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Background: Congenital malformations and adverse fetal outcomes secondary to teratogenic exposures are major public health concerns. We review all inquiries made to the Florida MotherToBaby service center as well as the novel Exposure Clinic, which offers direct patient counseling., Methods: We completed a retrospective review of all inquiries made to the MotherToBaby Florida service and the Exposure Clinic consults between its inception January 2019 through December 2021. All de-identified data was collected at the time of the inquiry and stored in the OTIS database. Aggregate data was then extracted and descriptive statistics were performed. A p value of less than .05 indicated statistical significance., Results: In 2019, there were 163 total inquiries, 265 in 2020, and 1,279 in 2021. These 1,707 inquiries covered 2,809 unique exposures. In the Exposure Clinic, 49 patients were seen in 2019, 140 in 2020, and 263 in 2021. The clinic's geographical reach increased over time with patients from 22 different counties being seen in 2021. Of all individual exposures, 45% were evaluated in 452 unique encounters in the Exposure Clinic and 55% were evaluated in 1255 unique encounters via traditional modes of contact. The average number of exposures discussed at each clinic appointment 2.8 versus 1.2 in inquiries via traditional methods. The majority of all exposures were regarding prescription medications, specifically psychiatric medications, followed by immunizations. The exposure with the single most inquiries was the COVID-19 vaccine., Conclusions: This novel clinic structure allows for complex counseling and clinical recommendations regarding exposures during pregnancy., (© 2022 Wiley Periodicals LLC.)

Background: Immediate postpartum family planning (IPPFP) helps prevent unintended and closely spaced pregnancies. Despite Ethiopia's rising facility-based delivery rate and supportive IPPFP policies, the prevalence of postpartum contraceptive use remains low, with little known about disparities in access to IPPFP counseling. We sought to understand if women's receipt of IPPFP counseling varied by individual and facility characteristics., Methods: We used weighted linked household and facility data from the national Performance Monitoring for Action Ethiopia (PMA-Ethiopia) study. Altogether, 936 women 5-9 weeks postpartum who delivered at a government facility were matched to the nearest facility offering labor and delivery care, corresponding to the facility type in which each woman reported delivering (n = 224 facilities). We explored women's receipt of IPPFP counseling and individual and facility-level characteristics utilizing descriptive statistics. The relationship between women's receipt of IPPFP counseling and individual and facility factors were assessed through multivariate, multilevel models., Results: Approximately one-quarter of postpartum women received IPPFP counseling (27%) and most women delivered government health centers (59%). Nearly all facilities provided IPPFP services (94%); most had short- and long-acting methods available (71 and 87%, respectively) and no recent stockouts (60%). Multivariate analyses revealed significant disparities in IPPFP counseling with lower odds of counseling among primiparous women, those who delivered vaginally, and women who did not receive delivery care from a doctor or health officer (all p < 0.05). Having never used contraception was marginally associated with lower odds of receiving IPPFP counseling (p < 0.10). IPPFP counseling did not differ by age, residence, method availability, or facility type, after adjusting for other individual and facility factors., Conclusion: Despite relatively widespread availability of IPPFP services in Ethiopia, receipt of IPPFP counseling remains low. Our results highlight important gaps in IPPFP care, particularly among first-time mothers, women who have never used contraception, women who delivered vaginally, and those who did not receive delivery care from a doctor or health officer. As facility births continue to rise in Ethiopia, health systems and providers must ensure that equitable, high-quality IPPFP services are offered to all women., (© 2021. The Author(s).)

