Search

Purpose of reviewDepression during the perinatal or antenatal period affects at least 1 in 10 women worldwide, with long term health implications for the mother and child. Concurrently, there is increasing evidence associating maternal exposure to per- and poly-fluoroalkyl substances (PFAS) to adverse pregnancy outcomes. We reviewed the body of evidence examining both the associations between PFAS exposure and perturbations in the maternal metabolome, and the associations between the maternal metabolome and perinatal/antenatal depression. Through this, we sought to explore existing evidence of the perinatal metabolome as a potential mediation pathway linking PFAS exposure and perinatal/antenatal depression.Recent findingsThere are few studies examining the metabolomics of PFAS exposure-specifically in pregnant women-and the metabolomics of perinatal/antenatal depression, let alone studies examining both simultaneously. Of the studies reviewed (N = 11), the majority were cross sectional, based outside of the US, and conducted on largely homogenous populations. Our review identified 23 metabolic pathways in the perinatal metabolome common to both PFAS exposure and perinatal/antenatal depression. Future studies may consider findings from our review to conduct literature-derived hypothesis testing focusing on fatty acid metabolism, alanine metabolism, glutamate metabolism, and tyrosine metabolism when exploring the biochemical mechanisms conferring the risk of perinatal/antenatal depression due to PFAS exposure. We recommend that researchers also utilize heterogenous populations, longitudinal study designs, and mediation approaches to elucidate key pathways linking PFAS exposures to perinatal/antenatal depression.

IntroductionGlobalization has increased the importance of multicultural research to address health disparities and improve healthcare outcomes for underrepresented communities. The International Nursing Network for HIV Research (The Network) serves as a platform for researchers to collaborate on cross-cultural and cross-national HIV studies. This article discusses the Network's approach to overcoming barriers in multicultural and multinational research in a qualitative context.MethodsThe network created a protocol to guide decision-making throughout the translation process of qualitative data collected from participants in their native languages. The protocol includes aspects of why, when, what, who, how, where, and by what means the translation is completed.ResultsThe protocol has allowed researchers to enhance the validity, reliability, and cultural sensitivity of translation process, ensuring the clarity and impact of their research findings.DiscussionRigorous translation practices promote cross-cultural understanding and respect for participants' perspectives, fostering global collaborations and knowledge exchange.

BACKGROUND: Professional societies such as the American College of Obstetricians and Gynecologists (ACOG) promote the idea that postpartum care is an ongoing process where there is adequate opportunity to provide services and support. Nonetheless, in practice, the guidelines ask clinicians to perform more clinical responsibilities than they might be able to do with limited time and resources. METHODS: We conducted an online survey among practicing obstetric clinicians (obstetrician/gynecologists (OB/GYNs), midwives, and family medicine doctors) in California about their priorities and care practices for the first postpartum visit and explored how they prioritize multiple clinical responsibilities within existing time and resources. Between September 2023 and February 2024, 174 out of 229 eligible participants completed the survey, a 76% response rate. From a list of care components, we used descriptive statistics to identify those that were highly prioritized by most clinicians and those that were considered a priority by very few and examined the alignment between prioritized components and recommended care practices. RESULTS: Clinicians were highly invested in the care components that they rated as most important, indicating that they always check these components or assess them when they perceive patient need. Depression and anxiety, breast health/breast feeding issues, vaginal birth complications and family planning counseling were highly ranked components by all clinicians. In contrast, clinicians more often did not assess those care components that infrequently ranked highly among the priority listing, consisting mainly of social drivers of health such as screening and counseling for intimate partner violence, working conditions and food/housing insecurity. In both instances, we found little discordance between priorities and care practices. However, OB/GYNs and midwives differed in some care components that they prioritized highly. CONCLUSIONS: While there is growing understanding of how important professional society recommendations are for maternal-infant health, clinicians face barriers completing all recommendations, especially those components related to social drivers of health. However, what the clinicians do prioritize highly, they are likely to perform. Now that Medi-Cal (Medicaid) insurance is available in California for up to 12 months postpartum, there is a need to understand what care clinicians provide and what gaps remain.

IntroductionThe concept of patient-provider trust in prenatal adverse childhood experiences (ACEs) screening remains unexplored. This concept analysis illuminates the role of trust in prenatal ACE screening to improve patient-provider relationships, increase patient uptake of ACE screening, and ensure that ACE screening is implemented in a strengths-based, trauma-informed way.MethodsA concept analysis was conducted using the Rodgers' evolutionary method to define the antecedents, attributes, and consequences of this construct. The databases searched were PubMed, PsychInfo, and Scopus between 2010 and 2021. A total of 389 articles were retrieved using the search terms prenatal, adverse childhood experiences screening, adverse childhood experiences, and adverse childhood experiences questionnaire. Included articles for detailed review contained prenatal screening, trauma screening (ACE or other), trust or building trust between patient and health care provider, patient engagement, and shared decision making. Excluded articles were those not in the context of prenatal care and that were exclusively about screening with no discussion about the patient-provider relationship or patient perspectives. A total of 32 articles were reviewed for this concept analysis.ResultsWe define trust in prenatal ACE screening as a network of evidence-based attributes that include the timing of the screening, patient familiarity with the health care provider, cultural competence, demystifying trauma, open dialogue between the patient and health care provider, and patient comfort and respect.DiscussionThis concept analysis elucidates the importance of ACE screening and provides suggestions for establishing trust in the context of prenatal ACE screening. Results give insight and general guidance for health care providers looking to implement ACE screening in a trauma-informed way. Further research is needed to evaluate pregnant patients' attitudes toward ACE screening and how a health care provider's trauma history might influence their care. More inquiry is needed to understand the racial, ethnic, and cultural barriers to ACE screening.

ObjectiveWe sought to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on perinatal outcomes while accounting for maternal depression or perceived stress and to describe COVID-specific stressors, including changes in prenatal care, across specific time periods of the pandemic.Study designData of dyads from 41 cohorts from the National Institutes of Health Environmental influences on Child Health Outcomes Program (N = 2,983) were used to compare birth outcomes before and during the pandemic (n = 2,355), and a partially overlapping sample (n = 1,490) responded to a COVID-19 questionnaire. Psychosocial stress was defined using prenatal screening for depression and perceived stress. Propensity-score matching and general estimating equations with robust variance estimation were used to estimate the pandemic's effect on birth outcomes.ResultsSymptoms of depression and perceived stress during pregnancy were similar prior to and during the pandemic, with nearly 40% of participants reporting mild to severe stress, and 24% reporting mild depression to severe depression. Gestations were shorter during the pandemic (B =  - 0.33 weeks, p = 0.025), and depression was significantly associated with shortened gestation (B =  - 0.02 weeks, p = 0.015) after adjustment. Birth weights were similar (B =  - 28.14 g, p = 0.568), but infants born during the pandemic had slightly larger birth weights for gestational age at delivery than those born before the pandemic (B = 0.15 z-score units, p = 0.041). More women who gave birth early in the pandemic reported being moderately or extremely distressed about changes to their prenatal care and delivery (45%) compared with those who delivered later in the pandemic. A majority (72%) reported somewhat to extremely negative views of the impact of COVID-19 on their life.ConclusionIn this national cohort, we detected no effect of COVID-19 on prenatal depression or perceived stress. However, experiencing the COVID-19 pandemic in pregnancy was associated with decreases in gestational age at birth, as well as distress about changes in prenatal care early in the pandemic.Key points· COVID-19 was associated with shortened gestations.. · Depression was associated with shortened gestations.. · However, stress during the pandemic remained unchanged.. · Most women reported negative impacts of the pandemic..

BackgroundLabor epidural analgesia (LEA) may influence gut microbiota. We explored the association between LEA and gut microbiota for both mothers and their newborns.MethodsIn this prospective cohort study, parturients aged 25-35 years with a gestational age of 37-42 weeks and planned vaginal delivery were recruited. Twenty-one parturients received LEA (the LEA group), and 24 did not (the control group). Maternal and neonatal fecal samples were collected, and the gut microbiota profiles were analyzed using the 16S rRNA gene sequencing. The impact of LEA on gut microbiota was assessed using the general liner models.ResultsWe showcased the gut microbiota profile from the phyla to species levels based on data on 45 mother-newborn dyads. The results of α- and β-diversity suggested significant changes in gut microbiota between the LEA and control groups. After adjusting for baseline confounders, the administration of LEA had positive correlations with R. ilealis (β = 91.87, adjusted P = 0.007) in mothers; LEA also had negative correlations with A. pittii (β = -449.36, adjusted P = 0.015), P. aeruginosa (β = -192.55, adjusted P = 0.008), or S. maltophilia (β = -142.62, adjusted P = 0.001) in mothers, and with Muribaculaceae (β = -2702.77, adjusted P = 0.003) in neonates.ConclusionLEA was associated with changes in maternal and neonatal gut microbiota, and future studies are still required to assess their impact on clinical outcomes and explore the mechanisms.

