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Body image, including how a woman views her genitals, has been shown to impact sexuality. Currently, there are no valid and reliable questionnaires to assess body image specific to women with genital changes from pelvic organ prolapse. The purpose of this study was to assess implementation of a body image questionnaire in women with pelvic organ prolapse. The Vaginal Changes Sexual and Body Esteem Scale showed utility and potential for demonstrating change in body image after prolapse surgery. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the validity and observed effect size of a new instrument, the Optimality Index-United States (OI-US), for use in perinatal clinical research. Using a large, hospital-based, midwifery service clinical database that included complete obstetric data for 3425 women, we examined discriminant validity and the effects of two different scoring methods used with the OI-US. Discriminant validity was confirmed by comparing OI scores for women who remained low risk and did not require physician involvement in their care (OI score mean = 84%; standard deviation [SD] = 8%) compared to those whose condition changed to require physician involvement in their care (mean = 71%; SD = 10%; P < .001). Two methods of scoring the OI-US were compared, finding no significant difference and suggesting that the types of data available and the research question can drive this decision. Finally, effect size was calculated by two methods: Cohen's d (-1.4) and the effect size correlation (r = -0.548), the latter of which corresponds to a d of -1.3, both resulting in a similarly large effect size estimation. The OI-US is a new instrument that shows promise for use in perinatal clinical research, particularly when assessing more subtle clinical differences in outcomes between study groups. [ABSTRACT FROM AUTHOR]

PURPOSE: To explore women's perceptions of transitioning to the birth facility when in labor. DESIGN: Qualitative. METHODS: Twenty-four nulliparous women were interviewed following their birth experiences. RESULTS: Pain was identified as the primary reason for transitioning to the hospital. Once arriving at the hospital, women often felt pressure to 'get it right' and not make multiple trips. Three themes were identified: (a) Don't trust your body, trust us; (b) This is not right; and (c) This is too labor! CLINICAL IMPLICATIONS: The implications for nursing involve increased recognition of the range of normal experiences and acknowledgment that pain is a primary basis for women coming to the hospital as opposed to cervical dilation. Reevaluating the instruction the healthcare providers give to women is warranted. [ABSTRACT FROM AUTHOR]

Doulas, women who primarily provide social support during childbirth, have been associated with a number of positive health outcomes. Because the primary model of practice for doulas is a fee-for-service model in which families privately hire a doula, many expectant women who could benefit from doula support are unable to access the service. The Doulas Care program, located in Ann Arbor, Michigan, represents one model in which doulas provide services without charge. As a result of their extended role in the community, doulas who work with the Doulas Care program have unique educational needs. Through the use of focus groups with the program's volunteer doulas, educational needs related to overcoming barriers to being a doula working in the community were identified. Recommendations for education and training are made to improve the support doulas offer as community health outreach workers. [ABSTRACT FROM AUTHOR]

PURPOSE: Health disparities in adults have received significant attention and research, yet the healthcare experiences of adolescents of color have been ignored. The purpose of this paper is to identify the shortcomings of our state of knowledge regarding adolescent health disparities and argue for the use of an inter-sectional, contextually embedded understanding of healthcare experiences. CONCLUSIONS: To understand health disparities, deficit-based models should be replaced with the framework proposed in this paper. PRACTICE IMPLICATIONS: Using the proposed model in practice will aid in identifying and preventing the health disparities experienced by adolescents of color. [ABSTRACT FROM AUTHOR]

Doulas face many unique rewards and challenges as they attempt to establish themselves as part of the maternity care team in a health care system that is highly specialized and in a culture in which the birth process is significantly medicalized. The authors conducted a survey of a random sample of doulas in the United States to gather a variety of information from doulas, including satisfaction with their work. The finding suggest that the vast majority of practicing doulas (96%) find their work personally and emotionally rewarding, but that only 34% find it financially satisfying. The rewards of being a doula include supporting new mothers, helping women have a positive birth experience, and being part of the birth process. Significant challenges, however, include lack of support from clinicians, balancing doula work with other demands and obligations (primarily related to family and other jobs), and being on call. [ABSTRACT FROM AUTHOR]

BACKGROUND: Women with abuse-related post-traumatic stress who are pregnant experience symptoms that nurses and midwives may not recognize or know how to respond to. AIM: The purpose of this article is to increase familiarity with the post-traumatic stress disorder diagnostic framework by illustrating the symptom categories and associated features with women's descriptions of the symptoms from qualitative interviews. METHODS: A secondary analysis was performed with data from a qualitative interview study of the maternity care experiences of 15 American women who had abuse-related post-traumatic stress during pregnancy. Content analysis was used to extract all participant statements describing how post-traumatic stress disorder symptoms and associated features manifested in pregnancy. These were then juxtaposed with the post-traumatic stress disorder diagnostic framework. RESULTS: Participants' interviews included a range of descriptions of the intrusive re-experiencing, avoidance and numbing, and hyperarousal core symptoms of post-traumatic stress disorder, as well as associated psychological features such as somatization, dissociation and interpersonal sensitivity, and associated behavioural features such as substance abuse, disordered eating, high-risk sexual behaviours, suicidality, and revictimization. CONCLUSIONS: Limitations of this study include that it is a secondary analysis, using a small North American sample, and focusing only on abuse-related post-traumatic stress disorder. Descriptive information from this qualitative study may bridge the gaps between psychiatric technical language, women's subjective experiences, and clinicians' perceptions of a woman's post-traumatic stress reactions. [ABSTRACT FROM AUTHOR]

Most of what is known about the meaning women assign to the experience of childbirth in the United States is based primarily on studies of Euro American, highly educated, married women of middle to higher income levels. Yet almost half a million adolescents give birth annually. This exploratory, qualitative study was conducted with 25 adolescents in an alternative school, partnered with the juvenile justice system, who had given birth. An open-ended question format was used for the interviews, and analysis was conducted by using extended case methodology. The study revealed a number of differences between the existing literature reports about women's interpretations of birth and the meanings assigned to childbirth experiences by the adolescents in this study. A key difference was the relationship between the pain of childbirth and responsibility for their child. The results provide an entrée into understanding unique characteristics of giving birth as an adolescent and potential roles health care providers can play to promote a positive experience. [ABSTRACT FROM AUTHOR]

An experimental, community-based, residential program, focused on health promotion, was established in 1990 for incarcerated pregnant women with short-term sentences and histories of drug abuse in a large, midwestern metropolitan area in the United States. Infants resided with mothers after birth. Prenatal care, delivery, postpartum, and family-planning services were initiated and provided by a nurse-midwifery service. Community-based health care, job training, and drug rehabilitation were provided for women during pregnancy through the fourth postpartum month. Program participants' prenatal, delivery, postpartum, and neonatal health outcomes are presented and compared with those of incarcerated women in the same state prison system who experienced usual correctional facility care and support. Program participants represented a group of obstetrically high-risk women. Health outcomes for both groups of incarcerated women and their infants were similar and more optimal than would have been expected given their preexisting health conditions and risk factors. [ABSTRACT FROM AUTHOR]

