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Abstract Background The COVID-19 pandemic has adversely affected access to essential healthcare services. This study aimed to explore healthcare providers’ perceptions and experiences of the response to the COVID-19 pandemic in three referral maternal and neonatal hospitals in Guinea. Methods We conducted a longitudinal qualitative study between June and December 2020 in two maternities and one neonatology referral ward in Conakry and Mamou. Participants were purposively recruited to capture diversity of professional cadres, seniority, and gender. Four rounds of in-depth interviews (46 in-depth interviews with 18 respondents) were conducted in each study site, using a semi-structured interview guide that was iteratively adapted. We used both deductive and inductive approaches and an iterative process for content analysis. Results We identified four themes and related sub-themes presented according to whether they were common or specific to the study sites, namely: 1) coping strategies & care reorganization, which include reducing staffing levels, maintaining essential healthcare services, suspension of staff daily meetings, insertion of a new information system for providers, and co-management with COVID-19 treatment center for caesarean section cases among women who tested positive for COVID-19; 2) healthcare providers’ behavior adaptations during the response, including infection prevention and control measures on the wards and how COVID-19-related information influenced providers’ daily work; 3) difficulties encountered by providers, in particular unavailability of personal protective equipment (PPE), lack of financial motivation, and difficulties reducing crowding in the wards; 4) providers perceptions of healthcare service use, for instance their fear during COVID-19 response and perceived increase in severity of complications received and COVID-19 cases among providers and parents of newborns. Conclusion This study provides insights needed to be considered to improve the preparedness and response of healthcare facilities and care providers to future health emergencies in similar contexts.

Background: The COVID-19 pandemic has adversely affected access to essential healthcare services. This study aimed to explore healthcare providers' perceptions and experiences of the response to the COVID-19 pandemic in three referral maternal and neonatal hospitals in Guinea. Methods: We conducted a longitudinal qualitative study between June and December 2020 in two maternities and one neonatology referral ward in Conakry and Mamou. Participants were purposively recruited to capture diversity of professional cadres, seniority, and gender. Four rounds of in-depth interviews (46 in-depth interviews with 18 respondents) were conducted in each study site, using a semi-structured interview guide that was iteratively adapted. We used both deductive and inductive approaches and an iterative process for content analysis. Results: We identified four themes and related sub-themes presented according to whether they were common or specific to the study sites, namely: 1) coping strategies & care reorganization, which include reducing staffing levels, maintaining essential healthcare services, suspension of staff daily meetings, insertion of a new information system for providers, and co-management with COVID-19 treatment center for caesarean section cases among women who tested positive for COVID-19; 2) healthcare providers' behavior adaptations during the response, including infection prevention and control measures on the wards and how COVID-19-related information influenced providers' daily work; 3) difficulties encountered by providers, in particular unavailability of personal protective equipment (PPE), lack of financial motivation, and difficulties reducing crowding in the wards; 4) providers perceptions of healthcare service use, for instance their fear during COVID-19 response and perceived increase in severity of complications received and COVID-19 cases among providers and parents of newborns. Conclusion: This study provides insights needed to be considered to improve the preparedness and response of healthcare facilities and care providers to future health emergencies in similar contexts. [ABSTRACT FROM AUTHOR]

Introduction: Recently in Portugal, several social and demographic changes have been observed with an emphasis on the increasing number of foreign citizens. The linguistic, cultural and social barriers cause challenges to maternal and child health care. This study aimed to characterize the sociodemographic and obstetrical data of mothers and newborns hospitalized in the maternity ward of a tertiary hospital in the southern region of Portugal. Methods: Cross-sectional observational study. A questionnaire was applied in the postpartum period to women admitted to the maternity ward of a tertiary hospital in Lisbon from 1 March 2021 to 30 June 2021. Results: 347 surveys were obtained from a total of 785 hospitalizations. The average maternal age was 31.8 years and the average paternal age was 33.7 years. Most mothers (79.1%) and fathers (77.3%) reported having, at least, secondary education. 19.5% of mothers and 7.7% of fathers were students or unemployed, 18.9% of parents were unqualified workers and 32.0% of mothers and 23.4% of fathers were professionals in the group of intellectual and scientific activities. More than a quarter of our population were migrants (27.6% of mothers and 26.2% of fathers) and, of these, 14.9% of mothers and 11.2% of fathers were not fluent in Portuguese. 7.9% of pregnancies did not meet the criteria for adequate prenatal care defined at the national level. There was an association (p < 0.01) between inadequate pregnancy surveillance and lower maternal age and lower educational level. There was no difference between the migrant and non-migrant population regarding the completion of the prenatal care program. Conclusions: The percentage of the migrant population is currently very expressive, with a non-negligible number of parents not fluent in Portuguese, which requires an adaptation of health resources to optimize the care provided. Lack of adequate prenatal care was expressive and was associated with lower maternal age and lower level of education.

