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Postpartum mothers are susceptible to lumbopelvic pain which may be exacerbated by loading, like carrying their infant in arms and with baby carriers. Nulliparous women carrying infant mannequins may biomechanically mimic mother–infant dyad, but this has not been studied. The purpose of our study was to investigate biomechanical differences of 10 mothers carrying their infants and 10 nulliparous women carrying infant mannequins under 3 gait conditions: carrying nothing, carrying in arms, and carrying in a baby carrier (babywearing). Spatiotemporal gait parameters, peak ground reaction forces and impulses, and lower extremity and trunk kinematics were collected using motion capture and force plates and compared using a mixed 2 × 3 (parity × condition) analysis of variance (α ≤.05). The largest differences occurred between carrying conditions: carrying in arms or babywearing increased vertical and anteroposterior ground reaction forces, trunk extension, ankle dorsiflexion, and hip and knee flexion. Kinematic differences were identified between arms and babywearing conditions. Together this suggests alterations in joint loading for both groups. Our study also contributes a novel understanding of postpartum health by demonstrating alterations in step time, anterior forces, and ankle and knee mechanics, suggesting that during gait, mothers carrying their own infants choose different propulsive strategies than nulliparous women carrying mannequins. [ABSTRACT FROM AUTHOR]

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.

BackgroundPregnant and postpartum women in Sub-Saharan Africa are at high risk of HIV acquisition. We evaluated a person-centered dynamic choice intervention for HIV prevention (DCP) among women attending antenatal and postnatal care.SettingRural Kenya and Uganda.MethodsWomen (aged 15 years or older) at risk of HIV acquisition seen at antenatal and postnatal care clinics were individually randomized to DCP vs. standard of care (SEARCH; NCT04810650). The DCP intervention included structured client choice of product (daily oral pre-exposure prophylaxis or postexposure prophylaxis), service location (clinic or out of facility), and HIV testing modality (self-test or provider-administered), with option to switch over time and person-centered care (phone access to clinician, structured barrier assessment and counseling, and provider training). The primary outcome was biomedical prevention coverage-proportion of 48-week follow-up with self-reported pre-exposure prophylaxis or postexposure prophylaxis use, compared between arms using targeted maximum likelihood estimation.ResultsBetween April and July 2021, we enrolled 400 women (203 intervention and 197 control); 38% were pregnant, 52% were aged 15-24 years, and 94% reported no pre-exposure prophylaxis or postexposure prophylaxis use for ≥6 months before baseline. Among 384/400 participants (96%) with outcome ascertained, DCP increased biomedical prevention coverage 40% (95% CI: 34% to 47%; P < 0.001); the coverage was 70% in intervention vs. 29% in control. DCP also increased coverage during months at risk of HIV (81% in intervention, 43% in control; 38% absolute increase; 95% CI: 31% to 45%; P < 0.001).ConclusionA person-centered dynamic choice intervention that provided flexibility in product, testing, and service location more than doubled biomedical HIV prevention coverage in a high-risk population already routinely offered access to biomedical prevention options.

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.

Background: The continuum of care (CoC) in maternal health refers to the continuity of individual reproductive health care across the antenatal, intrapartum, and postnatal periods. The CoC is an indicator of the quality of maternal and newborn health outcomes and women's empowerment is crucial to improving maternal and neonatal health service access and utilisation. Objective: To examine the spatial patterns of continuum of care use for maternal and neonatal health services and its correlation with women's empowerment. Methods: We analysed data from the Ethiopian Demographic and Health Surveys (EDHS) of 2011 and 2016. All women aged 15–49 who had live births in the preceding five years of the DHS surveys were included in the analysis. We measured the continuum of care using the modified co-coverage index (CoCI), which consisted of six indicators. Women's empowerment was assessed using a validated survey-based Women's Empowerment (SWPER) index. We used the Getis-Ord-Gi* spatial analysis tool to portray locations with clusters of CoC service use and spatial correlations between CoC use and women empowerment. Results: None of the newborn-mother pairs in the 2011 survey received the entire continuum of care and only 2.5% of newborn-mother pairs received the full range of continuum of care services in the 2016 survey. In 2016, 6.9% of mother-newborn pairs received the basic CoC services (four or more antenatal care [ANC] visits, skilled birth attendance [SBA], and postnatal care [PNC]), and no mother-newborn pair received all three services at the same time in 2011. The Amhara, Afar, and Somali regional states had the least CoC service use in both surveys. There was a positive spatial correlation between CoC use and women's empowerment domains. Conclusion: Our analysis showed that the use of four or more ANC visits, SBS, newborn PNC, Bacillus Calmette-Guérin (BCG) vaccine uptake, and tetanus toxoid protection at birth were low in Ethiopia. Women empowerment domains were found to have a positive spatial correlation with CoC services use. To improve and preserve continuity of care, it is critical to leverage every maternal health facility encounter to encourage sustained service usage at each step of the continuum. Government policies should prioritise women's empowerment and raise public awareness of maternity services. [ABSTRACT FROM AUTHOR]

Background: Improving maternal healthcare services is crucial to achieving the Sustainable Development Goal (SDG-3), which aims to reduce maternal mortality and morbidity. There is a consensus among different researchers that proper utilization of maternal healthcare services can improve the reproductive health of women, and this can be achieved by providing Antenatal Care (ANC) during pregnancy, Health Facility Delivery (HFD), and Postnatal Care (PNC) to all pregnant women. The main aim of this study was to investigate the utilization and factors associated with maternal and child healthcare services among women of reproductive age in the pastoralist communities in Kenya. Methods: A cross-sectional survey was conducted among 180 pastoralist women who gave birth in the past two years across ten mobile villages in Marsabit County between 2nd January and 29th February 2019. Three key outcomes were analyzed, whether they attended ANC 4+ visits, delivered at HF, and received PNC. Pearson χ2 test and multivariate logistic regression analysis were conducted by IBM SPSS27.0 following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The significance level was set at p < 0.05. Results: Of the 180 eligible pastoralist women (mean age 27.44 ± 5.13 years), 92.2% were illiterate, 93.9% were married, 33.3% were in polygamy, and 14.4% had mobile phones. The median commuting distance was 15.00 (10–74) km, 41.7% attended ANC 4+, 33.3% HFD, and 42.8% PNC. Those women residing close (≤ 15 km) to a health facility had a threefold higher ANC 4+ (OR 3.10, 95% CI 1.47–6.53), 2.8-fold higher HFD (OR 2.80, 95% CI 1.34–5.84), and 2.5-fold higher PNC (OR 2.49, 95% CI 1.19–5.22) probability. The likelihood was 30-fold higher for ANC 4+ (OR 29.88, 95% CI 6.68–133.62), 2.5-fold higher for HFD (OR 2.56, 95% CI 0.99–6.63), and 60-fold higher for PNC (OR 60.46, 95% CI 10.43–350.55) in women with mobile phones. A monogamous marriage meant a fivefold higher ANC 4+ (OR 5.17, 95% CI 1.88–14.23), 1.6-fold higher HFD (OR 1.67, 95% CI 0.77–3.62), and a sevenfold higher PNC (OR 7.05, 95% CI 2.35–21.19) likelihood. Hosmer Lemeshow test indicated a good-fitting model for ANC 4+, HFD, and PNC (p = 0.790, p = 0.441, p = 0.937, respectively). Conclusion: In conclusion, the utilization of three essential maternal health services is low. Geographic proximity, monogamous marriage, and possession of mobile phones were significant predictors. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community by providing mobile health outreach and health education. Plain Language Summary: Attending maternal healthcare clinics is essential to reduce maternal deaths and infections. This can be achieved by receiving antenatal care, delivering at health facilities, and checkups after delivery. We investigated the utilization and factors associated with maternal and child healthcare services among pastoralist women of reproductive age who have given birth in the past two years. Of one hundred and eighty women who participated, most of them were illiterate; the majority were married, of which almost a quarter were in polygamous marriages. This population's uptake of antenatal care, delivery in health facilities, and checkups after delivery is low. This means, that walking distance to the health facility was more than 15 km, almost half of women attended antenatal care and received checkups after delivery but only thirty-three percent delivered at a health facility. Geographic proximity, monogamy, and possession of mobile phones for communication were significant in determining the usage of maternal health care. Living close to a health facility means almost three times more antenatal care, two times more health facility delivery, and checkups after delivery. Women with mobile phones showed twenty-seven more times chances to attend antenatal care, more than four times chances to deliver in a health facility and sixty times more chances of having checkups after delivery. Monogamous marriage showed five times higher odds to attend ANC 4+ visits, and seven times having checkups after delivery. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community. [ABSTRACT FROM AUTHOR]