BACKGROUND: Health disparities in osteoarthritis (OA) outcomes exist both in the occurrence and treatment of functional limitation and disability for Mexican Americans. Although the effect of self-management of chronic illness is well established, studies demonstrate little attention to self-management of function or disability, despite the strong potential effect on both and, consequently, on patients' lives. OBJECTIVE: The purpose of this study pilot was to develop and test key variable relationships for a measure of disability self-management among Mexican Americans. METHODS: In this sequential, two-phased, mixed-methods, biobehavioral pilot study of Mexican American women and men with OA, a culturally tailored measure of disability self-management was created, and initial relationships among key variables were explored. RESULTS: First, a qualitative study of 19 adults of Mexican American descent born in Texas (United States) or Mexico was conducted. The Mexican American Disability Self-Management Scale was created using a descriptive content analysis of interview data. The scale was tested and refined, resulting in 18 items and a descriptive frequency of therapeutic management efforts. Second, correlations between study variables were estimated: Disability and function were negatively correlated. Disability correlated positively with social support and activity effort. Disability correlated negatively with disability self-management, pain, and C-reactive protein. Function was positively correlated with age, pain, and depression. Liver enzymes (alanine transaminase) correlated positively with pain and anxiety. DISCUSSION: This mixed-methods study indicates directions for further testing and interventions for disability outcomes among Mexican Americans.

ObjectiveThis study aimed to evaluate the incidence of brachial plexus birth injury (BPBI) and its associations with maternal demographic factors. Additionally, we sought to determine whether longitudinal changes in BPBI incidence differed by maternal demographics.Study designWe conducted a retrospective cohort study of over 8 million maternal-infant pairs using California's Office of Statewide Health Planning and Development Linked Birth Files from 1991 to 2012. Descriptive statistics were used to determine BPBI incidence and the prevalence of maternal demographic factors (race, ethnicity, age). Multivariable logistic regression was used to determine associations of year, maternal race, ethnicity, and age with BPBI. Excess population-level risk associated with these characteristics was determined by calculating population attributable fractions.ResultsThe incidence of BPBI between 1991 and 2012 was 1.28 per 1,000 live births, with peak incidence of 1.84 per 1,000 in 1998 and low of 0.9 per 1,000 in 2008. Incidence varied by demographic group, with infants of Black (1.78 per 1,000) and Hispanic (1.34 per 1,000) mothers having higher incidences compared with White (1.25 per 1,000), Asian (0.8 per 1,000), Native American (1.29 per 1,000), other race (1.35 per 1,000), and non-Hispanic (1.15 per 1,000) mothers. After controlling for delivery method, macrosomia, shoulder dystocia, and year, infants of Black (adjusted odds ratio [AOR] = 1.88, 95% confidence interval [CI] = 1.70, 2.08), Hispanic (AOR = 1.25, 95% CI = 1.18, 1.32), and advanced-age mothers (AOR = 1.16, 95% CI = 1.09, 1.25) were at increased risk. Disparities in risk experienced by Black, Hispanic, and advanced-age mothers contributed to a 5, 10, and 2% excess risk at the population level, respectively. Longitudinal trends in incidence did not vary among demographic groups. Population-level changes in maternal demographics did not explain changes in incidence over time.ConclusionAlthough BPBI incidence has decreased in California, demographic disparities exist. Infants of Black, Hispanic, and advanced-age mothers are at increased BPBI risk compared with White, non-Hispanic, and younger mothers.Key points· The incidence of BPBI has decreased over time.. · Demographic disparities in BPBI incidence and risk exist.. · Infants of Black, Hispanic, and advanced age mothers are at greatest risk of BPBI..

ObjectiveOur objective was to gauge adherence to nationally endorsed protocols in implementation of pulse oximetry (POx) screening for critical congenital heart disease (CCHD) in infants after mandate by all states and to assess associated characteristics.Study designBetween March and October 2019, an online questionnaire was administered to nurse supervisors who oversee personnel conducting POx screening. The questionnaire used eight questions regarding performance and interpretation of screening protocols to measure policy consistency, which is adherence to nationally endorsed protocols for POx screening developed by professional medical societies. Multilevel linear regression models evaluated associations between policy consistency and characteristics of hospitals and individuals, state of hospital location, early versus late mandate adopters, and state reporting requirements.ResultsResponses from 189 nurse supervisors spanning 38 states were analyzed. Only 17% received maximum points indicating full policy consistency, and 24% selected all four options for potential hypoxia that require a repeat screen. Notably, 33% did not recognize ≤90% SpO2 as an immediate failed screen and 31% responded that an infant with SpO2 of 89% in one extremity will be rescreened by nurses in an hour rather than receiving an immediate physician referral. Lower policy consistency was associated with lack of state reporting mandates (beta = -1.23 p = 0.01) and early adoption by states (beta = -1.01, p

IntroductionPostpartum health is in crisis in the United States, with rising pregnancy-related mortality and worsening racial inequities. The World Health Organization recommends four postpartum visits during the 6 weeks after childbirth, yet standard postpartum care in the United States is generally one visit 6 weeks after birth. We present community midwifery postpartum care in the United States as a model concordant with World Health Organization guidelines, describing this model of care and its potential to improve postpartum health for birthing people and babies.MethodsWe conducted semi-structured interviews with 34 community midwives providing care in birth centers and home settings in Oregon and California. A multidisciplinary team analyzed data using reflexive thematic analysis.ResultsA total of 24 participants were Certified Professional Midwives; 10 were certified nurse-midwives. A total of 14 midwives identified as people of color. Most spoke multiple languages. We describe six key elements of the community midwifery model of postpartum care: (1) multiple visits, including home visits; typically five to eight over six weeks postpartum; (2) care for the parent-infant dyad; (3) continuity of personalized care; (4) relationship-centered care; (5) planning and preparation for postpartum; and (6) focus on postpartum rest.ConclusionThe community midwifery model of postpartum care is a guideline-concordant approach to caring for the parent-infant dyad and may address rising pregnancy-related morbidity and mortality in the United States.

ObjectiveThe vast majority of the 300 000 pregnancy-related deaths every year occur in South Asia and sub-Saharan Africa. Increased access to quality antepartum and intrapartum care can reduce pregnancy-related morbidity and mortality worldwide. We used a population-based cross-sectional cohort design to: (1) examine the sociodemographic risk factors and structural barriers associated with pregnancy care-seeking and institutional delivery, and (2) investigate the influence of residential distance to the nearest primary health facility in a rural population in Mali.MethodsA baseline household survey of Malian women aged 15-49 years was conducted between December 2016 and January 2017, and those who delivereda baby in the 5 years preceding the survey were included. This study leverages the baseline survey data from a cluster-randomised controlled trial to conduct a secondary analysis. The outcomes were percentage of women who received any antenatal care (ANC) and institutional delivery; total number of ANC visits; four or more ANC visits; first ANC visit in the first trimester.ResultsOf the 8575 women in the study, two-thirds received any ANC in their last pregnancy, one in 10 had four or more ANC visits and among those that received any ANC, about one-quarter received it in the first trimester. For every kilometre increase in distance to the nearest facility, the likelihood of the outcomes reduced by 5 percentage points (0.95; 95% CI 0.91 to 0.98) for any ANC; 4 percentage points (0.96; 95% CI 0.94 to 0.98) for an additional ANC visit; 10 percentage points (0.90; 95% CI 0.86 to 0.95) for four or more ANC visits; 6 percentage points (0.94; 95% CI 0.94 to 0.98) for first ANC in the first trimester. In addition, there was a 35 percentage points (0.65; 95% CI 0.56 to 0.76) decrease in likelihood of institutional delivery if the residence was within 6.5 km to the nearest facility, beyond which there was no association with the place of delivery. We also found evidence of increase in likelihood of receiving any ANC care and its intensity increased with having some education or owning a business.ConclusionThe findings suggest that education, occupation and distance are important determinants of pregnancy and delivery care in a rural Malian context.Trial registration numberNCT02694055.

INTRODUCTION: Increasing the midwifery workforce has been identified as an evidence-based approach to decrease maternal mortality and reproductive health disparities worldwide. Concurrently, the profession of midwifery, as with all healthcare professions, has undergone a significant shift in practice with acceleration of telehealth use to expand access. We conducted a systematic literature review to identify and synthesize the existing evidence regarding how midwives experience, perceive and accept providing sexual and reproductive healthcare services at a distance with telehealth. METHODS: Five databases were searched, PubMed, CINHAL, PsychInfo, Embase and the Web of Science, using search terms related to midwives, telehealth and experience. Peer-reviewed studies with quantitative, qualitative or mixed methods designs published in English were retrieved and screened. Studies meeting the inclusion criteria were subjected to full-text data extraction and appraisal of quality. Using a convergent approach, the findings were synthesized into major themes and subthemes. RESULTS: After applying the inclusion/exclusion criteria, 10 articles on midwives experience of telehealth were reviewed. The major themes that emerged were summarized as integrating telehealth into clinical practice; balancing increased connectivity; challenges with building relationships via telehealth; centring some patients while distancing others; and experiences of telehealth by age and professional experience. CONCLUSIONS: Most current studies suggest that midwives experience of telehealth is deeply intertwined with midwives experience of the response to COVID-19 pandemic in general. More research is needed to understand how sustained use of telehealth or newer hybrid models of telehealth and in-person care are perceived by midwives.