Qualitative research participants who self-identified as having a history of childhood sexual abuse and abuse-related posttraumatic stress during the childbearing year were interviewed for the purpose of determining what these women perceive as optimal maternity care. Using a process of narrative analysis, desired care practices were identified. With the exception of one woman, all of the study participants wanted their maternity care provider to be competent to address trauma-related needs. Three groups emerged from the data, providing a useful structure for informing providers on how best to respond to diverse abuse-survivor clients: 1) women far along in recovery, 2) women who were not safe, and 3) women who were not ready to 'know.' The first group had the best trauma-related and maternity outcomes and the best childbearing experiences. For these women, having a provider who was a 'collaborative ally' seemed beneficial. The second group had safety needs that required a 'compassionate authority figure' who offered referral and follow-up care. Women in the third group were not ready to address trauma-related symptoms or issues overtly and appeared to need a provider who was a 'therapeutic mentor.' Four assessment factors help providers determine how to respond. [ABSTRACT FROM AUTHOR]

Recent, large, randomized, controlled trials of the effects of episiotomy on perineal damange have confirmed that episiotomy is associated with an increased risk of damage to the perineum. Yet episiotomy remains the most common surgical procedure women undergo. This article examines if clinician experience, rather than scientific evidence, forms the basis for continuing this practice. Perineal outcome data are analyzed for 865 low-risk women who were attended at birth by a university-based, tertiary-care hospital. Data were collected under routine, non-experimental conditions such that the circumstances of the labor and the clinician's preferences were allowed to determine management decisions regarding the use of episiotomy or other techniques of perineal management. Multivariate findings indicate that in the absence of episiotomy, rates of perineal integrity were highest among clinicians who usually had the lowest rate of episiotomy use. When an episiotomy was done, rates of third- and fourth-degree extensions were highest among clinicians who used episiotomy most frequently. This finding challenges the idea that clinicians who were very experienced with the use of episiotomy would avoid complications such as extensions. Future research should explore the use of nonsurgical techniques such as those employed by midwives to promote perineal integrity. Then interdisciplinary research and evidence-based education regarding these techniques can occur to improve perineal outcomes for all women. [ABSTRACT FROM AUTHOR]

A response to a letter to the editor in response to the article "Post-traumatic stress disorder and birthweight: methodological challenges," published in a previous issue is presneted.

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality globally. Safe Motherhood policies have been directed towards the reduction of PPH by recommending active management of third-stage labor as the standard of care. One component of active management involves routine use of a uterotonic agent within 1 minute of the delivery of the baby. A case study at Clínica Materno-Infantil, a free-standing public birth center in Honduras, is presented, focusing on methods to reduce PPH. The nursing staff was trained to estimate blood loss and in methods to manage PPH, including elements of active management of the third stage of labor. Medical records were reviewed and an analysis of PPH management compared to estimated blood loss (EBL) was conducted. There was no significant correlation between PPH management techniques and EBL (r = .060; P = .368). There was a statistically significant (P < .001) correlation between oxytocin administration and lower EBL (r = -.232), indicating that there was less blood loss when oxytocin was administered. At Clínica Materno-Infantil, routine use of a uterotonic agent appears beneficial and further implementation of active management of the third stage of labor appears warranted. [ABSTRACT FROM AUTHOR]

Study Objective: Lower urinary tract symptoms (LUTS) can have a pronounced impact on adolescent women's overall health and quality of life, both during adolescence and across the life course. Little research has examined adolescent women's knowledge, attitudes, and beliefs about bladder health and preventing LUTS., Methods: This study combines data from two large multi-site focus group studies of individuals born female who identified as women conducted by the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. The first study included data from 8 focus groups conducted in 2018 with 44 adolescents aged 11 through 17 years. The second consisted of data from 20 focus groups conducted in 2020 with 123 adolescents aged 13 through 17 years. We used directed content analysis, including deductive and inductive approaches, to explore textual data and identify emergent insights. We present themes that emerged from analyzing coded data related to knowledge, attitudes, and beliefs., Results: Themes included: (1) lack of information about bladder function, leading to limited knowledge, (2) hydration as a healthy behavior, (3) distinguishing healthy versus unhealthy voiding, (4) social and environmental barriers to voiding, and (5) shame and stigma of bladder related behaviors., Conclusion: Our data suggests that adolescent women are aware of healthy and unhealthy behaviors related to bladder health, despite little exposure to formal education about the bladder. Social and environmental factors, including stigma, appear to be primary drivers of adolescents' behaviors around bladder health, suggesting that multi-level socio-ecological prevention interventions are needed to prevent LUTS in this population., Competing Interests: Declaration of competing interest The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health (NIH) by cooperative agreements [grants U24DK106786, U01 DK106853, U01 DK106858, U01 DK106898, U01 DK106893, U01 DK106827, U01 DK106908, U01 DK106892, U01 DK126045]. Additional funding is from the National Institute on Aging and the NIH Office of Research on Women's Health. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health., (Copyright © 2024. Published by Elsevier Inc.)

Background: Although surveys and apps are available for women to report urination and bladder symptoms, they do not include their decisions regarding toileting. Real-world factors can interfere with toileting decisions, which may then influence bladder health. This premise lacks data per want of a robust data collection tool., Objective: The Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium engaged a transdisciplinary team to build and test WhereIGo, a mobile data collection app for Android and iOS. The design goal was a comprehensive reporting system for capturing environmental, sociocultural, and physical factors that influence women's decisions for toileting. Aims include having (1) an innovative feature for reporting physiologic urge sensation when "thinking about my bladder" and shortly before "I just peed," (2) real-time reporting along with short look-back opportunities, and (3) ease of use anywhere., Methods: The development team included a plain language specialist, a usability specialist, creative designers, programming experts, and PLUS scientific content experts. Both real-time and ecological momentary assessments were used to comprehensively capture influences on toileting decisions including perceived access to toileting, degree of busyness or stress or focus, beverage intake amount, urge degree, or a leakage event. The restriction on the maximal number of taps for any screen was six. PLUS consortium investigators did pilot-testing. Formal usability testing relied on the recruitment of community-dwelling women at four PLUS research sites. Women used the app for 2 consecutive days. Outcome measures were the system usability scale (SUS; 0-100 range) and the functional Mobile Application Rating Scale (1-5 range). These scales were embedded at the end of the app. The estimated a priori sample size needed, considering the SUS cut point score set at ≥74, was 40 women completing the study., Results: Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases since July 2015. The integrity of the build process was documented through multiple 5-minute videos presented to PLUS Consortium and through WhereIGo screenshots of the final product. Participants included 44 women, with 41 (93%) completing data collection. Participants ranged in age from 21 to 85 years, were predominantly non-Hispanic White (n=25, 57%), college-educated (n=25, 57%), and with incomes below US $75,000 (n=27, 62%). The SUS score was 78.0 (SE 1.7), which was higher than 75% of the 500 products tested by the SUS developers. The mean functional Mobile Application Rating Scale score was 4.4 (SE 0.08). The build and informal acceptability testing were completed in 2019, enrollment for formal usability testing completed by June 2020, and analysis was completed in 2022., Conclusions: WhereIGo is a novel app with good usability for women to report toileting decisions, urination, and fluid intake. Future research using the app could test the influence of real-time factors on bladder health., International Registered Report Identifier (irrid): RR1-10.2196/54046., (©Janis M Miller, Jean F Wyman, Lawrence An, Haitao Chu, Cynthia S Fok, Missy Lavender, Cora Elizabeth Lewis, Alayne D Markland, Leslie M Rickey, Ying Sheng, Siobhan Sutcliffe, Lisa Kane Low, Elizabeth R Mueller, The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 18.09.2024.)