Background: We designed and implemented a new model of care, Enhanced Antenatal Care (EAC), which offers a combined approach to midwifery-led care with six one-to-one visits and four group sessions., Aim: To assess EAC in terms of women's satisfaction with care, autonomy in decision-making, and its effectiveness in lowering childbirth fear., Methods: This was a quasi-experimental controlled trial comparing 32 nulliparous women who received EAC (n=32) and usual antenatal care (n=60). We compared women's satisfaction with care and autonomy in decision-making post-intervention using chi-square test. We administered a Fear of Birth Scale pre- and post-intervention and assessed change in fear of birth in each group using the Cohen's d for effect size. To isolate the effect of EAC, we then restricted this analysis to women who did not attend classes alongside maternal care (n=13 in EAC and n=13 in usual care)., Findings: Women's satisfaction with care in terms of monitoring their and their baby's health was similar in both groups. Women receiving EAC were more likely than those in usual care to report having received enough information about the postpartum period (75% vs 30%) and parenting (91% vs 55%). Overall, EAC was more effective than usual care in reducing fear of birth (Cohen's d=-0.21), especially among women not attending classes alongside antenatal care (Cohen's d=-0.83)., Conclusion: This study is the first to report findings on EAC and suggests that this novel model may be beneficial in terms of providing education and support, as well as lowering childbirth fear., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To study women's apprehensions, understanding and experiences of counselling concerning a screen-positive result in screening for fetal chromosomal defects., Methods: A questionnaire study including different steps of the prenatal screening process was carried out in Helsinki University Hospital. Women's experiences concerning counselling immediately after a screen-positive result and during further examinations in the Fetal Medicine Unit (FMU) were analyzed., Results: 143 women filled in the questionnaire. Less than half of the women considered the primary counselling after a screen-positive result to be explicit (43.9%) and sufficient (43.1%). In the FMU, 88.3% and 89.8% of women were satisfied with the explicitness and sufficiency of counselling. Most women (75%) experienced worry before further examinations but less than half (45%) had considered their personal values concerning diagnostic tests. Half (50.5%) of women expected the worry to continue even if diagnostic tests turn out normal. Most (81%) women were aware that diagnostic tests are voluntary and were confident (85.3%) with their decision to participate., Conclusions: After a screen-positive result, women have unanswered questions, experience anxiety and confusion. The possibility of an abnormal screening result is not seriously considered beforehand. To enable an informed consent for prenatal screening, improvements in prescreening counselling during the first visits of antenatal care need to be made., Competing Interests: The authors have declared that no competing interests exist.

Background: Biological nurturing is a neurobehavioral approach to breastfeeding support that encourages women to breastfed in a relaxed, laidback position. This approach has the potential to reduce breast problems (e.g., sore nipples), making good latch easier and thus facilitating the initiation of exclusive breastfeeding. However, its effects have not been adequately investigated in a real-life situation. The aim of this randomized controlled trial was to assess the effectiveness of biological nurturing, compared to usual hospital practices, on the frequency of breast problems and on the prevalence of exclusive breastfeeding at discharge from the maternity ward, after 1 week, and at one and 4 months., Methods: Open randomized parallel controlled trial carried out in a third level maternity ward (IRCCS Burlo Garofolo, Trieste, Italy) between March and December 2018. Two-hundred eight women who planned to give birth at the hospital and who expressed the intention to breastfeed were enrolled during pregnancy and randomized to receive breastfeeding support following either the biological nurturing approach or the usual care protocol based on the WHO/UNICEF 20-h course, in use at the hospital. The primary study outcome was the incidence of breast problems during hospital stay, defined as the presence of one or more of the following outcomes, collected separately: sore nipples, cracked nipples, engorgement and mastitis. The primary analysis was performed by intention to treat. The follow up lasted 4 months., Results: One hundred eighty eight out of 208 women (90.3%) were included in the analysis, 90 allocated to the biological nurturing group and 98 to the usual care group. At discharge from the maternity ward, biological nurturing significantly reduced the risk of breast problems (Relative risk [RR] 0.56, 95% Confidence Interval [CI] 0.40, 0.79), including cracked (RR 0.42, 95% CI 0.24, 0.74) and sore nipples (RR 0.59, 95% CI 0.40, 0.88). No statistically significant difference was observed for exclusive breastfeeding at discharge and up to 4 months. No adverse events occurred., Conclusions: The biological nurturing approach applied in the real-life situation of a third level hospital was effective in preventing breast problems., Trial Registration: Clinicaltrials.gov NCT03503500. Date of First Submission: 28 March 2018.