Abstract Background Mistreatment during labour and childbirth is a common experience for many women around the world. This study aimed to explore the manifestations of mistreatment and its influencing factors in public maternity hospitals in Tehran. Methods A formative qualitative study was conducted using a phenomenological approach in five public hospitals between October 2021 and May 2022. Sixty in-depth face-to-face interviews were conducted with a purposive sample of women, maternity healthcare providers, and managers. Data were analyzed with content analysis using MAXQDA 18. Results Mistreatment of women during labour and childbirth was manifested in four form: (1) physical abuse (fundal pressure); (2) verbal abuse (judgmental comments, harsh and rude language, and threats of poor outcomes); (3) failure to meet professional standards of care (painful vaginal exams, neglect and abandonment, and refusal to provide pain relief); and (4) poor rapport between women and providers (lack of supportive care and denial of mobility). Four themes were also identified as influencing factors: (1) individual-level factors (e.g., providers’ perception about women’s limited knowledge on childbirth process), (2) healthcare provider-level factors (e.g., provider stress and stressful working conditions); (3) hospital-level factors (e.g., staff shortages); and (4) national health system-level factors (e.g., lack of access to pain management during labour and childbirth). Conclusions Our study showed that women experienced various forms of mistreatment during labour and childbirth. There were also multiple level drivers for mistreatment at individual, healthcare provider, hospital and health system levels. Addressing these factors requires urgent multifaceted interventions.

Background: Mistreatment during labour and childbirth is a common experience for many women around the world. This study aimed to explore the manifestations of mistreatment and its influencing factors in public maternity hospitals in Tehran. Methods: A formative qualitative study was conducted using a phenomenological approach in five public hospitals between October 2021 and May 2022. Sixty in-depth face-to-face interviews were conducted with a purposive sample of women, maternity healthcare providers, and managers. Data were analyzed with content analysis using MAXQDA 18. Results: Mistreatment of women during labour and childbirth was manifested in four form: (1) physical abuse (fundal pressure); (2) verbal abuse (judgmental comments, harsh and rude language, and threats of poor outcomes); (3) failure to meet professional standards of care (painful vaginal exams, neglect and abandonment, and refusal to provide pain relief); and (4) poor rapport between women and providers (lack of supportive care and denial of mobility). Four themes were also identified as influencing factors: (1) individual-level factors (e.g., providers' perception about women's limited knowledge on childbirth process), (2) healthcare provider-level factors (e.g., provider stress and stressful working conditions); (3) hospital-level factors (e.g., staff shortages); and (4) national health system-level factors (e.g., lack of access to pain management during labour and childbirth). Conclusions: Our study showed that women experienced various forms of mistreatment during labour and childbirth. There were also multiple level drivers for mistreatment at individual, healthcare provider, hospital and health system levels. Addressing these factors requires urgent multifaceted interventions. Plain language summary: Mistreatment during labour and childbirth is a common experience for many women around the world. A picture of the nature and types of mistreatment; and especially its influencing factors has not yet been identified in Iran. A qualitative approach to explore manifestations of mistreatment during labour and childbirth while learning about the factors that influence them was used for this study. It obtained this information thanks to semi-structured interviews with women, maternity healthcare providers, and managers between October 2021 and May 2022. Our findings showed that women experienced various forms of mistreatment during labour and childbirth. At individual level, e.g., providers' perception about women's limited knowledge on childbirth process was an influencing factor for mistreatment. At healthcare provider level, a highlighted factor was provider stress and stressful working conditions. At hospital level, e.g., staff shortages played a main role; and at national health system level, participants believed that lack of access to pain management during labour and childbirth was an influencing factor for mistreatment. These findings can provide a good platform for designing and implementing intervention programs to reduce disrespectful maternity care. It can also be used as a guide for managers and policymakers to improve the quality of services provided to women. [ABSTRACT FROM AUTHOR]