Objective: To measure and assess the relationship of patient safety culture to reducing cesarean overuse., Study Setting: Maternity care hospitals in Michigan., Study Design: Cross-sectional observational design, combining individual survey data with hospital characteristics using existing databases. Multivariate Poisson regression assessed the associations between survey scores and hospital nulliparous term singleton vertex cesarean rates. Factor analysis determined the scalability of survey items., Data Collection Methods: Electronic survey distributed at the hospital site level., Principal Findings: A total of 3091 clinicians from 54 out of 57 eligible hospitals completed the survey. Confirmatory factor analysis demonstrated best fit with a univariate model with two local factors. The new scale encompassing both local factors, including vaginal birth microculture and safety culture, is entitled "Unit Norms." The safety culture subdomain demonstrated an association with a reduction in hospital cesarean rate [-0.15; 95% CI: -0.27 to -0.04; incident rate ratio (IRR) 0.86], parallel to but lower in magnitude to vaginal birth microculture (-0.18; 95% CI: -0.35 to -0.02; IRR 0.84)., Conclusions: Vaginal birth microculture remains the strongest predictor of cesarean delivery overuse; however, safety culture characteristics, including teamwork, psychological safety, and communication, correlate with lower cesarean delivery rates. Measuring these aspects of hospitals' culture may be important for other areas of quality improvement initiatives focused on quality and safety., (© The Author(s) 2024. Published by Mary Ann Liebert, Inc.)

Background: We describe variation in postpartum opioid prescribing across a statewide quality collaborative and assess the proportion due to practitioner and hospital characteristics., Methods: We assessed postpartum prescribing data from nulliparous, term, singleton, vertex births between January 2020 and June 2021 included in the clinical registry of a statewide obstetric quality collaborative funded by Blue Cross Blue Shield of Michigan. Data were summarized using descriptive statistics. Mixed effect logistic regression and linear models adjusted for patient characteristics and assessed practitioner- and hospital-level predictors of receiving a postpartum opioid prescription and prescription size. Relative contributions of practitioner and hospital characteristics were assessed using the intraclass correlation coefficient., Results: Of 40,589 patients birthing at 68 hospitals, 3.0% (872/29,412) received an opioid prescription after vaginal birth and 87.8% (9812/11,177) received one after cesarean birth, with high variation across hospitals. In adjusted models, the strongest patient-level predictors of receiving a prescription were cesarean birth (aOR 899.1, 95% CI 752.8-1066.7) and third-/fourth-degree perineal laceration (aOR 25.7, 95% CI 17.4-37.9). Receiving care from a certified nurse-midwife (aOR 0.63, 95% CI 0.48-0.82) or family medicine physician (aOR 0.60, 95%CI 0.39-0.91) was associated with lower prescribing rates. Hospital-level predictors included receiving care at hospitals with <500 annual births (aOR 4.07, 95% CI 1.61-15.0). A positive safety culture was associated with lower prescribing rates (aOR 0.37, 95% CI 0.15-0.88). Much of the variation in postpartum prescribing was attributable to practitioners and hospitals (prescription receipt: practitioners 25.1%, hospitals 12.1%; prescription size: practitioners 5.4%, hospitals: 52.2%)., Discussion: Variation in postpartum opioid prescribing after birth is high and driven largely by practitioner- and hospital-level factors. Opioid stewardship efforts targeted at both the practitioner and hospital level may be effective for reducing opioid prescribing harms., (© 2023 The Authors. Birth published by Wiley Periodicals LLC.)

Objective: Financial strain and unmet social needs are associated with greater risk for lower urinary tract symptoms. Little research has examined financial strain and unmet social needs in relation to the more holistic concept of bladder health. This study utilizes baseline data from RISE FOR HEALTH: A U.S. Study of Bladder Health to examine whether financial strain, unmet social needs, and meeting specific federal poverty level threshold levels are associated with lower urinary tract symptoms and poorer perceived bladder health, well-being, and function., Study Design: Participants were 18 years or older, born female or currently identified as a woman, and from the civilian, noninstitutionalized population residing in 50 counties in the United States that included or surrounded 9 recruitment centers. Data were collected through mailed or internet-based surveys. To address research questions, the 10-item Lower Urinary Tract Dysfunction Research Network - Symptom Index and selected Prevention of Lower Urinary Tract Symptoms Research Consortium bladder health scores were separately regressed on each financial strain, unmet social need, and federal poverty level variable, using linear regression adjusting for covariates (age, race/ethnicity, education, and vaginal parity) and robust variance estimation for confidence intervals (CI). Participants with no missing data for a given analysis were included (range of n=2564-3170). In separate sensitivity analyses, body mass index, hypertension, and diabetes were added as covariates and missing data were imputed., Results: The mean age of participants was 51.5 years (standard deviation=18.4). Not having enough money to make ends meet, housing insecurity, food insecurity, unreliable transportation, and percent federal poverty levels of 300% or less were consistently associated with more reported lower urinary tract symptoms and poorer perceived bladder health. For example, compared to food secure participants, women who worried that their food would run out at the end of the month had a Lower Urinary Tract Dysfunction Research Network - Symptom Index score that was 3.4 points higher (95% CI: 2.5, 4.3), on average. They also had lower mean scores across different bladder health measures, each assessed using a 100-point scale: global bladder health (-8.2, 95% CI: -10.8, -5.7), frequency (-10.2, 95% CI: -13.8, -6.7), sensation (-11.6, 95% CI: -15.1, -8.2), continence (-13.3, 95% CI: -16.7, -9.9), and emotional impact of bladder health status (-13.2, 95% CI: -16.5, -9.9). Across analyses, associations largely remained significant after additional adjustment for body mass index, hypertension, and diabetes. The pattern of results when imputing missing data was similar to that observed with complete case analysis; all significant associations remained significant with imputation., Conclusion: Financial strain and unmet social needs are associated with worse LUTS and poorer bladder health. Longitudinal research is needed to examine whether financial strain and unmet social needs influence the development, maintenance, and worsening of lower urinary tract symptoms; different mechanisms by which financial strain and unmet social needs may impact symptoms; and the degree to which symptoms contribute to financial strain. If supported by etiologic research, prevention research can be implemented to determine whether the amelioration of financial strain and social needs, including enhanced access to preventative care, may promote bladder health across the life course., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Importance: Although parturients report few postpartum symptoms, birth is clearly associated with future symptom development. The ability to identify asymptomatic at-risk women would facilitate prevention., Objective: The aim of the study was to develop a model predicting abnormal recovery in women at risk for childbirth-associated pelvic floor injury., Study Design: Women undergoing first vaginal birth at high risk of pelvic floor injury underwent examinations and ultrasound imaging and completed 6-week and 6-month postpartum questionnaires. We defined "abnormal" recovery as having ≥1 of the following 3 findings: (1) levator ani injury, (2) decreased objective pelvic floor strength, and (3) Pelvic Organ Prolapse Quantification point Bp ≥0. Descriptive statistics and bivariate analyses compared "normal" and "abnormal" recovery. Birth characteristics, 6-week examinations, and questionnaires potentially predicted abnormal recovery at 6 months. Significant variables were included as candidates in the multivariable logistic regression predicting "abnormal" recovery after birth., Results: Fifty-four women (63.5%) had normal and 31 (36.5%) had abnormal recovery at 6 months. At 6 weeks, women with abnormal recovery had decreased pelvic floor strength by Oxford scores (3 [2-5], 6 [2-8]; P = 0.002), lower point Bp (-1 [-3 to 0], -2 [-3 to -1]; P = 0.02), larger genital hiatus (4 [3 to 4], 3 [3 to 3.5]; P = 0.02), and higher levator ani injury rate (76.7%, 22.4%; P < 0.001). Between-group questionnaire differences were not clinically significant. Our final model included postpartum examination findings or birth characteristics: Oxford Scale, 6-week Pelvic Organ Prolapse Quantification GH strain, infant head circumference, and second stage ≥120 minutes. The area under the curve for predicting abnormal recovery at 6 months was 0.84, indicating a good sensitivity and specificity balance., Conclusion: The model identifies women at risk for an abnormal recovery trajectory., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2024 American Urogynecologic Society. All rights reserved.)