PurposeTo determine whether a diagnosis of a perinatal mood and anxiety disorder (PMAD) is associated with adverse perinatal outcomes.MethodsMental health symptom screening and diagnostic data from 82 women with single gestation in the Healthy Babies Before Birth study conducted from 2013 to 2018 were obtained by clinic interview. If a woman scored over 10 on the Patient Health Questionnaire (PHQ-9) or endorsed the suicidality item; or scored over 7 on the Overall Anxiety Severity and Impairment Scale (OASIS), a Structured Clinical Interview for DSM-IV (SCID) Axis I Disorders was administered. An adverse perinatal outcome was operationalized as a diagnosis of gestational diabetes mellitus, intrauterine growth restriction, preeclampsia, chorioamnionitis, hemorrhage, fetal death, preterm birth, or a low birthweight baby, and abstracted from the medical records.ResultsWomen were between 22.0 and 45.0 years old (Mean age = 33.1 ± 4.3). Mean BMI was 24.7 ± 5.6 (Range 16.8 to 47.1). Nineteen percent (16) of the 82 women had a SCID diagnosis of a PMAD. Thirty-seven percent (30) had a diagnosed adverse perinatal outcome. Multiple logistic regression was conducted with these predictors: SCID diagnosis of a PMAD, maternal age, BMI. All predictors were significant with respective odds ratios as follows: OR = 3.58, 95% CI 1.03-12.44, p = .045; OR = 2.30, 95% CI 1.21-4.38, p = .011; OR = 1.69, 95% CI 1.06-2.69, p = .027.ConclusionsA PMAD diagnosis was associated with 3.5 times higher odds of having an adverse perinatal outcome. For every 5 years a woman aged or every five units her BMI increased her odds of having an adverse perinatal outcome increased. Older age and increased BMI are well established adverse perinatal outcome risk factors. These results suggest that mental illness risk should also be consistently assessed in obstetric settings.

BackgroundEach year an estimated 2.3 million newborns die in the first 28 days of life. Most of these deaths are preventable, and high-quality neonatal care is fundamental for surviving and thriving. Service readiness is used to assess the capacity of hospitals to provide care, but current health facility assessment (HFA) tools do not fully evaluate inpatient small and sick newborn care (SSNC).MethodsHealth systems ingredients for SSNC were identified from international guidelines, notably World Health Organization (WHO), and other standards for SSNC. Existing global and national service readiness tools were identified and mapped against this ingredients list. A novel HFA tool was co-designed according to a priori considerations determined by policymakers from four African governments, including that the HFA be completed in one day and assess readiness across the health system. The tool was reviewed by > 150 global experts, and refined and operationalised in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania between September 2019 and March 2021.ResultsEight hundred and sixty-six key health systems ingredients for service readiness for inpatient SSNC were identified and mapped against four global and eight national tools measuring SSNC service readiness. Tools revealed major content gaps particularly for devices and consumables, care guidelines, and facility infrastructure, with a mean of 13.2% (n = 866, range 2.2-34.4%) of ingredients included. Two tools covered 32.7% and 34.4% (n = 866) of ingredients and were used as inputs for the new HFA tool, which included ten modules organised by adapted WHO health system building blocks, including: infrastructure, pharmacy and laboratory, medical devices and supplies, biomedical technician workshop, human resources, information systems, leadership and governance, family-centred care, and infection prevention and control. This HFA tool can be conducted at a hospital by seven assessors in one day and has been used in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania.ConclusionThis HFA tool is available open-access to adapt for use to comprehensively measure service readiness for level-2 SSNC, including respiratory support. The resulting facility-level data enable comparable tracking for Every Newborn Action Plan coverage target four within and between countries, identifying facility and national-level health systems gaps for action.

BackgroundPrior research suggests that physicians' personal experience with breastfeeding may influence their attitudes toward breastfeeding. This phenomenon has not been explored in well-newborn care physician leaders, whose administrative responsibilities often include drafting and approval of hospital breastfeeding and formula supplementation policies.MethodsWe conducted a mixed-methods study, surveying physicians in the Better Outcomes through Research for Newborns (BORN) network. We examined physician attitudes toward recommending breastfeeding and their breastfeeding experience. Qualitative analysis was conducted on responses to the question: "How do you think your breastfeeding experience influences your clinical practice?"ResultsOf 71 participants, most (92%) had a very positive attitude toward breastfeeding with 75% of respondents reporting personal experience with breastfeeding. Of these, 68% had a very positive experience, 25% had a somewhat positive experience, and 6% had a neutral experience. Four themes emerged with respect to the effect of breastfeeding experience on practice: (1) empathy with breastfeeding struggles, (2) increased knowledge and skills, (3) passion for breastfeeding benefits, and (4) application of personal experience in lieu of evidence-based medicine, particularly among those who struggled with breastfeeding.ConclusionsWell-newborn care physician leaders reported positive attitudes about breastfeeding, increased support toward breastfeeding persons, and a perception of improved clinical lactation skills. Those who struggled with breastfeeding reported increased comfort with recommending formula supplementation to their own patients. Medical education about evidence-based breastfeeding support practices and provision of lactation support to physicians has the potential to affect public health through improved care for the patients they serve.

IntroductionTo describe and compare intervention rates and experiences of respectful care when Hungarian women opt to give birth in the community.MethodsWe conducted a cross-sectional online survey (N = 1257) in 2014. We calculated descriptive statistics comparing obstetric procedure rates, respectful care indicators, and autonomy (MADM scale) across four models of care (public insurance; chosen doctor or chosen midwife in the public system; private midwife-led community birth). We used an intention-to-treat approach. After adjusting for social and clinical covariates, we used logistic regression to estimate the odds of obstetric procedures and disrespectful care and linear regression to estimate the level of autonomy (MADM scale).FindingsIn the sample, 99 (7.8%) saw a community midwife for prenatal care. Those who planned community births had the lowest rates of cesarean at 9.1% (public: 30.4%; chosen doctor: 45.2%; chosen midwife 16.5%), induced labor at 7.1% (public: 23.1%; chosen doctor: 26.0%; chosen midwife: 19.4%), and episiotomy at 4.44% (public: 62.3%; chosen doctor: 66.2%; chosen midwife: 44.9%). Community birth clients reported the lowest rates of disrespectful care at 25.5% (public: 64.3%; chosen doctor: 44.3%; chosen midwife: 38.7%) and the highest average MADM score at 31.5 (public: 21.2; chosen doctor: 25.5; chosen midwife: 28.6). In regression analysis, community midwifery clients had significantly reduced odds of cesarean (0.35, 95% CI 0.16-0.79), induced labor (0.27, 95% CI 0.11-0.67), episiotomy (0.04, 95% CI 0.01-0.12), and disrespectful care (0.36, 95% CI 0.21-0.61), while also having significantly higher average MADM scores (5.71, 95% CI 4.08-7.36).ConclusionsHungarian women who plan to give birth in the community have low obstetric procedure rates and report greater respect, in line with international data on the effects of place of birth and model of care on experiences of perinatal care.

IntroductionWe 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.MethodsWe 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.ResultsOf 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).ConclusionsEfforts 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.

BackgroundMany long-term care facilities in the United States face significant problems with nurse retention and turnover. These challenges are attributed, at least in part, to moral distress and a negative nurse practice environment.ObjectiveThe purpose of the study was divided into two parts: first, to investigate the relationships among nurse practice environment, moral distress, and intent to stay; second, to explore the potential mediating effect of the nurse practice environment on the intent to stay among those with high levels of moral distress.DesignThis study was a descriptive, cross-sectional survey using targeted sampling.ParticipantsA total of 215 participants completed the surveys. Participants were nationally representative of long-term care nurses by age, years of experience, employment status, and type of health setting.MethodsThis study was an online national survey of long-term care nurses' perceptions of their intent to stay, moral distress level (Moral Distress Questionnaire), and nurse practice environment (Direct Care Staff Survey). Structural equation modeling analysis explored intent to stay, moral distress, and the nurse practice environment among long-term care nurses.ResultsThe mean moral distress score was low, while the mean nurse practice environment and intent to stay scores were high. Moral distress had a significant, moderately negative association with the nurse practice environment (β = -0.41), while the nurse practice environment had a significant, moderately positive association with intent to stay (β = 0.46). The moral distress had a significant, moderately negative association with intent to stay (β = -0.20). The computed structural equation modeling suggested a partially mediated model (indirect effect = -0.19, p = 0.001).ConclusionSince the nurse practice environment partially mediates the relationship between moral distress and intent to stay, interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.Clinical relevanceOur study demonstrated that the nurse practice environment mediates moral distress and intent to stay. Interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.

Worldwide, health professionals from all specialties are encouraging patients to reduce alcohol use if not abstain, and abstinence is clearly encouraged for tobacco. However, for users of substances that meet diagnostic criteria for substance use disorder (addiction), reducing use or abstaining will be difficult without appropriate addiction treatment. Moreover, this group is the most at risk and the most likely to benefit from reducing use. We propose research-based arguments to better combine encouragement to reduce or abstain from alcohol and tobacco to systematic screening for addiction and facilitated access to addiction treatment to make alcohol and tobacco preventable deaths truly preventable.