Supportive counselling is an important part of the treatment process for perinatal mood disorders in KK Women's and Children's Hospital (KKH). This study aims to investigate the extent to which patients deem each component of supportive counselling important to their treatment and recovery process. Sixty-six patients seen during their pregnancy or postnatal period for anxiety or depressive disorders were surveyed at the point of their discharge. Patients were asked to rate on a four-point scale the importance they attributed to each of thirteen components of supportive counselling practised by the perinatal mental health team at KKH. Patients were also asked to identify the three most important components in their treatment experience. The final two survey questions assessed the effects of the treatment process on patients' perceived partner support and patients' optimism towards motherhood. Results corroborate the importance of building a trusting relationship between treatment providers and patients, providing empathic support while patients learn to accept the changes in their lives and engaging patients' partners in the treatment process. It is recommended that perinatal mental healthcare providers continue to build on the therapeutic effects of empathic understanding and engaging patients' partners in the treatment process., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Several Central and Eastern European countries have recently enacted retrogressive laws and policies introducing new preconditions that women must fulfill before they can obtain legal abortion services. Mandatory waiting periods and biased counseling and information requirements are particularly common examples of these new prerequisites. The present article considers these requirements in light of international human rights standards and public health guidelines, and outlines the manner in which, by imposing regressive barriers on women's access to legal abortion services, these new laws and policies undermine women's health and well-being, fail to respect women's human rights, and reinforce harmful gender stereotypes and abortion stigma., (© 2017 International Federation of Gynecology and Obstetrics.)

Objectives: The aim of this study was to assess the effects of follow-up counselling on the duration and severity of nausea and vomiting in pregnant women., Study Design: This study is quasi-experimental and included 62 pregnant women with nausea and vomiting. The group that received counselling was considered to be the experimental group, and the group that received a standard outpatient clinic service was the control group. Data were collected with a demographic data form, that is, the Nausea and Vomiting in Pregnancy Instrument and Pregnancy Unique Quantification of Emesis and Nausea. Significance tests of the differences between two mean values, the Mann-Whitney U test and survival analyses were used to test the hypotheses., Results: In pregnant women with mild or moderate nausea and vomiting, nausea and vomiting terminated in a significantly shorter time in the experimental group than in the control group (p <0.001), but this difference was not significant for pregnant women with severe nausea and vomiting (p > 0.05). In addition, the number of weekly telephone follow-ups in the experimental group was significantly smaller (p <0.001)., Conclusion: Counselling effectively reduced the duration and severity of mild or moderate nausea and vomiting during pregnancy. However, it did not affect the duration of severe nausea and vomiting during pregnancy., (Copyright © 2015 Elsevier B.V. All rights reserved.)

The 2011 Christchurch New Zealand earthquake adversely affected large numbers of people and resulted in many mothers and infants evacuating the city. In the town of Timaru, an emergency day-stay breastfeeding service assisted evacuee women. The service was established after media messaging alerted mothers to the importance of breastfeeding and the location of breastfeeding assistance. The local hospital provided rooms for the breastfeeding support service, which delivered counselling to mothers experiencing breastfeeding challenges. The vulnerability of infants in emergencies demands that governments and aid organisations plan to support their wellbeing and access to safe food and liquid. Plans should be developed in accordance with the Emergency Nutrition Network's Operationalguidance on infant and young child feeding in emergencies and include breastfed and formula-fed infants. Many countries have existing health resources and personnel with the expertise to support infant feeding in emergencies. However, only comprehensive pre-emergency planning can ensure that infants are protected.