Background: Postnatal care (PNC) is essential for early identification and management of life-threatening obstetric complications. Despite efforts by the Ethiopian government to improve maternal and child health service use, PNC service has remained low, and disparity across geographic locations is a major public health problem. This study aimed to investigate the change and contributing factors in PNC service use across geographical locations (rural-urban) and over time (2016 to 2019) in Ethiopia. Methods: We analyzed data on women who gave birth from the 2016 and 2019 Ethiopian Demographic and Health Surveys. A total of 6,413 weighted samples (4,308 in 2016 and 2,105 in 2019) were included in the analysis. A multivariate decomposition analysis technique was used to determine the change and identify factors that contributed to the change across geographical locations and over time. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05. Results: The prevalence of PNC use was higher among urban residents, and the urban-rural disparity reduced from 32.59% in 2016 to 19.08% in 2019. The difference in the composition of explanatory variables was the only statistically significant for the urban-rural disparity in PNC use in both surveys. Specifically, female household heads (4.51%), delivery at a health facility (83.45%), and birth order of two to three (5.53%) and four or more (-12.24%) in 2016 significantly contributed to the urban-rural gap. However, in 2019, middle wealth index (-14.66%), Muslim religion (3.84%), four or more antennal care contacts (18.29%), and delivery at a health facility (80.66%) significantly contributed to the urban-rural gap. PNC use increased from 16.61% in 2016 to 33.86% in 2019. About 60% of the explained change was due to the difference in the composition of explanatory variables. Particularly, urban residence (-5.79%), a rich wealth index (2.31%), Muslim (3.42%), and other (-2.76%) religions, having radio or television (1.49%), 1–3 (-1.13%), and 4 or more (11.09%) antenatal care contacts, and delivery at a health facility (47.98%) were statistically significant contributors to the observed change. The remaining 40% of the overall change was due to the difference in unknown behaviors (coefficient) of the population towards PNC. Conclusions: There was a significant change in PNC service use by residence location and over time in Ethiopia, with urban women in both surveys being more likely to use PNC service. The urban-rural disparity in PNC uptake was due to the difference in the composition of explanatory variables, whereas the change over time was due to the change in both the composition of explanatory variables and population behavior towards PNC. Increased antenatal care contacts and delivery at a health facility played a major role in explaining the gap in PNC services across residences and over time in Ethiopia, highlighting the importance of stepping up efforts to enhance their uptake in rural settings. [ABSTRACT FROM AUTHOR]

Maternal morbidity and mortality remain significant challenges in the United States, with substantial burden during the postpartum period. The Centers for Disease Control and Prevention, in partnership with the National Association of Community Health Centers, began an initiative to build capacity in Federally Qualified Health Centers to (1) improve the infrastructure for perinatal care measures and (2) use perinatal care measures to identify and address gaps in postpartum care. Two partner health center-controlled networks implemented strategies to integrate evidence-based recommendations into the clinic workflow and used data-driven health information technology (HIT) systems to improve data standardization for quality improvement of postpartum care services. Ten measures were created to capture recommended care and services. To support measure capture, a data cleaning algorithm was created to prioritize defining pregnancy episodes and delivery dates and address data inconsistencies. Quality improvement activities targeted postpartum care delivery tailored to patients and care teams. Data limitations, including inconsistencies in electronic health record documentation and data extraction practices, underscored the complexity of integrating HIT solutions into postpartum care workflows. Despite challenges, the project demonstrated continuous quality improvement to support data quality for perinatal care measures. Future solutions emphasize the need for standardized data elements, collaborative care team engagement, and iterative HIT implementation strategies to enhance perinatal care quality. Our findings highlight the potential of HIT-driven interventions to improve postpartum care within health centers, with a focus on the importance of addressing data interoperability and documentation challenges to optimize and monitor initiatives to improve postpartum health outcomes. [ABSTRACT FROM AUTHOR]

Background: Postpartum contraception plays a critical role in reducing the occurrence of rapid subsequent pregnancy, offering individuals reproductive choice, and promoting overall reproductive planning and well-being. In this study, we investigated the relationship between psychosocial stress during pregnancy, postpartum depressive symptoms (PDS), and postpartum contraceptive use. Materials and Methods: We analyzed data from the Pregnancy Risk Assessment Monitoring System (2012–2019), which included comprehensive information about maternal experiences, views, and needs before, during, and after pregnancy from four states and a large city, with a total sample size of N = 36,356. We conducted descriptive analyses as well as adjusted multivariable logistic regression models. Main Findings: Our findings demonstrate significant negative associations between partner-related (adjusted odds ratio [aOR] = 0.82, 95% confidence interval [95% CI]: 0.76–0.89, p ≤ 0.001) and trauma-related (aOR = 0.83, 95% CI: 0.75–0.92, p ≤ 0.001) stressors and postpartum contraceptive use. Additionally, we observed a negative association between PDS and postpartum contraceptive use (OR = 0.88, 95% CI: 0.80–0.97, p ≤ 0.01), indicating that individuals experiencing PDS are less likely to utilize contraception after giving birth. Furthermore, our study highlights racial/ethnic, socioeconomic, and parity postpartum contraceptive use disparities. Conclusions: Our findings emphasize the importance of incorporating psychosocial stressors and mental health into the promotion of effective postpartum contraception practices. These results have valuable implications for health care providers, policymakers, and researchers as they can guide the development of targeted interventions and support systems to contribute to improved reproductive health outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic caused unprecedented levels of stress amongst pregnant women and new mothers. The current qualitative study explored the ways in which perinatal women made meaning of their experiences during the COVID-19 pandemic. Methods: Data came from a parent study in which 54 perinatal (pregnant and postpartum) women in the United States completed semi-structured interviews from October 2021 to January 2022 describing their experiences during the COVID-19 pandemic. The data was interpreted using a hermeneutic, phenomenological approach to delve deeply into the concept of meaning-making. Results: Despite high levels of stress and challenging circumstances, participants reported engaging in meaning-making through finding connection, focusing on gratitude, and identifying openings for change. Unique forms of meaning-making amongst this population include a sense of connection to women throughout history, connection to their baby, and recognition of the need for systemic change for perinatal women. Conclusions: Perinatal women coped with the stress of the COVID-19 pandemic by making meaning from their experiences. Future research should further explore the importance of these aspects of meaning-making to perinatal women and implement these findings to adapt prevention and treatment approaches to address perinatal stress, especially during times of crisis. [ABSTRACT FROM AUTHOR]

Introduction: Discharge "against medical advice" (AMA) in the obstetric population is overall under-studied but disproportionally affects marginalized populations and is associated with worse perinatal outcomes. Reasons for discharges AMA are not well understood. The objective of this study is to identify the obstacles that prevent obstetric patients from accepting recommended care and highlight the structural reasons behind AMA discharges. Methods: Electronic health records of patients admitted to antepartum, peripartum, or postpartum services between 2008 and 2018 who left "AMA" were reviewed. Progress notes from clinicians and social workers were extracted and analyzed. Reasons behind discharge were categorized using qualitative thematic analysis. Results: Fifty-seven (0.12%) obstetric patients were discharged AMA. Reasons for discharge were organized into two overarching themes: extrinsic (50.9%) and intrinsic (40.4%) obstacles to accepting care. Eleven participants (19.3%) had no reason documented for their discharge. Extrinsic obstacles included childcare, familial responsibilities, and other obligations. Intrinsic obstacles included disagreement with provider regarding medical condition or plan, emotional distress, mistrust or discontent with care team, and substance use. Discussion: The term "AMA" casts blame on individual patients and fails to represent the systemic barriers to staying in care. Obstetric patients were found to encounter both extrinsic and intrinsic obstacles that led them to leave AMA. Healthcare providers and institutions can implement strategies that ameliorate structural barriers. Partnering with patients to prevent discharges AMA would improve maternal and infant health and progress towards reproductive justice. Significance: What is Already Known on this Subject?: Obstetric patients who leave "against medical advice (AMA)" have worse perinatal outcomes and often are from marginalized communities. The term, AMA, is also stigmatizing, placing blame on individual decision making rather than systemic barriers to access. Reasons for leaving AMA are not well understood in the obstetric population. What does this Study add?: We reframe the discussion around leaving AMA by describing obstacles in accepting care. Patients experienced both extrinsic and intrinsic obstacles to accepting medical care, from childcare issues to disagreement with treatment plan. Partnering with patients to overcome these obstacles would improve maternal and infant health and increase equity and reproductive justice. [ABSTRACT FROM AUTHOR]