ImportanceEpidural analgesia is used by approximately 70% of birthing persons in the US to alleviate labor pain and is a common cause of elevated temperature in the birthing parent during labor, which, in turn, is associated with adverse neonatal outcomes such as hypoxic-ischemic encephalopathy (HIE).ObjectiveTo determine whether epidural analgesia is associated with increased risk of HIE after adjusting for the birthing person's maximal temperature before epidural placement and for the propensity to get an epidural.Design, setting, and participantsThis retrospective, population-based cohort study was conducted at 15 Kaiser Permanente Northern California hospitals. Participants included singleton neonates born at 35 weeks' or later gestational age between 2012 and 2019. Elective cesarean deliveries and deliveries within 2 hours of hospital admission were excluded. Data analysis was performed from November 2022 to June 2024.ExposureThe primary exposure was epidural analgesia during labor.Main outcomes and measuresThe primary outcome was HIE, defined as the presence of both neonatal acidosis (ie, pH

BackgroundFollowing a decline in perinatal HIV transmission from 20% to 10% between 2010 and 2017 in Kenya, rates have since plateaued with an estimated 8% transmission rate in 2021. Between October 2016 and September 2021, Family AIDS Care & Education Services (FACES) supported HIV care and treatment services across 61 facilities in Kisumu County, Kenya with an emphasis on service strengthening for pregnant and postpartum women living with HIV to reduce perinatal HIV transmission. This included rigorous implementation of national HIV guidelines and implementation of 3 locally adapted evidence-based interventions targeted to the unique needs of women and their infants. We examined whether these person-centered program enhancements were associated with changes in perinatal HIV transmission at FACES-supported sites over time.Methods and findingsWe conducted a repeated cross-sectional study of annually aggregated routinely collected documentation of perinatal HIV transmission risk through the end of breastfeeding at FACES-supported facilities between October 2016 and September 2021. Data included 12,599 women living with HIV with baseline antenatal care metrics, and, a separate data set of 11,879 mother-infant pairs who were followed from birth through the end of breastfeeding (overlapping with those in antenatal care 2 years prior). FACES implemented 3 interventions for pregnant and postpartum women living with HIV in 2019: (1) high-risk clinics; (2) case management; and (3) a mobile app to support treatment engagement. Our primary outcome was infant HIV acquisition by the end of breastfeeding (18 to 24 months). We compared infant HIV acquisition risk in the final year of the FACES program (2021) to the year before intervention scale-up and following implementation of the "Treat All" policy (2018). Mother-infant pair loss to follow-up was a secondary outcome. Program data were aggregated by year and site, thus in multivariable regression, we adjusted for site-level characteristics, including facility type, urban versus rural, number of women with HIV in antenatal care each year, and the proportion among them under 25 years of age. Between October 2016 and September 2021, 81,172 pregnant women received HIV testing at the initiation of antenatal care, among whom 12,599 (15.5%) were living with HIV, with little variation in HIV prevalence over time. The risk of infant HIV acquisition by 24 months of age declined from 4.9% (101/2,072) in 2018 to 2.2% (48/2,156) in 2021 (adjusted risk difference -2.6% [95% confidence interval (CI): -3.7, -1.6]; p < 0.001). Loss to follow-up declined from 9.9% (253/2,556) in 2018 to 2.5% (59/2,393) in 2021 (risk difference -7.5% [95% CI: -8.8, -6.2]; p < 0.001). During the same period, UNAIDS estimated rates of perinatal transmission in the broader Nyanza region and in Kenya as a whole did not decline. The main limitation of this study is that we lacked a comparable control group.ConclusionsThese findings suggest that implementation of person-centered interventions was associated with significant declines in perinatal HIV transmission and loss to follow-up of pregnant and postpartum women.

In recent years, increased attention has been given to using deep learning (DL) of artificial intelligence (AI) in healthcare to address nursing challenges. The adoption of new technologies in nursing needs to be improved, and AI in nursing is still in its early stages. However, the current literature needs more clarity, which affects clinical practice, research, and theory development. This study aimed to clarify the meaning of deep learning and identify the defining attributes of artificial intelligence within nursing. We conducted a concept analysis of the deep learning of AI in nursing care using Walker and Avant's 8-step approach. Our search strategy employed Boolean techniques and MeSH terms across databases, including BMC, CINAHL, ClinicalKey for Nursing, Embase, Ovid, Scopus, SpringerLink and Spinger Nature, ProQuest, PubMed, and Web of Science. By focusing on relevant keywords in titles and abstracts from articles published between 2018 and 2024, we initially found 571 sources. Thirty-seven articles that met the inclusion criteria were analyzed in this study. The attributes of evidence included four themes: focus and immersion, coding and understanding, arranging layers and algorithms, and implementing within the process of use cases to modify recommendations. Antecedents, unclear systems and communication, insufficient data management knowledge and support, and compound challenges can lead to suffering and risky caregiving tasks. Applying deep learning techniques enables nurses to simulate scenarios, predict outcomes, and plan care more precisely. Embracing deep learning equipment allows nurses to make better decisions. It empowers them with enhanced knowledge while ensuring adequate support and resources essential for caregiver and patient well-being. Access to necessary equipment is vital for high-quality home healthcare. This study provides a clearer understanding of the use of deep learning in nursing and its implications for nursing practice. Future research should focus on exploring the impact of deep learning on healthcare operations management through quantitative and qualitative studies. Additionally, developing a framework to guide the integration of deep learning into nursing practice is recommended to facilitate its adoption and implementation.

BackgroundThis qualitative study aims to assess perspectives of clinicians and clinic staff on mail-order pharmacy dispensing for medication abortion.MethodsParticipants included clinicians and staff involved in implementing a mail-order dispensing model for medication abortion at eleven clinics in seven states as part of a prospective cohort study, which began in January 2020 (before the FDA removed the in-person dispensing requirement for mifepristone). From June 2021 to July 2022, we invited participants at the participating clinics, including six primary care and five abortion clinics, to complete a semi-structured video interview about their experiences. We then conducted qualitative thematic analysis of interview data, summarizing themes related to perceived benefits and concerns about the mail-order model, perceived patient interest, and potential barriers to larger-scale implementation.ResultsWe conducted 24 interviews in total with clinicians (13 physicians and one nurse practitioner) and clinic staff (n = 10). Participants highlighted perceived benefits of the mail-order model, including its potential to expand abortion services into primary care, increase patient autonomy and privacy, and to normalize abortion services. They also highlighted key logistical, clinical, and feasibility concerns about the mail-order model, and specific challenges related to integrating abortion into primary care.ConclusionClinicians and clinic staff working in primary care and abortion clinics were optimistic that mail-order dispensing of medication abortion can improve the ability of some providers to provide abortion and enable more patients to access services. The feasibility of mail-order pharmacy dispensing of medication abortion following the Supreme Court Dobbs decision is to be determined.Trial registrationRegistry: Clinicaltrials.gov.Trial registration numberNCT03913104. Date of registration: first submitted on April 3, 2019 and first posted on April 12, 2019.

BackgroundPregnant people are vulnerable to new or worsening mental health conditions. This study aims to describe prevalence and course of depression and anxiety symptoms in pregnancy during the pre-vaccine COVID-19 pandemic.MethodsThis is a prospective cohort study of pregnant individuals with known or suspected COVID-19. Participants completed Edinburgh Postnatal Depression Scale (EPDS) and Generalized-Anxiety Disorder-7 (GAD-7) questionnaires, screening tools for depression and anxiety, at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum. Prevalence of elevated depressive and anxiety symptoms at each visit was described. Univariable logistic regression analysis was used to determine the association between demographic and clinical factors and those with elevated depression or anxiety symptoms.Results317 participants were included. The prevalence of elevated antepartum depression symptoms was 14.6%, 10.3%, and 20.6% at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum, respectively. The rate of elevated anxiety symptoms was 15.1%, 10.0%, and 17.3% at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum, respectively. A prior history of depression and/or anxiety (p's

BackgroundThe rates of suicide and opioid use disorder (OUD) among pregnant and postpartum women continue to increase. This research characterized OUD and suicide attempts among Medicaid-enrolled perinatal women and examined prenatal OUD diagnosis as a marker for postpartum suicide attempts.MethodsData from Oregon birth certificates, Medicaid eligibility and claims files, and hospital discharge records were linked and analyzed. The sample included Oregon Medicaid women aged 15-44 who became pregnant and gave live births between January 2008 and January 2016 (N = 61,481). Key measures included indicators of suicide attempts (separately for any means and opioid poisoning) and OUD diagnosis, separately assessed during pregnancy and the one-year postpartum period. Probit regression was used to examine the overall relationship between prenatal OUD diagnosis and postpartum suicide attempts. A simultaneous equations model was employed to explore the link between prenatal OUD diagnosis and postpartum suicide attempts, mediated by postpartum OUD diagnosis.ResultsThirty-three prenatal suicide attempts by any means were identified. Postpartum suicide attempts were more frequent with 58 attempts, corresponding to a rate of 94.3 attempts per 100,000. Of these attempts, 79% (46 attempts) involved opioid poisoning. A total of 1,799 unique women (4.6% of the sample) were diagnosed with OUD either during pregnancy or one-year postpartum with 53% receiving the diagnosis postpartum. Postpartum suicide attempts by opioid poisoning increased from 55.5 per 100,000 in 2009 to 105.1 per 100,000 in 2016. The rate of prenatal OUD also almost doubled over the same period. Prenatal OUD diagnosis was associated with a 0.15%-point increase in the probability of suicide attempts by opioid poisoning within the first year postpartum. This increase reflects a three-fold increase compared to the rate for women without a prenatal OUD diagnosis. A prenatal OUD diagnosis was significantly associated with an elevated risk of postpartum suicide attempts by opioid poisoning via a postpartum OUD diagnosis.ConclusionsThe risk of suicide attempt by opioid poisoning is elevated for Medicaid-enrolled reproductive-age women during pregnancy and postpartum. Women diagnosed with prenatal OUD may face an increased risk of postpartum suicides attempts involving opioid poisoning.

