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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]

Background/Aims: Mental health can influence the likelihood that a woman will initiate and continue breastfeeding behaviour that is associated with improved infant and maternal health. Mental health outcomes are associated with variables such as optimism and coping. The aim of this study was to explore the relationship between coping, optimism and mental health, and their impact on breastfeeding duration. Methods: A total of 612 women who had breastfed completed an online questionnaire comprising the hospital anxiety and depression scale, cognitive emotional regulation questionnaire, brief coping orientation to problems experienced inventory and life orientation test. Data were analysed using correlations, ordinal linear regression and mediation analysis. Results: There was a direct relationship between breastfeeding duration and depression but no direct relationship between duration and anxiety. A mediation analysis showed no mediating between breastfeeding duration and depression. Optimism did mediate the relationship between anxiety and duration, with optimism being associated with reduced anxiety and increased duration. Conclusions: The findings highlight the importance of support for mothers while breastfeeding to improve mental health outcomes and foster coping strategies, such as optimism. [ABSTRACT FROM AUTHOR]

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

Perinatal mental health conditions have been associated with adverse pregnancy outcomes, including maternal death. This quality improvement project analyzed pregnancy-associated death among veterans with mental health conditions in order to identify opportunities to improve healthcare and reduce maternal deaths. Pregnancy-associated deaths among veterans using Veterans Health Administration (VHA) maternity care benefits between fiscal year 2011 and 2020 were identified from national VHA databases. Deaths among individuals with active mental health conditions underwent individual chart review using a standardized abstraction template adapted from the Centers for Disease Control and Prevention (CDC). Thirty-two pregnancy-associated deaths were identified among 39,720 paid deliveries with 81% (n = 26) occurring among individuals with an active perinatal mental health condition. In the perinatal mental health cohort, most deaths (n = 16, 62%) occurred in the late postpartum period and 42% (n = 11) were due to suicide, homicide, or overdose. Opportunities to improve care included addressing (1) racial disparities, (2) mental health effects of perinatal loss, (3) late postpartum vulnerability, (4) lack of psychotropic medication continuity, (5) mental health conditions in intimate partners, (6) child custody loss, (7) lack of patient education or stigmatizing patient education, and (8) missed opportunities for addressing reproductive health concerns in mental health contexts. Pregnancy-associated deaths related to active perinatal mental health conditions can be reduced. Mental healthcare clinicians, clinical teams, and healthcare systems have opportunities to improve care for individuals with perinatal mental health conditions. [ABSTRACT FROM AUTHOR]

Background: Pulmonary embolism (PE) can be fatal yet difficult to diagnose in pregnancy. Computed tomography pulmonary angiogram (CTPA) or ventilation/perfusion (V/Q) scans are often conducted, potentially leading to low positive scan rates. Methods: Retrospective data analysis was conducted for pregnant women and non-pregnant age-matched control who underwent CTPA and/or V/Q scan for investigation of PE. The main outcomes were the positive and non-diagnostic imaging rates. Results: In total, 440 women underwent V/Q or CTPA scans, 86 of whom were pregnant (19.5%). The positive scan rate was 3.5% and 8.8% in the pregnant and non-pregnant groups, respectively (p = 0.1). The non-diagnostic scan rate was similar between pregnant and non-pregnant groups (13.9% vs 9.9%, p = 0.3). Within the pregnant group, there were more non-diagnostic CTPAs than V/Q scans (p = 0.005). Conclusion: Our study confirms a low positive imaging rate and a relatively high non-diagnostic CTPA rate in pregnancy. Newer strategies are needed to reduce the number of negative imaging studies conducted. [ABSTRACT FROM AUTHOR]

Background: Advancing maternal age is increasingly prevalent and is associated with severe maternal morbidity often requiring intensive care unit (ICU) admission. Objectives: To describe maternal ICU admissions at a quaternary care hospital in Montreal, Canada, and evaluate the association between maternal age and composite of: need for invasive interventions, ICU stay > 48 h, or maternal death. Methods: Chart review of ICU admissions during pregnancy/postpartum (2006–2016); logistic regressions to evaluate the impact of age on outcomes. Results: With 5.1 ICU admissions per 1000 deliveries, we included 187 women (mean age 32 ± 6.3 years; 20 (10.7%) ≥ 40 years). The composite outcome occurred in 105 (56.2%) patients; there were two maternal deaths. Age ≥ 40 years increased the odds of invasive interventions (OR 4.03; 95% confidence interval [CI] 1.15–14.1) but not of the composite outcome (OR 2.30; 95% CI 0.66–8.02). Conclusion: Peripartum women aged ≥ 40 years had worse outcomes in ICU, with an increased need for invasive interventions. [ABSTRACT FROM AUTHOR]

Objective The objective of the study was to evaluate whether patients with oxytocin discontinued during the second stage of labor (≥30 minutes prior to delivery) had a lower rate of postpartum hemorrhage (PPH) compared with those with oxytocin continued until delivery or discontinued <30 minutes prior to delivery. Study Design Retrospective cohort study was performed from August 1, 2014 to July 31, 2019. Singleton pregnancies of 24 to 42 weeks gestation were included if they reached the second stage of labor and received oxytocin during labor. Patients on anticoagulants were excluded. Patients with oxytocin discontinued ≥30 minutes prior to delivery represented STOPPED and those with oxytocin continued until delivery or discontinued <30 minutes prior to delivery represented CONTINUED. Patient data were abstracted from the electronic medical record. The primary outcome was PPH (≥1,000 mL blood loss). Univariable analyses were performed to compare groups. Multi-variable logistic regression was performed to adjust for prespecified confounders. Planned sub-group analyses by the route of delivery were performed. Results Of 10,421 total patients, 1,288 had oxytocin STOPPED and 9,133 had oxytocin CONTINUED. There were no significant differences in age, race, or ethnicity, body mass index, public insurance, gestational diabetes, or pregnancy-induced hypertension between STOPPED and CONTINUED. The PPH rate was 15.2 and 5.7% in STOPPED and CONTINUED, respectively (p < 0.001). After adjusting for confounders, STOPPED remained at higher odds for PPH (adjusted odds ratio 2.859, 95% confidence interval 2.394, 3.414, p < 0.001). Among cesarean deliveries only, there was no significant difference in the rate of PPH between STOPPED and CONTINUED (38.0 vs. 36.4%, respectively, p = 0.730). However, among vaginal deliveries, the rate of PPH was actually lower in STOPPED than CONTINUED (3.4 vs. 5.2%, respectively, p = 0.024). Conclusion The rate of PPH was higher in patients with oxytocin STOPPED compared with CONTINUED. However, among vaginal deliveries, there was a significantly lower rate of PPH in STOPPED. These disparate findings may be explained by the variable impact of second-stage oxytocin on PPH as a function of delivery type. Key Points It is unclear if oxytocin use in the second stage of labor may independently increase the risk of hemorrhage. Patients with oxytocin discontinued during the second stage of labor had a higher rate of PPH. PPH was significantly lower among vaginal deliveries in patients with oxytocin discontinued. [ABSTRACT FROM AUTHOR]