Objective: To identify characteristics associated with a higher likelihood of patient-initiated encounters with a health care professional before the scheduled 6-week postpartum visit. Methods: We performed a retrospective cohort study of postpartum persons who received prenatal care and delivered at a single academic level IV maternity care center in 2019. We determined associations between maternal sociodemographic and obstetric characteristics and the likelihood of patient-initiated early postpartum encounters with χ2 tests for categorical variables and Wilcoxon rank sum tests for continuous and ordinal variables. Results: A total of 796 patients were included in our analysis, and 324 (40.7%) initiated an early postpartum encounter. Significantly more postpartum persons who initiated early postpartum encounters were primiparous persons (54.3%) than multiparous (33.8%) persons (P <.001). Postpartum persons who desired breastfeeding or who had prolonged maternal hospitalization, episiotomy, or cesarean or operative vaginal delivery were also significantly more likely to initiate early postpartum encounters (all P≤.002). Of postpartum persons who initiated early encounters, 44 (13.6%) initiated in-person visits, 138 (42.6%) initiated telephone or patient portal communication, and 142 (43.8%) initiated encounters of both types. Specifically, 39.2% of postpartum persons initiated at least one early postpartum encounter for lactation support, and nearly half of early postpartum encounters occurred during the first week after hospital discharge. Conclusion: Early postpartum encounters were more common among primiparas and postpartum persons who were breastfeeding or had prolonged hospitalization, episiotomy, cesarean delivery, or operative vaginal delivery. Future studies should focus on the development of evidence-based guidelines for recommending early postpartum visits. Significance: Most pregnancy-related maternal deaths occur during the postpartum period; therefore, optimization of postpartum care is a priority for obstetric clinicians. Postpartum encounters before 6 weeks are sought most frequently by primiparas or postpartum persons who breastfeed or have prolonged hospitalization, episiotomy, or operative vaginal/cesarean delivery. Understanding who initiates early postpartum encounters, preferred methods of contact, and their most frequently asked questions will allow obstetric health practices to better meet the postpartum needs of patients. [ABSTRACT FROM AUTHOR]

Objectives: To understand differences in the relationship between parental leave duration and postpartum care across sociodemographic and income groups. Methods: We used data from six states participating in the Center for Disease Control and Prevention's yearly PRAMS study from 2016 to 2019 with a total sample of 12,442 people. Bivariable analyses assessed demographics among those who took more or less parental leave and estimated the prevalence of not accessing postpartum care by demographics, stratified by leave length. We used propensity score weighting to estimate the predicted risk and risk ratios of not accessing postpartum care with < 7 as compared to > = 7 weeks of leave, stratified by income. Results: There were significant differences in the prevalence of not accessing care stratified by leave duration, and disparities in utilization by race, ethnicity, and income. A shorter leave duration was associated with a higher risk of not accessing care (RR: 1.98 [CI 1.25–3.20] in higher income group, RR: 1.45 [CI 1.08, 1.99] in lower). The absolute risk of not accessing care was highest in the lower income group regardless of leave duration, though patterns of increased utilization with longer leave duration were consistent in both groups. Conclusions for practice: While shorter leave durations increased the risk of not attending postpartum care, those with lower incomes had the highest absolute risk of not attending care. Policies to support paid leave and extended leave duration are necessary, along with additional supports to increase postpartum care utilization, particularly among low-income families. Significance: What is already known on this subject?: Postpartum care helps identify pregnancy and birth-related complications and coordinate follow-up care, serving as an important avenue for identification and treatment of maternal morbidities. Parental leave is associated with improved health outcomes postpartum. Disparities in both parental leave and postpartum care have been observed across multiple sociodemographic groups. What does this study add?: A shorter leave duration increased the risk of not attending postpartum care. However, those with lower incomes had the highest absolute risk of not attending care. These findings suggest leave duration is important for postpartum care attendance, and that low-income families should receive further support to improve postpartum care attendance regardless of leave duration. [ABSTRACT FROM AUTHOR]

Despite success in achieving viral suppression during pregnancy in people living with HIV (PLWH), postpartum adherence remains a challenge. We aimed to describe rates of adherence at a Prevention of Mother-to-Child HIV Transmission (PMTCT) Center before and during the COVID-19 pandemic. This study was conducted from a cohort of PLWH who received prenatal care and were virally suppressed near delivery. We tracked combined antiretroviral therapy (cART) pickups for 12 months and HIV viral load (VL) from 2 to 12 months after delivery. We defined flexible adherence as a monthly pickup of cART and strict adherence as also having VL < 200 copies/mL and at least one maternal HIV VL between two and twelve months postpartum. Pre-pandemic was defined as delivery from March 2017-February 2019 and pandemic as March 2020-February 2022. During the study, 1119 PLWH were followed, and 965 (86%) were suppressed near delivery. There were 511 pre-pandemic and 290 pandemic participants. Adherence rates were 66/511 (13%) and 38/290 (13%), respectively. During the pandemic, more participants conceived using cART and were undetectable at the start of prenatal care; nevertheless, postpartum adherence was no better than pre-pandemic underscoring the need to improve strategies for adherence specific to this subset of PLWH in the postpartum period. [ABSTRACT FROM AUTHOR]

Background: Standardization of health systems often hinders client‐centered care. This study investigates whether allowing more flexibility in the planning range of the Dutch home‐based postpartum care service improves its quality of care, as innovative approach to client‐centered care. Methods: A randomized controlled trial was conducted (2017–2019), in which pregnant women who intended to breastfeed were assigned into two groups (1:1). The intervention group was allowed to receive care up to the 14th‐day postpartum, instead of the first 8–10 consecutive days ("usual care"). Primary outcome measure was the proportion of newborns still receiving exclusively breastmilk on final caring day of the service. This so‐called successful breastfeeding rate is currently used by the Dutch health sector to measure the quality of care. Secondary outcome measures were self‐care experience, overall care experience, and exclusive breastfeeding duration rate. Results: Based on data from 1275 participants, there was no difference in exclusive breastfeeding on final caring day (86,7% intervention group vs. 88,9% control group, RR: 1.03, 95% CI: 0.98–1.07). Both groups showed similar self‐care experiences. Women in the intervention group had slightly poorer overall care experience and lower exclusive breastfeeding duration rates. Conclusions: This study found no effect on the quality of care when allowing more flexibility in the planning range of home‐based postpartum care. Women can, therefore, be offered more flexibility to suit them. Given the confusion in interpreting the sector's current main quality indicator, we call for an inclusive dialogue on how to best measure the quality of home‐based postpartum care. [ABSTRACT FROM AUTHOR]

Introduction: Postpartum 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. Methods: We 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. Results: A 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. Conclusion: The 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. [ABSTRACT FROM AUTHOR]

Background: To prevent the spread of SARS‐CoV‐2, hospitals around the world adopted protocols that, in varying ways, resulted in the exclusion of partners from hospital postnatal care wards. The objective of this study was to examine the effect this exclusion had on partners' satisfaction with postnatal care. Methods: An online survey (the Swedish Pregnancy Panel) including free‐text comments was conducted before and during the first wave of the COVID‐19 pandemic; partners of pregnant women were recruited at an early ultrasound appointment and followed until 2 months after childbirth. Data were linked to the Swedish Pregnancy Register. Results: The survey was completed by 524 partners of women who gave birth during the pandemic and 203 partners of women who gave birth before. Partners' satisfaction with hospital postnatal care dropped 29.8 percent (−0.94 OLS, 95% CI = −1.17 to −0.72). The drop was largest for partners of first‐time mothers (−1.40 OLS, 95% CI = −1.69 to −1.11), but unrelated to clinical outcomes such as mode of birth and most social backgrounds, except higher income. The qualitative analysis showed that partners (1) felt excluded as partners and parents, (2) thought the strain on staff led to deficiencies in the care provided, and (3) perceived the decision about partner restrictions as illogical. Conclusions: The exclusion of partners from the hospital postnatal wards clearly impaired satisfaction with care, and partners of first‐time mothers were particularly affected. Planning for future restrictions on partners from hospital wards should factor in these consequences. [ABSTRACT FROM AUTHOR]

