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This study assesses the impact of a voucher project that targeted vulnerable and poor pregnant women in Uganda. Highly subsidised vouchers gave access to a package of safe delivery services consisting of four antenatal visits, safe delivery, one postnatal visit, the treatment and management of selected pregnancy-related medical conditions and complications, and emergency transport. Vouchers were sold during the project's operational period from 2016 to 2019. This study covers 8 out of 25 project-benefiting districts in Uganda and a total of 1,881 pregnancies, including both beneficiary and non-beneficiary mothers. Using a matching design, the results show a positive effect on the survival of new-born babies. The difference in the survival rate between the control group and the treatment group is 5.4% points, indicating that the voucher project reduced infant mortality by more than 65 per cent. [ABSTRACT FROM AUTHOR]

Sensitive and responsive caregiving is a critical protective factor for children in Sub-Saharan Africa (SSA) during their first 1000 days of life. Health initiatives may benefit from evaluating the experience of caregivers in SSA to understand their parenting experiences. This study utilized linguistic analysis to gain insight into the lived experience of 19 Sesotho-speaking mothers of infants aged 18–30 months in low-income areas of Mangaung, Free State, South Africa. Women were asked the same set of questions about their child's first 1000 days of life, and we used LIWC (Linguistic Inquiry and Word Count) LIWC to evaluate the perspectives of mothers in SA compared to published LIWC norms. Analyses revealed word use patterns associated with psychological processes such as negative affect, social processes, anger and anxiety. Findings are discussed within the context of Sesotho culture to aid in the future intervention development for this vulnerable population. This study is important because it yields important information about the subjective experience of an understudied critical population of mothers in SSA. Further, this study points to future directions for the field of understanding the impact of motherhood on women in low resource settings. [ABSTRACT FROM AUTHOR]

This study aims to document the cultural significance of vertical birthing positions and knowledge of easing complicated deliveries among the Porja hilly tribal group, Visakhapatnam district, Andhra Pradesh, India. With the purposive sampling method, 31 postpartum mothers were selected on the inclusion criteria of having been given childbirth in the last six months. The socio-demographic profile of the respondents was presented to understand the socio-cultural living conditions. The qualitative data collection involved 31 face-to-face in-depth interviews with postpartum women and two focus group discussions involving six to eight traditional birth attendants (TBAs) on the cultural efficacy of upright positions. Handwritten transcripts of the interviews and conversations were transcribed and coded into themes and categories. Qualitative themes reveal that the pregnant women with anaemia and morbidity conditions had been exposed to maternal distress and foetal distress (breathing problems and loss of consciousness) but had managed by adopting immediate alternative vertical birthing positions with the suggestion of TBAs. The findings suggest that vertical birth positions are age-old childbirth customs which have been adopted as as a priority option by labouring women, especially in socio-economically disadvantaged societies where medical facilities are unavailable. [ABSTRACT FROM AUTHOR]

Introduction: Despite the emphasis on more systematic and high-quality health care services in the maternal period, a high maternal mortality rate in developing countries is still reported. North Korea, one of the closed countries in the world, is no exception. This study aimed to explore the maternal health experiences in North Korea. Methodology: Qualitative content analysis suggested by Graneheim and Lundman was used to analyze the data of 10 female North Korean defectors. Results: Three categories were derived: pregnancy without self-determination rights, a huge gap between the policies on maternal protection and the reality, and discriminatory childbirth and postpartum care. The theme was "perilous existence of maternal health." Discussion: We highlighted the need for awareness of maternity protection led by health care professionals such as nurses to guarantee Universal Health Coverage as a human right for North Korean women. [ABSTRACT FROM AUTHOR]

Unstructured, verbal, obstetrical anesthesia handovers have led to omission of critical information, which can harm patients or delay care. The SAFE Handover Tool is a standardized mnemonic: Sick patients, At-risk patients, Follow-ups, and Epidurals. Use of the tool during handover significantly increases the percentage of relevant parturients that are discussed and improves provider communication. This study implemented the SAFE Handover Tool for Certified Registered Nurse Anesthetists (CRNAs) in a Level III (Subspecialty) Maternal Care unit. A mixed methodology was used to operationalize handover quality. Descriptive, statistical, and content analyses showed significant improvements between PRE- and POST-implementation assessments of handover quality after using the SAFE Handover Tool. The SAFE Handover Tool improved the quality of CRNA communication and enabled situational awareness. A modified SAFE Handover Tool was subsequently integrated into the obstetrical anesthesia electronic charting system. The SAFE Handover Tool is a novel, low-cost, sustainable method to improve CRNA handovers and patient safety. [ABSTRACT FROM AUTHOR]