Background: Women and children in sub-Saharan Africa bear a disproportionate burden of HIV/AIDS. Integration of HIV with maternal and child services aims to reduce the impact of HIV/AIDS. To assess the potential gains and risks of such integration, this paper considers pregnant women's and providers' perceptions about the effects of integrated HIV testing and counselling on care seeking by pregnant women during antenatal care in Tanzania., Methods: From a larger evaluation of an integrated maternal and newborn health care program in Morogoro, Tanzania, this analysis included a subset of information from 203 observations of antenatal care and interviews with 57 providers and 190 pregnant women from 18 public health centers in rural and peri-urban settings. Qualitative data were analyzed manually and with Atlas.ti using a framework approach, and quantitative data of respondents' demographic information were analyzed with Stata 12.0., Results: Perceptions of integrating HIV testing with routine antenatal care from women and health providers were generally positive. Respondents felt that integration increased coverage of HIV testing, particularly among difficult-to-reach populations, and improved convenience, efficiency, and confidentiality for women while reducing stigma. Pregnant women believed that early detection of HIV protected their own health and that of their children. Despite these positive views, challenges remained. Providers and women perceived opt out HIV testing and counselling during antenatal services to be compulsory. A sense of powerlessness and anxiety pervaded some women's responses, reflecting the unequal relations, lack of supportive communications and breaches in confidentiality between women and providers. Lastly, stigma surrounding HIV was reported to lead some women to discontinue services or seek care through other access points in the health system., Conclusion: While providers and pregnant women view program synergies from integrating HIV services into antenatal care positively, lack of supportive provider-patient relationships, lack of trust resulting from harsh treatment or breaches in confidentiality, and stigma still inhibit women's care seeking. As countries continue rollout of Option B+, social relations between patients and providers must be understood and addressed to ensure that integrated delivery of HIV counselling and services encourages women's care seeking in order to improve maternal and child health.

Background: Pregnancy after perinatal death is characterised by elevated stress and anxiety, increasing the risk of adverse short-term and long-term outcomes., Objectives: This metasynthesis aimed to improve understanding of parents' experiences of maternity care in pregnancy after stillbirth or neonatal death., Search Strategy: Six electronic databases were searched using predefined search terms., Selection Criteria: English language studies using qualitative methods to explore the experiences of parents in pregnancy after perinatal loss, were included subject to quality appraisal framework., Data Collection and Analysis: Searches were initiated in December 2011 and finalised in March 2013. Studies were synthesised using an interpretive approach derived from meta-ethnography., Main Results: Fourteen studies were included in the synthesis, graded A (no or few flaws, high trustworthiness; n = 5), B (some flaws, unlikely to affect trustworthiness; n = 5) and C (some flaws, possible impact on trustworthiness; n = 4). Three main themes were identified; co-existence of emotions, helpful and unhelpful coping activities and seeking reasssurance through interactions., Conclusion: Parents' experiences of pregnancy are profoundly altered by previous perinatal death; conflicted emotions, extreme anxiety, isolation and a lack of trust in a good outcome are commonly reported. Emotional and psychological support improves parents' experiences of subsequent pregnancy, but the absence of an evidence base may limit consistent delivery of optimal care within current services., (© 2014 Royal College of Obstetricians and Gynaecologists.)

Drawing on an exploratory qualitative case study investigating everyday practices within an antenatal clinic in rural Uganda, this paper investigates the dynamics of consent and counselling within a prevention of mother-to-child HIV transmission (PMTCT) programme, from the perspectives of various health professionals involved at different stages of the PMTCT trajectory. The paper contributes to the existing literature by focusing not on clients' views but, rather, by elucidating how different cadres of health workers view and practice the human rights principles of informed consent and opting out, that are reflected in Uganda's HIV testing policies. By investigating the roles and responsibilities of community counsellors, post-test counsellors, and midwives, we illustrate how the practice of counselling in PMTCT is influenced by two hegemonic discourses: the health of a child should be protected, and the health worker knows best. As a result, a directive form of counselling in PMTCT settings, with its focus on the health of the baby, silences women's right to opt out of HIV tests.