BackgroundHuman Immunodeficiency Virus (HIV) remains a significant public health concern worldwide. Women living with HIV/AIDS (WLHA) have the additional and unique need to seek sexual and reproductive health services. WLHA's maternal health journeys can be shaped by the cultural norms and resources that exist in their society. This study sought to understand if and how WLHA's family planning, pregnancy, and motherhood experiences could be influenced by the patriarchal culture, gender roles, and HIV stigma in Vietnam, specifically.MethodsBetween December 2021 and March 2022, 30 WLHA with diverse socioeconomic backgrounds and childbirth experiences were interviewed in Hanoi, Vietnam. These semi-structured interviews covered topics including HIV stigma, gender norms, pregnancy experiences, and child-rearing challenges. Interviews were audio recorded, transcribed, and analysed using ATLAS.ti.ResultsQualitative analyses of participant quotes revealed how limited information on one's health prospects and reproductive options posed a significant challenge to family planning. Societal and familial expectations as well as economic circumstances also influenced reproductive decision-making. WLHA often encountered substandard healthcare during pregnancy, labor, and delivery. Stigma and lack of provider attentiveness resulted in cases where women were denied pain relief and other medical services. Communication breakdowns resulted in failure to administer antiretroviral therapy for newborns. Motherhood for WLHA was shadowed by concerns for not only their own health, but also the wellbeing of their children, as HIV stigma affected their children at school and in society as well. Many WLHA highlighted the constructive or destructive role that family members could play in their childbirth decision-making and care-giving experiences.ConclusionsOverall, this study underscores the complex ways that cultural expectations, family support, and stigma in healthcare impact WLHA. Efforts to educate and engage families and healthcare providers are warranted to better understand and address the needs of WLHA, ultimately improving their reproductive and maternal health.

Pregnant women in sub-Saharan Africa have high rates of maternal morbidity. There is interest in the impact of the vaginal microbiome on maternal health, including HIV and sexually transmitted infection (STI) acquisition. We characterized the vaginal microbiota of South African women ≥ 18 years with and without HIV in a longitudinal cohort over two visits during pregnancy and one visit postpartum. At each visit, we obtained HIV testing and self-collected vaginal swabs for point-of-care testing for STIs and microbiota sequencing. We categorized microbial communities and evaluated changes over pregnancy and associations with HIV status and STI diagnosis. Across 242 women (mean age 29, 44% living with HIV, 33% diagnosed with STIs), we identified four main community state types (CSTs): two lactobacillus-dominant CSTs (dominated by Lactobacillus crispatus and Lactobacillus iners respectively) and two diverse, non-lactobacillus-dominant CSTs (one dominated by Gardnerella vaginalis and one by diverse facultative anaerobes). From the first antenatal visit to the third trimester (24-36 weeks gestation), 60% of women in the Gardnerella-dominant CST shifted to lactobacillus-dominant CSTs. From the third trimester to postpartum (mean 17 days post-delivery), 80% of women in lactobacillus-dominant CSTs shifted to non-lactobacillus-dominant CSTs with a large proportion in the facultative anaerobe-dominant CST. Microbial composition differed by STI diagnosis (PERMANOVA R2 = 0.002, p = 0.004), and women diagnosed with an STI were more likely to be categorized as L. iners-dominant or Gardnerella-dominant CSTs. Overall, we found a shift toward lactobacillus dominance during pregnancy and the emergence of a distinct, highly diverse anaerobe-dominant microbiota profile in the postpartum period.

ObjectiveMaterial and MethodResultsConclusionThe aim was to determine the effect of midwives’ attitudes towards evidence-based practices in childbirth on mothers’ perception and satisfaction with childbirth practices.This cross-sectional study was carried out with the participation of 34 midwives working in the delivery rooms of three public hospitals in a province in the south of Türkiye and 287 postpartum women whose deliveries were facilitated by these midwives. A Personal Information Form and the Midwives’ Evidence-Based Practices Attitude Scale during Labor (MEBPAS) were administered to the midwives. A Personal Information Form, the Birth Practices Perception Scale (BPPS), and the Birth Satisfaction Scale-Revised (BSS-R) were administered to the postpartum women.Because the skewness and kurtosis values were between −2 and + 2, the data showed normal distribution. The multiple linear regression model showed that the dimensions of MEBPAS (Interventional Practices, Supportive Care Practices, Movement and Nutrition Practices, Early Postpartum Period Practices) explained 29.4% of the total variance in BSS-R (F = 30.798; p = 0.041) and 53.4% of the total variance in BPPS (F = 83.094; p < 0.001). According to the Structural Equation Modeling, Interventional Practices, Movement and Nutrition Practices, and Early Postpartum Period Practices had statistically significant positive effects on BSS-R (respectively, β = 0.286, p < 0.001; β = 0.479, p = 0.016, and β = 1.009, p < 0.001), while Interventional Practices, Supportive Care Practices, and Early Postpartum Period Practices had statistically significant negative effects on BPPS (respectively, β=-0.048, p < 0.001; β=-0.026, p = 0.027, and β=-0.039, p = 0.034).It was found that midwives’ positive attitudes towards evidence-based practices in childbirth positively affected women’s perceptions and satisfaction with birth practices. [ABSTRACT FROM AUTHOR]

BackgroundAimsDesignMethodsResultsConclusionsImpact statement\nPlain language summaryThe COVID-19 pandemic and recovery period have exacerbated workforce challenges for nurses and midwives. The increasingly complex nature of healthcare, combined with rising workloads and staff attrition highlights the need for initiatives that improve workplace satisfaction and retention. In response, mentoring programs aimed at enhancing job satisfaction and retention are being increasingly implemented.This study sought to measure the workplace satisfaction of nurses and midwives across five New South Wales local health districts, utilising data captured from a wider study investigating the implementation of the Deadly Aboriginal and Torres Strait Islander Nursing and Midwifery Mentoring program.An exploratory, mixed methods study using purposive sampling was employed.A secondary analysis of a modified version of the Nursing Workplace Satisfaction Questionnaire, was used to quantify intrinsic, extrinsic, and relational workplace satisfaction constructs among nursing and midwifery staff. Open ended questions included in the survey were thematically analysed using methods developed by Braun and Clarke (2022).Between June–October 2023, n = 106 participants returned the survey. Differences between intrinsic (items 2 & 5), extrinsic (item 9) relational (items 13-15) constructs were observed for health districts, Aboriginality, age, and professional role characteristics (P < 0.05). Five qualitative themes emerged from the data: Helping people is the priority; Teams make a difference to my workplace satisfaction; Managers impact my satisfaction; Scope and recognition; and Organisational factors.Overall, our findings indicate noticeable differences in workforce satisfaction and retention across various factors, including workforce areas, Aboriginality, age, and professional roles. For these groups, initiatives aimed at improving satisfaction and retention should prioritise fostering teamwork and a sense of belonging, as these elements have significant impact on job satisfaction for nurses and midwives and provide valuable guidance for nursing leaders.This study identifies that teamwork and belongingness impact workplace satisfaction for nurses and midwives.The COVID-19 pandemic has exacerbated workloads for nurses and midwives, with staff shortages and increased patient acuity negatively impacting workplace satisfaction. This study utilised an exploratory survey design to assess specific factors influencing the satisfaction and retention of nurses and midwives. Through mixed methods data collection and analysis, our findings highlight that while teamwork and belongingness are well-established contributors to workplace satisfaction, there are distinct variations across different workforce demographics. In particular, we found that teamwork and a sense of belonging were stronger among certain workforce areas but less evident among Aboriginal and Torres Strait Islander nurses and midwives, older workforce members (age), and practicing midwives. These gaps highlight critical areas where strategies can be developed to better support these groups and offering nursing leaders targeted opportunities for intervention. [ABSTRACT FROM AUTHOR]