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

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

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

Background: Poland has one of the highest cesarean birth (CB) rates in Europe. For this study, we used the Robson Ten‐Group Classification System (TGCS) to analyze trends in the induction and CB rates in one hospital in Poland over a period of 11 years. We compare these trends with changes in National Legislative and Medical Guidelines introduced during this time that were aimed at lowering rates of unnecessary medical interventions. Methods: We conducted a retrospective study including all births after 24 weeks' gestation between 2010 and 2020 from one tertiary hospital (n = 66,716 births). After the deletion of records with missing data, 66,678 births were included in the analysis. All births were classified according to the Robson TGCS. The size, CB rate, and contribution of each group for every year were calculated. Linear regression analyses were used to analyze trends over time. Results: The total CB rate varied from 29.6% to 33.0% during the study period, with a linear increase of 0.045 percentage points annually (R2 = 0.021; F(1) = 0.189; p = 0.674). This study was considerably lower than the total CB rate for Poland, which rose from 33.9% in 2010 to 45.1% in 2020, increasing at a rate of 1.13 percentage points per year (R2 = 0.93; F(1) = 61.88; p < 0.001). Induction rates among both nulliparous (R1 + R2) and multiparous (R3 + R4) women at term also increased. Study groups R5 (previous cesarean birth), R2 (nulliparous in induced or prelabor cesarean delivery), and R1 (nulliparous women at term with single cephalic pregnancy in spontaneous labor) were the highest contributors to the overall CB rate. The greatest decrease in the CB rate was detected in group R5b (more than one previous CB). None of the groups showed statistically significant increases in CB rates over the study period. Conclusions: The CB rate in the hospital where the study was conducted was considerably lower than the total CB rate in Poland. When compared with countries with similar CB rates, group R2b (women with nulliparous, prelabor cesarean birth) in our study was considerably larger. More comparisons across different hospital settings in Poland are needed. However, as hospitals are not encouraged to routinely collect the data needed to construct TGCS, such comparisons are very difficult to conduct. [ABSTRACT FROM AUTHOR]

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

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

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

Background: Women's dissatisfaction with perinatal health care services is associated with poor postpartum outcomes for the mother and the baby. The Mackey Childbirth Satisfaction Rating Scale is a frequently used measure of women's childbirth satisfaction. However, its factor structure has been inconsistent across investigations. The goal of this study was to evaluate the psychometric properties of the scale (i.e., factor structure and sources of validity evidence). Methods: This study is a descriptive prospective investigation. Participants included 106 pregnant women (mean age = 31.86, SD = 4.12) recruited from a public university hospital situated in South Madrid. Sources of construct validity of the Mackey were explored with the Women's View of Birth Labor Satisfaction Questionnaire. Sources of criterion validity were investigated with measures of pain (labor, delivery, and just after birth) and post‐traumatic stress symptoms. Results: Minor adaptations in item distribution resulted in an adequate fit of the original six‐factor solution of the Mackey scale (i.e., oneself, the partner, the baby, the nurse, the physician, and overall satisfaction). Sources of validity evidence supported the construct and criterion validity of the scale. Conclusions: Obtaining a psychometrically and conceptually sound factor solution is fundamental when validating a scale. With the present study, researchers and clinicians (e.g., midwives) will be able to measure women's childbirth satisfaction in a more robust manner. Both antecedents and consequences of satisfaction were found to correlate with several satisfaction subscales, which might help guide prevention programs in mother care in a more efficient way. [ABSTRACT FROM AUTHOR]

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

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

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

In this article, we perform a thematic analysis of a sample of 70 #ButNotMaternity Instagram posts. #ButNotMaternity is a hashtag that emerged in the United Kingdom during the COVID-19 pandemic whereby the public, healthcare workers and campaigners shared experiences and concerns about pandemic maternity care restrictions and their disproportionate disadvantages for pregnant women. In the article, we analyse four themes that emerged from our thematic analysis – Individual experiences, loneliness and overcoming adversity, Voicing anger and absurdity, Mobilising anger and calls to action and Coordinated activism. Thinking about #ButNotMaternity in the context of 'freelance feminism', our article has a twofold aim. First, we explore the concept of 'freelance feminism' through #ButNotMaternity, asking to what extent this campaign draws from freelance tactics. Second, we use the hashtag to illuminate maternity inequality and modes of resistance during the COVID-19 pandemic. Through our thematic analysis, we argue that while 'freelance feminism' might be becoming hegemonic as a dominant mode of organising feminist activism and resistance, inspired by Malik et al. (2020), we also showcase how creative campaigns are potential places where collective action, structural critique and resistance may emerge. [ABSTRACT FROM AUTHOR]

The article presents an editorial focuses on the implications of childbirth during war in Israel following the October 7 attacks, exploring the impact on birth outcomes, perinatal mental health, and changes in birth plans and procedures. It highlights the unique challenges faced by maternity ward staff and birthing individuals in a high-income country with accessible healthcare but high exposure to war.

Introduction: Exclusive breastfeeding is recognized as the optimal source of nutrition for infants. Although exclusive breastfeeding rates have increased overall in the United States, substantial inequities exist in breastfeeding among individuals of different socioeconomic statuses, races, and ethnicities. The purpose of this study was to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. Methods: The current study included a cross-sectional design, with a sample of 242 pregnant women in Arkansas enrolled in a Healthy Start program. Results: The majority of the participants (56.6%) indicated their infant feeding intentions included a combination of breastfeeding and formula feeding. There were substantial differences in breastfeeding intentions among women of different races/ethnicities, with 18.5% of Marshallese women indicating they planned to exclusively breastfeed, compared to 42.1% of White women, 47.6% of Black women, and 31.8% of Hispanic women (p < 0.001). Women over the age of 18 and with higher educational attainment were more likely to intend on exclusively breastfeeding. Discussion: This is the first study to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. The study found that race/ethnicity and age were most strongly associated with breastfeeding intentions. These findings are critical to identifying populations for resource allocation and to developing culturally-tailored interventions to help women in Arkansas achieve their desired infant feeding methods. Significance: What is already known on this subject?: Exclusive breastfeeding is recognized as the optimal source of nutrition for infants, and it has been associated with decreased risk of obesity and cardiometabolic disease for both mother and infant. Although exclusive breastfeeding rates have increased overall in the United States, substantial inequities exist in breastfeeding among individuals of different socioeconomic statuses, races, and ethnicities. What this study adds?: This is the first study to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. The study found that race/ethnicity and age were most strongly associated with breastfeeding intentions. [ABSTRACT FROM AUTHOR]

