Improving health and achieving health equity includes access to sexual and reproductive health care for all populations, especially those most in need. However, access to life-saving and life-affirming contraception with an individual's chosen perinatal provider can be impeded by restrictive regulations that limit scope and practice authority. This is especially true for the majority of community and direct entry midwives in the United States who have historically been unable to legally provide effective contraceptive methods. Recently, licensed midwives in Washington state were the first in the nation to achieve prescriptive authority, enabling their clients to directly obtain contraception and access to medications for common prenatal and postpartum conditions. Sustained advocacy efforts in the state's capitol enabled the Midwives’ Association of Washington State to build relationships over time with legislators and government agencies to achieve this long-term goal. We present a successful midwifery-led innovation that achieved scope expansion for licensed midwives whose practice authority was limited by restrictive laws. Lessons learned are described and strategies offered to aid midwives and their advocates in other locales who want to improve health equity and access to contraception. Midwives are well positioned to provide this essential care to individuals living in underserved rural and urban areas and those from historically marginalized communities, but their ability to do so is limited by restrictive legislation.
{"title":"Prescriptive Authority for Direct Entry Midwives in Washington State: Increasing Client Access to Contraception","authors":"Britney Zell CPM, MSM, LM, Kristin Effland CPM, MA, Mercedes Snyder CPM, LM, Karen Hays CNM, DNP, ARNP (ret.), Wendy Gordon CPM, DM, MPH, LM","doi":"10.1111/jmwh.13606","DOIUrl":"10.1111/jmwh.13606","url":null,"abstract":"<p>Improving health and achieving health equity includes access to sexual and reproductive health care for all populations, especially those most in need. However, access to life-saving and life-affirming contraception with an individual's chosen perinatal provider can be impeded by restrictive regulations that limit scope and practice authority. This is especially true for the majority of community and direct entry midwives in the United States who have historically been unable to legally provide effective contraceptive methods. Recently, licensed midwives in Washington state were the first in the nation to achieve prescriptive authority, enabling their clients to directly obtain contraception and access to medications for common prenatal and postpartum conditions. Sustained advocacy efforts in the state's capitol enabled the Midwives’ Association of Washington State to build relationships over time with legislators and government agencies to achieve this long-term goal. We present a successful midwifery-led innovation that achieved scope expansion for licensed midwives whose practice authority was limited by restrictive laws. Lessons learned are described and strategies offered to aid midwives and their advocates in other locales who want to improve health equity and access to contraception. Midwives are well positioned to provide this essential care to individuals living in underserved rural and urban areas and those from historically marginalized communities, but their ability to do so is limited by restrictive legislation.</p>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 4","pages":"600-605"},"PeriodicalIF":2.1,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139479726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hülya Türkmen PhD, RN, Serap Çetinkaya RN, Hafize Kiliç RN, Serpil Dinçer Tuna RN, Mehmet Şirvanci MD, Hilmi Mutlu MD
Introduction
Acupressure and cold application are nonpharmacologic methods that midwives can use for labor pain. The purpose of this study was to determine the effects of ice massage applied to the SP6 acupressure point during labor on labor pain, labor comfort, labor duration, and anxiety.
Methods
A single-masked, randomized controlled trial was conducted with 100 nulliparous women, including 50 in the intervention group and 50 in the control group. Rotational ice massage was applied to the SP6 point on both legs of the pregnant women in the intervention group at 4 to 5 cm, 6 to 7 cm, and 8 to 9 cm dilation amounts during 3 contractions. Routine oxytocin was administered to all pregnant women to promote progress of labor. Standard midwifery care was provided to the control group. Data were collected using a Personal Information Form, the Visual Analog Scale (VAS), a partograph form, the Childbirth Comfort Questionnaire (CCQ), and the State-Trait Anxiety Inventory State subscale.
Result
The VAS pain scores of the pregnant women in the intervention group were significantly lower compared with the control group following the intervention at dilatations of 4 to 5 cm, 6 to 7 cm, and 8 to 9 cm (P = .001, P = .003, P <.001, respectively). The total CCQ and comfort level scores of the pregnant women in the intervention group at 8 to 9 cm cervical dilatation were significantly higher than the control group (P = 0.044, P = .027, respectively). Additionally, as the anxiety levels of the pregnant women increased, their total comfort scores decreased (P <.05).