Background: There is critical need to strengthen the global nursing and midwifery workforce. This is especially true in Malawi where they are the primary providers of obstetric and neonatal care. In Neno district, Malawi, in 2017, we implemented an intensive training and longitudinal bedside mentorship intervention for nurses and midwives. From inception, there was a pre-planned project target completion after 5 years, including a staged handover to local ownership after 3 years. The objective of this study was to assess differences in reported maternal and neonatal complications following project completion and handover to local leadership. Methods: The project was a partnership between an academic institution and local nongovernmental organization. In October 2020, the intervention was handed over and maintained by the local organization with limited support from the academic institution. Data from January 2019 to May 2023 were extracted from the Malawi District Health Information Software 2. Bivariate analyses explored differences in the pre- and post-handover periods for all government-collected, birth-related variables. The "pre-handover" period encompassed January 2019 to September 2020 and "post-handover" from October 2020 to May 2023. Multivariate linear regression explored outcomes while controlling for health facility. Results: Data were collected from 10 health facilities in the district and included a total of 23,259 births. Overall, there were few significant changes between periods. Exceptions were in reporting of antepartum hemorrhage (p < 0.01), maternal sepsis (p = 0.01), and manual removal of the placenta (p < 0.01), where we observed decreases in reporting. There was a significant decrease in the reporting of neonatal sepsis (p = 0.01) in the bivariate analysis, which remained only borderline significant in the multivariate model (p = 0.05). Where differences occurred, they were associated with improvements in reported identification of complications and provision of associated emergency care. Conclusions: Few differences in reported maternal and neonatal complications between the periods suggest positive impact of the intervention was sustained following project handover and transition of activities to local leadership. These findings strengthen support for longitudinal mentorship as a pivotal component for skill retention after training. Transparent partnerships which include pre-determined end points and time for handover of activities to local ownership are crucial components for sustainability. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Method Results Conclusion Implications for the Profession Impact Reporting Method Patient or Public Contribution The study aimed to analyse selected clinical data affecting the quality of life of women with endometriosis.A cross‐sectional study.The study was conducted in 2020–2022 among 425 women with endometriosis receiving health care. A diagnostic survey method with a questionnaire technique was used. The research tools are the Endometriosis Health Profile and a standardised interview questionnaire.Infertility, medical treatment and sexual intercourse were the dimensions of quality of life most poorly rated by respondents with endometriosis. Lower quality of life was linked to the presence of painful periods, the presence of pain during intercourse and having surgery for endometriosis.The main clinical variables influencing the quality of life of women with endometriosis include problems with getting pregnant, the necessity for long‐term therapy and sexual problems caused by the condition. The occurrence of painful menstruation, dyspareunia and having undergone surgery for endometriosis is associated with lower ratings of women's general quality of life.The study will help to develop a more holistic approach to caring for endometriosis patients. This will result in a better diagnosis, individualised therapy and psychological support, all of which will enhance the overall quality of life. The study's results may impact the development of health policies, endometriosis support services for women and public awareness initiatives.The study highlighted key determinants affecting health‐related quality of life for women with endometriosis. The analysis of clinical data revealed that infertility, treatment and dyspareunia are the dimensions of quality of life most poorly rated by women with endometriosis. These findings are significant for those providing care to women with endometriosis, as well as for policymakers responsible for the organisation of health care systems.The STROBE guidelines.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim Background Method Results Implications for nursing/midwifery and health policy To determine the experiences of nurses and midwives providing perinatal care in an earthquake area.On February 6, 2023, two earthquakes measuring 7.8 and 7.6 magnitudes struck Turkey, affecting a large area. It is crucial for perinatal care to be rapidly organized, provided under the most suitable conditions, and delivered by qualified health professionals. Understanding the post‐disaster experiences of nurses and midwives is crucial to addressing this issue.This is a qualitative study using phenomenological methodology with 8 nurses and 12 midwives in the earthquake‐affected area. Personal information and semistructured interview forms were used for data collection. Content analysis was used for data analysis.Participants had a mean age of 33.75 years. The experiences of nurses and midwives were grouped into five themes: emotions experienced, challenges encountered, problems in perinatal services, coping mechanisms, and recommendations. The emotions experienced theme encompasses both positive and negative emotions. The challenges encountered theme includes challenging environmental conditions, organizational issues, problems with medical supplies and drugs, and being a victim of the earthquake. The problems in perinatal services theme includes pregnancy, childbirth, and postpartum services. The coping mechanism's theme encompasses problem‐focused and emotion‐focused coping strategies. The recommendations theme includes education and awareness, preparedness for disasters, and sustainable services.Nurses and midwives working in the earthquake‐affected area experienced numerous physical and psychological challenges and encountered difficulties in delivering health services. A disaster education course including simulated disaster drills and practice can be integrated into the education system. Strengthening healthcare facilities against disasters and raising awareness among the community are crucial. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Discussion Immigrants and newcomers are identified by many provincial midwifery associations as “priority populations.” Recently, newcomer populations have shifted considerably, with more people coming to Canada with precarious immigration status who are increasingly ineligible for public healthcare insurance and facing barriers to accessing care. Our aims were to: (1) gain an understanding of the policies related to equitable access to midwifery care and how they may apply to migrant groups without public healthcare insurance and (2) identify existing policy themes, gaps, and regulatory barriers that limit access for this vulnerable population in Canada.We conducted a high‐level document content analysis using a health equity framework. We aimed to identify language related to equitable access in midwifery services, with particular emphasis on uninsured populations. A total of 64 documents were analyzed, including legislation and publicly available statements from midwifery regulatory bodies and associations.Midwifery regulatory authorities and associations across Canada are consistent in establishing an expectation that midwives will provide accessible care to diverse clientele. However, how these commitments are put into practice varies considerably between jurisdictions. We compared the cases of Manitoba and Ontario to illustrate the disconnect between commitments to priority populations and implementation.While there is a clearly demonstrated intention to provide equitable access to midwifery care to all people, including “priority populations” like migrants and newcomers, in practice, these commitments have not been fully realized. Equity is encumbered by broader structural issues, such as the growth in the number of newcomers without access to public health insurance. Moves toward equity within midwifery and healthcare more broadly need to meaningfully engage with other policy sectors, such as immigration, to be able to adapt to emerging issues affecting reproductive care, such as the growing precarity of newcomer populations in Canada. [ABSTRACT FROM AUTHOR]

Background: Sustainable Development Goals (SDGs) are universally recognised targets designed to combat poverty, inequality, and climate change. However, there exists limited awareness and understanding of these goals among nursing and midwifery students. To address this knowledge gap, a co-designed audio podcast was introduced as an educational tool to enhance students' comprehension of SDGs and their relevance to the healthcare profession. Methods: A prospective study was conducted at Queen's University Belfast, involving 566 first-year nursing and midwifery students. A 60-minute SDG podcast, co-designed with students and stakeholders, was made accessible within the university's learning management system. Pre- and post-test questionnaires were administered to assess changes in students' knowledge levels and attitudes toward SDGs. Additionally, 37 participants engaged in focus group interviews six months after listening to the podcast to explore their experiences and reflections. Quantitative data was analysed using paired t-tests and descriptive statistics, while qualitative data was analysed thematically. Results: The podcast significantly increased students' awareness of SDGs and their understanding of the goals' relevance to their profession and personal lives. Post-test scores showed substantial improvements across all three sub-scales: knowledge, professional relevance, and personal relevance. Moreover, participants rated the podcast as a valuable learning resource with high acceptability, although some expressed uncertainty about replay intentions. Focus group interviews revealed three themes, including 1) More than you know', which described how participants developed new knowledge and understanding about SDGs, 2) 'Nurse-Midwife Nudges', which illuminated how participants made minor changes to their behaviour and 3) 'Fitting Format', which highlighted how participants favoured the use of an audio podcast to learn about SDGs. Discussion: This study demonstrates the potential of audio podcasts as an effective and engaging tool for increasing awareness and understanding of SDGs among nursing and midwifery students. The results suggest that such interventions can positively impact students' knowledge, attitudes, and behavioural intentions regarding the SDGs. The findings also emphasise the importance of co-design in developing educational resources tailored to the specific needs and preferences of students. [ABSTRACT FROM AUTHOR]

Background: Fear of childbirth affects women worldwide and can have adverse consequences. Midwives have implemented a number of interventions, autonomously or as part of a professional team. However, midwives have been unable to identify the most appropriate intervention for ensuring the reduction or alleviation of this fear to provide the best perinatal outcomes. Objective: This study aimed to evaluate the effectiveness of a prenatal educational intervention followed by specific support during childbirth, designed and delivered exclusively by midwives for women with a high fear of childbirth. Method: This randomized controlled trial was performed with two arms in two phases: an online prenatal education phase followed by a support phase during childbirth. Participating women with a high fear of childbirth, which was determined using the Wijma Delivery Expectancy Questionnaire A-Spanish version, were assigned to the experimental group or the usual care control group at a 1:1 ratio. Results:Women showed a reduction in fear of childbirth in both phases of the study. According to the intention-to-treat analysis, a significant mean difference was observed in the prenatal stage in favor of the intervention group, and a nonsignificant difference was observed in favor of this same group after delivery. Discussion: The effectiveness of continuous specific prenatal education with preferential support during childbirth by midwives was indicated by improvements in the level of fear of childbirth. [ABSTRACT FROM AUTHOR]

This series of six articles is inspired by themes arising from the Royal College of Midwives' state of midwifery education report. The series explores the current landscape and challenges in educating the future midwifery workforce, particularly those that relate to the higher education workforce. This penultimate article examines the interplay between the practice and academic environments and the impact this has on both students and staff alike, particularly in the wake of changing standards for student supervision. The article explores whether the nature of being an educator in a health field such as midwifery is unique because of the need to support students through placement challenges when there are limitations on what higher education institutions can realistically influence. It also examines the 'extra' responsibilities put on midwifery education staff to support students by way of 'academic assessor' roles. [ABSTRACT FROM AUTHOR]

Background/Aims: Personalised care is associated with high-quality, safe maternity care. Limited evidence exists on midwives' perception of personalised care and potential barriers and facilitators associated with implementing it in practice. The aim of this study was to explore midwives' perspectives of personalised care. Methods: An online mixed-methods survey was conducted exploring the perspectives of 46 NHS midwives. Data were analysed using descriptive statistics and thematic analysis. Results: Assessing individual needs was perceived as a key facilitator and time restrictions were considered a significant barrier to providing personalised care in practice. Conclusions: Providing personalised care is associated with increased job satisfaction for midwives, and key barriers include inflexible healthcare systems and limited resources. Implications for practice: The findings contribute to an understanding of the factors that influence the provision of personalised care and have the potential to inform improvements in maternity services. [ABSTRACT FROM AUTHOR]