Context: Transcultural skills are especially useful for those involved in the perinatal period, when parents and babies must adapt to one another in a setting of migration a long a focus of transcultural clinical practice. Objective: The aim of this article is to provide useful transcultural skills for any health care worker (e.g., psychologists, child psychiatrists, midwives, family doctors, pediatricians, specialized child-care attendants, and social workers) who provide care or support to families during the perinatal period. It highlights the cultural aspects requiring attention in relation to representations of pregnancy, children’s needs, obstetric complications, and postnatal problems. Taking into account the impact of culture on clinical evaluation and treatment can enable professionals to distinguish what involves cultural representations of pregnancy, babies, and sometimes of disease from what is associated with interaction disorders or maternal psychopathology. Methods: After explaining the relevance of transcultural clinical practices to provide migrant mothers with better support, we describe 9 themes useful to explore from a transcultural perspective. This choice is based on the transcultural clinical practice in our specialized department. Results: The description of these 9 themes is intended to aid in their pragmatic application and is illustrated with short clinical vignettes for specific concepts. We describe situations that are extreme but often encountered in liaison transcultural clinical practice for maternity wards: perinatal mourning with cultural coding, mediation in refusal of care, cultural misunderstandings, situations of complex trauma and of multiple contextual vulnerabilities, and difficulties associated with acculturation. Discussion: The transcultural levers described here make it possible to limit cultural misunderstandings and to promote the therapeutic alliance. It presupposes the professionals will concomitantly analyze their cultural countertransference and acquire both the knowledge and know-how needed to understand the elements of cultural, political, and social issues needed to develop clinical finesse. Conclusion: This combined theoretical-clinical article is intended to be pedagogical. It provides guidelines for conducting transcultural child psychiatry/ psychological interviews in the perinatal period aimed at both assessment and therapy. [ABSTRACT FROM AUTHOR]

ContextTranscultural skills are especially useful for those involved in the perinatal period, when parents and babies must adapt to one another in a setting of migration a long a focus of transcultural clinical practice.ObjectiveThe aim of this article is to provide useful transcultural skills for any health care worker (e.g., psychologists, child psychiatrists, midwives, family doctors, pediatricians, specialized child-care attendants, and social workers) who provide care or support to families during the perinatal period. It highlights the cultural aspects requiring attention in relation to representations of pregnancy, children’s needs, obstetric complications, and postnatal problems. Taking into account the impact of culture on clinical evaluation and treatment can enable professionals to distinguish what involves cultural representations of pregnancy, babies, and sometimes of disease from what is associated with interaction disorders or maternal psychopathology.MethodsAfter explaining the relevance of transcultural clinical practices to provide migrant mothers with better support, we describe 9 themes useful to explore from a transcultural perspective. This choice is based on the transcultural clinical practice in our specialized department.ResultsThe description of these 9 themes is intended to aid in their pragmatic application and is illustrated with short clinical vignettes for specific concepts. We describe situations that are extreme but often encountered in liaison transcultural clinical practice for maternity wards: perinatal mourning with cultural coding, mediation in refusal of care, cultural misunderstandings, situations of complex trauma and of multiple contextual vulnerabilities, and difficulties associated with acculturation.DiscussionThe transcultural levers described here make it possible to limit cultural misunderstandings and to promote the therapeutic alliance. It presupposes the professionals will concomitantly analyze their cultural countertransference and acquire both the knowledge and know-how needed to understand the elements of cultural, political, and social issues needed to develop clinical finesse.ConclusionThis combined theoretical-clinical article is intended to be pedagogical. It provides guidelines for conducting transcultural child psychiatry/psychological interviews in the perinatal period aimed at both assessment and therapy.

Background & Aim: In recent years, women's experience of disrespect and misconduct during childbirth has been raised as a significant problem around the world. This study aimed to determine the prevalence of disrespectful maternity care and its associated factors. Methods & Materials: This is a cross-sectional study conducted in 2019 on 357 mothers who gave birth at hospitals affiliated to TUMS. The data collection tool included socio-demographic characteristics form, and the disrespectful maternity care questionnaire, measuring various domains of abuse. The questionnaire was completed by interviewing mothers. Data was analyzed using descriptive tests, Chi-square test and multivariate logistic regression through the SPSS software version 24. Results: All participants reported at least one form of disrespect, of which “not allowing for mobility, fluid and companion” was the most prevalent (99.7%) and “stigma and discrimination” was the least prevalent (4.5%). Statistical analysis showed a significant relationship between older age, ethnic minority, primiparity, higher socioeconomic status, delivery time (night, day) and a history of illness with more experience of different forms of disrespect. Conclusion: This study confirmed a relatively high prevalence of disrespectful maternity care in hospitals based on international standards, which requires serious and prompt attention of top-level managers to take action to eliminate or limit this type of behavior.