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

Medical nutrition therapy is recognized as the cornerstone to optimal glycemic management of gestational diabetes (GDM) during pregnancy and registered dietitian nutritionists (RDNs) are central to delivery of this, yet data are lacking on their views of the barriers and enablers to performing this role. This qualitative study aimed to explore the perspectives of RDNs providing medical nutrition therapy to people with GDM across the Republic of Ireland. Focus groups and semistructured interviews were conducted with RDNs from maternity settings whose roles included providing dietetics services to people with GDM. Five focus groups and 2 semistructured interviews were conducted with 16 RDNs from 13 maternity sites, whose roles included medical nutrition therapy to people with GDM, in Ireland in February to March 2021. A topic guide addressing GDM management, postpartum care, and future type 2 diabetes prevention was followed. Data from focus groups and interviews were analyzed using reflexive thematic analysis. RDNs collectively viewed their role as central to supporting people with GDM. Three themes were generated: Theme 1—a complex layered role—addressed complexities in dietetics practice. Theme 2 highlighted challenges in providing optimum care with sub themes of huge changes with COVID-19, care is not equal, and no defined postpartum pathway. Theme three reported on framing future health needs through sub themes of the 6-week check is a missed opportunity, people need to understand their risk, and more integrated care and type 2 diabetes prevention is needed. RDNs recognize the need for continuity of care in pregnancy and postpartum for people diagnosed with GDM. However, perceived disparities in allocation of dietetics services for GDM and an absence of agreed care pathways were seen as barriers to optimum care. Collaboration and communication across primary and secondary care settings are essential and require improvement. [ABSTRACT FROM AUTHOR]

Mode of birth has been linked to offspring health. Changes in DNA methylation (DNAm) may represent a potential mechanism; however, findings are heterogeneous and limited to early infancy. This preregistered study examined whether mode of birth (vaginal birth compared with elective or emergency cesarean section) affects DNAm at birth, in childhood, and adolescence and whether these effects are modified by the postnatal care environment, specifically by breastfeeding and mother–infant bonding. Using data from 876 mother–infant dyads from the U.K. Avon Longitudinal Study of Parents and Children, we examined differentially methylated cytosine-phosphate-guanine dinucleotides and regions associated with mode of birth. DNAm was quantified using Illumina Infinium Human Methylation 450 K BeadChip in cord blood (at birth) and in peripheral blood (at 7 and 15–17 years). Analyses controlled for maternal age, education, smoking during pregnancy, child sex, gestational week at birth, and batch effects. We also examined interactions of mode of birth with breastfeeding practices and mother–infant bonding. In cord blood, two cytosine-phosphate-guanine dinucleotides (cg05230316; cg13230077) were linked to mode of birth (pFDR <.050). DNAm in childhood or adolescence was not statistically associated with mode of birth (pFDR >.050), and breastfeeding and mother–infant bonding were not moderators (p >.050). Overall, findings suggest mode of birth may have a small effect on cord blood DNAm, but these effects may not persist into later developmental stages. Other postnatal influences should be considered, and further investigation is needed to address study limitations. Public Significance Statement: This study suggests that the mode of birth, whether a child is born vaginally or by emergency or elective cesarean section, has a small effect on how the child's genes are methylated in cord blood cells at birth. DNA methylation in peripheral blood cells during childhood and adolescence was not predicted by mode of birth. Breastfeeding and mother–infant bonding did not buffer the effects of mode of birth, highlighting the necessity to further investigate other postnatal factors as potential determinants of the offspring methylome across development. [ABSTRACT FROM AUTHOR]

In the peripartum, putative mechanisms in the transmission of prenatal contextual risk and maternal psychological distress include biological and social processes. In this study, path analyses were used to test unique, cascading pathways of prenatal contextual risk and pre- and postnatal maternal psychological distress through social mediators (parenting) and biological mediators (infant stress physiology) on infant temperament and toddler adjustment. The sample is comprised of racially and ethnically diverse first-time mothers (N = 200) living in low-income contexts (<200% poverty) who were followed from pregnancy to 18–36 months postpartum. In pregnancy, mothers reported contextual risk and psychological distress (anxiety, depression). In the postpartum, mothers reported their psychological distress. At 2–4 months postpartum, observed mother–infant interactions were coded for sensitive responsiveness. Infant cortisol baseline and reactivity to a lab stressor were collected when infants were 4–6 months old. Mothers reported on infant's temperament (negative affect, effortful control) at 10–12 months and on child adjustment (internalizing, externalizing symptoms) at 18–36 months. Prenatal contextual risk predicted infant cortisol reactivity. Prenatal psychological distress predicted postnatal distress but, when accounting for postnatal distress, did not predict putative mediators or indicators of child adjustment. In contrast, maternal postnatal depression predicted subsequent maternal sensitive responsiveness, which in turn predicted later infant baseline cortisol and cortisol reactivity. Baseline cortisol predicted infant negative affectivity, which predicted toddler internalizing and externalizing symptoms. There was no evidence of mediated effects of prenatal variables on child adjustment outcomes, whereas contextual risk, postnatal psychological distress, and parenting were more salient predictors of child adjustment. Public Significance Statement: Children growing up in low-income contexts are more likely to have adjustment problems compared with advantaged peers. The mechanisms of this are not well-understood. This study tests potential contributors to children's adjustment outcomes from pregnancy to toddlerhood, finding that for families living in the context of low income, contextual risk factors, a mother's mental health after giving birth, a child's stress physiology, and parenting behaviors all contribute to children's adjustment. [ABSTRACT FROM AUTHOR]

Background: The core of postnatal care is that midwives recognise the needs of women and new‐born babies and provide the highest possible quality of care and medical safety to optimise the health and well‐being of new families. The study aimed to describe midwives' experiences in providing postnatal care for families during the first week after the birth of their baby. Method s : An interview study included 18 midwives who interchangeably worked within the models of traditional hospital care, hotel‐based care, home‐based care, hospital‐based check‐ups, and specialist care at a breastfeeding clinic at one university hospital in Sweden. Data collected were analysed using thematic analysis according to Braun and Clarke. Findings: The main theme: 'Like a torch that enlightens new parents along a narrow and winding path into parenthood – a midwife's transitional support' was explored and comprised two themes: (1) Strengthening parents' self‐confidence in their parental role by handling over parental responsibility; and (2) Challenging to facilitate parents' understanding of their parental role. Conclusions: Midwives expressed that supporting parents in the parental transition was a delicate task and included balancing mothers', babies', and partners' needs. The midwives guided parents into parenthood during postnatal care in a strategic manner by strengthening parents in their parental role. Postnatal care delivered by midwives is crucial for new parents and their babies. [ABSTRACT FROM AUTHOR]

Perinatal care provides important health care opportunities for many individuals at risk for cervical cancer. Pregnancy does not alter cervical cancer screening regimens. ASCCP risk-based management has a colposcopy threshold of a 4% immediate risk of cervical intraepithelial neoplasia (CIN) 3 or cancer, but the actual risk can be considerably higher based on current and past screening results. Improving cervical cancer outcomes with diagnosis during pregnancy rather than postpartum and facilitating further evaluation and treatment postpartum for lesser lesions are the perinatal management goals. Although colposcopy indications are unchanged in pregnancy, some individuals with lower risk of CIN 2--3 and reliable access to postpartum evaluation may defer colposcopy until after delivery. Cervical intraepithelial neoplasia diagnosed in pregnancy tends to be stable, with frequent regression postpartum, though this is not universal. Colposcopic inspection during pregnancy can be challenging. Although biopsies in pregnancy are subjectively associated with increased bleeding, they do not increase complications. Endocervical curettage and expedited treatment are unacceptable. Treatment of CIN 2--3 in pregnancy is not recommended. Excisional biopsies in pregnancy are reserved for suspicion of malignancy that cannot be confirmed by colposcopic biopsy and when excisional biopsy results would alter oncologic or pregnancy care. Surveillance of high-grade lesions in pregnancy uses human papillomavirus-based testing, cytology, and colposcopy, with biopsy of worsening lesions every 12--24 weeks from diagnosis until postpartum evaluation. Mode of delivery does not definitively affect persistence of CIN postpartum. Postpartum care may involve a full colposcopic evaluation or expedited excisional procedure if indicated. [ABSTRACT FROM AUTHOR]

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Background Prolonged postpartum amenorrhea is a sign of secondary infertility. However, there are no reports on postpartum menstrual resumption delay in Japanese women. We conducted an Adjunct Study of the Japan Environment and Children's Study (JECS) to elucidate the actual state of postpartum menstrual resumption delay in Japan and related factors. Methods An Adjunct Study questionnaire was sent to 2,729 mothers who participated in the study of Shinshu Subunit Center in the JECS, and 762 mothers were included in the analysis. The participants were categorized into the normal and delayed groups based on the weeks of postpartum menstrual resumption. To investigate the factors associated with postpartum menstrual resumption delay, a multiple logistic regression analysis was conducted with the weeks of postpartum menstrual resumption as the dependent variable. Results The study included 762 women, of which 61 (8.0%) had delayed menstruation, not occurring until 72 weeks postpartum. The multivariate analysis revealed a significant correlation between postpartum menstrual resumption delay and age at delivery, past history of irregular menstruation, history of taking oral contraceptives, breastfeeding at 18 months, and the level of satisfaction with the husband's participation in childcare. Conclusion Postpartum menstruation in Japanese women occurred later than before. In addition to previous findings, another factor was the husband's satisfaction with his participation in childcare. We should not only focus on the physical aspects of mothers, but also provide midwifery care that proposes and supports family planning suitable for each family. [ABSTRACT FROM AUTHOR]