Aim: To describe the current state of the literature on nurses' and midwives' knowledge, perceptions and experiences of managing parental postnatal depression (PPND). Design: The Joanna Briggs Institute scoping review method and the PRISMA extension for Scoping Reviews guided the work. Data Sources: A systematic search of PubMed, CINAHL, Embase, MEDLINE, PsycINFO and Scopus databases was conducted in January and February 2023. Review Methods: Peer‐reviewed primary research articles published in English between 2012 and 2023 that involved nurses or midwives managing PPND were included. Rayyan was used to screen titles, abstracts and full‐text articles. A spreadsheet was used to organize extracted data and synthesize results. Results: Twenty‐nine articles met the inclusion criteria. Most study samples were of mothers, and few were from middle‐ and lower‐income countries. Nurses and midwives lacked knowledge about PPND, yet they felt responsible for its management. Nurses and midwives faced significant organizational and systems‐level challenges in managing PPND. However, nurses and midwives facilitated PPND care in collaboration with other healthcare providers. Conclusion: The review highlights significant gaps in the nurses' and midwives' care of PPND. Educational programmes are necessary to increase nurse and midwife knowledge of PPND and strategies for its management, including facilitating collaboration across the healthcare system and eliminating organizational and systemic‐related barriers. Additional focused research is needed on nurses' and midwives' knowledge, perception of and experience with PPND beyond mothers, such as with fathers, sexually and gender‐minoritized parents and surrogate mothers. Finally, additional research is needed in middle‐ and lower‐income countries where nurses and midwives may face a higher burden of and unique cultural considerations in managing PPND. Impact: PPND can affect the parent's mental and physical health and relationship with their child. If left untreated, PPND can lead to long‐term consequences, including child developmental delays, behavioural problems and difficulties with parental–child attachment. Reporting Method: This scoping review adheres to PRISMA Extension for Scoping Review guidelines and the Joanna Briggs Institute scoping review method. Patient or Public Contribution: This research is a scoping review of published peer‐reviewed studies. [ABSTRACT FROM AUTHOR]

This article examines a neglected context for understanding the ontology and epistemology of race in Shakespeare's drama: the role of the midwife. Early modern midwives performed an important cultural function by not only assisting women in labour, but also pronouncing the sex and paternity of a newborn. As Caroline Bicks has shown, this was a time when a midwife was thought to have significant influence over how a body was literally shaped and interpreted at the moment of its birth, thereby determining its reception in the community. Nowhere in Shakespeare's canon is the midwife's authority more manifest – and threatening – than in Titus Andronicus, where the midwife's role includes establishing an infant's race. After Tamora, Empress of Rome, delivers a baby fathered by her lover, Aaron 'the Moor', he asks: 'How many saw the child?' By subsequently killing the birth attendants, Aaron calls attention to how controlling the destiny of his son will depend upon rewriting the script of his nativity. Merging critical interest in early modern childbirth with Shakespeare scholarship on race and performance, I show how newly born bodies are midwived into racialized subjects, illuminating how midwifery discourses can broaden our understanding of early modern racecraft. My specific claim is that the statements made by Tamora's nurse concerning Aaron's 'black' son can be read as a performative utterance that confers, constitutes and attempts to naturalize the newborn's raced identity. [ABSTRACT FROM AUTHOR]

Background and aim: Immigrant women in many high-income countries including Sweden, report unmet need of sexual and reproductive health and rights, and face worse pregnancy outcomes and higher risk of unintended pregnancies. Postpartum contraceptive services are often inadequate to meet their needs. Co-design has shown to reduce health inequities, yet little is known about using this method for postpartum contraceptive service development and even less in collaborating with immigrant populations. The aim of this paper is to describe the co-design process and the strategies that were developed to help develop tailored and acceptable postpartum contraceptive services for immigrant women in Sweden. Methods: The paper describes a co-design process that took place during 2022–2023, including the cyclical digital consultations with Arabic and Somali speaking immigrant women, midwives and researchers, as well as the outputs from the process. The theoretical framework for the co-design process was the ‘Double Diamond’ Design Process Model. Data analysis included qualitative content analysis. Results: The co-design process led to the joint development of intervention materials and strategies to improve postpartum contraceptive services. Specifically, the process revealed ideas on how to improve contraceptive counseling within three pre-identified areas of change: improve physical access to contraceptive services; improved communication strategies using visual aids and information charts; and empowerment strategies that focus on reflective practice without assumptions about what a group of women might expect. We found that participants contributed actively to the process with ideas and suggestions, and that the co-design process facilitated positive reflections on ongoing counseling practices. Conclusion: The co-design process resulted in the successful and participative development of innovative tools and activities to improve contraceptive counseling services. This approach is original because it involves both immigrant women, often left behind, and midwives delivering the services. Whilst this interplay allowed for careful refinement of services and tools by using an iterative process, it also facilitated reflective midwifery practice. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Data Sources Review Methods Results Conclusions Implications for the Profession Impact Reporting Method Patient and Public Contribution To summarise the barriers and facilitators to the clinical implementation of perineal techniques and to provide evidence‐based insights for decision‐making based on existing research.A scoping review.Nine electronic databases (PubMed, Cochrane Library, Embase, CINAHL, ProQuest, CNKI, WanFang, VIP and SinoMed) were systematically searched on 4 February 2024.This study followed Joanna Briggs Institute's scoping review methodology. The barriers and facilitators identified in the included studies were mapped to the domains of the Consolidated Framework for Implementation Research (CFIR): intervention characteristics, outer setting, inner setting, characteristics of individuals and process.A total of 18 studies were finally included and analysed. The most frequently identified facilitator was theoretical education for midwives (inner setting). Common barriers included: lack of time to implement perineal techniques (intervention characteristics); labour pain and women's stress due to insufficient understanding of the birthing process, as well as women's reluctance to receive the perineal techniques (outer setting); risk factors for OASIS (inner setting); insufficient theoretical education for midwives and inadequate prenatal education for pregnant women (inner setting) and concerns about potential medical disputes among performers (characteristics of individuals).Many of the factors influencing the implementation of perineal techniques identified in this review are modifiable. Developing implementation strategies based on these factors can promote the successful implementation of these perineal techniques in clinical settings.This scoping review could serve as a reference framework for health authorities in developing strategies to promote the use of perineal techniques in clinical practice.Existing research has primarily focused on the outer setting, inner setting and characteristics of individuals implementing perineal techniques. Therefore, there is a need for more high‐quality studies focusing on intervention characteristics and the implementation process.This study followed the PRISMA extension for scoping reviews.Not applicable. [ABSTRACT FROM AUTHOR]

Background: Transmission of SARS-CoV-2 highlighting the importance of social distancing guidelines. Following a series of lockdowns and the widespread vaccination of the European population, many countries began to lift these restrictions. During this period, while some parents yearned for emotional support and family presence, others found that the solitude facilitated by the restrictions was beneficial for bonding and breastfeeding. In France, postnatal stays are generally longer than in other countries, and the limited availability of home-based follow-up care, combined with pandemic isolation measures, further complicated perspectives on visitation restrictions. Therefore, the objective of this study was to assess the satisfaction of mothers and caregivers regarding these visit restrictions in French maternity settings during the COVID-19 pandemic. Methods: We conducted two multicentre descriptives surveys across five French maternity wards (three in Paris and two in Lyon) from June 1st to July 15th, 2021. Participants included mothers, selected based on criteria such as French-speaking, at-term birth (≥ 37 weeks), and hospitalisation with their newborn, as well as caregivers working in the postpartum units. Satisfaction with visitation restrictions was assessed using a four-point Likert scale, which was then dichotomised into "mostly satisfied" versus "mostly dissatisfied" for the analysis. Multivariable logistic regression models were used to identify factors associated with satisfaction. Results: We analysed complete responses from 430 of the 2,142 mothers (20.1%) and 221 of the 385 caregivers (57.4%) who participated during the study period. The majority of mothers (68.8%, n = 296/430) and caregivers (90.5%, n = 200/221) declare themselves satisfied with the policy of restricting visits to maternity wards. The main source of mother's satisfaction came from a quieter stay, but they regretted the absence of their other children. Conclusions: Maternity visit restriction policies were largely supported by mothers and caregivers, especially when partners and siblings were allowed. Revisiting these policies, along with the postpartum stay length, may improve care, though further evaluation in non-pandemic settings is needed. [ABSTRACT FROM AUTHOR]

Background: Ultrasound technology is indispensable in perinatal care due to its non-invasive and painless nature, offering vital insights into foetal development and childbirth. With the academisation of midwifery in Germany, there is a growing necessity to incorporate ultrasound training into midwifery education. This paper discusses the development and implementation of an introductory obstetric ultrasound curriculum tailored for midwifery students, focusing on fundamental ultrasound techniques in obstetrics. Materials and methods: We used Kern's six-step approach of curricular development comprising [1] problem identification and general needs assessment [2], needs assessment of the targeted learners [3], goals and objectives [4], educational strategies [5], implementation, and [6] evaluation and feedback. The individual components of the curriculum were meticulously designed based on comprehensive literature reviews, thorough consultations with experienced ultrasound experts and evaluated needs of participants prior to the course instruction. Results: Twenty-seven ultrasound-naive midwifery students participated in the newly developed obstetric ultrasound course. Structured as a modular and integrated framework, the course aimed to provide theoretical and practical instruction in basic obstetric ultrasound, with intrapartum sonography and focused assessment with abdominal sonography for trauma (FAST) as key supplementary specialisations. The results demonstrated a significant increase in the students' overall knowledge and practical skills, as evidenced by the median post-course total score rising from 20 to 60 out of 75 (p < 0.001) in the objective structured clinical examination (OSCE) and from 9 to 19 out of 20 (p = 0.001) in the knowledge test. Additionally, students reported high satisfaction with the course and noted substantial personal benefits. Conclusion: The integration of basic obstetric ultrasound training within the midwifery curriculum is feasible and effective to teach fundamental knowledge and skills of obstetric ultrasound examinations to midwifery students. Expansion, standardisation and regulatory structures are critical components for a continued improvement and realistic integration into midwifery educational frameworks and thus the further development of the midwifery profession. [ABSTRACT FROM AUTHOR]