Discussion
Ice application to the SP6 point during stage 1 of childbirth reduced labor pain, increased comfort, and reduced anxiety levels. No adverse events were found in the intervention group with ice massage applied to the SP6 point. Therefore, this method can be used as a safe and effective midwifery intervention in childbirth.
{"title":"The Effect of Ice Massage Applied to the SP6 Point on Labor Pain, Labor Comfort, Labor Duration, and Anxiety: A Randomized Clinical Trial","authors":"Hülya Türkmen PhD, RN, Serap Çetinkaya RN, Hafize Kiliç RN, Serpil Dinçer Tuna RN, Mehmet Şirvanci MD, Hilmi Mutlu MD","doi":"10.1111/jmwh.13600","DOIUrl":"10.1111/jmwh.13600","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Acupressure and cold application are nonpharmacologic methods that midwives can use for labor pain. The purpose of this study was to determine the effects of ice massage applied to the SP6 acupressure point during labor on labor pain, labor comfort, labor duration, and anxiety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single-masked, randomized controlled trial was conducted with 100 nulliparous women, including 50 in the intervention group and 50 in the control group. Rotational ice massage was applied to the SP6 point on both legs of the pregnant women in the intervention group at 4 to 5 cm, 6 to 7 cm, and 8 to 9 cm dilation amounts during 3 contractions. Routine oxytocin was administered to all pregnant women to promote progress of labor. Standard midwifery care was provided to the control group. Data were collected using a Personal Information Form, the Visual Analog Scale (VAS), a partograph form, the Childbirth Comfort Questionnaire (CCQ), and the State-Trait Anxiety Inventory State subscale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>The VAS pain scores of the pregnant women in the intervention group were significantly lower compared with the control group following the intervention at dilatations of 4 to 5 cm, 6 to 7 cm, and 8 to 9 cm (<i>P</i> = .001, <i>P</i> = .003, <i>P</i> <.001, respectively). The total CCQ and comfort level scores of the pregnant women in the intervention group at 8 to 9 cm cervical dilatation were significantly higher than the control group (<i>P</i> = 0.044, <i>P</i> = .027, respectively). Additionally, as the anxiety levels of the pregnant women increased, their total comfort scores decreased (<i>P</i> <.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Ice application to the SP6 point during stage 1 of childbirth reduced labor pain, increased comfort, and reduced anxiety levels. No adverse events were found in the intervention group with ice massage applied to the SP6 point. Therefore, this method can be used as a safe and effective midwifery intervention in childbirth.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 4","pages":"491-498"},"PeriodicalIF":2.1,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13600","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139466096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nancy A. Niemczyk CNM, CHSE, PhD, Elizabeth Humphreys SN, Lauren Narbey CNM, CRNP, MSc, MSN
{"title":"Research and Professional Literature to Inform Practice, January/February 2024","authors":"Nancy A. Niemczyk CNM, CHSE, PhD, Elizabeth Humphreys SN, Lauren Narbey CNM, CRNP, MSc, MSN","doi":"10.1111/jmwh.13607","DOIUrl":"10.1111/jmwh.13607","url":null,"abstract":"","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 1","pages":"160-164"},"PeriodicalIF":2.7,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13607","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139482072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joy A. Fatunbi MD, Brent C. Monseur MD, ScM, Vincenzo Berghella MD, Jerrine R. Morris MD, MPH
Introduction
The purpose of this study was to explore patient demographic factors associated with counseling against breastfeeding and concurrent marijuana use.
Methods
A cross-sectional study derived using data from the Centers for Disease Control and Prevention administered Pregnancy Risk Assessment Monitoring System (PRAMS) in collaboration with state and local health departments. This study sample included survey participants whose responses indicate they received counseling discouraging breastfeeding with concurrent marijuana use. Bivariate and multivariate regression analyses assessed the relationship between factors associated with counseling against breastfeeding and concurrent marijuana use.
Results
Of the 10,911 participants in this sample, 9,695 participants who answered the question about receiving counseling discouraging breastfeeding while using marijuana were included in the analysis (89% response rate for the total sample). Twenty nine percent of participants were advised by a provider not to breastfeed while using marijuana. Participants who received this counseling were more likely to be people of color, age less than or equal to 29, with a high school education or less, unmarried, report governmental or no insurance prepregnancy, and report marijuana use postpartum. In the multivariate analysis, age less than or equal to 20 (P = .001), being unmarried (P = .023), and marijuana use postpartum (P = .034) remained associated with counseling against breastfeeding.