Distinguishing urgent from non-urgent communication is critical. We aimed to understand how hospital staff choose what communication technologies to use. A mixed methods study was conducted with four focus groups, with staff working on postpartum care units, and log data from a hands-free communication system was analyzed. We found that urgent communications were appropriate for the hands-free device, with less urgent communications sent through secure chat in the electronic health record. Exceptions included when the intended recipient was in the operating room and during sensitive discussions. The most common duration of calls on the hands-free device was 16--60 seconds, with few more than 5minutes. The most frequent reason for incomplete calls was the user not logging in (36%), which could be reduced by eliminating logging in and training. We recommend an interruptive communication technology for urgent information and an electronic health record chat for less urgent information that does not require an immediate response. We recommend forwarding and sending calls to a hospital-provided cellphone from the hands-free communication system for provider roles that do not align with the intended workflow for hands-free communications. [ABSTRACT FROM AUTHOR]

Background: The first 100 days after childbirth are important for women recovering from pregnancy and birth. Aim: To describe the most common clinical events or health needs documented in women's primary care records in the first 100 days after childbirth. Design and setting: Cross-sectional study using electronic health records from UK primary care data. Method: Primary care records were examined from childbirth up to 100 days after childbirth for women aged 16–49 years who had given birth to a single live infant between 2006 and 2016 using IQVIA Medical Research Data. The most common clinical events or health needs based on documented symptoms, diagnoses, and medications were identified. How these varied by patient characteristic was explored. Results: In total, 925 712 contacts were identified during the 100 days following 309 573 births. Women were most likely to use primary care to have a postnatal visit or check (60.6%, n = 187 455), for monitoring (such as a blood pressure reading) (49.9%, n = 154 328), and to access contraception (49.7%, n = 153 876). Younger women were more likely to have contacts for preventive care compared with older women, but were less likely to have contacts for ongoing mental and physical symptoms or conditions and pre-existing conditions. The highest peak in contacts occurred 42 days after birth, and related to a postnatal check or visit, monitoring a patient, and recording lifestyle factors (such as smoking status). Conclusion: Primary care services should seek to match the needs of new mothers, taking account of a high volume of contacts, for a broad range of planned and responsive care following childbirth. [ABSTRACT FROM AUTHOR]

Background Methods Results Discussion Three‐quarters of pregnancy‐related deaths occur from 1 day to 1 year after birth, and medical complications frequently occur after birth. Postpartum health concerns are often urgent, requiring timely medical care, which may contribute to a reliance on acute care. One approach to improving postpartum health is to investigate birthing parents' accounts of acute care use in the months after birth, which is what we did in this study.This mixed‐methods study included questionnaire responses, semi‐structured interviews, and chart review of 18 English‐speaking individuals who used acute care in the 90 days after birth in the southeastern United States. Interviews were conducted remotely, recorded, and professionally transcribed. Qualitative data were inductively coded to iteratively develop categories and themes with respect to contributors and barriers to postpartum acute care use.Birthing parents engaged in complex decision‐making processes to decide where and when to seek postpartum acute care in response to their urgent health concerns. Many described fear and uncertainty about their postpartum health. Most participants contacted a healthcare practitioner before using acute care, followed their guidance, and were treated or otherwise reassured at the acute care visit.These findings suggest multilevel opportunities for strengthening healthcare systems, including better‐preparing individuals for the postpartum period and structuring care to accommodate birthing parents and include their support systems. The insights from this study can inform multilevel strategies for strengthening healthcare so that birthing parents are safe and well postpartum. [ABSTRACT FROM AUTHOR]

Aim Background Design Review methods Results Conclusions Summary statement To examine the effect of the provision of care on health outcomes when provided based on Orem's Self‐Care Deficit Theory during perinatal period.The perinatal period is a process with multidimensional care needs for the mother, baby and family. Care based on nursing theories can improve the quality of perinatal care.A systematic review and meta‐analysis.Studies on this topic from 2006 to 2020 have been accessed by nine database searches. The methodological quality of the studies was assessed using the Critical Appraisal Checklists for experimental and quasi‐experimental studies, developed by the Joanna Briggs Institute. This study was conducted by following the Preferred Reporting System for Systematic Reviews and Meta‐Analyses.This systematic review included nine studies with a total sample size of 839 women. These studies showed that care based on Orem's theory significantly helped prolong the mean duration of pregnancy, reduced the incidence of preterm labor, improved hygiene behaviour and increased empowerment. Concerning the perinatal period, this intervention significantly improved self‐care and readiness for hospital discharge, adaptation and breastfeeding self‐efficacy and reduced nipple pain and pain due to abdominal distension.The implementation of this theory into care during the perinatal period can contribute to improved health outcomes.What is already known about this topic? The quality of pregnancy and postpartum care is important for the maternal health. The use of nursing theories—which nursing knowledge is produced—improves care quality and ensures that care is organized systematically. What this paper adds? There is insufficient research that supports Orem's theory of self‐care deficit in pregnancy and postpartum care and also no systematic review about this topic, but the current meta‐analysis showed that postnatal and prenatal treatments based on Orem's theory have a positive impact on the self‐care agency. The implications of this paper: The use of Orem's theory helps nurses understand women and their needs during pregnancy and postpartum periods. Integrating Orem's theory of self‐care deficit into pregnancy and postpartum nursing care services can help increase women's self‐care power. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality (MM) remains a real scourge that hits hardest in the poorest regions of the world, particularly those affected by conflict. However, despite this worrying reality, few studies have been conducted about MM ratio in the Democratic Republic of Congo (DRC). The study aimed to describe the trends as well as the epidemiological profile and causes of reported institutional maternal deaths between 2013 and 2022 in Eastern DRC. Methods: A retrospective descriptive study was conducted between March 2023 and August 2023 in eight Health Zones (HZ), five in South Kivu Province (Mwana, Minova, Miti-Murhesa, Kamituga and Idjwi) and three in North Kivu Province (Kirotshe, Karisimbi and Kayna) in the eastern region of the DRC. Our study covers 242 health facilities: 168 health centers (HC), 16 referral health centers (RHCs),50 referral hospitals (RH) and 8 general referral hospitals (GRHs). Data from registers and medical records of maternal deaths recorded in these zones from 2013–2022 were extracted along with information on the number of deliveries and live births. Sociodemographic, clinical parameters, blood and ultrasound tests and suspected causes of death between provinces were assessed. Results: In total, we obtained 177 files on deceased women. Of these, 143 (80.8%) were retained for the present study, including 75 in the 3 HZs of North Kivu and 68 in the 5 HZs of South Kivu. From 2013 to 2022, study sites experienced two significant drops in maternal mortality ratio (MMR) (in 2015 and 2018), and a spike in 2016–2017. Nonetheless, the combined MMR (across study sites) started and ended the 10-year study period at approximately the same level (53 and 57 deaths per 100,000 live births in 2013 and 2022 respectively). Overall, 62,6% of the deaths were reported from secondary hospital. Most deaths were of married women in their thirties (93.5%). Almost half (47.8%) had not completed four antenatal consultations. The main direct causes of death were, in decreasing order of frequency: post-partum haemorrhage (55.2%), uterine rupture (14.0), hypertensive disorders (8.4%), abortion (7.7%) puerperal infections (2.8%) and placental abruption (0.7%). When comparing among provinces, reported abortion-related maternal mortality (14.1% vs 0%) was more frequent in North Kivu than in South Kivu. Conclusion: This study imperatively highlights the need for targeted interventions to reduce maternal mortality. By emphasizing the crucial importance of antenatal consultations, intrapartum/immediate post-partum care and quality of care, significant progress can be made in guaranteeing maternal health and reducing many avoidable deaths. [ABSTRACT FROM AUTHOR]