Background: Mistreatment during childbirth is a growing concern worldwide, especially in developing countries, such as Iran. In response, we launched a comprehensive implementation research (IR) project to reduce mistreatment during childbirth and enhance positive birth experiences in birth facilities. This study identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the Consolidated Framework for Implementation Research (CFIR). Methods: An exploratory qualitative study, involving 30 in-depth interviews, was conducted between July 2022 and February 2023. Participants included a purposive sample of key stakeholders at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals) with sufficient knowledge, direct experience, and/or collaboration in the implementation of the studied interventions. Interviews were transcribed verbatim and coded using directed qualitative content analysis (CFIR constructs) in MAXQDA 18. Results: The identified challenges were: (1) individual level (childbirth preparation classes: e.g., adaptability, design quality and packaging, cosmopolitanism; presence of birth companions: e.g., patient needs and resources, structural characteristics, culture); (2) healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority, access to knowledge and information, reflecting and evaluating); (3) hospital level (evaluating the performance of maternity healthcare providers: e.g., executing, external policies and incentives); and (4) national health system level (implementation of pain relief during childbirth guidelines: e.g., networks and communications, patient needs and resources, executing, reflecting and evaluating). Conclusions: This study provides a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth and highlights potential implications for policy makers and practitioners of maternal health programs. We encourage them to take the lessons learned from this study and revise their current programs and policies regarding the quality of maternity care by focusing on the identified challenges. Plain English summary: Evidence suggests that mistreatment during childbirth is a growing concern worldwide, especially in developing countries, such as Iran. In this qualitative study, through 30 in-depth interviews with key stakeholders at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals), we identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the Consolidated Framework for Implementation Research (CFIR). The data were analyzed using directed content analysis and a deductive approach in MAXQDA 18 software. The identified challenges were: (1) individual level (childbirth preparation classes: e.g., adaptability; presence of birth companions: e.g., patient needs and resources); (2) healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority); (3) hospital level (evaluating the performance of maternity healthcare providers: e.g., executing, external policies and incentives); and (4) national health system level (implementation of pain relief childbirth guidelines: e.g., networks and communications). This study provides a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth; and highlights potential implications for policy makers and practitioners of maternal health programs. [ABSTRACT FROM AUTHOR]

Background: Globally, disrespectful, and abusive childbirth practices negatively impact women's health, create barriers to accessing health facilities, and contribute to poor birth experiences and adverse outcomes for both mothers and newborns. However, the degree to which disrespectful maternity care is associated with complications during childbirth is poorly understood, particularly in Ethiopia. Aim: To determine the extent to which disrespectful maternity care is associated with maternal and neonatal-related complications in central Ethiopia. Methods: A multicentre cross-sectional study was conducted in the West Shewa Zone of Oromia, Ethiopia. The sample size was determined using the single population proportion formula. Participants (n = 440) were selected with a simple random sampling technique using computer-generated random numbers. Data were collected through face-to-face interviews with a pretested questionnaire and were entered into Epidata and subsequently exported to STATA version 17 for the final analysis. Analyses included descriptive statistics and binary logistic regression, with a 95% confidence interval (CI) and an odds ratio (OR) of 0.05. Co-founders were controlled by adjusting for maternal sociodemographic characteristics. The primary exposure was disrespectful maternity care; the main outcomes were maternal and neonatal-related complications. Results: Disrespectful maternity care was reported by 344 women (78.2%) [95% CI: 74–82]. Complications were recorded in one-third of mothers (33.4%) and neonates (30%). Disrespectful maternity care was significantly associated with maternal (AOR = 2.22, 95% CI: 1.29, 3.8) and neonatal-related complications (AOR = 2.78, 95% CI: 1.54, 5.04). Conclusion: The World Health Organization advocates respectful maternal care during facility-based childbirth to improve the quality of care and outcomes. However, the findings of this study indicated high mistreatment and abuse during childbirth in central Ethiopia and a significant association between such mistreatment and the occurrence of both maternal and neonatal complications during childbirth. Therefore, healthcare professionals ought to prioritise respectful maternity care to achieve improved birth outcomes and alleviate mistreatment and abuse within the healthcare sector. [ABSTRACT FROM AUTHOR]

Background: In the Australian maternity system, general practitioners play a vital role in advising and directing prospective parents to maternity models of care. Optimising model of care discussions and the decision-making process avoids misaligning women with over or under specialised care, reduces the potential for disruptive care transitions and unnecessary healthcare costs, and is critical in ensuring consumer satisfaction. Current literature overwhelmingly focusses on women's decision-making around model of care discussions and neglects the gatekeeping role of the General Practitioner (GP). This study aimed to explore and describe the factors influencing Australian GPs decision-making when referring pregnant women to maternity models of care. Methods: This study used a qualitative descriptive approach. General practitioners (N = 12) with experience referring women to maternity models of care in Australia participated in a semi-structured interview. Interviews occurred between October and November 2021 by telephone or videoconference. Reflexive thematic analysis was facilitated by NVivo-12 data management software to codify and interpret themes from the data. Findings: Two broad themes were interpreted from the data. The first theme entitled 'GP Factors', incorporated three associated sub-themes including '1) GPs Previous Model of Care Experience', '2) Gaps in GP Knowledge' and '3) GP Perception of Models of Care'. The second theme, entitled 'Woman's Factors', encapsulated two associated sub-themes including the '4) Woman's Preferences' and '5) Access to Models'. Conclusions: This study provides novel evidence regarding general practitioner perspectives of the factors influencing model of care decision-making and referral. Predominant findings suggest that gaps in GP knowledge regarding the available models of care are present and are largely informed by prior personal and professional experience. Most GPs described referring to models of care they perceive positively and centring their model of care discussions on the woman's preferences and accessibility. The exploration and description of factors influencing model of care decisions provide unique insight into the ways that all stakeholders can experience access to a broader range of models of care including midwifery-led continuity of care models aligned with consumer-demand. In addition, the role of national primary health networks is outlined as a means to achieving this. [ABSTRACT FROM AUTHOR]

