = 89) among the reasons for doing so. Conclusions: Evidence‐based policies aimed at preventing attrition from the perinatal care workforce, which might include targeting compensation models and work–life balance. [ABSTRACT FROM AUTHOR]

Objective: To assess key birth outcomes in an alternative maternity care model, midwifery‐based birth center care. Data Sources: The American Association of Birth Centers Perinatal Data Registry and birth certificate files, using national data collected from 2009 to 2019. Study Design: This observational cohort study compared key clinical birth outcomes of women at low risk for perinatal complications, comparing those who received care in the midwifery‐based birth center model versus hospital‐based usual care. Linear regression analysis was used to assess key clinical outcomes in the midwifery‐based group as compared with hospital‐based usual care. The hospital‐based group was selected using nearest neighbor matching, and the primary linear regressions were weighted using propensity score weights (PSWs). The key clinical outcomes considered were cesarean delivery, low birth weight, neonatal intensive care unit admission, breastfeeding, and neonatal death. We performed sensitivity analyses using inverse probability weights and entropy balancing weights. We also assessed the remaining role of omitted variable bias using a bounding methodology. Data Collection: Women aged 16–45 with low‐risk pregnancies, defined as a singleton fetus and no record of hypertension or cesarean section, were included. The sample was selected for records that overlapped in each year and state. Counties were included if there were at least 50 midwifery‐based birth center births and 300 total births. After matching, the sample size of the birth center cohort was 85,842 and the hospital‐based cohort was 261,439. Principal Findings: Women receiving midwifery‐based birth center care experienced lower rates of cesarean section (−12.2 percentage points, p < 0.001), low birth weight (−3.2 percentage points, p < 0.001), NICU admission (−5.5 percentage points, p < 0.001), neonatal death (−0.1 percentage points, p < 0.001), and higher rates of breastfeeding (9.3 percentage points, p < 0.001). Conclusions: This analysis supports midwifery‐based birth center care as a high‐quality model that delivers optimal outcomes for low‐risk maternal/newborn dyads. [ABSTRACT FROM AUTHOR]