Background: Person-centered maternity care (PCMC) is the process of maternity care that is responsive to and respectful of each woman's choices, values, and needs. It reflects the quality of maternal health services. The provision of PCMC is influenced by the maternal sociodemographic and obstetric-related variables However, there is little information about person-centered maternity care in Ethiopia; particularly, communication & autonomy, and supportive care are not well investigated. Therefore, the purpose of this study was to assess the proportion of person-centered maternity care and associated factors among women who give birth at the public hospital, in North West, Ethiopia, 2023. Methods: A facility-based cross-sectional study was conducted among 763 mothers who give birth at public hospitals in the South Gondar zone. The study participants were selected using a systematic random sampling technique. Data were collected through exit interviews using a structured pretested Amharic version questionnaire. EPI- Data version 4.6 was used for data entry and SPSS Version 25 for analysis. Bivariable & multivariable linear regression analysis was computed. Predictor variables were identified by using unstandardized β and a 95% confidence interval. A variable that has a p-value < 0.05 was considered statistically significant. Results: The mean person-centered maternity care was 42.33 out of 90. Mothers living in rural areas (β = -1.43, 95% CI: -2.76,-0.11), 3–4 providers present during labor and delivery (β = -1.58, 95% CI:-3.67,-0.27), had no history of facility delivery (β = -2.28,95% CI:-4.43,-0.13), two days length of stay at hospitals (β = 1.69,95% CI:0.40,2.48), and highest wealth (β = 1.05,95% CI:0.42,1.41) were factors significantly associated with person-centered maternity care (PCMC). Conclusion: The mean score of PCMC was low in the study area compared to studies done in low- and middle-income countries. Highest wealth, 3–4 health providers present during labor and delivery, had no history of facility delivery, and had two-day lengths of stay at hospitals were predictors for PCMC. Therefore, strengthening facility delivery and promoting hospital stays for more than a day as a part of first postnatal care is paramount for increasing PCMC. [ABSTRACT FROM AUTHOR]

Background: Transposition of the great arteries (TGA) is the most common cyanotic congenital heart defect in neonates but with low prenatal detection rate. This study sought to review the prenatal diagnosis, associated abnormalities, and mid-term postnatal outcomes of fetuses with TGA and investigate the integrated prenatal and postnatal management for TGA neonates. Methods: A total of 134 infants prenatally diagnosed with TGA in Guangdong Provincial People's Hospital, China, from January 2009 to December 2022 were included in the study. The prenatal ultrasound data and neonatal records were reviewed to assess the accuracy of prenatal diagnosis. Univariate and multivariate logistic and Cox analyses were used to identify risk factors associated with prognosis in such individuals. Results: The population originated from 40 cities in 10 provinces in China, with integrated antenatal and postnatal management rate reaching 94.0% (126/134) and a high accuracy rate (99.3%) of prenatal primary diagnosis. The median period of follow-up was 1.6 [interquartile range (IQR) 0.1–4.3] years. There were 3 (2.2%) postnatal deaths, 118 (88.1%) patients undergoing arterial switch operation (ASO), 3 (2.2%) undergoing Rastelli operations and 5 (3.7%) doing stage operations. Of 118 patients receiving ASO, the major morbidity occurred in 64 patients (54.2%), and right ventricular outflow tract obstruction (RVOTO) in 31 (26.3%). In the multivariate logistic analysis, gestational ages at birth (OR = 0.953, 95% CI 0.910–0.991; p = 0.025) and cardiopulmonary bypass (CPB) time (OR = 1.010, 95% CI 1.000–1.030; p = 0.038) were identified as independent risk factors associated with major morbidity. In the Cox multivariate analysis, aortic cross-clamping time (HR = 1.030, 95% CI 1.000–1.050; p = 0.017) was identified as independent risk factor associated with RVOTO. Conclusion: Earlier gestational ages at birth and longer CPB time are significantly associated with increased morbidity. Integrated prenatal and postnatal management is recommended for patients with prenatal diagnosis of TGA. [ABSTRACT FROM AUTHOR]

Afghanistan has one of the highest maternal mortality rates in the world. Inadequate postnatal care (PNC) increases the risk of maternal mortality. This study aimed to analyze the socioeconomic and demographic factors that affect postnatal care utilization. A secondary analysis was conducted in 2019 based on the data from the 2015 Afghanistan Demographic and Health Survey. The sample included 29,461 married women aged 15–49 interviewed during the survey. This was a cross-sectional study in which a frequency distribution of independent variables for the study sample was carried out, Pearson's chi-square test was conducted for association, and the strength of association was measured using binary logistic regression. The study found that 39.9% of married women used postnatal care services. The findings of this study suggest that place of delivery and women who gave birth at health facilities were more likely to use PNC than women who delivered at home. Women age 30–39 and 20–29 positively associated with PNC use compared with mothers aged < 20 years. Each level of women's educational attainment increased their use of PNC, and women with higher education were more likely to use PNC than those without education. Furthermore, women who visited 1–3 and more than four ANC visits were more likely to use PNC than women who did not visited ANC. Moreover, women exposed to mass media were more likely to use PNC than those who were not exposed to mass media. Finally, women who lived in the northern and western regions were more likely to use PNC than those who lived in the central region, while women who lived in the southern and southeastern regions were less likely to use PNC than those who lived in the central region. Therefore, strengthening the provision of information, education, and communication could be a communication channel to further improve PNC utilization. Meanwhile further studies are needed to focus on the quality of maternal health care and PNC services in Afghanistan in order to obtain more precise information. [ABSTRACT FROM AUTHOR]

The aim of the researchers of this study was to investigate the effectiveness of care given in line with Levine's conservation model in reducing the risk of postpartum depression. There were 56 participants in the experimental group and 56 participants in the control group. To reduce postpartum depression, a nursing care program was created by examining the theoretical structure of Levine's Conservation Model. Seven home visits were paid and a nursing care program was implemented. The first four home visits were paid once a week and the remaining three home visits were paid every 15 days. The women were given trainings on different subjects during each home visits. All the trainings were given in accordance with each conservation model. During the fourth home visit, the researcher who was a Pilates instructor taught the puerperae how to do Pilates exercises by demonstrating the exercises. It was determined that in the puerperae in the experimental group, sleep quality improved, that their postpartum fatigue decreased and energy increased, and that their risk of developing postpartum depression decreased. Holistic care given based on Levine's Conservation model improves symptoms of insomnia, fatigue and depression in postpartum women. Levine's Conservation model can be used in routine care to reduce physical, psychological and social problems experienced by women in the postpartum period. Highlights: • Nursing interventions can prevent the risk of developing postpartum depression by detecting women with postpartum depressive symptoms in the early period. • Holistic nursing care given for 3 months under the guidance of Levine's Conservation Model reduced the risk of developing depression by eliminating the insomnia and fatigue of the puerperal women. • Training on breastfeeding, hygiene, nutrition and pilates exercises given to women with postpartum depressive symptoms and keeping a diary relieved women psychologically. [ABSTRACT FROM AUTHOR]

Background: By addressing physical and psychosocial needs, group care (GC) improves health-related behaviours, peer support, parent-provider interactions and may improve birth outcomes. Hence, global implementation of GC is encouraged. Context analyses prior to implementation are vital to elucidate which local factors may support or hinder implementation. Methods: Contextual analyses conducted in the Netherlands and Suriname were compared to identify the factors relevant to the implementability of GC as perceived by healthcare professionals (HCPs). 32 semi-structured interviews were conducted with Dutch and Surinamese healthcare professionals. Audio recordings were transcribed verbatim and coded using the Framework approach. The Consolidated Framework for Implementation Research guided the development of the interview guide and of the coding tree. Results: Outer setting: Concerns regarding funding surfaced in both countries. Due to limited health insurance coverage, additional fees would limit accessibility in Suriname. In the Netherlands, midwives dreaded lower revenue due to reimbursement policies that favour one-on-one care. Inner setting: Appropriate space for GC was absent in one Dutch and three Surinamese facilities. Role division regarding GC implementation was clearer in the Netherlands than in Suriname. Innovation: HCPs from both countries expected increased social support, health knowledge among women, and continuity of care(r). Individuals/innovation deliverers: Self-efficacy and motivation emerged as intertwined determinants to GC implementation in both countries. Individuals/innovation recipients: Competing demands can potentially lower acceptability of GC in both countries. While Dutch HCPs prioritised an open dialogue with mothers, Surinamese HCPs encouraged the inclusion of partners. Process: Campaigns to raise awareness of GC were proposed. Language barriers were a concern for Dutch but not for Surinamese HCPs. Conclusions: While the most striking differences between both countries were found in the outer setting, they trickle down and affect all layers of context. Ultimately, at a later stage, the process evaluation will show if those outer setting barriers we identified prior to implementation actually hindered GC implementation. Changes to the health care systems would ensure sustained implementation in both countries, and this conclusion feeds into a more general discussion: how to proceed when contextual analyses reveal barriers that cannot be addressed with the time and resources available. [ABSTRACT FROM AUTHOR]