Purpose: We aimed to estimate the prevalence of a wide range of lower urinary tract symptoms (LUTS) in US women, and explore associations with bother and discussion with health care providers, friends, and family., Materials and Methods: We analyzed baseline data collected from May 2022 to December 2023 in the RISE FOR HEALTH study-a large, regionally representative cohort study of adult female community members. LUTS and related bother were measured by the 10-item Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index, and discussion was assessed by a study-specific item., Results: Of the 3000 eligible participants, 73% (95% CI 71%-74%) reported any storage symptoms, 52% (95% CI 50%-53%) any voiding or emptying symptoms, and 11% (95% CI 10%-13%) any pain with bladder filling, for an overall LUTS prevalence of 79% (95% CI 78%-81%). This prevalence estimate included 43% (95% CI 41%-45%) of participants with mild to moderate symptoms and 37% (95% CI 35%-38%) with moderate to severe symptoms. Over one-third of participants reported LUTS-related bother (38%, 95% CI 36%-39%) and discussion (38%, 95% CI 36%-40%), whereas only 7.1% (95% CI 6.2%-8.1%) reported treatment. Urgency and incontinence (including urgency and stress incontinence) were associated with the greatest likelihood of bother and/or discussion (adjusted prevalence ratios = 1.3-2.3), even at mild to moderate levels. They were also the most commonly treated LUTS., Conclusions: LUTS, particularly storage LUTS such as urgency and incontinence, were common and bothersome in the RISE study population, yet often untreated. Given this large burden, both prevention and treatment-related interventions are warranted to reduce the high prevalence and bother of LUTS.

Aims: To describe women's experiences with a range of bladder self-care practices., Design: We conducted a secondary, directed content analysis of qualitative data from the Study of Habits, Attitudes, Realities and Experiences, a multisite focus group study designed to explore adolescent and adult women's experiences, perceptions, beliefs, knowledge and behaviours related to bladder health. This study was conducted by the National Institute of Diabetes and Digestive and Kidney Diseases' Prevention of Lower Urinary Tract Symptoms Research Consortium. Study methods were informed by the Consortium's conceptual framework, based on a social ecological model adapted from Glass and McAtee's Society-Behavior-Biology Nexus., Methods: Participants were recruited at seven geographically diverse United States research centres between July 2017 and April 2018. Data for the current analysis were collected using a semi-structured discussion group with 36 focus groups involving 316 community-dwelling adult women aged 18-93 years. Coded text was re-examined according to eight self-care behavioural domains identified through literature review and expert opinion as potentially influencing bladder health., Results: Participants described many self-care practices they had adopted to prevent bladder problems or manage existing symptoms and conditions. Eight themes were identified: 'Choosing fluids, foods and medications'; 'Dressing for bladder health'; 'Promoting bodily cleanliness'; 'Managing toileting environments'; 'Timing when to void'; 'Exercising pelvic floor muscles for bladder control'; 'Limiting physical activities that challenge the bladder' and 'Staying home and navigating when away'. Thirteen subthemes were derived from five of the eight themes., Conclusion: Women use a broad array of self-care practices related to their bladder health. Research is needed to examine the efficacy of self-care behaviours for preventing or managing bladder symptoms and conditions, and to discern potential risks. Results have important implications for development of bladder health promotion interventions and public health messaging around women's bladder health., Implications for the Profession And/or Patient Care: This study provides a comprehensive framework for understanding women's bladder self-care practices, which can be used by clinicians and public health professionals in designing interventions to promote bladder health and function., Impact: Women with and without lower urinary tract symptoms use a broad range of self-care practices that may affect their bladder health, including some that may be harmful. Because of the high prevalence of bladder symptoms in women, this study may help patient assessment and counselling regarding self-care practices., Reporting Method: This study was reported according to the Standards for Reporting Qualitative Research (SRQR)., Patient or Public Contribution: No patient or public contribution., (© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: The evolution of nursing education requires a combination of strong academic faculty and expert clinicians. Different professional growth and development pathways are necessary to build a robust faculty with clinical and research expertise. Some schools have implemented a formal clinical track (CT) to complement the traditional tenure track for the professional advancement of CT., Methods: The article presents a case example of how one institution maintains and advances a strong CT using the Kotter Change Model and discusses future directions., Results: The school's infrastructure for promotion, which follows a similar structure and guidelines as Tenure Track (TT) Promotion and Tenure Guidelines, has led to an increase in the school's scholarly productivity among CT faculty across ranks. Increasing poster and podium presentations as well as publications to a national and international audience results in greater reach and improved reputation for the school, both nationally and internationally., Conclusions: While there is still work to be done to advance equity and inclusion for nursing CTs, developing and maintaining a CT with system-level structures holds significant value and provides a clear path to promotion, invests in clinical scholarship, and includes clinical faculty as full citizens in academia., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: This article evaluates the impact of adopting a practice of elective induction of labor (eIOL) at 39 weeks among nulliparous, term, singleton, vertex (NTSV) pregnancies in a statewide collaborative., Study Design: We used data from a statewide maternity hospital collaborative quality initiative to analyze pregnancies that reached 39 weeks without a medical indication for delivery. We compared patients who underwent an eIOL versus those who experienced expectant management. The eIOL cohort was subsequently compared with a propensity score-matched cohort who were expectantly managed. The primary outcome was cesarean birth rate. Secondary outcomes included time to delivery and maternal and neonatal morbidities. Chi-square test, t -test, logistic regression, and propensity score matching methods were used for analysis., Results: In 2020, 27,313 NTSV pregnancies were entered into the collaborative's data registry. A total of 1,558 women underwent eIOL and 12,577 were expectantly managed. Women in the eIOL cohort were more likely to be ≥35 years old (12.1 vs. 5.3%, p  < 0.001), identify as white non-Hispanic (73.9 vs. 66.8%, p  < 0.001), and be privately insured (63.0 vs. 61.3%, p  = 0.04). When compared with all expectantly managed women, eIOL was associated with a higher cesarean birth rate (30.1 vs. 23.6%, p  < 0.001). When compared with a propensity score-matched cohort, eIOL was not associated with a difference in cesarean birth rate (30.1 vs. 30.7%, p  = 0.697). Time from admission to delivery was longer for the eIOL cohort compared with the unmatched (24.7 ± 12.3 vs. 16.3 ± 11.3 hours, p  < 0.001) and matched (24.7 ± 12.3 vs. 20.1 ± 12.0 hours, p  < 0.001) cohorts. Expectantly managed women were less likely to have a postpartum hemorrhage (8.3 vs. 10.1%, p  = 0.02) or operative delivery (9.3 vs. 11.4%, p  = 0.029), whereas women who underwent an eIOL were less likely to have a hypertensive disorder of pregnancy (5.5 vs. 9.2%, p  < 0.001)., Conclusion: eIOL at 39 weeks may not be associated with a reduced NTSV cesarean delivery rate., Key Points: · Elective IOL at 39 weeks may not be associated with a reduced NTSV cesarean delivery rate.. · The practice of elective induction of labor may not be equitably applied across birthing people.. · Further research is needed to identify best practices to support people undergoing labor induction.., Competing Interests: None declared., (Thieme. All rights reserved.)