Purpose: The purpose of this study was to assess selected predictors for the inclusion of oral health counseling by Illinois Women, Infants, and Children (WIC) providers., Methods: A questionnaire was developed and mailed to all 166 WIC sites to assess attitudes towards oral health counseling. Variables that revealed significant associations in bivariate analysis (P< or =.05) were considered as candidates for building a final logistic regression model in which frequency of oral health counseling was the outcome., Results: A response rate of 76% was achieved after 1 mailing, with 27% of the WIC providers having some form of oral health training. There were no statistically significant differences in the frequency of WIC providers discussing oral health with their clients by age, gender, and level of education of the provider. In the final logistic regression analysis, variables significantly associated with the frequency of WIC providers' dicussing oral health with their clients were having: (1) oral health training; and (2) nursing training., Conclusions: The results suggest that Women, Infants, and Children (WIC) providers, who have had some oral health training, are more likely to provide counseling about dental disease and its prevention. This information was used to develop an educational tool for these nondental, health care providers.

Unlabelled: Adverse childbirth experiences can evoke fear and overwhelming anxiety for some women and precipitate posttraumatic stress disorder. The objective of this study was to assess a midwife-led brief counseling intervention for postpartum women at risk of developing psychological trauma symptoms., Method: Of 348 women screened for trauma symptoms, 103 met inclusion criteria and were randomized into an intervention (n = 50) or a control (n = 53) group. The intervention group received face-to-face counseling within 72 hours of birth and again via telephone at 4 to 6 weeks postpartum. Main outcome measures were posttraumatic stress symptoms, depression, self-blame, and confidence about a future pregnancy., Results: At 3-month follow-up, intervention group women reported decreased trauma symptoms, low relative risk of depression, low relative risk of stress, and low feelings of self-blame. Confidence about a future pregnancy was higher for these women than for control group women. Three intervention group women compared with 9 control group women met the diagnostic criteria for posttraumatic stress disorder at 3 months postpartum, but this result was not statistically significant., Discussion: A high prevalence of postpartum depression and trauma symptoms occurred after childbirth. Although most women improved over time, the intervention markedly affected participants' trajectory toward recovery compared with women who did not receive counseling., Conclusions: A brief, midwife-led counseling intervention for women who report a distressing birth experience was effective in reducing symptoms of trauma, depression, stress, and feelings of self-blame. The intervention is within the scope of midwifery practice, caused no harm to participants, was perceived as helpful, and enhanced women's confidence about a future pregnancy.

Exclusive breastfeeding is rare in Bangladesh. About 90% of women have home deliveries, so the Baby-Friendly Hospital Initiative has no mechanism to reach them. Mother support groups do not exist, and community health workers do not have time to promote and support exclusive breastfeeding. To provide this kind of support at the community level, an area in Dhaka was selected for a peer-counseling intervention program. Using certain selection criteria, 1 woman from each community was trained as a peer counselor. The training was based on the World Health Organization/United Nations International Children's Emergency Fund 40-hour breastfeeding counseling course and related books. Counseling skills were taught using demonstrations and role play, followed by practical training in the project area. The intervention was very successful, as 70% of the mothers in the project area breastfed their infants exclusively for 5 months compared to only 6% in the control area. The authors describe the peer counseling training, strategies used for peer counseling visits, and lessons learned.

Background: Most mothers breastfeed in Bangladesh, but they rarely practise exclusive breastfeeding. Hospital-based strategies for breastfeeding promotion cannot reach them because about 95% have home deliveries. We postulated that with the intervention of trained peer counsellors, mothers could be enabled to breastfeed exclusively for the recommended duration of 5 months., Methods: 40 adjacent zones in Dhaka were randomised to intervention or control groups. Women were enrolled during the last trimester of pregnancy between February and December, 1996. In the intervention group, 15 home-based counselling visits were scheduled, with two visits in the last trimester, three early postpartum (within 48 h, on day 5, between days 10 and 14), and fortnightly thereafter until the infant was 5 months old. Peer counsellors were local mothers who received 10 days' training., Findings: 363 women were enrolled in each group. Peer counselling significantly improved breastfeeding practices. For the primary outcome, the prevalence of exclusive breastfeeding at 5 months was 202/228 (70%) for the intervention group and 17/285 (6%) for the control group (difference=64%; 95% CI 57%-71%, p>0.0001). For the secondary outcomes, mothers in the intervention group initiated breastfeeding earlier than control mothers and were less likely to give prelacteal and postlacteal foods. At day 4, significantly more mothers in the intervention group breastfed exclusively than controls., Interpretation: Peer counsellors can effectively increase the initiation and duration of exclusive breastfeeding. We recommend incorporation of peer counsellors in mother and child health programmes in developing countries.