Discussion
Our results suggest that individuals are being counseled differently. Unmarried and young people (age <20 years) were more likely to report receiving counseling against breastfeeding with concurrent marijuana use. Given the growing national acceptability of marijuana use, the known benefits of breastfeeding, and the unclear risks of marijuana in human milk, there is a need to standardize counseling to avoid a missed opportunity to educate breastfeeding populations who use marijuana and to reduce the risk of counseling based on providers’ personal attitudes and biases not aligned with evidence-based guidelines.
引言本研究旨在探讨与母乳喂养咨询和同时吸食大麻相关的患者人口统计学因素：这是一项横断面研究，使用的数据来自美国疾病控制与预防中心（Centers for Disease Control and Prevention）与州和地方卫生部门合作管理的妊娠风险评估监测系统（PRAMS）。该研究样本包括调查参与者，他们的回答表明他们接受过劝阻母乳喂养同时吸食大麻的咨询。二元和多元回归分析评估了与劝阻母乳喂养和同时吸食大麻相关的因素之间的关系：在 10,911 名样本参与者中，有 9,695 名参与者回答了在吸食大麻的同时接受劝阻母乳喂养咨询的问题，这些参与者被纳入分析范围（总样本的回答率为 89%）。有 29% 的参与者在吸食大麻期间接受过医疗服务提供者不要母乳喂养的建议。接受这种建议的参与者更有可能是有色人种、年龄小于或等于 29 岁、高中或以下学历、未婚、孕前报告有政府保险或无保险、产后报告吸食大麻。在多变量分析中，年龄小于或等于 20 岁（P = .001）、未婚（P = .023）和产后吸食大麻（P = .034）仍与母乳喂养咨询有关：讨论：我们的研究结果表明，个人受到的咨询有所不同。未婚和年轻人（年龄
{"title":"Factors Associated with Provider Counseling Against Breastfeeding in the Setting of Marijuana Use: A Population-Based Survey","authors":"Joy A. Fatunbi MD, Brent C. Monseur MD, ScM, Vincenzo Berghella MD, Jerrine R. Morris MD, MPH","doi":"10.1111/jmwh.13583","DOIUrl":"10.1111/jmwh.13583","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The purpose of this study was to explore patient demographic factors associated with counseling against breastfeeding and concurrent marijuana use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study derived using data from the Centers for Disease Control and Prevention administered Pregnancy Risk Assessment Monitoring System (PRAMS) in collaboration with state and local health departments. This study sample included survey participants whose responses indicate they received counseling discouraging breastfeeding with concurrent marijuana use. Bivariate and multivariate regression analyses assessed the relationship between factors associated with counseling against breastfeeding and concurrent marijuana use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 10,911 participants in this sample, 9,695 participants who answered the question about receiving counseling discouraging breastfeeding while using marijuana were included in the analysis (89% response rate for the total sample). Twenty nine percent of participants were advised by a provider not to breastfeed while using marijuana. Participants who received this counseling were more likely to be people of color, age less than or equal to 29, with a high school education or less, unmarried, report governmental or no insurance prepregnancy, and report marijuana use postpartum. In the multivariate analysis, age less than or equal to 20 (<i>P</i> = .001), being unmarried (<i>P</i> = .023), and marijuana use postpartum (<i>P</i> = .034) remained associated with counseling against breastfeeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our results suggest that individuals are being counseled differently. Unmarried and young people (age <20 years) were more likely to report receiving counseling against breastfeeding with concurrent marijuana use. Given the growing national acceptability of marijuana use, the known benefits of breastfeeding, and the unclear risks of marijuana in human milk, there is a need to standardize counseling to avoid a missed opportunity to educate breastfeeding populations who use marijuana and to reduce the risk of counseling based on providers’ personal attitudes and biases not aligned with evidence-based guidelines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 4","pages":"455-461"},"PeriodicalIF":2.1,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amanda Millatt MPH, Kimberly K. Trout CNM, PhD, Rachel Ledyard MPH, Susan E. Brunk CNM, MSN, Dominique G. Ruggieri PhD, Lesley Bates CNM, MSN, Anne M. Mullin BS, Heather H. Burris MD, MPH
Introduction
From 2013 to 2019, Black women comprised 73% of pregnancy-related deaths in Philadelphia. There is currently a dearth of research on the continuity of midwifery care from initiation of prenatal care through birth in relation to characteristics such as race/ethnicity and income. The aim of this study was to investigate whether race/ethnicity and insurance status were associated with the likelihood of a pregnant person who begins prenatal care with a midwife to remain in midwifery care for birth attendance.