Community engagement has been named a research priority by the National Institutes of Health, and scholars are calling for community engagement as an approach to address racism and equity in science. Robust community-engaged research can improve research quality, increase inclusion of traditionally marginalized populations, broaden the impact of findings on real-life situations, and is particularly valuable for underexplored research topics. The goal of this paper is to describe lessons learned and best practices that emerged from community engagement in a multi-institution population health research consortium. We describe how a foundation was laid to enable community-engaged research activities in the consortium, using a staged and stepped process to build and embed multi-level community-engaged research approaches.. We staged our development to facilitate (a) awareness of community engagement among consortium members, (b) the building of solidarity and alliances, and (c) the initiation of long-term engagement to allow for meaningful research translation. Our stepped process involved strategic planning; building momentum; institutionalizing engagement into the consortium infrastructure; and developing, implementing, and evaluating a plan. We moved from informal, one-time community interactions to systematic, formalized, capacity-building reciprocal engagement. We share our speed bumps and troubleshooting that inform our recommendations for other large research consortia-including investing the time it takes to build up community engagement capacity, acknowledging and drawing on strengths of the communities of interest, assuring a strong infrastructure of accountability for community engagement, and grounding the work in anti-racist principles.

Purpose: Although maternal depression is associated with adverse outcomes in women and children, its relationship with lower urinary tract symptoms (LUTS) in offspring is less well-characterized. We examined the association between prenatal and postpartum maternal depression and LUTS in primary school-age daughters., Design: Observational cohort study., Subjects and Setting: The sample comprised 7148 mother-daughter dyads from the Avon Longitudinal Study of Parents and Children., Method: Mothers completed questionnaires about depressive symptoms at 18 and 32 weeks' gestation and 21 months postpartum and their children's LUTS (urinary urgency, nocturia, and daytime and nighttime wetting) at 6, 7, and 9 years of age. Multivariable logistic regression models were used to estimate the association between maternal depression and LUTS in daughters., Results: Compared to daughters of mothers without depression, those born to mothers with prenatal and postpartum depression had higher odds of LUTS, including urinary urgency (adjusted odds ratio [aOR] range = 1.99-2.50) and nocturia (aOR range = 1.67-1.97) at 6, 7, and 9 years of age. Additionally, daughters born to mothers with prenatal and postpartum depression had higher odds of daytime wetting (aOR range = 1.81-1.99) and nighttime wetting (aOR range = 1.63-1.95) at 6 and 7 years of age. Less consistent associations were observed for depression limited to the prenatal or postpartum periods only., Conclusions: Exposure to maternal depression in the prenatal and postpartum periods was associated with an increased likelihood of LUTS in daughters. This association may be an important opportunity for childhood LUTS prevention. Prevention strategies should reflect an understanding of potential biological and environmental mechanisms through which maternal depression may influence childhood LUTS., Competing Interests: Conflicts of Interest: Dr Epperson consults to Asarina Pharma, Sweden, and Sage Therapeutics, Cambridge, Massachusetts. Dr Epperson is also a site investigator for a randomized controlled trial sponsored by Sage Therapeutics. The other authors declare that they have no conflict of interest., (Copyright © 2024 by the Wound, Ostomy and Continence Nurses Society.)

Objective: The purpose of this analysis was to explore adolescent and adult women's preferences for the content and delivery of public health messaging around bladder health. Materials and Methods: This was a directed content analysis of focus group data from the Study of Habits, Attitudes, Realities, and Experiences, which explored adolescent and adult women's experiences, perceptions, beliefs, knowledge, and behaviors related to bladder health and function across the life course. This article reports an analysis of the "Public Health Messaging" code, which includes participants' views on what information is needed about bladder health, attributes of messaging, and preferred locations and delivery methods. Results: Forty-four focus groups were conducted with 360 participants (ages 11-93 years) organized into six age groups. Across age groups, participants wanted messaging on maintaining bladder health and preventing bladder problems. They offered suggestions for a wide variety of methods to deliver bladder health information. Ideas for delivery methods fell into three broad categories: (1) traditional in-person modes of delivery, which included individual communication with providers in clinical settings and group-based methods in schools and other community settings where adolescent and adult women naturally gather; (2) internet-based website and social media delivery methods; and (3) static (noninteractive) modes of delivery such as pamphlets. Participants recommended the development of multiple delivery methods to be tailored for specific audiences. Conclusions: These findings can inform development of broad ranging public health messaging tailored to audiences of all ages with a goal of engaging adolescent and adult women across the bladder health risk spectrum.