Teenagers who are pregnant face many difficult issues, and counseling by physicians can be an important source of help. We suggest guidelines for this counseling, beginning with a review of the scope and consequences of adolescent pregnancy. Communication strategies should be aimed at building rapport with techniques such as maintaining confidentiality, avoiding judgmental stances, and gearing communication to cognitive maturity. Techniques for exploring family relationships are useful because these relationships are key influences on subsequent decisions and behaviors. We discuss topics related to abortion and childbearing, such as safety, facilitation of balanced decision making, the use of prenatal care, and the formulation of long-term plans. Physicians who can effectively discuss these topics can help pregnant teenagers make informed decisions and improve their prospects for the future.

This study looked at 12 midwives in the Riverside Health Authority who counselled parturient women about having the HIV antibody test. Results showed that the uptake rate of the test varied considerably across midwives (82% to 3%). Uptake rate varied, to some extent, by ethnic group of the midwife; Afro-Caribbeans having 36% uptake, others 11%. However, the wide variation within these groups suggests that ethnicity alone does not explain the difference in uptake rate. Factors which could be associated with uptake rate are the individual characteristics of both the midwife and of the antenatal clinic attender, such as age, ethnicity, knowledge of and attitudes to HIV and antibody testing, as well as the counselling approach of the individual midwife.

Pre-test counselling has been seen as a pre-requisite for HIV screening. As HIV moves into the heterosexual community, the role of HIV screening in ante-natal care has increased. As vertical transmission is the major contributor to perinatal infection HIV screening of pregnant women has become a reality. The pregnant population comprises large numbers, the practical difficulties of routine pre-test counselling and the informational demand from pregnant women themselves has necessitated the provision of ante-natal leaflets about HIV infection and AIDS. A survey of 24 London hospitals revealed only three leaflets in use, two from one hospital and one from an AIDS Charity. A content evaluation of the leaflets revealed varying readability, elements of bias and presentation factors which may all affect the usefulness of such leaflets. An in depth qualitative group on the leaflet with highest readability revealed particular concerns and highlighted the fact that the leaflets could be seen as additions and addendums to counselling but were not sufficient in themselves.

Crisis pregnancy centers (CPCs) provide social support, material aid, and counseling against abortion. We evaluated the perspectives of CPC clients to understand how they found the CPC that they attended for services. In 2019, we conducted in-depth interviews with 21 clients of 10 CPCs in Ohio, who were recruited from the CPC (n = 9) or an abortion clinic (n = 12), to understand their experiences attending the center. This analysis focused on the ways in which pregnant people end up as clients at a CPC seeking assistance instead of attending another setting, such as a medical center. We identified two pathways through which clients find CPCs. First, in the internet pathway, clients needing abortion services found CPCs via internet search for pregnancy symptoms, abortion care, or ultrasound services. Second, in the social safety network pathway, clients needing material aid found CPCs through recommendations from trusted others and due to the proximity of CPCs to their homes. Structural conditions influence the pathways clients pursue, such as the need for healthcare services and material aid. Future research should further explore the demographics of those who attend CPCs and motivations for attendance. [ABSTRACT FROM AUTHOR]