Methods
This was a retrospective cohort study of a diverse population of pregnant patients who gave birth in a large tertiary care hospital and had their first prenatal visit with a certified nurse-midwife (CNM) between June 2, 2009, and June 30, 2020 (n = 5121). We used multivariable, log-binomial regression models to calculate risk ratios of transferring to physician care (vs remaining within CNM care), adjusted for age, race/ethnicity, prepregnancy body mass index, insurance type, and comorbidities.
Results
After adjusting for pregnancy-related risk factors, non-Hispanic Black patients (adjusted relative risk [aRR], 1.14; 95% CI, 1.04-1.24) and publicly insured patients (aRR, 1.11; 95% CI, 1.01-1.22) were at higher risk of being transferred to physician care compared with non-Hispanic White and privately insured patients. Secondary analysis revealed that non-Hispanic Black patients had higher risk of transferring and having an operative birth (aRR, 1.35; 95% CI, 1.18-1.55), whereas publicly insured patients were at higher risk of being transferred for reasons other than operative births (aRR, 1.35; 95% CI, 1.18-1.54).
Discussion
These findings indicate that Black and publicly insured patients were more likely than White and privately insured patients to transfer to physician care even after adjustment for comorbid conditions. Thus, further research is needed to identify the factors that contribute to racial and economic disparity in continuity of midwifery care.
{"title":"Giving Birth With a Midwife in Attendance: Associations of Race and Insurance Status With Continuity of Midwifery Care in Philadelphia","authors":"Amanda Millatt MPH, Kimberly K. Trout CNM, PhD, Rachel Ledyard MPH, Susan E. Brunk CNM, MSN, Dominique G. Ruggieri PhD, Lesley Bates CNM, MSN, Anne M. Mullin BS, Heather H. Burris MD, MPH","doi":"10.1111/jmwh.13604","DOIUrl":"10.1111/jmwh.13604","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>From 2013 to 2019, Black women comprised 73% of pregnancy-related deaths in Philadelphia. There is currently a dearth of research on the continuity of midwifery care from initiation of prenatal care through birth in relation to characteristics such as race/ethnicity and income. The aim of this study was to investigate whether race/ethnicity and insurance status were associated with the likelihood of a pregnant person who begins prenatal care with a midwife to remain in midwifery care for birth attendance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective cohort study of a diverse population of pregnant patients who gave birth in a large tertiary care hospital and had their first prenatal visit with a certified nurse-midwife (CNM) between June 2, 2009, and June 30, 2020 (n = 5121). We used multivariable, log-binomial regression models to calculate risk ratios of transferring to physician care (vs remaining within CNM care), adjusted for age, race/ethnicity, prepregnancy body mass index, insurance type, and comorbidities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After adjusting for pregnancy-related risk factors, non-Hispanic Black patients (adjusted relative risk [aRR], 1.14; 95% CI, 1.04-1.24) and publicly insured patients (aRR, 1.11; 95% CI, 1.01-1.22) were at higher risk of being transferred to physician care compared with non-Hispanic White and privately insured patients. Secondary analysis revealed that non-Hispanic Black patients had higher risk of transferring and having an operative birth (aRR, 1.35; 95% CI, 1.18-1.55), whereas publicly insured patients were at higher risk of being transferred for reasons other than operative births (aRR, 1.35; 95% CI, 1.18-1.54).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>These findings indicate that Black and publicly insured patients were more likely than White and privately insured patients to transfer to physician care even after adjustment for comorbid conditions. Thus, further research is needed to identify the factors that contribute to racial and economic disparity in continuity of midwifery care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 4","pages":"514-521"},"PeriodicalIF":2.1,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139111401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is important for health care professionals to address women's pain and anxiety during pelvic examinations. This study aimed to evaluate the impact of virtual reality (VR) on pain and anxiety management during pelvic examinations.