Introduction: The current gold standard instrument used to measure fear of childbirth is the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ). However, the existing scale is long, has translational challenges, and lacks data specific to experiences of a diverse population in the United States, making it challenging to assess how fear of childbirth impacts perinatal health care disparities. The objective of this study was to revise the WDEQ and analyze its reliability and validity for use in the United States., Methods: The questionnaire was revised using qualitative data from a previously published study of fear of childbirth within a racially, ethnically, and economically diverse group of pregnant or postpartum people in the United States. Psychometric properties were analyzed in terms of construct validity, reliability, and factor analysis from a group of 329 participants., Results: The revised and shortened 10 item WDEQ-10 comprises 3 subscales: fear of environmental factors, fear of death or injury, and fear of how they feel. The results indicate that the WDEQ-10 demonstrates good reliability and validity and confirmed the multidimensionality of fear of childbirth through a 3-factor solution., Discussion: The WDEQ-10 is a readable and accessible instrument that will allow health care providers and researchers to accurately measure complex components of how pregnant people experience fear of childbirth., (© 2023 The Authors. Journal of Midwifery & Women's Health published by Wiley Periodicals LLC on behalf of American College of Nurse Midwives (ACNM).)

Objective: The Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium launched the RISE FOR HEALTH (RISE) national study of women's bladder health which includes annual surveys and an in-person visit. For the in-person exam, a standardized, replicable approach to conducting a pelvic muscle (PM) assessment was necessary. The process used to develop the training, the products, and group testing results from the education and training are described., Methods: A comprehensive pelvic muscle assessment (CPMA) program was informed by literature view and expert opinion. Training materials were prepared for use on an electronicLearning (e-Learning) platform. An in-person hands-on simulation and certification session was then designed. It included a performance checklist assessment for use by Clinical Trainers, who in collaboration with a gynecology teaching assistant, provided an audit and feedback process to determine Trainee competency., Results: Five discrete components for CPMA training were developed as e-Learning modules. These were: (1) overview of all the clinical measures and PM anatomy and examination assessments, (2) visual assessment for pronounced pelvic organ prolapse, (3) palpatory assessment of the pubovisceral muscle to estimate muscle integrity, (4) digital vaginal assessment to estimate strength, duration, symmetry during PM contraction, and (5) pressure palpation of both myofascial structures and PMs to assess for self-report of pain. Seventeen Trainees completed the full CPMA training, all successfully meeting the a priori certification required pass rate of 85% on checklist assessment., Conclusions: The RISE CPMA training program was successfully conducted to assure standardization of the PM assessment across the PLUS multicenter research sites. This approach can be used by researchers and healthcare professionals who desire a standardized approach to assess competency when performing this CPMA in the clinical or research setting., (© 2023 Wiley Periodicals LLC.)

Competing Interests: The authors declare no conflicts of interest.

Purpose: We examined how antecedent sexual health factors affect lower urinary tract symptoms (LUTS) in adolescent women., Methods: We analyzed 1,941 adolescent women from the Avon Longitudinal Study of Parents and Children at age 19. At ages 15 and 17, participants reported use of oral contraceptives (OCs), history of sexual intercourse, number of sexual partners, and condom use. At age 19, The Bristol Female Lower Urinary Tract Symptoms questionnaire quantified the frequency over the past month: stress incontinence, any incontinence, urgency, sensation of incomplete emptying, bladder pain, and urinary tract infection. Multivariable regression models examined associations between sexual health behaviors reported at ages 15 and 17 and six LUTS reported at age 19, after controlling for covariates., Results: Commonly reported LUTS at age 19 were past-month stress incontinence (26.8%), bladder pain (26.3%), any urine leakage (22.1%), and urinary tract infection (15.4%). OC use by age 17 was associated with urgency (odds ratio [OR] = 1.62, 95% confidence interval [CI] 1.19-2.20), incomplete emptying (OR = 1.62, 95% CI = 1.17-2.26), bladder pain (OR = 1.45, 95% CI = 1.15-1.83), and urinary tract infections (OR = 1.68, 95% CI = 1.28-2.21) at age 19 after adjustment for covariates. However, associations were attenuated after adjustment for condom use and number of sexual partners. Sexual intercourse by age 17 was associated with 1.53-2.65 increased odds of LUTs categories except incontinence, with lower confidence interval boundaries > 1.0. Associations were stronger among women with ≥ 3 sexual partners (vs. 0) by age 17., Discussion: We found longitudinally assessed associations between OC use, sexual intercourse, and number of sexual partners during adolescence and LUTS at age 19., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Existing bladder-specific measures lack the ability to assess the full range of bladder health, from poor to optimal health., Objective: This study aimed to report evidence of validity of the self-administered, multidimensional bladder health scales and function indices for research in adult women., Study Design: A cross-sectional population-based validation study with random assignment to paper or electronic administration was conducted using national address-based probability sampling supplemented by purposive sampling of women with lower urinary tract symptoms in 7 clinical research centers. Construct validity of the bladder health scales and function indices was guided by a multitrait-multimethod approach using health and condition-specific questionnaires, bladder diaries, expert ratings of bladder health, and noninvasive bladder function testing. Internal dimensional validity was evaluated using factor analysis; internal reliability was assessed using paired t-tests and 2-way mixed-effects intraclass correlation coefficient models. Chi-square, Fisher exact, or t-tests were used for mode comparisons. Convergent validity was evaluated using Pearson correlations with the external construct measures, and known-group validity was established with comparison of women known and unknown to be symptomatic of urinary conditions., Results: The sample included 1072 participants. Factor analysis identified 10 scales, with Cronbach's alpha ranging from 0.74 to 0.94. Intraclass correlation coefficients of scales ranged from 0.55 to 0.94. Convergent validity of the 10 scales and 6 indices ranged from 0.52 to 0.83. Known-group validity was confirmed for all scales and indices. Item distribution was similar by mode of administration., Conclusion: The paper and electronic forms of the bladder health scales and function indices are reliable and valid measures of bladder health for use in women's health research., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Our aim was to evaluate variation in opioid prescribing rates and prescription size following childbirth across providers and hospitals., Methods: This retrospective cohort study analyzed claims data from a single-payer Preferred Provider Organization from June 2014 to May 2019 in 84 hospitals in a statewide quality collaborative. All patients aged 12-55 years, undergoing childbirth, with continuous enrollment in pregnancy were included. The primary outcome was the predicted rate of postpartum opioid fills from 7 days before birth to 3 days after discharge. Secondary outcomes included postpartum opioid prescription size in oral morphine equivalents, a standardized measure that includes the number of pills prescribed times the strength of the medication. Multilevel regression models accounted for clustering. We calculated attributable variation in opioid fills using the intraclass correlation coefficient., Results: Of 41,427 births, 15,459 patients (37.2%) filled a postpartum opioid prescription (vaginal, 4,624/27,536 [16.8%]; cesarean, 10,835/13,891 [78.0%]). The median postpartum prescription size was 150 oral morphine equivalents (interquartile range [IQR], 30) (vaginal, 135; [IQR, 45]; cesarean, 150 [IQR, 75]). In adjusted models, the rates of opioid prescribing after vaginal birth differed from cesarean birth (vaginal median, 12.1% [range, 1.1%-60.0%]; cesarean median, 80.4% [range, 43.6%-90.2%]). More variation in postpartum opioid fills was attributable to providers and hospitals for vaginal (provider, 29%; hospital, 24%) than cesarean birth (provider, 8%; hospital, 6%). Variation in prescription size was driven by providers for vaginal birth (provider, 27%; hospital, 6%) and providers and hospitals for cesarean birth (provider, 29%; hospital, 21%)., Conclusions: Across a statewide quality collaborative, variation in postpartum opioid prescribing is attributable to providers and hospitals. Future efforts at the provider and hospital levels are needed to implement best practices for postpartum opioid prescribing., (Copyright © 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this analysis was to explore adolescent and adult women's interest in public health messaging around bladder health and perceptions of its usefulness. Materials and Methods: Directed content analysis of focus group data from the Study of Habits, Attitudes, Realities, and Experiences, which explored adolescent and adult women's experiences, perceptions, beliefs, knowledge, and behaviors related to bladder health across the life course. This article reports an analysis of the "Public Health Messaging" code, which included participants' desire or need for information about bladder health and recommendations for appropriate priority audiences. Results: Forty-four focus groups were conducted with 360 participants organized into six age groups (11-93 years). There was consensus across age groups that more information about the bladder is wanted and needed throughout the life course, as there is currently a lack of reliable educational resources. Information on bladder health was seen as useful and important because it enables people to anticipate negative changes in bladder health and act to prevent these. Several priority audiences were identified based on their risk of developing symptoms, but participants also saw value in educating the general public regardless of risk status. They also recommended education for parents and teachers who are in positions to control bathroom access. Conclusions: Results indicate a uniform desire for information on women's bladder health and a need for more research to develop individual prevention strategies and public health messaging for women of all ages, as well as guidance for organizations with a role in supporting bladder health.