Background: A birth companion is a powerful mechanism for preventing mistreatment during childbirth and is a key component of respectful maternity care (RMC). Despite a growing body of evidence supporting the benefits of birth companions in enhancing the quality of care and birth experience, the successful implementation of this practice continues to be a challenge, particularly in developing countries. Our aim was to investigate the acceptability, adoption, appropriateness, feasibility, and fidelity of implementation strategies for birth companions to mitigate the mistreatment of women during childbirth in Tehran. Methods: This exploratory descriptive qualitative study was conducted between April and August 2023 at Valiasr Hospital in Tehran, Iran. Fifty-two face-to-face in-depth interviews were conducted with a purposive sample of women, birth companions, and maternity healthcare providers. Interviews were audio-recorded, transcribed verbatim, and analyzed using content analysis, with a deductive approach based on the Implementation Outcomes Framework in the MAXQDA 18. Results: Participants found the implemented program to be acceptable and beneficial, however the implementation team noticed that some healthcare providers were initially reluctant to support it and perceived it as an additional burden. However, its adoption has increased over time. Healthcare providers felt that the program was appropriate and feasible, and it improved satisfaction with care and the birth experience. Participants, however, highlighted several issues that need to be addressed. These include the need for training birth companions prior to entering the maternity hospital, informing women about the role of birth companions, assigning a dedicated midwife to provide training, and addressing any physical infrastructure concerns. Conclusion: Despite some issues raised by the participants, the acceptability, adoption, appropriateness, feasibility, and fidelity of the implementation strategies for birth companions to mitigate the mistreatment of women during childbirth were well received. Future research should explore the sustainability of this program. The findings of this study can be used to support the implementation of birth companions in countries with comparable circumstances. [ABSTRACT FROM AUTHOR]

Background: Assessing women's perceptions of the care they receive is crucial for evaluating the quality of maternity care. Women's perceptions are influenced by the care received during pregnancy, labour and birth, and the postpartum period, each of which with unique conditions, expectations, and requirements. In England, three Experience of Maternity Care (EMC) scales – Pregnancy, Labour and Birth, and Postnatal – have been developed to assess women's experiences from pregnancy through the postpartum period. This study aimed to validate these scales within the Iranian context. Methods: A methodological cross-sectional study was conducted from December 2022 to August 2023 at selected health centers in Tabriz, Iran. A panel of 16 experts assessed the qualitative and quantitative content validity of the scales and 10 women assessed the face validity. A total of 540 eligible women, 1–6 months postpartum, participated in the study, with data from 216 women being used for exploratory factor analysis (EFA) and 324 women for confirmatory factor analysis (CFA) and other analyses. The Childbirth Experience Questionnaire-2 was employed to assess the convergent validity of the Labour and Birth Scale, whereas women's age was used to assess the divergent validity of the scales. Test-retest reliability and internal consistency were also examined. Results: All items obtained an impact score above 1.5, with Content Validity Ratio and Content Validity Index exceeding 0.8. EFA demonstrated an excellent fit with the data (all Kaiser-Meyer-Olkin measures > 0.80, and all Bartlett's p < 0.001). The Pregnancy Scale exhibited a five-factor structure, the Labour and Birth Scale a two-factor structure, and the Postnatal Scale a three-factor structure, explaining 66%, 57%, and 62% of the cumulative variance, respectively, for each scale. CFA indicated an acceptable fit with RMSEA ≤ 0.08, CFI ≥ 0.92, and NNFI ≥ 0.90. A significant correlation was observed between the Labour and Birth scale and the Childbirth Experience Questionnaire-2 (r = 0.82, P < 0.001). No significant correlation was found between the scales and women's age. All three scales demonstrated good internal consistency (all Cronbach's alpha values > 0.9) and test-retest reliability (all interclass correlation coefficient values > 0.8). Conclusions: The Persian versions of all three EMC scales exhibit robust psychometric properties for evaluating maternity care experiences among urban Iranian women. These scales can be utilized to assess the quality of current care, investigate the impact of different care models in various studies, and contribute to maternal health promotion programs and policies. [ABSTRACT FROM AUTHOR]

Background: Despite the resources and personnel mobilized in Latin America and the Caribbean to reduce the maternal mortality ratio (MMR, maternal deaths per 100 000 live births) in women aged 10–54 years by 75% between 2000 and 2015, the region failed to meet the Millenium Development Goals (MDGs) due to persistent barriers to access quality reproductive, maternal, and neonatal health services. Methods: Using 1990–2019 data from the Global Burden of Disease project, we carried out a two-stepwise analysis to (a) identify the differences in the MMR temporal patterns and (b) assess its relationship with selected indicators: government health expenditure (GHE), the GHE as percentage of gross domestic product (GDP), the availability of human resources for health (HRH), the coverage of effective interventions to reduce maternal mortality, and the level of economic development of each country. Findings: In the descriptive analysis, we observed a heterogeneous overall reduction of MMR in the region between 1990 and 2019 and heterogeneous overall increases in the GHE, GHE/GDP, and HRH availability. The correlation analysis showed a close, negative, and dependent association of the economic development level between the MMR and GHE per capita, the percentage of GHE to GDP, the availability of HRH, and the coverage of SBA. We observed the lowest MMRs when GHE as a percentage of GDP was close to 3% or about US$400 GHE per capita, HRH availability of 6 doctors, nurses, and midwives per 1,000 inhabitants, and skilled birth attendance levels above 90%. Conclusions: Within the framework of the Sustainable Development Goals (SDGs) agenda, health policies aimed at the effective reduction of maternal mortality should consider allocating more resources as a necessary but not sufficient condition to achieve the goals and should prioritize the implementation of new forms of care with a gender and rights approach, as well as strengthening actions focused on vulnerable groups. [ABSTRACT FROM AUTHOR]