The maternity ward at the Rebro Hospital in Zagreb was established in the newly opened new hospital on 12 May 1942. It operated discontinuously at the gynaecology and obstetrics department during three periods between 1942 and 1946, when it was closed. It was located on the second floor of the eastern part of the hospital with 24 beds. During the activity of the maternity ward from 13 May 1942 to 16 December 1942, 24 May 1944 to 28 August 1945, and from 6 February 1946 to 28 July 1946, there were 1,337 births. They were registered as live births, stillbirths and aborted children weighing 450 grams or more, so perinatal mortality was therefore significantly higher (38.89 ‰) because, in addition to physiological, a significant number of pathological births were performed in the hospital. The head of the newly established ward was Ass. prof. prim. Dr Filip Dražančić, who worked alongsideward doctors and midwives. Most of the women who gave birth were from Zagreb, with a smaller number of women from other parts of Croatia, primary housewives aged 20-30. In the mentioned period, three mothers died. All obstetric procedures, episiotomies, caesarean section, assistance during breech delivery, rotating of a baby, forceps, and treatment of perineallacerations were performed under local infiltration, spinal (lumbar) or general inhalation anaesthesia using ether. Along with a significant number of home midwifery deliveries and the already established hospital maternity wards in the Petrova and Merkur sanatoriums, the maternity ward at the Rebro hospital,until now only sporadically mentioned as an institution, had an important place in the development of hospital obstetrics in Zagreb and Croatia. [ABSTRACT FROM AUTHOR]

Co-design aims to bring designers and end-users together to improve the quality of design projects. In this paper, we study how the distance between designers and users can be reduced with an empathic approach particularly in settings where it is significant. By investigating various approaches on empathy in design and architecture, we were able to retrospectively understand different aspects of the design process of a maternity ward project in which we were involved. Engaging a theoretical clarification of empathy as a multi-dimensional concept made it possible to empirically explicate diverse difficulties that designers face when trying to employ empathy as a guiding philosophy in their work. As a result, we identified three registers of empathy on a varying scale of depth that can be integrated in the design process. Our work shows that various registers of empathy can complement each other or be utilised in different circumstances where one form might be more appropriate than another. By presenting these registers, we seek to unbox the different views on empathy and draw attention to the potential of empathic engagement when aiming for depth in a project. [ABSTRACT FROM AUTHOR]

This study aims to describe the local guidelines for the supplemental feeding of infants of Swedish women’s clinics with maternity wards. Purposeful sampling was used during a four-week data collection time in 2019. Guidelines from 41 of the 43 Swedish women’s clinics with maternity wards were analysed using qualitative and quantitative content analysis. The information provided, and length of the guidelines varied widely in 38 guidelines. Feeding methods were included in 28 guidelines, but 10 provided no information about feeding methods. The most common feeding methods were cup feeding and feeding probes. Suggestions for supplemental feeding included infant formula (32), breast milk (27) and no suggestions (6). The methods to support breastfeeding were skin-to-skin contact (25), breastfeeding freely (22), a caring plan (18), extra supervision (3), optimising the caring environment (2), supplying a breast pump (1) and breastfeeding observation (1). Twenty-two guidelines included information about how long formula should be given and that the feeding should be phased out gradually. We conclude that a national guideline for the supplemental feeding of infants is needed to ensure equal best practice care for infant safety and the support of parents to increase the breastfeeding rate. More national guidelines are needed in general because it is easier to update only one set of guidelines.

Background & Aim: In recent years, women's experience of disrespect and misconduct during childbirth has been raised as a significant problem around the world. This study aimed to determine the prevalence of disrespectful maternity care and its associated factors. Methods & Materials: This is a cross-sectional study conducted in 2019 on 357 mothers who gave birth at hospitals affiliated to TUMS. The data collection tool included socio-demographic characteristics form, and the disrespectful maternity care questionnaire, measuring various domains of abuse. The questionnaire was completed by interviewing mothers. Data was analyzed using descriptive tests, Chi-square test and multivariate logistic regression through the SPSS software version 24. Results: All participants reported at least one form of disrespect, of which “not allowing for mobility, fluid and companion” was the most prevalent (99.7%) and “stigma and discrimination” was the least prevalent (4.5%). Statistical analysis showed a significant relationship between older age, ethnic minority, primiparity, higher socioeconomic status, delivery time (night, day) and a history of illness with more experience of different forms of disrespect. Conclusion: This study confirmed a relatively high prevalence of disrespectful maternity care in hospitals based on international standards, which requires serious and prompt attention of top-level managers to take action to eliminate or limit this type of behavior. [ABSTRACT FROM AUTHOR]

It has been proven that post-vaccination immunity to measles virus after two doses of vaccine is not able to persistently protect against infection throughout life. The goal of this research was to determine the immune layer to the measles virus among women in labor and maternity ward personnel in the same medical institution. The levels of IgG antibodies to measles virus in the umbilical cord blood of 594 women in labor and 88 workers of the maternity ward were studied by ELISA. It was revealed that 22.7% of umbilical cord blood serum samples from parturient women and 21.4% of blood serum samples from maternity ward personnel were seronegative (