Objective: To develop and test the psychometric properties of a shared decision-making tool: Childbirth Options, Information, and Person-Centered Explanation (CHOICEs)., Design: Multiphase instrument development study beginning with item development through a cross-sectional postpartum survey., Setting: The cross-sectional postpartum survey was distributed online through convenience and snowball sampling methods., Methods: We developed instrument items through an iterative process with key stakeholders. We evaluated reliability based on internal consistency and differential item functioning analysis. We evaluated validity on evidence of construct validity. We used criterion-related item mapping to evaluate whether the measure addressed the full spectrum of shared decision making related to maternity care., Results: Surveys were completed by 1,171 participants. A Cronbach's α coefficient of .99 supported internal consistency reliability. Infit and outfit statistics that ranged from 0.92 to 1.55 supported item fit. Differential item functioning analysis showed that CHOICEs scores were invariant between different demographic groups. Significant positive correlations between scores on CHOICEs and the Mothers on Respect index (r = 0.75, p = .01) and the Mothers Autonomy in Decision-Making scale (r = 0.75, p = .01) supported criterion-related validity. Item mapping suggested more items were needed to capture the full spectrum of shared decision making., Conclusion: We recommend using CHOICEs to evaluate shared decision making in maternity care for research and quality improvement projects., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2022 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: The goal of this manuscript is to review the current literature on bladder health education, summarize P revention of L ower U rinary Tract S ymptoms (PLUS) [50] findings on environmental factors that influence knowledge and beliefs about toileting and bladder function, and describe how PLUS work will contribute to improved understanding of women's bladder-related knowledge and inform prevention intervention strategies., Recent Findings: Analysis of focus group transcripts revealed the various ways women view, experience, and describe bladder function. In the absence of formal bladder health educational platforms, women appear to develop knowledge of normal and abnormal bladder function from a variety of social processes including environmental cues and interpersonal sources. Importantly, focus group participants expressed frustration with the absence of structured bladder education to inform knowledge and practices., Summary: There is a lack of bladder health educational programming in the USA, and it is unknown to what degree women's knowledge, attitudes, and beliefs influence their risk of developing lower urinary tract symptoms (LUTS). The PLUS Consortium RISE FOR HEALTH study will estimate the prevalence of bladder health in adult women and assess risk and protective factors. A Knowledge, Attitudes, and Beliefs (KAB) questionnaire will be administered to determine KAB around bladder function, toileting, and bladder-related behaviors, and examine the relationship of KAB to bladder health and LUTS. The data generated from PLUS studies will identify opportunities for educational strategies to improve bladder health promotion and well-being across the life course., Competing Interests: Conflict of Interest S.S. Brady reports grants from 1 U24DK106786, during the conduct of the study. B.R Williams reports grants from NIH-NIDDK, during the conduct of the study. J.F. Wyman reports grants from National Institutes of Diabetes and Digestive and Kidney Disorders/National Institutes of Health, during the conduct of the study. A.S. James reports grants from NIH, during the conduct of the study; grants from NCI, outside the submitted work. M.A. Brault reports grant K01TW011480 from the Fogarty International Center at NIH, outside the submitted work. L.M. Rickey, D.R. Camenga, A.L. Smith, D.Y. LaCoursiere, M.D. Lavender, and L.K. Low declare that they have no conflict of interest. Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium declare no conflict of interest.

In the United States, about 1 in 5 women have experienced childhood sexual abuse, and a similar proportion experience rape as adults. Childhood sexual abuse and other forms of trauma have serious impacts on our patients' reproductive health. The American College of Obstetricians and Gynecologists recommends universal screening for a history of sexual abuse and universal application of a trauma-informed approach to care. Despite these recommendations, universal screening is far from universally practiced, and trauma-informed care, despite being the standard of care, is far from standard. Given the high prevalence of trauma in the United States, its impact on perinatal outcomes, the sensitive nature of reproductive healthcare, and the likelihood that many patients may not disclose their trauma history, we advocate for trauma-informed reproductive healthcare as the standard of care., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to explore how doulas of color conceptualize both their work and how their racial and ethnic identities influence their work within the context of racial disparities in birth outcomes in the United States., Methods: We conducted semistructured qualitative interviews with doulas of color who had attended at least 3 births as doulas. Participants were recruited from across the United States. The interviews were audio recorded and transcribed verbatim. Qualitative content analysis was used to derive themes from the transcribed interviews., Results: Interviews were conducted with 8 doulas of color, ranging in age from 21 to 47 from across the United States. All participants were either current college students or had earned a college degree. Although many of the doulas identified as being of more than one racial or ethnic group, nearly all participants identified closely with being Black or African American first, and their other racial groups second. Four major themes emerged: relationship with the medical system, role of identity in the doulas' work, role of class, and divisions within the natural birth movement., Discussion: The majority of doulas who participated in this study stated that their racial identity strongly influenced their work, particularly when working with women of the same race or ethnicity due to their shared identities. Several participants initially became doulas because of a desire to alleviate disparities in birth outcomes for women of color. This suggests a commitment on the part of the study participants to serving their communities and to bridging the gap between women of color and the health care system. Several participants also noted that they feel alienated by both the health care system and the mainstream natural birth community., (© 2021 by the American College of Nurse-Midwives.)