The aim of this study was to propose Management, Outcome, Risk, and Expectation (MORE) as a risk based stratification to aid in antenatal parental counseling and decision making through a systematic review of published literature. A Preferred Reporting Items for Systematic Reviews and Meta Analyses compliant systematic review was conducted to include articles that covered antenatal counseling of pediatric surgical conditions. The following information was solicited for each anomaly: primary organ system of involvement, single or multi system anomaly, natural history of the disease, standard management of the anomaly, need for antenatal intervention, and whether the anomaly requires any alteration in the obstetric management. Twenty two studies were identified fulfilling the inclusion criteria, between 1993 and 2023. Only two studies were found to have GRADE A recommendation and Level I evidence. Most of the studies were review articles/ survey, and 6 studies were found to be retrospective observational studies. Based on the analysis of the solicited information, the anomalies were stratified into a group subsequently maturing them into a simplified MORE classification scheme which stressed the importance of Management (10, 45.45%), Outcome (9, 40.90%), Risk (9, 40.90%), and Expectation (10, 45.45%) categories during antenatal counseling. MORE classification of fetal structural anomalies is a simple but comprehensive framework to assist the physicians and other medical personnel antenatal parental counseling and decision making. [ABSTRACT FROM AUTHOR]

Treatment for substance use disorder (SUD) is frequently accompanied by concurrent trauma counseling. However, the needs of perinatal clients with SUD remain unaddressed, despite their clinical and multicultural needs concerning trauma, gender, and perinatal status. Relational cultural theory (RCT), which aims to enhance clients' capacities for relational resilience and growth-fostering relationship, may help augment client access to adaptive support networks. We present an overview of the clinical needs of perinatal clients with dual diagnoses and propose a creative and relational approach to this vital work. [ABSTRACT FROM AUTHOR]

Background: Australia's caesarean rate is higher than Organisation for Economic Co‐operation and Development (OECD) average, and is rising. Vaginal birth after caesarean (VBAC) is safe for selected women. Midwifery continuity of care (CoC) is associated with higher rates of vaginal birth compared to other models; however, impacts on VBAC attempts and success are unknown. Aims: The primary aim was to determine if there is a difference in achieving VBAC between CoC and non‐CoC (NCoC) models. The secondary aim was to determine if there is a difference in the proportion of women attempting VBAC between these models. Materials and Methods: Retrospective review of antenatal records and birthing data of all women who birthed in 2021 with one or more previous caesareans. Women were included if they had two or fewer caesareans. Women were excluded if contraindications to VBAC existed. Results: There were 142/1109 (12.8%) women who had previous caesareans and were eligible to attempt VBAC. There were 47/109 (43.1%) women who attempted vaginal birth after one caesarean with 78.7% success. After one caesarean, women in CoC were more likely to achieve VBAC than NCoC (45.2% vs 26.1%; relative risk (RR) 1.76, 95% CI 1.04–3.00), although when stratified by private and midwifery CoC models, women in midwifery CoC models were more likely to be successful (private RR 0.69, 95% CI 0.23–2.07 vs midwifery RR 2.48, 95% CI 1.50–4.11). Women in CoC were more likely to attempt VBAC (54.7% vs 34.8%; RR 1.57, 95% CI 1.02–2.41), and receive counselling about VBAC (92.5% vs 62%; RR 1.48, 95% CI 1.41–3.11). Conclusion: CoC improves the rate of attempted and successful VBAC through several factors, including increased counselling and greater provision of birth choices. [ABSTRACT FROM AUTHOR]

Congenital heart disease is now the most common reason for women to attend a high-risk joint cardiac–obstetric clinic. With advances in medical care and surgical techniques, most children born with congenital heart disease reach childbearing age and have a good prognosis for long-term survival with a good quality of life. Pregnancy remains a major life event for these women, posing additional risks with the potential for severe morbidity and mortality. The hemodynamic changes induced by pregnancy can unmask undiagnosed congenital heart disease or exacerbate pre-existing conditions. Therefore, specialist care is essential for a successful pregnancy outcome. Women with complex congenital heart disease embarking on pregnancy need the support of a multidisciplinary team, including cardiologists, obstetricians, anaesthetists, midwives and adult congenital heart disease clinical nurse specialists. Clinical nurse specialists in particular play a crucial role in coordinating, supporting, educating and advocating for the mother and fetus through preconception, pregnancy, the puerperium and beyond. [ABSTRACT FROM AUTHOR]