Despite a relatively permissive abortion law, women in the Netherlands encounter difficulties in accessing abortion care. Little is known about their experiences. This study explores women's experiences with (online) abortion services and relevant health professionals' experiences delivering care, with the goal of identifying key barriers encountered by abortion-seekers in the Netherlands. An exploratory qualitative research design with a constructivist approach and an abbreviated grounded theory method was used. Interviews with 20 women who had had an abortion and 14 health professionals who provide abortion care, and 200 emails of women seeking abortion care through the non-governmental organisation Women on Web, were coded inductively and deductively (using the Candidacy Framework) thereby generating themes. Abortion-seekers faced barriers including: (i) burden of taboo, (ii) vulnerability (emotional, financial, and social), (iii) health professional evaluation and (iv) disempowerment and distress. The overarching theme was women's lack of autonomy in access to abortion care. The key barriers to abortion access in the Netherlands are the institutionalisation of taboo in abortion law and care, complex candidacy regulations, lack of permeability for certain marginalised groups, and women's inability to speak openly about abortion. To increase the permeability of abortion care, and thereby women's autonomy, legislators and policy-makers must trust women to make their own reproductive decisions and avoid actions that stigmatise abortion and hinder access to care, while actively developing systemic support for vulnerable groups. [ABSTRACT FROM AUTHOR]

Purpose: To explore the feasibility of infant hearing screening from a developing country context. Methods: A descriptive research design was employed, using a combination of surveys, questionnaires and face-to-face semi-structured interviews; as well as conduction of audiological measures such as otoacoustic emissions (OAEs) and automated auditory brainstem responses (AABR) during hearing screening. Participants comprised low-risk neonates, high-risk neonates and primary health care nursing managers. Results: Findings indicated that (1) screening at the Midwife Obstetric Unit 3-day assessment clinic may be more practical; (2) screening at primary health care clinics is not feasible until the identified barriers are addressed and; (3) factors such as ambient noise levels, availability of space for screening and time of discharge influence the practicability and efficiency of screening within a hospital context. Conclusion: There are a number of factors which influence the practicability and efficiency of newborn hearing screening. Each of these factors may vary depending on the level of healthcare setting and may either facilitate or act as barriers toward the implementation of newborn hearing screening in the South African context. [ABSTRACT FROM AUTHOR]

Background: Food-assisted maternal and child health and nutrition (FA-MCHN) programs are widely used to address undernutrition, but little is known about their effectiveness in improving child linear growth.Objective: We assessed the impact of Burundi's Tubaramure FA-MCHN program on linear growth. The program targeted women and their children during the first 1000 d and included 1) food rations, 2) strengthening of health services and promotion of their use, and 3) behavior change communication (BCC). A second objective was to assess the differential effect when varying the timing and duration of receiving food rations.Methods: We used a 4-arm, cluster-randomized controlled study to assess program impact with the use of cluster fixed-effects double-difference models with repeated cross-sectional data (baseline and follow-up 4 y later with ∼3550 children in each round). Treatment arms received food rations (corn-soy blend and micronutrient-fortified vegetable oil) for the first 1000 d (T24), from pregnancy through the child reaching 18 mo (T18), or from birth through the child reaching 24 mo ["no food during pregnancy" (TNFP)]. All treatment arms received BCC for the first 1000 d. The control arm received no food rations or BCC.Results: Stunting (height-for-age z score <2 SDs) increased markedly from baseline to follow-up, but Tubaramure had a significant (P < 0.05) beneficial effect in the T24 [7.4 percentage points (pp); P < 0.05], T18 (5.7 pp; P < 0.05), and TNFP (4.6; P = 0.09) arms; the differences in effect across arms were not significant (P > 0.01). Secondary analyses showed that the effect was limited to children whose mother and head of household had some primary education and who lived in households with above-median assets.Conclusions: FA-MCHN programs are an effective development tool to improve child linear growth and can protect children from political and economic shocks in vulnerable countries such as Burundi. A better understanding of how to improve the nutritional status of children in the worst-off households is needed. This trial was registered at www.clinicaltrials.gov as NCT01072279. [ABSTRACT FROM AUTHOR]