The purpose of this study was to expand our understanding of fear of childbirth (FOC) by examining the interplay between individual, provider, identity, and culture among women historically underrepresented in FOC research to develop a deeper understanding of FOC. Purposive sampling was used to recruit 22 participants into three different focus groups, each with a unique demographic makeup. The results provide evidence that people's birth experiences and their experiences with fear surrounding childbirth are affected by many other social mechanisms, including relationships with providers, birth setting, race, class, gender, sexual orientation, and ethnicity.

Background: Toileting behaviors are increasingly recognized as factors potentially contributing to development of lower urinary tract symptoms (LUTS)., Objectives: To examine adult women's toileting behaviors and LUTS across age and race/ethnicity groups and relationships between toileting behaviors and LUTS., Design: Planned secondary analysis of questionnaire data collected in a focus group study on bladder health., Settings: Questionnaires were completed at the conclusion of focus groups conducted in community settings affiliated with seven research centers across the United States., Participants: Community-living women regardless of LUTS status., Methods: Forty-four focus groups were conducted with 360 adolescent and adult cisgender women. After each focus group, participants completed questionnaires to assess toileting behaviors (Toileting Behaviors-Women's Elimination Behaviors Scale (TB-WEB)) and their experience of LUTS (Lower Urinary Tract Symptom Tool), This analysis includes quantitative data from the subgroup of 316 participants who completed the questionnaires., Results: Participants ranged in age from 18-93 years (Mean=50.2 years). A significant effect for age was found for delayed voiding behavior, reported by 76.5% of women ages 18-25 years and 21.9% of those 75+ years ( p <0.001). Conversely, reports of premature voiding were lowest in the youngest and higher in the oldest three age groups ( p =0.022). Racial/ethnic differences were found for three domains of toileting behavior. Black and Hispanic women expressed a stronger preference for voiding at home rather than away from home (98.9%, 93.5%, respectively) compared to White women (90.4%, p =0.041), were more likely to void prematurely (37.6%, 33.3% vs. 21.2%, p=0.048) and to crouch, squat, or stand rather than sit to void when away from home (69.9%, 58.3% vs. 41.3%, p<0.001). Four toileting behavior domains were significantly associated with LUTS. Premature voiding was associated with any bothersome LUTS (OR=2.5; 95% confidence interval [CI]=1.3-4.8) and any bothersome storage LUTS (OR=2.9; CI=1.5-5.5). Delayed voiding was associated with bothersome emptying symptoms (OR=2.8; CI=1.1-6.6). Straining to void was associated with bothersome storage symptoms (OR=2.0; CI=1.0-3.7), bothersome emptying symptoms (OR=3.7; CI=1.9-7.3), and any bothersome LUTS (OR=2.3; CI=1.2-4.3). Preference for non-sitting positions to void when away from home was associated with bothersome emptying symptoms (OR=2.5; CI=1.3-4.8) and any bothersome LUTS (OR=1.8; CI=1.0-3.2)., Conclusions: These findings highlight the need for research to understand underpinnings of age and racial/ethnic differences in toileting behaviors and identify mechanisms by which toileting behaviors might influence development of LUTS over time. Understanding causal pathways is important in the development of public health interventions to encourage toileting behaviors that support bladder health., Competing Interests: Conflict of Interest: None

Background: Instruction in ethics is an essential component of midwifery education. However, the evidence for how midwifery students experience ethics instruction in the classroom and via clinical experience is limited., Objective: This study explores midwifery students' perceptions of ethics education and their opinions about essential components of ethics education., Design: This was a qualitative descriptive thematic study, exploring student midwives' experiences of ethics education in their midwifery programs. We conducted focus group interviews with students from three midwifery programs in the United States (U.S.)., Setting: Graduate midwifery educational programs in the United States., Participants: Thirty-nine students from three graduate midwifery programs participated in four focus group discussions., Results: Thematic analysis identified three primary themes and associated subthemes: 1) current experience and identified needs, 2) the preceptor dilemma, with subthemes the critical role of modeling ethics and powerlessness within interprofessional conflicts, and 3) complicated relationships: advocacy, autonomy and choice. Students relied primarily upon clinical preceptors rather than classroom discussion as a significant source of learning ethics content and ethical behavior. Students called for explicit identification of ethics learning when it occurs, particularly midwifery-specific content, as well as increased opportunities for reflection and integration of their experiences., Conclusion: This study shows the need for intentional inclusion of midwifery-specific ethics content into the overall midwifery education program content, in both classroom and clinical experiences. Midwifery programs should integrate ethics content in their curricula in a way that complements other midwifery content. This study also demonstrates the key role of clinical preceptors in student ethics learning., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To determine the proportion of informed choices women made about donating their newborns' blood samples for research., Design: A quantitative analysis of informed choice using data on women's knowledge and attitudes from a descriptive, cross-sectional survey., Setting: The state of Michigan., Participants: Women (N = 69, ≥18 years old) who had (a) newborns 0 to 3 months of age, (b) yes or no decisions regarding use of the blood sample for research on file, (c) no evidence of an infant death in the state database, (d) completed the knowledge scale, (e) completed the attitude scale, and (f) recalled the decision (i.e., yes or no) about donating blood samples., Methods: We used the multidimensional measure of informed choice to calculate the proportion of informed choices in data on women's knowledge, attitudes, and decisions about biospecimen research., Results: Fifty-five percent (38/69) of participants made informed choices about donating newborn blood samples for research, and 45% made uninformed choices (31/69). Inadequate knowledge about biospecimen research contributed to 87% of uniformed choices (27/31). Participants who declined to donate their newborns' blood samples struggled with making decisions consistent with their values., Conclusion: Nearly half of the participants made uninformed choices about donating the blood samples of their newborns for research. Women need more information about genetics and the storage and research use of newborns' blood samples to make informed choices. Nurses need to be made aware of the ethical, legal, and social implications of such research because they are primary sources of advocacy, information, and support for childbearing women and may be charged with overseeing or obtaining informed consent. Additional research with larger, more diverse samples is needed., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2021 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)