Background: Access to maternity care in the U.S. remains inequitable, impacting over two million women in maternity care "deserts." Living in these areas, exacerbated by hospital closures and workforce shortages, heightens the risks of pregnancy-related complications, particularly in rural regions. This study investigates travel distances and time to obstetric hospitals, emphasizing disparities faced by those in maternity care deserts and rural areas, while also exploring variances across races and ethnicities. Methods: The research adopted a retrospective secondary data analysis, utilizing the American Hospital Association and Centers for Medicaid and Medicare Provider of Services Files to classify obstetric hospitals. The study population included census tract estimates of birthing individuals sourced from the U.S. Census Bureau's 2017-2021 American Community Survey. Using ArcGIS Pro Network Analyst, drive time and distance calculations to the nearest obstetric hospital were conducted. Furthermore, Hot Spot Analysis was employed to identify areas displaying significant spatial clusters of high and low travel distances. Results: The mean travel distance and time to the nearest obstetric facility was 8.3 miles and 14.1 minutes. The mean travel distance for maternity care deserts and rural counties was 28.1 and 17.3 miles, respectively. While birthing people living in rural maternity care deserts had the highest average travel distance overall (33.4 miles), those living in urban maternity care deserts also experienced inequities in travel distance (25.0 miles). States with hotspots indicating significantly higher travel distances included: Montana, North Dakota, South Dakota, and Nebraska. Census tracts where the predominant race is American Indian/Alaska Native (AIAN) had the highest travel distance and time compared to those of all other predominant races/ethnicities. Conclusions: Our study revealed significant disparities in obstetric hospital access, especially affecting birthing individuals in maternity care deserts, rural counties, and communities predominantly composed of AIAN individuals, resulting in extended travel distances and times. To rectify these inequities, sustained investment in the obstetric workforce and implementation of innovative programs are imperative, specifically targeting improved access in maternity care deserts as a priority area within healthcare policy and practice. [ABSTRACT FROM AUTHOR]

Trauma exposure is associated with numerous negative outcomes, many of which are amplified within at-risk populations. Two under-researched and at-risk populations, incarcerated women and perinatal women, both report high rates of trauma, psychopathology, and PTSD compared to the general population. One common measure of trauma exposure in various populations, including incarcerated women and perinatal women, is the Trauma History Questionnaire (THQ). However, no known studies have validated the THQ within these two unique, understudied populations. Using data from two studies of incarcerated women and one study of perinatal women, researchers explored indices of THQ construct, predictive, and convergent validity. The study also included between-sample comparisons, highlighting differences in trauma incidence between the included samples. Analyses supported statistically significant relations between THQ scores and Severity of Violence Against Women Scale (SVAWS), depressive symptoms, PTSD, and psychological distress. Prenatal women's THQ scores were also predictive of later postpartum depressive symptoms. Significantly higher THQ scores were found within the incarcerated samples compared to the perinatal sample. The study results provide further information about trauma within incarcerated and perinatal populations, as well as increase understanding of the utility of trauma assessments within these vulnerable groups. [ABSTRACT FROM AUTHOR]

U.S. veterans of childbearing age represent one of the fastest growing populations using Veterans Affairs (VA) health care. The VA does not provide obstetric care directly but pays for VA-enrolled veterans to obtain outside obstetric care. The VA also provides maternity care coordination (MCC) services, including lactation support. Breastfeeding benefits mothers and babies; however, previous research shows that veteran mothers quit exclusive breastfeeding earlier than the American Academy of Pediatrics and World Health Organization recommendation of 6 months. This study aimed to understand facilitators and barriers to breastfeeding among a cohort of veterans who used VA maternity care benefits. Qualitative data from an open-ended question from a national sample of postpartum veterans using VA pregnancy benefits were coded using deductive and inductive content analysis within a matrix framework. Quantitative data were used to contextualize the responses. Four themes emerged from the data: (1) impacts on health of baby/mother; (2) the ability to breastfeed; (3) early postnatal experiences breastfeeding; and (4) cost/convenience. Among those who responded to the open-ended breastfeeding question (329/669), most participants (n = 316; 96%) attempted breastfeeding their current baby. Respondents who did not initiate breastfeeding or who discontinued breastfeeding earlier than planned cited diverse reasons. These included low milk supply, poor latch, nipple pain, mental health factors, and low confidence in their ability to continue breastfeeding. Participants cited the MCC program as a facilitator to breastfeeding, and non-VA hospital experiences were mentioned as barriers. Veterans in this cohort of 329 veterans who responded to an open-ended breastfeeding question wanted and attempted to breastfeed; however, barriers such as lactation challenges and unsupportive health care providers made it difficult to continue the practice. As the MCC program grows to include more lactation professionals, MCCs may address barriers such as lactation challenges and unsupportive non-VA health care providers. Further program development should focus on addressing these challenges prenatally. [ABSTRACT FROM AUTHOR]

We assessed awareness of the maternal health benefits of lactation among a sample of nulliparous pregnant individuals in the United States, identified variables associated with awareness of these benefits, and examined whether awareness of these benefits impacts breastfeeding attitudes or intentions. We administered a web-based survey to nulliparous U.S.-born individuals carrying a singleton gestation of at least 28 weeks. We assessed awareness of the maternal health benefits of lactation using 10 items to create a summative score. We examined variation in awareness of these benefits by demographic characteristics, health insurance, and personal or family health history and used multivariable models to estimate associations between awareness of the maternal health benefits of lactation and breastfeeding intentions. Of the 675 individuals invited to complete surveys, 451 (67%) responded. Only 50% were aware that breastfeeding lowers maternal risk of breast cancer; fewer were aware that breastfeeding lowers the risk of ovarian cancer (35%), diabetes (27%), and hypertension and heart disease (26%). Awareness of the maternal benefits of lactation did not vary by age or race/ethnicity. However, significant regional variation was noted. In multivariable models, scores of awareness of the maternal health benefits of breastfeeding were significantly associated with intentions to breastfeed for at least 12 months (adjusted odds ratio, 1.23; 95% confidence interval, 1.11, 1.37). Efforts to increase awareness of the maternal health benefits of lactation are still needed. Increasing awareness of the maternal health benefits of lactation may strengthen intentions to breastfeed as recommended. [ABSTRACT FROM AUTHOR]

Breastfeeding provides physical, psychological, and immunological benefits to both the mother and infant, but breastfeeding rates are suboptimal. The purpose of this study was to examine whether residing in a maternity care desert (a county with no hospital offering obstetric care and no OB/GYN or certified nurse midwife providers) was associated with lower breastfeeding rates among birthing people in Louisiana from 2019 to 2020. Data provided by the March of Dimes were used to classify Louisiana parishes by level of access to maternity care. Using data on all live births provided by the Louisiana Office of Vital Records (n = 112,151), we fit adjusted modified Poisson regression models with generalized estimating equations and exploratory geospatial analysis to examine the association between place of residence and breastfeeding initiation and racial disparities in initiation. We conducted a secondary within-group analysis by fitting the fully adjusted model stratified by race/ethnicity for non-Hispanic white and non-Hispanic Black birthing people. We found that residing in a parish with limited (odds ratio [OR] = 0.87; 95% confidence interval [CI] [0.77, 0.99]) to no access (OR = 0.88; 95% CI [0.80, 0.97]) was significantly associated with lower breastfeeding initiation rates. The within-group analysis determined that both non-Hispanic Black and non-Hispanic white birthing people residing in a parish with limited or no maternity care access had lower breastfeeding initiation rates. Reducing rural and racial inequities in breastfeeding may require structural changes and investments in infrastructure to deliver pregnancy care. [ABSTRACT FROM AUTHOR]