It has been proven that post-vaccination immunity to measles virus after two doses of vaccine is not able to persistently protect against infection throughout life. The goal of this research was to determine the immune layer to the measles virus among women in labor and maternity ward personnel in the same medical institution. The levels of IgG antibodies to measles virus in the umbilical cord blood of 594 women in labor and 88 workers of the maternity ward were studied by ELISA. It was revealed that 22.7% of umbilical cord blood serum samples from parturient women and 21.4% of blood serum samples from maternity ward personnel were seronegative (<0.18 IU/ml). Levels of IgG antibodies to measles virus in low values (<1.0 IU/ml) were detected in 67% of blood serum samples among women in labor and 68.9% among employees of the maternity ward. Among women in labor, women under 35 years of age are at the highest risk of contracting measles; the proportion of women with low levels of protective antibodies in this age group was almost 70%, and the proportion of women without protective levels of antibodies was 23%. Compared with the age group 36–43, the age of women in labor under 35 was associated with a higher chance of not having immune protection against infection with measles virus OR [95% CI] = 2.2 [1.1–4.5] (p = 0.02) or had a low level of protection OR [95% CI] = 1.9 [1.2–3.0] (p = 0.001). It was also found that among women over 35 years of age, the proportion of persons with a high level of antibodies in women in labor was statistically significantly higher than among members of the maternity ward staff (13 and 0%, respectively, p = 0.007). Thus, maternity ward employees and women in labor constitute a risk group for measles due to the presence of a high proportion of seronegative persons among women of childbearing age (both maternity ward employees and women in labor). These conditions create the need to revise current approaches to present vaccination procedures, especially in the current epidemiological situation with COVID-19. [ABSTRACT FROM AUTHOR]

This study aims to describe the local guidelines for the supplemental feeding of infants of Swedish women's clinics with maternity wards. Purposeful sampling was used during a four-week data collection time in 2019. Guidelines from 41 of the 43 Swedish women's clinics with maternity wards were analysed using qualitative and quantitative content analysis. The information provided, and length of the guidelines varied widely in 38 guidelines. Feeding methods were included in 28 guidelines, but 10 provided no information about feeding methods. The most common feeding methods were cup feeding and feeding probes. Suggestions for supplemental feeding included infant formula (32), breast milk (27) and no suggestions (6). The methods to support breastfeeding were skin-to-skin contact (25), breastfeeding freely (22), a caring plan (18), extra supervision (3), optimising the caring environment (2), supplying a breast pump (1) and breastfeeding observation (1). Twenty-two guidelines included information about how long formula should be given and that the feeding should be phased out gradually. We conclude that a national guideline for the supplemental feeding of infants is needed to ensure equal best practice care for infant safety and the support of parents to increase the breastfeeding rate. More national guidelines are needed in general because it is easier to update only one set of guidelines. [ABSTRACT FROM AUTHOR]

Introduction: Maternity wards are of the highly sensitive wards in hospital. Errors in midwifery tasks can lead to life threatening risks for the mother and infant and higher medical costs. The present study is an attempt to qualitatively and quantitatively assess human errors in midwife staff using preventive human error analysis and engineering approach. Methods: The study was carried out as a case study in the maternity ward of Shoushtar Women Hospital. The participants were selected through convenient sampling and seven midwifery experts took part in the study. The work process in maternity ward was categorized into four categories of admittance, pre-labor, labor, and post-labor and the tasks and sub-tasks were determined based on hierarchical task analysis (HTA). Afterwards, human errors were quantified using EA technique and then, using PHEA technique a description of error in each tasks and error control solutions were provided. Results: The results clarified that the highest risks of human errors were in the tasks like cervix check, serum therapy, infant's body check, preparing delivery equipment, and wearing personal protective equipment. Conclusion: Since, midwifery tasks are rule base and regulations and they are performed at a higher level of awareness and cognition, preventing errors entails continuous presence of a midwife next to patient's bed along with an assistant midwife and codification of an infant examination checklist. Programming empowerment education including safety education to midwives is also recommended. [ABSTRACT FROM AUTHOR]

Designing the maternity ward of hospitals is crucial due to the special conditions of mothers before, during, and after birth. Numerous environmental factors affect mothers, and it calls for an evidence-based design of these spaces. Although many investigations have drawn their attention to the issue, there is a paucity of research in terms of the significance of the birth environment factors. Therefore, the specific question of the research is that to what extent each of these factors is significant? In order to answer this question, the researchers devised a questionnaire based on which the most prominent variables could be ascertained. The questionnaire contained four main domains, including fear cascade, facilities, aesthetics and support, and the researchers distributed them among mothers in four hospitals in Golestan province, Iran. Six influential spaces affecting mothers, including communication space, hospitalization room, nursing station, neonatal room, operation room and external space, were investigated in this regard. Using the descriptive-analytical method and SPSS software, the research hypotheses were tested, and the Friedman test was employed to rank the domains and their variables. The findings demonstrated the significance of the aesthetic domain and such variables as the nursing station, natural light in corridors, and view to the doctor room. The study offered fresh insights into the design of a peaceful maternity ward. [ABSTRACT FROM AUTHOR]