Background: Simulation training provides safe environment for skill acquisition and retention. This study addresses a critical challenge in Africa – umbilical cord and placenta management after childbirth – aiming to bridge theoretical learning with practical experiences through simulation. We realized a new low-cost high-fidelity simulator of placenta and umbilical cord. We conducted a needs-based training course for nursing and midwifery students at St. Luke Hospital of Wolisso, Ethiopia, to validate our new simulator and compare its acceptability and teaching effectiveness with other two simulators (conventional low-fidelity model and human placenta). Methods: We surveyed St. Luke Hospital medical experts to obtain their feedback on the new simulator's face, content, and usability. We carried out a simulation training course for 67 students who received theoretical lectures and simulation courses being divided into three groups according to the simulator used. We assessed the simulators' user acceptability using the Technology Acceptance Model (TAM) and compared the final objective evaluations by tutors between groups. Results: Experts confirmed the new simulator's fidelity, material quality, and usability. Students training on the new simulator demonstrated higher objective scores and perceived it as more useful and user-friendly compared to human placenta, while there was no difference between conventional simulator and human placenta in the TAM items. Conclusion: We validated a new high-fidelity simulator developed by the Sant'Anna School of Advanced Studies in Pisa, Italy, using the TAM scale and robust statistical methods, thanks to a successful collaboration with St. Luke's Hospital in a simulation training course where students achieved higher objective scores and perceived the simulator as more useful and easier to use than a real human placenta, suggesting significant educational benefits and potential for future research. [ABSTRACT FROM AUTHOR]

Health inequalities continue to exacerbate in the European Region, this underlines the need to strengthen the equity impact of public health policies. Nurses and midwives, professional groups that account for 61.8% of the practicing health professionals, work at the point of care, interdisciplinary and see the effects of health inequalities in their everyday work supporting communities and the environment where they are born, live, work and age. The government chief nursing and midwifery officer (GCNMOs) influence, provide policy advice and lead health systems planning and delivery of services. Further to this, it is increasingly being document that they participate in public health policy and inspire others to commit to the implementation of a new vision to strengthen equity impact on population health outcomes. In 2023, a series of discussions with GCNMOs, multidisciplinary researchers and experts, representing 35 of 53 countries in the WHO European Region explored the implications as to how GCNMOs can contribute to addressing the social determinants of health inequalities. Based on this dialogue, we provide a proposal of public health actions for health equity that will benefit from GCNMOs in delivering co-benefits for better health and inclusive growth. These actions can include equity-responsive health systems and health promotion, universal social protection, secure employment and healthy working conditions, environmental protection, education, decent housing, or urban planning among others. Unless governments facilitate the process where GCNMOs have clear mandates, sufficient authority, recognition, and support to engage in policy advocacy, governments will miss out on building fairer and healthier societies that are truly intersectoral and collaborative. [ABSTRACT FROM AUTHOR]

Background/Objectives: New mothers face significant challenges during the postpartum period, which can impact their maternal performance. This study aimed to assess the effect of tele-continuous midwifery care on maternal functioning and neonatal perception in first-time Iranian mothers. Methods: A randomized controlled field trial was conducted from January to May 2023 on 48 first-time mothers in the postpartum ward at Arash Women's Hospital, Tehran. Participants were randomly assigned to either an intervention or control group. The intervention group received tele-continuous care for six weeks postpartum, while the control group received standard care. The Barkin Index of Maternal Functioning (BIMF) and the Neonatal Perception Inventory (NPI) were used to collect data in the second and sixth weeks after delivery. Data were analyzed using SPSS 26. Results: The mean age was 26.2 ± 4.8 years in the intervention group and 28.0 ± 6.1 years in the control group. An independent t-test revealed a significant difference in maternal functioning (BIMF score) between the intervention and control groups by the sixth week postpartum (p < 0.0001). A significant improvement in BIMF scores was observed within the intervention group from the second to the sixth week (p = 0.007). However, the McNemar's test on the NPI showed no significant difference in the proportions of negative and positive maternal perceptions within the intervention group (p = 0.219) and in the control group (p = 0.508). Conclusions: Tele-continuous midwifery care effectively enhances maternal functioning during the vulnerable postpartum period, highlighting the necessity of ongoing support for new mothers. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Discussion Conclusion The land we call Canada is a settler colonial country where reproductive healthcare is used as a mechanism to control, subjugate, and erase Indigenous people and to advance the White settler state. Healthcare providers play an integral role in the healthcare system and contribute to Canada's colonization. In this piece, we critically analyze how settler midwifery is complicit with colonialism in reproductive healthcare by exploring the history of midwifery in Canada, midwifery education, and contemporary settler midwifery.European settlers omitted the history of Indigenous midwifery in Canada and to justify their erasure, they conceptualized Indigenous Peoples as uncivilized and their birthing practices as substandard. To establish a colonial healthcare system, settler midwives replaced traditional Indigenous birth attendants. When midwifery became regulated, midwives were required to train in formal post‐secondary institutions that sustain colonial logics, systems, and practices. Midwifery education programs maintain colonialism by reinforcing medicalized Western practices and sustaining barriers to the growth of Indigenous midwifery. As a result, Western birthing practices are widespread among settler midwives and Indigenous Peoples face barriers to comprehensive and culturally sensitive care. To decolonize Canadian midwifery, we must dismantle stereotypes about Indigenous Peoples and their birthing practices in historical narratives, implement an anti‐colonial approach to midwifery education, support Indigenous midwives in returning birth home, and improve the provision of culturally sensitive care.Settler midwifery in Canada is complicit in colonialism; building anti‐colonial alliances can help support Indigenous midwives in leading a decolonial future for reproduction and birthing. [ABSTRACT FROM AUTHOR]

Objective: Eating disorders (EDs) comprise a range of illnesses characterised by disordered eating, distressing thoughts, and changes in weight. EDs in the perinatal period are a growing concern. Maternity staff receive little training in this area and often report feeling ill-equipped to recognise or respond to presentations of ED during this time. The study aimed to develop and evaluate an online educational module for clinicians and support workers to improve knowledge of EDs in the perinatal period. Method: Education modules were developed using a co-design process with consumer advocates, peer support workers, clinicians, and experts. Consumer perspectives, evidence-based videos, activities, and text relating to screening, management, monitoring and referral of perinatal individuals with EDs were included in the module. Quantitative and qualitative data from pre- and post- surveys were used to evaluate changes in knowledge and confidence before and after completing the module, and to assess staff satisfaction, usability, and obtain feedback for improvement. Results: Use of the online education module significantly increased staff knowledge of EDs in the perinatal period. Participants also felt more confident in discussing the topic with patients, screening, supporting, and referring a person with ED in the perinatal period. Participants also reported the module was engaging and easy-to-use. Conclusions: Findings indicate that the ED online education module is an engaging and easy-to-use tool for improving the knowledge and skills of the healthcare workforce, thereby improving patient care and health outcomes. The development of additional online resources for clinicians would be beneficial for increasing staff capability and improving patient services. Plain English Summary: Eating disorders (ED) in pregnancy and after birth are a serious and growing concern for maternity services. Few educational and training options currently exist to support clinicians to identify and manage EDs during this time. The authors co-designed an online education module with lived experience consumers, peer workers, and clinicians, designed to improve identification, management, and referral of women experiencing ED's. Evaluation of the modules using online surveys showed that the online module was acceptable and engaging for users, and increased staff knowledge and confidence in identifying and managing these presentations. Online modules are a cost-effective resource that could improve staff capabilities and patient care in the long term. [ABSTRACT FROM AUTHOR]

Aim: This study explores the experiences of interprofessional collaboration of Canadian midwives and obstetricians from midwives' perspective. Design: A concurrent mixed‐methods approach that combined a small validation study and qualitative thematic analysis was used to provide evidence of the nature and importance of collaboration between Registered Midwives (RMs) and obstetricians. Method: Eighteen RMs across Canada completed a demographic survey and the Midwifery‐Obstetrician Collaboration (MOC) scale in 2023. The quantitative analyses were conducted to assess the reliability of the Midwifery‐Obstetrician Collaboration (MOC) and accumulate preliminary evidence to support its validity. Semi‐structured interviews were conducted with 13 participants. After completing the interviews, themes were identified using thematic analysis. Results: The primary themes identified were knowledge of midwifery scope affects collaboration, collaboration is necessary for effective patient care, midwife‐physician collaboration is impacted by power differentials and hierarchies, and proposed methods to improve physician‐midwife collaboration. Although a small sample size did not permit extensive statistical testing, the quantitative results supported the reliability of the MOC scale. In addition, a strong correlation between the MOC and the communication subscale of the Inter‐Professional Collaboration (IPC) scale provided evidence of the MOC's concurrent validity as a measure of collaboration between midwives and physicians. Conclusion: This study provides support for the Midwifery‐Obstetrics Collaboration (MOC) Scale as an assessment tool to evaluate collaboration between midwives and OB/GYNs in obstetrics care. While the 18 RMs recruited for this study provided a fulsome analysis for the qualitative portion, a larger study is necessary to provide more extensive quantitative analysis to validate the MOC scale for continued use among RMs and OBs. Implications: The implications of this study are to foster strong interprofessional relationships between midwives and OBs and to improve the health outcomes of pregnant women and newborns. Reporting Method: The authors adhered to Consolidated criteria for reporting qualitative research (COREQ). [ABSTRACT FROM AUTHOR]