Methods
The study was a randomized controlled clinical trial reported in according to the Consolidated Standards of Reporting Trials 2010 Guidelines. The research was conducted with 128 women (64 intervention, 64 control) who received care at a tertiary hospital outpatient clinic between November 2021 and February 2022. The intervention group received VR application via virtual glasses during pelvic examination, while the control group received routine care. Anxiety was measured using the State-Trait Anxiety Inventory before and after the pelvic examination, and the Visual Analog Scale was used to assess pain after the pelvic examination. The study was registered at ClinicalTrials.gov (NCT05545488).
Results
The mean anxiety scores of the women in the intervention and control groups were similar pretest (59.00 and 57.77). The mean anxiety score decreased after the pelvic examination to 36.53 in the intervention group and 47.55 in the control group. Results indicated a significant main effect for group assignment (F9.56; η2 = .071; P = .002), a significant main effect for time (F384.14; η2 = .753; P < .001), and a significant interaction between group and time (F53.95; η2 = .300; P < .001). Pain scores after the pelvic examination were lower in the intervention group (4.25) than in the control group (6.41; P < .001).
Conclusion
VR was effective in the management of pain and anxiety during pelvic examination. Future studies should compare the effectiveness of VR with other methods in reducing pain and anxiety during a pelvic examination.
{"title":"The Effect of Virtual Reality On Pain and Anxiety Management During Pelvic Examination: A Randomized Controlled Trial","authors":"Gülay Kurt CM, Msc, Neslihan Keser Ozcan PhD, CN","doi":"10.1111/jmwh.13587","DOIUrl":"10.1111/jmwh.13587","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>It is important for health care professionals to address women's pain and anxiety during pelvic examinations. This study aimed to evaluate the impact of virtual reality (VR) on pain and anxiety management during pelvic examinations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study was a randomized controlled clinical trial reported in according to the Consolidated Standards of Reporting Trials 2010 Guidelines. The research was conducted with 128 women (64 intervention, 64 control) who received care at a tertiary hospital outpatient clinic between November 2021 and February 2022. The intervention group received VR application via virtual glasses during pelvic examination, while the control group received routine care. Anxiety was measured using the State-Trait Anxiety Inventory before and after the pelvic examination, and the Visual Analog Scale was used to assess pain after the pelvic examination. The study was registered at ClinicalTrials.gov (NCT05545488).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean anxiety scores of the women in the intervention and control groups were similar pretest (59.00 and 57.77). The mean anxiety score decreased after the pelvic examination to 36.53 in the intervention group and 47.55 in the control group. Results indicated a significant main effect for group assignment (<i>F</i><sub>9.56</sub>; η<sup>2</sup> = .071; <i>P</i> = .002), a significant main effect for time (<i>F</i><sub>384.14</sub>; η<sup>2</sup> = .753; <i>P</i> < .001), and a significant interaction between group and time (<i>F</i><sub>53.95</sub>; η<sup>2</sup> = .300; <i>P</i> < .001). Pain scores after the pelvic examination were lower in the intervention group (4.25) than in the control group (6.41; <i>P</i> < .001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>VR was effective in the management of pain and anxiety during pelvic examination. Future studies should compare the effectiveness of VR with other methods in reducing pain and anxiety during a pelvic examination.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 4","pages":"543-549"},"PeriodicalIF":2.1,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13587","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study evaluated the effect of the noise level of the nonstress test (NST) device on stress parameters in primigravid women.
Methods
A total of 44 pregnant women participated in a randomized clinical trial between February and October, 2021. The participants were divided randomly into 4 equal groups using an automated web-based randomization system and ensuring allocation concealment: the control group (NST device volume turned off), intervention group I (1-35 dB(A)), intervention group II (36-60 dB(A)), and intervention group III (61 dB(A) and above). A data collection form was used to record personal information and stress parameters. Stress parameters (blood pressure, heart rate, oxygen saturation [SpO2], blood glucose, salivary cortisol, and salivary adrenocorticotropic hormone [ACTH]) levels were measured pretest (0-2 minutes before NST starts), midtest (at 10 minutes of the NST), and posttest (within 0-2 minutes after NST was finished). The study was registered at ClinicalTrials.gov (identifier: NCT05488704).