Clinical learning environments influence the learning and performance of learners by creating learning opportunities and experiences. The maternity ward offers a major educational opportunity for midwifery students, obstetrics and gynecology residents and medical interns to acquire and improve crucial skills. This study seeks to determine the way in which the clinical learning environment of the maternity ward creates learning opportunities and enables the accumulation of experiences for the noted learners. This qualitative study was conducted using inductive content analysis at the Maternity Ward of Shahid Beheshti Hospital, affiliated with University of Medical Sciences. Midwifery students, medical interns and obstetrics and gynecology residents spend a certain period of time in this ward as a mandatory part of their obstetrics and gynecology training. Data were collected through semi-structured individual interviews and observations and were then analyzed in MAXQDA concurrently with data collection. Three main categories emerged from the analysis of the data collected from the interviews and observations: disorganized learning opportunities, heavy emotional load and learners' abandonment in the care-provider and learner role. The maternity ward lacked the necessary organization to generate an environment conducive to learning and independent practice for the three groups of learners. The learners' training and acquired skills were thus affected by the clinical learning environment. [ABSTRACT FROM AUTHOR]

This study aims to determine the hospital practices implemented before, during, and after birth in Turkey, and to identify the support to families during this process. Purposive sampling was used in the study to identify the hospitals to be surveyed. Ankara, İstanbul, and İzmir, the provinces with the highest number of hospitals in Turkey, were selected for the collection of data. There were 178 eligible private hospitals in these provinces. The questionnaire form of the Canadian Hospitals Maternity Policies and Practices Survey was used to collect data and the necessary permissions were obtained. There are many restrictions and variations in maternity-related hospital practices in Turkey. 71.4% of the responding private hospitals identified themselves as baby-friendly. 57.1% had a policy facilitating families being together immediately after birth, 39.5% encouraged the presence of the father in the delivery room. 44.9% did not have any policy for assessing women who were going home to potentially violent situations. Eighty-five percent reported that they did not have a written policy or guidelines about procedures regarding labor, birth, or postpartum periods. This study recommended that private hospitals should review their maternal practices and routines in an evidence-based way that helps parents, culturally sensitive standards for mothers should be developed and supervised by related health authorities, and structures should be created to effectively deal with patients' complaints. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the association between use of silicone nipple shields in the maternity ward and exclusive breastfeeding interruption in the first 6 months of the infant's life. Cohort study. Interviews were conducted personally at the mother's home at 1 and 6 months postpartum and by telephone at 2 and 4 months. 287 mother-infant dyads. Lactating mothers were randomly selected at two maternity wards (one public, one private) in Porto Alegre, Brazil. Data were analyzed using Kaplan-Meier survival curves and Cox multivariate regression. The outcome of interest was exclusive breastfeeding interruption before 6 months of the infant's life. Nipple shields were used by 6.2 % of the women in the public maternity ward and by 25.8 % of those in the private setting. Median duration of exclusive breastfeeding was 11 days (95 %CI 0.0–36.9) among women who used the accessory vs. 89 days (95 %CI 60.8–117.2) among those who did not. Nipple shield use in the maternity ward was associated with exclusive breastfeeding interruption before 6 months of infant's life (adjusted risk ratio = 1.47; 95 %CI 1.01–2.15). The risk was higher in the first months of breastfeeding, ranging from 2.0 to 1.47 in the first and sixth months, respectively. The use of silicone nipple shields in the maternity ward increased the risk of exclusive breastfeeding interruption before 6 months of the infant's life, especially in the first months. These findings suggest caution in recommending this accessory to new mothers. [ABSTRACT FROM AUTHOR]