Objectives. To examine the accessibility of hospital facilities with maternity care services in 1 rural county in Alabama in preparation for the initiation of prenatal care services at a federally qualified health center. Methods. We analyzed driving distance (in miles) from maternal city of residence in Conecuh County, Alabama to hospital of delivery, using 2019–2021 vital statistics data and geographic information system (GIS) software. Results. A total of 370 births to mothers who have home addresses in Conecuh County were reported, and 368 of those were in hospital facilities. The majority of deliveries were less than 30 miles (median = 23 miles) from the maternal city of residence. Some women traveled more than 70 miles for obstetrical care. Conclusions. Pregnant patients in Conecuh County experience significant geographic barriers related to perinatal care access. Using GIS for this analysis is a promising approach to better understand the unique challenges of pregnant individuals in this rural population. Public health policy efforts need to be geographically tailored to address these disparities. (Am J Public Health. 2024;114(S4):S330–S333. https://doi.org/10.2105/AJPH.2024.307692) [ABSTRACT FROM AUTHOR]

The authors provide information on a training program developed by primary care training and enhancing staff in the Division of Medicine and Dentistry, Bureau of Health Workforce, Health Resources and Services Administration (HRSA) designed to integrate public health and primary care training. Topics discussed include the dual model of training, how the program can improve maternal health, and program activity.

Objective This study aimed to assess the association between active glycemic management and large for gestational age (LGA) neonates and cesarean delivery (CD) among pregnant women with impaired fasting glucose (IFG). Study Design Retrospective cohort study using electronic health record data of women with IFG who delivered at the Kaiser Permanente Northern California from 2012 to 2017. IFG was defined as isolated fasting glucose ≥95 mg/dL. Women with gestational diabetes mellitus (GDM) or in whom GDM could not be ruled out were excluded. Baseline and treatment characteristics, and pregnancy outcomes were compared among women with IFG who participated in telephonic home glucose monitoring and glycemic management through a centralized standardized program (participants) with those who did not participate (nonparticipants). The relative risks (RRs) of perinatal complications associated with participation versus nonparticipation were estimated with Poisson's regression models. Results We identified 1,584 women meeting inclusion criteria of whom 1,151 (72.7%) were participants and 433 (27.3%) were nonparticipants. There were no differences between groups in baseline characteristics or comorbidities, except for higher mean levels of fasting glucose (FG) at the time of IFG diagnosis in participants than in nonparticipants (98.9 vs. 98.0 mg/dL, p = 0.01). Participants received hypoglycemic medications more frequently than nonparticipants (68.2 vs. 0.9%, p < 0.01). The rate of LGA was significantly lower in participants compared with nonparticipants (19.1 vs. 25.0%, p = 0.01). After adjusting for age, race/ethnicity, education, body mass index, and level of FG impairment, the RR for LGA for participants compared with nonparticipants was 0.68, 95% CI: 0.55–0.84. The risk of CD did not differ significantly by participation status, in unadjusted or adjusted analyses. Conclusion Active standardized glycemic management was associated with a decreased risk of LGA for women with IFG. This finding supports an active glycemic management strategy for patients with IFG during pregnancy to reduce the risk of LGA, similar to GDM management. Key Points Pregnant women with IFG have increased rates of LGA. Active management of IFG is associated with a decreased LGA. Treatment of IFG like GDM may improve perinatal outcomes. [ABSTRACT FROM AUTHOR]

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

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

Background: Food taboos and cultural beliefs among pregnant and breast-feeding women influence their food consumption patterns and hence the health of women and unborn children. Cognizant of their neglect in programs aimed to ameliorate hidden hunger among pregnant and breast-feeding women in Buyende and other resource-poor communities in sub-Saharan Africa, we opted for a study to unravel them to inform program design. Methods: We documented food taboos and beliefs amongst pregnant and breast-feeding women from six sub-counties of Buyende district in Eastern Uganda. A mixed-methods approach was used, which was comprised of questionnaire interviews with 462 women, eight focus group discussions with 6–10 participants in each and a total of 15 key informant interviews. Results: The present study revealed that 129 (27.9%) of the respondents practice food taboos and adhere to cultural beliefs related to their dietary habits during pregnancy and breast-feeding that are fuelling the prevalence of hidden hunger. The most tabooed foods during pregnancy were sugarcane (17.8%), fishes which included lung fish, catfish and the Lake Victoria sardine (Rastrineobola argentea) (15.2%), oranges (6.6%), pineapples (5.9%), eggs (3.3%), chicken (3.3%) and cassava, mangoes and Cleome gynandra (each at 3%). Most foods were avoided for reasons associated with pregnancy and labour complications and undesirable effects on the baby. Most women learnt of the taboos and beliefs from the elders, their own mother, grandparents or mother-in-law, but there was also knowledge transmission in social groups within the community. Conclusions: The taboos and cultural beliefs in the study area render pregnant and breast-feeding women prone to micronutrient deficiency since they are denied consumption of a diversity of nutritious foods. There is a need to educate such women about consumption of nutrient-rich foods like fish, eggs, fruits and vegetables in order to improve their health, that of the unborn and children being breast fed. Additionally, culturally appropriate nutrition education may be a good strategy to eliminate inappropriate food taboos and beliefs with negative impact on the health of pregnant and breast-feeding women. [ABSTRACT FROM AUTHOR]

To investigate the clinical outcomes and Doppler patterns changes in monochorionic diamniotic (MCDA) twins with selective fetal growth restriction (sFGR). We retrospectively analyzed 362 sFGR cases from January 2010 to May 2016 at a single tertiary referral center. The Doppler waveforms of umbilical artery end-diastolic flow were collected, and all neonates were subjected to an early neonatal brain scan. A total of 66/100 (66 %) type I cases were stable, whereas 25/100 (25 %) cases changed to type II and 9/100 (9 %) changed to sFGR complicated twin-twin transfusion syndrome (TTTS). A total of 48.9 % (22/45) sFGR cases were complicated with polyhydramnios and 30.4 % (7/23) sFGR cases were complicated with oligohydramnios, both of which were progressed to sFGR with TTTS. Mild cerebral injury was significantly associated with Doppler flow abnormalities, earlier gestational age at delivery and type of sFGR diagnosis. Severe cerebral injury was significantly associated with gestational age at delivery (31.6 vs. 34.1, p=0.002) and larger birthweight discordance (43.9 vs. 29.3 %, p=0.011). Doppler patterns in sFGR can gradually change, with important consequences with regard to management and outcomes. Along with abnormal Doppler findings, earlier occurrence of sFGR and delivery are associated with subsequent neonatal cerebral injury. [ABSTRACT FROM AUTHOR]