Disadvantaged childbearing women experience barriers to accessing health and social care services and face greater risk of adverse medical, social and emotional outcomes. Support from doulas (trained lay women) has been identified as a way to improve outcomes; however, in the UK doula support is usually paid-for privately by the individual, limiting access among disadvantaged groups. As part of an independent multi-site evaluation of a volunteer doula service, this study examined women's experiences of one-to-one support from a trained volunteer doula during pregnancy, labour and the post-natal period among women living in five low-income communities in England. A mixed methods multi-site evaluation was conducted with women (total n = 137) who received the service before December 2012, using a combination of questionnaires ( n = 136), and individual or group interviews ( n = 12). Topics explored with women included the timing and nature of support, its impact, the relationship with the doula and negative experiences. Most women valued volunteer support, describing positive impacts for emotional health and well-being, and their relationships with their partners. Such impacts did not depend upon the volunteer's presence during labour and birth. Indeed, only half (75/137; 54.7%) had a doula attend their birth. Many experienced volunteer support as a friendship, distinct from the relationships offered by healthcare professionals and family. This led to potential feelings of loss in these often isolated women when the relationship ended. Volunteer doula support that supplements routine maternity services is potentially beneficial for disadvantaged women in the UK even when it does not involve birth support. However, the distress experienced by some women at the conclusion of their relationship with their volunteer doula may compromise the service's impact. Greater consideration is needed for managing the ending of a one-to-one relationship with a volunteer, particularly given the likelihood of it coinciding with a period of heightened emotional vulnerability. [ABSTRACT FROM AUTHOR]

Objective: The study examined the effectiveness of a perinatal collaborative care intervention in moderating the effects of adverse neonatal birth events on risks of postpartum depressive symptoms and impaired functioning among women of lower socioeconomic status with antenatal depression.Methods: A randomized controlled trial with blinded outcome assessments was conducted in ten public health centers, comparing MOMCare (choice of brief interpersonal psychotherapy, pharmacotherapy, or both) with intensive maternity support services (MSS-Plus). Participants had probable diagnoses of major depressive disorder or dysthymia during pregnancy. Generalized estimating equations estimated differences in depression and functioning measures between groups with and without adverse birth events within the treatment arms. A total of 160 women, 43% of whom experienced at least one adverse birth event, were included in the analyses.Results: For women who received MOMCare, postpartum depression scores (measured with the Symptom Checklist-20) did not differ by whether or not they experienced an adverse birth event (mean±SD scores of .86±.51 for mothers with an adverse birth event and .83±.56 for mothers with no event; p=.78). For women who received MSS-Plus, having an adverse birth event was associated with persisting depression in the postpartum period (mean scores of 1.20±.0.61 for mothers with an adverse birth event and .93±.52 for mothers without adverse birth event; p=.04). Similar results were seen for depression response rates and functioning.Conclusions: MOMCare mitigated the risk of postpartum depressive symptoms and impaired functioning among women of low socioeconomic status who had antenatal depression and who experienced adverse birth events. [ABSTRACT FROM AUTHOR]

• Adverse childhood events (ACEs) continue to impact the transition to motherhood. • Relationships with close family members were generally strained. • Treatment should include the establishment of formal sources of social support. • The ability to bond to the baby is sometimes delayed. • Practitioners should be aware of behaviors/cognitions that reflect these delays. The aim of the present study was to gain an understanding of how vulnerable mothers with adverse childhood experiences transition towards motherhood. Semi-structured interviews were conducted with a convenience sample of 15 vulnerable (young) mothers who were residing in a mother-baby home at the time of the study. By means of inductive thematic analyses, a number of themes were identified that characterized the transition to motherhood. The results showed that mothers experienced a number of adversities during childhood which made them aware early on what type of mother they wanted to be for their children. Because of medical complications or involvement of child protective services, the ability to take care and bond with the baby was sometimes delayed. Further, the arrival of the baby was often considered a turning point: to bring change to the life of the mother or a second chance to motherhood. Relationships with their own parents were generally strained and sometimes put on hold to protect oneself. The mothers also mentioned difficulties with accepting and asking for support, their outlook on social support was generally ambiguous. Clinical implications of the results are discussed in the light of traditional care and the theory on ambiguous loss. [ABSTRACT FROM AUTHOR]