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Background: Being aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period is often overlooked but remains a significant contributor to unintended pregnancies and may lead to maternal and neonatal comorbidities. Exploring the extent of awareness and associated factors could help tailor more interventions toward reducing the rates of short-interval unplanned pregnancies. Objective: This study explores the extent to which Ghanaian women are aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period and its associated factors. Design: A cross-sectional study was conducted using the 2017 Ghana Maternal Health Survey. The women participants were sampled using a two-stage cluster sampling design. Methods: We analyzed the 2017 Ghana Maternal Health Survey data of 8815 women who had given birth and received both antenatal care and postnatal checks after delivery in health facilities (private and public) and responded to questions on being aware of short interpregnancy intervals. A multivariable survey logistic regression was used for the analysis. Results: Of the 8815 women, approximately 62% of women who received both antenatal care and postnatal examinations before discharge reported being aware of short interpregnancy intervals. Postnatal examination before discharge but not antenatal care was associated with a higher awareness of short interpregnancy intervals. Women who received a postnatal examination were more aware of short interpregnancy intervals than their counterparts (adjusted odds ratio = 1.29, 95% confidence interval: 1.03–1.61). Also, awareness of short interpregnancy intervals increased with age, education, knowledge of the fertile period, contraceptive use, and delivery via cesarean section. Conclusion: Over a decade following the initiation of Ghana's free maternal health policy, there remains a significant gap in the awareness of short interpregnancy intervals, even among women who received both antenatal pregnancy care and postnatal examinations before discharge. The unawareness of the short interpregnancy interval observed in approximately 38% of women raises concerns about the effectiveness of counseling or education provided during antenatal care and immediate post-partum care regarding birth spacing, contraceptive use, the timing of resumption of sexual activity, and the extent to which women adhere to such guidance. Plain Language Summary: A study found more women were unaware of pregnancy soon after birth before menses Unplanned pregnancies may lead to worsened health conditions for mothers and newborn infants. One possible way this unplanned pregnancy could happen is through unknowingly becoming pregnant soon after birth before menstruation resumes. However, the more we know about pregnancy soon after birth before menstruation resumes, the better we can introduce measures to reduce it. This study examines how well Ghanaian women are aware of the possibility of becoming pregnant soon after birth before menstruation resumes and factors that may influence the awareness. This study analyzed 2017 data collected from women who received pre-delivery care and post-delivery checks before discharge from a health facility. The study findings revealed that 38% of the 8815 women who received both pre-delivery care and post-delivery checks were unaware of pregnancy soon after birth before menstruation resumed. Factors such as post-delivery checks, contraceptive use, delivery through cesarean section, women aged 30 years and over with secondary education and higher, and having knowledge of the periods more appropriate for a woman to be pregnant were more aware of pregnancy soon after birth before menstruation resumed. We proposed that effective counseling and adherence from women who are not planning to get pregnant soon after birth could help reduce the rate of pregnancy soon after birth before menstruation resumes. These unplanned pregnancies can also be avoided by educating women about birth spacing, contraceptive use, and the timing of resumption of sexual activity. [ABSTRACT FROM AUTHOR]

The purpose of this systematic literature was to summarize the literature on pregnancy options counseling for women and patients who experience an unintended pregnancy across healthcare and social service settings. We conducted a systematic literature review using the PRISMA Checklist. Following the literature search of 8 electronic databases, we used a three-stage search process to screen articles for inclusion. A total of 20 peer-reviewed articles met the inclusion criteria for this study. Half (n = 10) of the articles reviewed were empirical studies utilizing quantitative or qualitative methodology while the other half (n = 10) were conceptual or non-empirical. The articles affirmed a shared definition of pregnancy options counseling, but terminology differences were noted over time. Lastly, variations of intervention practices appeared across practice settings, with referral practice variations being the most notable. Pregnancy options counseling practices varied across settings, suggesting patients who received this intervention may not have accessed equitable or ethical care. [ABSTRACT FROM AUTHOR]