Background: Among hypertensive disorders of pregnancy (HDP), eclampsia is a rare but serious event, often considered avoidable. Detailed assessment of the adequacy of care for the women who have eclampsia can help identify opportunities for improvement and for prevention of the associated adverse maternal and neonatal outcomes. Objective: 1/ To estimate the incidence and describe the characteristics of women with eclampsia and to compare them with those of women with non-eclamptic hypertensive disorders of pregnancy (HDP)-related severe maternal morbidity (SMM) and of control women without SMM 2/ To analyse the quality of management in women who had eclampsia, at various stages of their care pathway. Methods: It was a planned ancillary analysis of the EPIMOMS population-based study, conducted in six French regions in 2012–2013. Among the 182,309 maternities of the source population, all women with eclampsia (n = 51), with non-eclamptic HDP-related SMM (n = 351) and a 2% representative sample of women without SMM (n = 3,651) were included. Main outcome was the quality of care for eclampsia assessed by an independent expert panel at three different stages of management: antenatal care, care for pre-eclampsia and care for eclampsia. Results: The eclampsia incidence was 2.8 per 10,000 (95%CI 2.0–4.0). Antenatal care was considered completely inadequate or substandard in 39% of women, as was pre-eclampsia care in 76%. Care for eclampsia was judged completely inadequate or substandard in 50% (21/42), mainly due to inadequate use of magnesium sulphate. Conclusion: The high proportion of inadequate quality of care underlines the need for an evidence-based standardisation of care for HDP. [ABSTRACT FROM AUTHOR]

Background: The burden of maternal and child mortality is high in the Democratic Republic of the Congo (DRC). While health workers (HWs) with adequate knowledge and practice of maternal and child health (MCH) are crucial to reduce this burden, the skill level of HWs in charge of MCH in the DRC is currently insufficient. This study aimed to assess the knowledge and practice of HWs towards MCH in Kasai and Maniema, two DRC provinces with very high maternal mortality ratios and under-5 mortality rates. Methods: This cross-sectional study was conducted in 96 health facilities of Kasai and Maniema provinces in 2019. All HWs in charge of MCH were eligible for the study. Data were collected using a structured questionnaire containing 76 questions on knowledge and practice of MCH. Analyses were performed using the Wilcoxon-Mann-Whitney test, Kendall's correlation test, and a multivariate linear mixed regression model. Results: Among participating HWs, 42.6% were A2 nurses (lowest qualification), 81.9% had no up-to-date training in MCH, and 48.4% had only 1-5 years of experience in MCH. In the two provinces combined, about half of HWs had poor knowledge (50.6%) and poor practice (53.3%) of MCH. Knowledge and practice scores were higher in Maniema than in Kasai (P < 0.001). Good knowledge and practice scores were significantly associated with high qualification (P = 0.001), continuing up-to-date training in MCH (P = 0.009), and 6 years of experience or more in MCH (P = 0.01). Conclusion: In Maniema and Kasai provinces, about half of HWs had poor knowledge and poor practice of MCH. The conversion of A1 nurses into midwives as well as the provision of up-to-date training in MCH, supervision, and mentorship could improve the skill level of HWs and could thus reduce the burden of MCH in the DRC. Plain Language summary: This study assessed the knowledge and practice of health workers (HWs) towards maternal and child health (MCH) in Kasai and Maniema, two provinces of the Democratic Republic of the Congo (DRC) with very high maternal and child mortality rates. About half of surveyed HWs had poor knowledge and poor practice of MCH. Good knowledge and good practice were associated with high qualification, up-to-date training, and 6 years of experience or more in MCH. The conversion of A1 nurses into midwives as well as the provision of up-to-date training in MCH, supervision, and mentorship could improve the skill level of HWs and could thus reduce the burden of MCH in the DRC. [ABSTRACT FROM AUTHOR]

Numerous initiatives at the national, state, and local levels are focused on addressing the U.S. maternal health crisis. However, most efforts fail to center women's voices and personal perspectives about pregnancy experiences and complications. This article describes the Illinois Maternal Health Digital Storytelling Project conducted by the University of Illinois at Chicago, in partnership with StoryCenter, a storytelling nonprofit organization based in Berkeley, California. The project aimed to elevate voices (stories) to complement other sources of data on maternal outcomes. We relied on partners to help recruit storytellers with a self-identified perinatal-related challenge. We screened interested individuals using a trauma-informed approach and a social worker provided storytellers with support during the project. Two groups participated in this project, one in 2021 and another in 2022, culminating with 10 digital stories. Both instances were conducted virtually and included group and individual skills-based sessions where storytellers learned to create and edit their digital stories. The storytellers own their digital stories and provided consent to include them in ongoing dissemination efforts. In September 2021, a webpage was launched to house the stories, and this resource is being shared widely. Evaluation efforts of the webpage are ongoing to understand how these digital stories are being used to inform maternal health efforts. Digital stories add richness to ongoing maternal health prevention work and may serve as a powerful tool to elicit understanding among providers, practitioners, and constituents. [ABSTRACT FROM AUTHOR]

This article provides an overview of the use of digitally enabled programmes to support perinatal mental healthcare in the NHS in Scotland, focusing on the Perinatal Wellbeing Programme from SilverCloud®. This follow up to a previous article published in the British Journal of Midwifery considers the experiences of using this programme in a Scottish context, examining feedback from users of the intervention. [ABSTRACT FROM AUTHOR]

How a woman experiences birth is influenced by how she is treated, and who has power and control in the birthing environment. Focus on 'delivery' of an infant disregards the transformative event for the woman, with poorer physical and psychological outcomes. New evidence is needed to understand how to prevent trauma and improve maternal wellbeing. This paper presents a feminist methodology to view the lived experience of caesarean birth. Feminist birthing theories integrated with a phenomenological perspective provide insight for those working in maternity care and create a novel framework for researchers considering the position of women in a medicalised healthcare system. Feminist phenomenology with a theoretical feminist overlay refreshes the methodological framework for a new understanding of how this perinatal event impacts women. [ABSTRACT FROM AUTHOR]