Background: Racial inequities in severe maternal morbidity (SMM) and mortality constitute a public health crisis in the United States. Doula care, defined as care from birth workers who provide culturally appropriate, non-clinical support during pregnancy and postpartum, has been proposed as an intervention to help disrupt obstetric racism as a driver of adverse pregnancy outcomes in Black and other birthing persons of colour. Many state Medicaid programs are implementing doula programs to address the continued increase in SMM and mortality. Medicaid programs are poised to play a major role in addressing the needs of these populations with the goal of closing the racial gaps in SMM and mortality. This study will investigate the most effective ways that Medicaid programs can implement doula care to improve racial health equity. Methods: We describe the protocol for a mixed-methods study to understand how variation in implementation of doula programs in Medicaid may affect racial equity in pregnancy and postpartum health. Primary study outcomes include SMM, person-reported measures of respectful obstetric care, and receipt of evidence-based care for chronic conditions that are the primary causes of postpartum mortality (cardiovascular, mental health, and substance use conditions). Our research team includes doulas, university-based investigators, and Medicaid participants from six sites (Kentucky, Maryland, Michigan, Pennsylvania, South Carolina and Virginia) in the Medicaid Outcomes Distributed Research Network (MODRN). Study data will include policy analysis of doula program implementation, longitudinal data from a cohort of doulas, cross-sectional data from Medicaid beneficiaries, and Medicaid healthcare administrative data. Qualitative analysis will examine doula and beneficiary experiences with healthcare systems and Medicaid policies. Quantitative analyses (stratified by race groups) will use matching techniques to estimate the impact of using doula care on postpartum health outcomes, and will use time-series analyses to estimate the average treatment effect of doula programs on population postpartum health outcomes. Discussion: Findings will facilitate learning opportunities among Medicaid programs, doulas and Medicaid beneficiaries. Ultimately, we seek to understand the implementation and integration of doula care programs into Medicaid and how these processes may affect racial health equity. Study registration The study is registered with the Open Science Foundation (https://doi.org/10.17605/OSF.IO/NXZUF). [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Migrant women are a heterogenous group with both higher and lower risk for pregnancy complications and adverse birth outcomes compared with women in the receiving countries. This study aimed to investigate women's use of Swedish healthcare postpartum, in terms of hospital stay >48 h, readmission to hospital, and specialized out‐patient clinic visits, in relation to maternal country of birth.A population‐based register study including 278 219 primiparous and 367 776 multiparous women in Sweden (2014–2019) using data from Swedish Pregnancy Register, National Patient Register and Statistics Sweden. Multivariable logistic regression analyses were used to estimate associations between maternal country of birth and outcomes, adjusting for year of birth, maternal age, education, pre‐gestational hypertension and diabetes, and healthcare region, presented as crude and adjusted odds ratios (aOR) with 95% confidence interval (CI) with Swedish‐born women as reference.Subgroups of migrant women had higher odds of postpartum hospital stays > 48 h, particularly women from Eritrea (primiparous aOR 2.80, CI 2.49–3.15; multiparous aOR 2.78, CI 2.59–2.98), Somalia (primiparous aOR 2.61, CI 2.34–2.92; multiparous aOR 1.87, CI 1.79–1.97), and India (primiparous aOR 2.52, CI 2.14–2.97; multiparous aOR 2.61, CI 2.33–2.93), compared to Swedish‐born women. Primiparous women from Afghanistan (aOR 1.32, CI 1.08–1.6), Iraq (aOR 1.30, CI 1.16–1.46), and Iran (aOR 1.23, CI 1.04–1.45) had slightly higher odds of hospital readmission, along with multiparous women from India (aOR 1.34, CI 1.02–1.76) and Somalia (aOR 1.24, CI 1.11–1.38). Specialized out‐patient clinic visits were most common in primiparous women from Somalia (aOR 1.47, CI 1.35–1.59), Iran (aOR 1.31, CI 1.22–1.42) and Afghanistan (aOR 1.31, CI 1.18–1.46), and in multiparous women from Iran (aOR 1.30, CI 1.20–1.41) and Iraq (aOR 1.15, CI 1.11–1.20), however less common in women from some other countries.The use of Swedish health care during the postpartum period varied among women, depending on their country of birth. Women from certain countries had particularly high odds of postpartum hospital stays exceeding 48 h, compared to Swedish‐born women, regardless of parity and pre‐gestational medical disorders. Further studies are needed to determine whether the individual needs of migrant women are being met during the postpartum period or not. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aimed to estimate the prevalence of pregnancy- and lactation-associated osteoporosis in postpartum women within 1 year of delivery. We searched MEDLINE via PubMed and Igaku Chuo Zasshi for articles published in English or Japanese from the inception of the database to September 2021. Two researchers independently screened and included observational studies reporting the prevalence of pregnancy- and lactation-associated osteoporosis in postpartum women within 1 year of delivery. Of the 3,425 screened records, 8 articles centered on postpartum women were included in the review. Seven studies used dual-energy X-ray absorptiometry for assessing bone mineral density, while one used a quantitative ultrasound method. In the seven studies that used dual-energy X-ray absorptiometry, the parameters used to define osteoporosis were the T-score (two studies), Z-score (three studies), both T- and Z-scores (one study), and young adult mean (one study). Evaluation timeframes included 1 week (three studies), 1-2 months postpartum (three studies), and 1 week to 12 months postpartum (one study). The estimated prevalence of pregnancy- and lactation-associated osteoporosis defined by dual-energy X-ray absorptiometry was as follows: lumbar spine (six studies), 5% (95% confidence interval [CI], 0-13; heterogeneity [I²] = 99%) and femoral neck (three studies), 12% (95% CI, 0-30; I² = 99%). Pregnancy and lactation were found to elevate the fracture risk in women, underscoring the necessity for a standardized assessment in diagnosing pregnancy- and lactation-associated osteoporosis. This imperative step aims to enable early detection and treatment of bone mineral loss among postpartum women. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding information stored within electronic health records (EHR) has recently been used for pharmacoepidemiological research, however the data are primarily collected for clinical care. Objectives: To characterise breastfeeding information recorded in structured fields in EHR during infant and postpartum health care visits, and to assess the validity of lactation status based on EHR data versus maternal report at research study visits. Methods: We assessed breastfeeding information recorded in structured fields in EHR from one health system for a subset of 211 patients who were also enrolled in a study on breast milk composition between 2014 and 2017 that required participants to exclusively breastfeed their infants until at least 1 month of age. We assessed the frequency of breastfeeding information in EHR during the first 12 months of age and compared lactation status based on EHR with maternal report at 1 and 6‐month study visits (reference standard). Results: The median number of breastfeeding records in the EHR per infant was six (interquartile range 3) with most observations clustering in the first few weeks of life and around well‐infant visits. At the 6‐month study visit, 93.8% of participants were breastfeeding and 80.1% were exclusively breastfeeding according to maternal report. Sensitivity of EHR data for identifying ever breastfeeding was at or near 100%, and sensitivity for identifying ever exclusive breastfeeding was 98.0% (95% CI: 95.0%, 99.2%). Sensitivities were 97.3% (95% CI: 93.9%, 98.9%) for identifying any breastfeeding and 94.4% (95% CI: 89.7%, 97.0%) for exclusive breastfeeding, and positive predictive values were 99.5% (95% CI: 97.0%, 99.9%) for any breastfeeding and 95.0% (95% CI: 90.4%, 97.4%) for exclusive breastfeeding. Conclusions: Breastfeeding information in structured EHR fields have the potential to accurately classify lactation status. The validity of these data should be assessed in populations with a lower breastfeeding prevalence. [ABSTRACT FROM AUTHOR]