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) is a public health concern internationally. Studies examining a range of cohorts have been reported from various regions of the world, but little is known about the molecular epidemiology of MRSA in Armenia. Methods Between May and September 2013, twenty isolates of methicillin-resistant Staphylococcus aureus (MRSA; mecA positive) were recovered from hospital personnel (n = 10; 9 females, 1 male) and environmental sites (n = 10) in the maternity ward of one of the teaching hospitals in Armenia. Results Multi-locus sequence type clonal complex (MLST-CC) assignments inferred from spa typing data revealed the majority belonged to 3 pandemic lineages of MRSA including: t008-CC8-SCCmecV (n = 10; 7 from personnel); t021-CC30-SCCmecIV (n = 5; all environmental); and t1523-CC45 (n = 2; 1 from personnel), one harboured SCCmecV the other was SCCmec non-typable. The remainder identified as belonging to genotype t364-CC182, both of which harboured a novel SCCmec cassette with kdp, rif5, ccrB2 and ccrC detected by PCR (both from personnel); and t325-CC88-SCCmecIV (n = 1; environmental). All MRSA were negative for the Panton-Valentine Leukocidin (PVL) locus and three CC8 strains were positive for the arginine catabolic element (ACME). Conclusions In this small study, we report for the first time of the occurrence of diverse MRSA genotypes belonging to both pandemic and more sporadic international clones in Armenia harbouring the smaller SCCmec types and/or ACME, both of which have been associated with strain fitness. Further surveillance is warranted to better understand the prevalence, clinical and molecular epidemiology of MRSA throughout Armenia.

There exists initial evidence for beneficial daylight effects in hospital bedrooms. However, study results with automatically controlled dynamic bedroom lights were so far inconclusive. It can be hypothesized that inclusion of critically ill patients and unpleasant fixed bright light stimuli so far could have masked non-visual light effects on patient's sleep, mood and circadian physiology. Therefore, a temporarily adjustable dynamic light was installed in double bedrooms in a maternity clinic. Although mothers were exposed to fixed morning bright light under dynamic light they were allowed to adjust light intensities the rest of the day. In contrast, light colours were automatically changed over 24 h and could not be altered. Double bedrooms with standard switchable light were utilized as active control condition. A sample of 72 women, giving birth to healthy term babies, were randomly assigned to bedrooms with dynamic or standard light. Light conditions adjusted by mothers, sleep quality, mood and diurnal melatonin level, as well as physical activity levels of mothers and neonates, were recorded. Mothers exposed themselves and their babies to higher daytime and lower evening light levels under dynamic light compared to standard light after the period of fixed morning bright light exposure had ended. Although no overall effects on maternal parameters could be observed under dynamic light, we could reveal an earlier daily onset of neonatal physical activity levels in these bedrooms. To conclude, this study indicates that an adjustable dynamic light may substantially affect indoor light exposure in a maternity ward. Further studies are necessary to explore light effects on mothers and substantiate study results on neonates. Image 1 • Women in childbed could temporarily adjust dynamic bedroom lights (DL). • Non-visual light effects on mothers and neonates were compared to standard bedroom lighting. • Under DL, mothers stayed under higher daytime light levels and lower evening light levels. • Maternal sleep quality, mood, physical activity and melatonin levels were not affected by DL. • Under DL, the onset of neonate's most active hours occurred earlier. [ABSTRACT FROM AUTHOR]

BACKGROUND: Clinical training during internship is an important part of medical education. The maternity ward is a clinical environment in which medical students pass their obstetrics and gynecology internship to obtain competencies in this field. The present study was conducted to explain medical interns' manner of learning in the maternity ward. MATERIAL AND METHODS: The present study was conducted using a qualitative approach with the inductive content analysis method. This study observed the maternity wards of teaching hospitals affiliated to medical sciences universities of Isfahan and Shahrekord. Data were collected through observation and semi-structured individual interviews. RESULTS: Two main categories and seven subcategories emerged from the analysis of the data. Inadequate participation in learning opportunities included the following three subcategories: the incongruousness of the learning opportunities with the educational goals, inadequate readiness for participation in learning opportunities, and the overlap between learning opportunities and diminished autonomous practice. Inadequate formal and structured education included the following four subcategories: inadequate learning support and direction, subordinate roles and aimless presence, the pale educational role played by the attendants and senior residents, and learning through the support of midwifery educators. CONCLUSION: Participation in and access to learning opportunities in the maternity ward are very difficult for interns. Interns, therefore, need to attend the maternity ward by a structured program and in the company of training supervisors or competent educators to obtain the required competencies in pregnancy and childbirth.

Abstract Background Swaziland has one of the highest HIV prevalence rates in sub-Saharan Africa, 26 % of the adult population is infected with HIV. The prevalence is highest among pregnant women, at 41.1 %. According to Swaziland’s prevention of mother-to-child transmission (PMTCT) guidelines, approximately 50 % of pregnant women are eligible for antiretroviral therapy (ART) by CD4 criteria (