Background/Aims 'Labour hopscotch' is a visual tool that encourages activity during pregnancy and childbirth. It has been used in one advanced midwife practitioner service since 2017 and more widely across in Ireland since 2020. The biomechanics for birth toolkit was added to advanced midwife practitioner care in 2022. This study's aim was to ascertain if the biomechanics for birth toolkit impacted gestation of spontaneous onset of labour rates and birth outcomes. Methods A retrospective study of onset of labour and birth outcomes was conducted for women before (n=155) and after (n=154) the biomechanics for birth toolkit was incorporated into care. Results Before the toolkit was included, there was a 57.2% spontaneous onset of labour rate, with 33.2% birthing before 41 weeks. After the kit's inclusion, there was a 72.2% spontaneous onset of labour, with 91.8% birthing before 41 weeks. Induction rates dropped from 42.8% to 27.8%, with emergency caesarean section rates following induction dropping from 33.1% to 23.8%. Conclusions Using the biomechanics for birth toolkit alongside the labour hopscotch tool could increase spontaneous onset of labour rates, optimise physiological birth, reduce inductions and emergency caesarean section following induction. [ABSTRACT FROM AUTHOR]

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

Objective Evidence is inconsistent regarding grand multiparity and its association with adverse obstetric outcomes. Few large American cohorts of grand multiparas have been studied. We assessed if increasing parity among grand multiparas is associated with increased odds of adverse perinatal outcomes. Study Design Multicenter retrospective cohort of patients with parity ≥ 5 who delivered a singleton gestation in New York City from 2011 to 2019. Outcomes included postpartum hemorrhage, preterm delivery, hypertensive disorders of pregnancy, shoulder dystocia, birth weight > 4,000 and <2,500 g, and neonatal intensive care unit (NICU) admission. Parity was analyzed continuously, and multivariate analysis determined if increasing parity and other obstetric variables were associated with each adverse outcome. Results There were 2,496 patients who met inclusion criteria. Increasing parity among grand multiparas was not associated with any of the prespecified adverse outcomes. Odds of postpartum hemorrhage increased with history (adjusted odds ratio [aOR]: 2.65, 95% confidence interval [1.83, 3.84]) and current cesarean delivery (aOR: 4.59 [3.40, 6.18]). Preterm delivery was associated with history (aOR: 12.36 [8.70–17.58]) and non-White race (aOR: 1.90 [1.27, 2.84]). Odds of shoulder dystocia increased with history (aOR: 5.89 [3.22, 10.79]) and birth weight > 4,000 g (aOR: 9.94 [6.32, 15.65]). Birth weight > 4,000 g was associated with maternal obesity (aOR: 2.92 [2.22, 3.84]). Birth weight < 2,500 g was associated with advanced maternal age (aOR: 1.69 [1.15, 2.48]), chronic hypertension (aOR: 2.45 [1.32, 4.53]), and non-White race (aOR: 2.47 [1.66, 3.68]). Odds of hypertensive disorders of pregnancy increased with advanced maternal age (aOR: 1.79 [1.25, 2.56]), history (aOR: 10.09 [6.77–15.04]), and non-White race (aOR: 2.79 [1.95, 4.00]). NICU admission was associated with advanced maternal age (aOR: 1.47 [1.06, 2.02]) and non-White race (aOR: 2.57 [1.84, 3.58]). Conclusion Among grand multiparous patients, the risk factor for adverse maternal, obstetric, and neonatal outcomes appears to be occurrence of those adverse events in a prior pregnancy and not increasing parity itself. Key Points Increasing parity is not associated with adverse obstetric outcomes among grand multiparas. Prior adverse pregnancy outcome is a risk factor for the outcome among grand multiparas. Advanced maternal age is associated with adverse obstetric outcomes among grand multiparas. [ABSTRACT FROM AUTHOR]

Objective We examined mode of delivery among pregnant women with epilepsy (PWWE) versus pregnant controls (PC). We hypothesize that PWWE are more likely to deliver by cesarean. Study Design The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is an observational, prospective, multicenter investigation of pregnancy outcomes funded by the National Institute of Health (NIH). MONEAD enrolled patients from December 2012 through January 2016. PWWE were matched to PC in a case:control ratio of 3:1. This analysis had 80% power to detect a 36% increase in cesarean frequency assuming a baseline rate of 30% among PC at an α = 0.05. Results This report analyzed 331 PWWE (76%) and 102 PC (24%) who gave birth while enrolled in the study. PWWE and PC had similar rates of cesarean delivery (34.7 vs. 28.6%; p = 0.27). Of women with cesarean, rates of cesarean without labor were similar between groups for those delivering in recruitment hospitals (48.2 vs. 50.0%) but in nonrecruitment hospitals, cesarean rates without labor were over two-fold higher among PWWE than those of PC (68.8 vs. 30.8%; p = 0.023). Receipt of a cesarean after labor did not differ for PWWE compared to PC or by type of antiepileptic drug among the PWWE. Conclusion These findings suggest that the obstetrical experiences of PWWE and PC are similar. An interesting deviation from this observation was the mode of delivery with higher unlabored cesarean rates occurring among PWWE in nonrecruitment hospitals. As the study recruitment hospitals were tertiary academic centers and nonrecruitment hospitals tended to be community-based institutions, differences in perinatal expertise might contribute to this difference. Key Points Unlabored cesarean rates higher among women with epilepsy. Provider preference may influence delivery mode among women with epilepsy. Type and amount of antiepileptic drug was not associated with mode of delivery. [ABSTRACT FROM AUTHOR]

Purpose: Perinatal intimate partner violence (IPV) is a prevalent problem in Peru, but no evidence-based interventions have been developed to address the needs of Peruvian pregnant women exposed to IPV. The current qualitative study examined existing resources in Lima, Peru for IPV-exposed pregnant women, barriers to women's access to resources, and how to make a new intervention for these women accessible and responsive to their needs. Method: Using thematic analysis, the study analyzed qualitative focus groups data from healthcare providers (N = 11) and pregnant women (N = 14, 50% of whom had experienced perinatal IPV) in Lima. Results: Women used word of mouth from other women to determine which community resources were trustworthy. Obstacles to resource utilization included IPV-related barriers, emotional barriers, and lack of knowledge about, access to, and trust in community and legal resources. Participants discussed that future interventions for IPV-exposed pregnant women should provide information to bolster women's resilience across the lifespan, such as childhood education about safe sex and gender equality, and education in adulthood about safety planning for IPV, healthy relationships, and maternal health and infant care. To improve resource accessibility, participants described the importance of fostering trust among women and healthcare providers, providing childcare, transportation, and mental and physical health services at little to no cost. Conclusion: Study findings have important implications for mental health supports, women's access to information, and broader social efforts aimed at reducing perinatal IPV in Peru, especially the role of accessible community resources in fostering women's resilience. [ABSTRACT FROM AUTHOR]