Objective To compare the prevalence of unintended pregnancy measured by the Demographic and Health Survey (DHS) and the London Measure of Unplanned Pregnancy in Bangladesh, and explore the extent of discordance between the measures and the factors associated with the discordance. Methods In 2023, we conducted a cross-sectional survey in four randomly selected districts in Bangladesh: Kurigram, Mymensingh, Pabna and Satkhira. We randomly selected 20 hospitals, five from each district. We collected data from 1200 women who had recently delivered a baby and were visiting the hospitals for postnatal care. We interviewed the women about their pregnancy intention in their last pregnancy using questions in the DHS and the London Measure of Unplanned Pregnancy and examined the discordance in their responses. We used multivariable logistic regression analysis to identify factors associated with discordant responses in reported pregnancy intention. Findings The prevalence of unintended pregnancy was 24.3% (292/1200) using the DHS measure and 31.0% (373/1200) using the London Measure of Unplanned Pregnancy. Discordance in responses to pregnancy intention between the two measures was 27.1% (325/1200). Factors associated with discordance were older age, female sex of the last child born, having more than two children, being in a poorer wealth quintile, living in a rural area and living in Kurigram district. Conclusion The prevalence of unintended pregnancy in Bangladesh measured by the DHS measure may be an underestimate, suggesting that the adverse effects of unintended pregnancy are greater than realized and emphasizing the need to bolster Bangladesh's family planning programme. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the societal costs of untreated perinatal mood and anxiety disorders (PMADs) in Vermont for the 2018–2020 average annual birth cohort from conception through five years postpartum. Methods: We developed a cost analysis model to calculate the excess cases of outcomes attributed to PMADs in the state of Vermont. Then, we modeled the associated costs of each outcome incurred by birthing parents and their children, projected five years for birthing parents who do not achieve remission by the end of the first year postpartum. Results: We estimated that the total societal cost of untreated PMADs in Vermont could reach $48 million for an annual birth cohort from conception to five years postpartum, amounting to $35,910 in excess societal costs per birthing parent with an untreated PMAD and their child. Conclusion: Our model provides evidence of the high costs of untreated PMADs for birthing parents and their children in Vermont. Our estimates for Vermont are slightly higher but comparable to national estimates, which are $35,500 per birthing parent–child pair, adjusted to 2021 US dollars. Investing in perinatal mental health prevention and treatment could improve health outcomes and reduce economic burden of PMADs on individuals, families, employers, and the state. [ABSTRACT FROM AUTHOR]

Objective: This study explores rates of birth-related symptoms of trauma in a population of parents experiencing severe perinatal mental illness. Method: Birthing-parents admitted to a perinatal inpatient unit completed birth trauma measures on admission which were descriptively analyzed. Results: The population had higher rates of birth-related potentially traumatic events and trauma-related symptoms than the general population. Conclusions: The findings highlight that assessing for and responding to experiences of birth trauma is highly relevant to an inpatient perinatal population. [ABSTRACT FROM AUTHOR]

The article focuses on maternal mortality rates in the U.S. compared to other high-income nations, highlighting significant disparities, particularly among racial and ethnic groups. It discusses the high overall maternal mortality rate in the U.S., especially noting the stark contrast with countries like New Zealand and Chile, and underscores the disproportionate impact on Black women, who experience significantly higher mortality rates compared to other demographic groups.

Despite recommendations for ongoing care after pregnancy, many individuals do not see a primary care clinician within the first postpartum year, missing a critical window to engage reproductive-age individuals in primary care. We administered an anonymous, cross-sectional, trilingual survey at a large urban safety-net hospital to assess postpartum individuals' preferences, health concerns, and anticipated barriers to primary care during the year after pregnancy. While 90% of respondents preferred a visit within one year, most individuals – including those with complicated pregnancies – did not recall a primary care recommendation from their pregnancy care team. Respondents reported a variety of primary care-amenable health concerns, and many social and logistical barriers to care. Preference for virtual care increased if self-monitoring tools were hypothetically available, indicating virtual visits may improve primary care access. Significance: What is Already Known on the Subject?: The postpartum year is a time of increased health risks, when individuals – especially those with recent pregnancy complications – are likely to benefit from ongoing care. In minoritized and structurally marginalized communities, low rates of postpartum follow-up compound high rates of pregnancy complications, perpetuating health inequities. What this Study Adds?: In a racially, ethnically, and linguistically diverse and predominantly low-income sample, most postpartum individuals were unaware of recommendations to connect with primary care in the year after pregnancy, and most anticipated logistical and financial barriers to care. Increased care transition counseling, and logistical and financial support, are needed to help postpartum individuals access ongoing care. [ABSTRACT FROM AUTHOR]

Existing research documents significant racial disparities in pregnancy-related deaths in the United States. Recently, the National Center for Health Statistics (NCHS) identified inconsistencies in maternal mortality data due to irregularities in previous data collection. Yet, corrections of the data still highlight stark differences across racial identity. Additionally, data indicates that while many people die during labor and delivery, a considerable percentage of people die up to a year postpartum. To assess disparities in the timing of pregnancy-related deaths using corrected data, we analyzed aggregated vital statistics data from 2015 to 2018 (n = 4,261). We present relative risk ratios from multinomial logistic regressions to examine the association between race and ethnicity and the timing of pregnancy-related deaths (pregnant at the time of death, 42 days post pregnancy, and 43 days to one-year post pregnancy). Results highlight significant differences in the distribution of timing of pregnancy-related deaths across nativity status and geographic region. Findings document a disproportionate percentage of pregnancy-related deaths among foreign-born people who give birth. Overall, results suggest extending our framing of postpartum care beyond a hospital stay. Significance: What is already known on this subject?: Data shows that there are significant socioeconomic and racial disparities in pregnancy-related deaths, with Native American and Black women having elevated risk of mortality (Leonard et al., Health Services Research 48(2):455–475, 2019). Reduced access to affordable and adequate maternal care through closures of medical clinics, provider bias, and the rising cost of healthcare have been shown to significantly contribute to higher rates of pregnancy-related deaths, particularly among low-income and racial minority women (Lorch et al., Health Services Research 48(2):455–475, 2013). What does this study add?: This study provides assessments of racial disparities in timing of pregnancy-related deaths that emphasize important differences across nativity status to help us understand these disparities. [ABSTRACT FROM AUTHOR]

Objectives: This qualitative study explored experiences of 15 women in New York City who suffered physical, emotional, and socioeconomic consequences of severe maternal morbidity (SMM). This study aimed to increase our understanding of additional burdens these mothers faced during the postpartum period. Methods: Qualitative analysis of in-depth interviews (n = 15) with women who had given birth in NYC hospitals and experienced SMM. We focused on how experiences of SMM impacted postpartum recoveries. Grounded theory methodology informed analysis of participants' one-on-one interviews. To understand the comprehensive experience of postpartum recovery after SMM, we drew on theories about social stigma, reproductive equity, and quality of care to shape constant-comparative analysis and data interpretation. Findings: Three themes were generated from data analysis: 'Caring for my body' defined by challenges during physical recuperation, 'caring for my emotions' which highlighted navigation of mental health recovery, and 'caring for others' defined by care work of infants and other children. Most participants identified as Black, Latinx and/or people of color, and reported the immense impacts of SMM across aspects of their lives while receiving limited access to resources and insufficient support from family and/or healthcare providers in addressing postpartum challenges. Conclusions for Practice: Findings confirm the importance of developing a comprehensive trauma-informed approaches to postpartum care as a means of addressing SMM consequences. Significance: What is Already Known on this Subject?: For every maternal death, approximately 100 women suffer from life-threatening complications—referred to as severe maternal morbidity (SMM). SMM affects 2,500 to 3,000 women annually. Health impacts can be acute or chronic, including mental health conditions and physical disabilities. What this Study Adds?: The postpartum recovery period is a time for acute vulnerability for people recovering from an SMM event. Women reported navigating an array of physical, social, and emotional traumas and challenges for which they had limited support. This study confirms the need for directive and strategic investment in the postpartum recovery of survivors of SMM to ensure optimum health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Congenital heart defects (CHDs) are among the most frequent congenital defects, and they significantly burden the healthcare system due to their high mortality rate and high cost of care for survivors. We aimed to highlight the incidence of CHDs in a tertiary center in Western Romania. Methods: A retrospective study was carried out between 2018 and 2022 at the "Pius Brinzeu" Emergency County Hospital Timisoara. Relevant information about the mothers and the newborns were collected and statistically analyzed. Results: The incidence of CHDs from 2018 to 2022 in our center was 5.3%. Eleven types of malformations were diagnosed postnatally in 541 newborns, with 28.8% of cases having more than one type of CHD. The antenatal detection rate was 28%, with the highest rates for tetralogy of Fallot, hypoplastic left heart syndrome, or significant ventricular septal defects and the lowest for pulmonary stenosis. The lower antenatal detection rate was influenced mainly by incomplete or absent prenatal care. Conclusions: The incidence of CHDs is clearly dependent of a multifactorial approach, and the results highlight this. With an incidence almost 50% lower than reported within the literature and a low rate of prenatal detections, CHDs could be a more of a burden to endure regarding medical treatment. Improvements in patients' education, prenatal care, and screening programs could improve diagnosis, decrease mortality, and optimize postnatal care. [ABSTRACT FROM AUTHOR]