Background & Aim: Teamwork (between obstetricians and midwives) is one of the main pillars of success in the provision of appropriate services in the maternity wards. Therefore, this study aimed to identify the factors influencing teamwork in a maternity ward in a public hospital in Tehran, Iran. Methods & Materials: In this qualitative study, nine midwives and four obstetricians were selected through purposive sampling. Data were collected through semi-structured interviews from an affiliated hospital of Tehran University of Medical Sciences in 2013-2014. Data were analyzed using conventional content analysis. Results: Two themes including the teamwork barriers (four categories) and facilitators (three categories) were extracted from the data analysis. The main categories of teamwork barriers were the underlying issues (inter-professional conflicts, legal issues, and salary and financial issues), individual problems (physical problems, negative personality characteristics and domestic problems), lack of skills (lack of abilities and motivation, educational weakness and lack of experience) and the external management system (inappropriate policy making and planning, hierarchical structure, lack of team evaluation and lack of justice). The main categories of teamwork facilitators were the internal management of team (good leader or manager, appropriate workplace climate, values clarification of the team members’ practices, and proper implementation of regulations), cooperation, collaboration and empathy (help and cooperation and empathy and support), and essential personal qualities for teamwork (good communication and good personality characteristics). Conclusion: In this study, the teamwork barriers and facilitators in the maternity wards were comprehensively identified at different levels. According to the results, interventions can be designed and implemented to enhance teamwork.

Copyright of Journal of Japan Academy of Midwifery is the property of Japan Academy of Midwifery and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Japan Academy of Midwifery is the property of Japan Academy of Midwifery and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This descriptive quantitative study aimed to evaluate puerperas’ opinions regarding experiencing the presence of the companion in the process of birth and puerperium, in a public maternity unit, a center of excellence for high risk pregnancies, in the State of Paraná. Data collection occurred between August and September 2012 with 105 puerperas, using a semi-structured questionnaire. The presence of the companion was considered positive, and the tasks he undertook provided the puerpera with security, especially for care for her and the baby. It stood out that the service users wish to have a companion, regardless of the institution’s structural conditions.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a public health concern internationally. Studies examining a range of cohorts have been reported from various regions of the world, but little is known about the molecular epidemiology of MRSA in Armenia. Methods: Between May and September 2013, twenty isolates of methicillin-resistant Staphylococcus aureus (MRSA; mecA positive) were recovered from hospital personnel (n = 10; 9 females, 1 male) and environmental sites (n = 10) in the maternity ward of one of the teaching hospitals in Armenia. Results: Multi-locus sequence type clonal complex (MLST-CC) assignments inferred from spa typing data revealed the majority belonged to 3 pandemic lineages of MRSA including: t008-CC8-SCCmecV (n = 10; 7 from personnel); t021-CC30-SCCmecIV (n = 5; all environmental); and t1523-CC45 (n = 2; 1 from personnel), one harboured SCCmecV the other was SCCmec non-typable. The remainder identified as belonging to genotype t364-CC182, both of which harboured a novel SCCmec cassette with kdp, rif5, ccrB2 and ccrC detected by PCR (both from personnel); and t325-CC88-SCCmecIV (n = 1; environmental). All MRSA were negative for the Panton-Valentine Leukocidin (PVL) locus and three CC8 strains were positive for the arginine catabolic element (ACME). Conclusions: In this small study, we report for the first time of the occurrence of diverse MRSA genotypes belonging to both pandemic and more sporadic international clones in Armenia harbouring the smaller SCCmec types and/or ACME, both of which have been associated with strain fitness. Further surveillance is warranted to better understand the prevalence, clinical and molecular epidemiology of MRSA throughout Armenia. [ABSTRACT FROM AUTHOR]

Background & Aim: Teamwork (between obstetricians and midwives) is one of the main pillars of success in the provision of appropriate services in the maternity wards. Therefore, this study aimed to identify the factors influencing teamwork in a maternity ward in a public hospital in Tehran, Iran. Methods & Materials: In this qualitative study, nine midwives and four obstetricians were selected through purposive sampling. Data were collected through semi-structured interviews from an affiliated hospital of Tehran University of Medical Sciences in 2013-2014. Data were analyzed using conventional content analysis. Results: Two themes including the teamwork barriers (four categories) and facilitators (three categories) were extracted from the data analysis. The main categories of teamwork barriers were the underlying issues (inter-professional conflicts, legal issues, and salary and financial issues), individual problems (physical problems, negative personality characteristics and domestic problems), lack of skills (lack of abilities and motivation, educational weakness and lack of experience) and the external management system (inappropriate policy making and planning, hierarchical structure, lack of team evaluation and lack of justice). The main categories of teamwork facilitators were the internal management of team (good leader or manager, appropriate workplace climate, values clarification of the team members' practices, and proper implementation of regulations), cooperation, collaboration and empathy (help and cooperation and empathy and support), and essential personal qualities for teamwork (good communication and good personality characteristics). Conclusion: In this study, the teamwork barriers and facilitators in the maternity wards were comprehensively identified at different levels. According to the results, interventions can be designed and implemented to enhance teamwork. [ABSTRACT FROM AUTHOR]