Results
NST sound levels above 35 dB(A) increased the average cortisol and ACTH levels in the posttest. NST sound levels were positively correlated with posttest cortisol (r = .448) and posttest glucose (r = .302). There was interaction effect on heart rate, glucose, and cortisol level by time, indicating that the intervention groups experienced a significant acceleration in heart rate, glucose, and cortisol level after a noise intervention compared with the control group.
Discussion
Midwives should continue applying NST below 36 dB(A), considering the factors that may induce stress during the NST process.
{"title":"The Effect of Nonstress Device Noise Level on Stress Parameters in Primigravid Women: A Randomized Controlled Trial","authors":"Turan Ayşenur PhD, Gençtürk Nuran PhD, Kaya Cihan MD, Bulut Huri PhD","doi":"10.1111/jmwh.13581","DOIUrl":"10.1111/jmwh.13581","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This study evaluated the effect of the noise level of the nonstress test (NST) device on stress parameters in primigravid women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 44 pregnant women participated in a randomized clinical trial between February and October, 2021. The participants were divided randomly into 4 equal groups using an automated web-based randomization system and ensuring allocation concealment: the control group (NST device volume turned off), intervention group I (1-35 dB(A)), intervention group II (36-60 dB(A)), and intervention group III (61 dB(A) and above). A data collection form was used to record personal information and stress parameters. Stress parameters (blood pressure, heart rate, oxygen saturation [SpO<sub>2</sub>], blood glucose, salivary cortisol, and salivary adrenocorticotropic hormone [ACTH]) levels were measured pretest (0-2 minutes before NST starts), midtest (at 10 minutes of the NST), and posttest (within 0-2 minutes after NST was finished). The study was registered at ClinicalTrials.gov (identifier: NCT05488704).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>NST sound levels above 35 dB(A) increased the average cortisol and ACTH levels in the posttest. NST sound levels were positively correlated with posttest cortisol (<i>r</i> = .448) and posttest glucose (<i>r</i> = .302). There was interaction effect on heart rate, glucose, and cortisol level by time, indicating that the intervention groups experienced a significant acceleration in heart rate, glucose, and cortisol level after a noise intervention compared with the control group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Midwives should continue applying NST below 36 dB(A), considering the factors that may induce stress during the NST process.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 2","pages":"279-286"},"PeriodicalIF":2.7,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brittany L. Ranchoff MPH, Mary T. Paterno CNM, PhD, Laura B. Attanasio PhD
Introduction
Continuity of care with an individual clinician is associated with increased satisfaction and better outcomes. Continuity of clinician type (ie, obstetrician-gynecologist or midwife) may also impact care experiences; however, it is unknown how common it is to experience discontinuity of clinician type and what its implications are for the birth experience. We aimed to identify characteristics associated with having a different clinician type for prenatal care than for birth and to compare intrapartum experiences by continuity of clinician type.
Methods
For this cross-sectional study, data were from the 2017 Listening to Mothers in California survey. The analytic sample was limited to individuals with vaginal births who had midwifery or obstetrician-gynecologist prenatal care (N = 1384). Bivariate and multivariate analysis examined characteristics of individuals by continuity of clinician type. We then examined associations of clinician type continuity with intrapartum care experiences.
Results
Overall, 74.4% of individuals had the same type of clinician for prenatal care and birth. Of individuals with midwifery prenatal care, 45.1% had a different birth clinician type, whereas 23.5% of individuals who had obstetrician-gynecologist prenatal care had a different birth clinician type. Continuity of clinician type was positively associated with having had a choice of perinatal care clinician. There were no statistically significant associations between clinician type continuity and intrapartum care experiences.
Discussion
Findings suggest individuals with midwifery prenatal care frequently have a different type of clinician attend their birth, even among those with vaginal births. Further research should examine the impact of multiple dimensions of continuity of care on perinatal care quality.
{"title":"Continuity of Clinician Type and Intrapartum Experiences During the Perinatal Period in California","authors":"Brittany L. Ranchoff MPH, Mary T. Paterno CNM, PhD, Laura B. Attanasio PhD","doi":"10.1111/jmwh.13603","DOIUrl":"10.1111/jmwh.13603","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Continuity of care with an individual clinician is associated with increased satisfaction and better outcomes. Continuity of clinician type (ie, obstetrician-gynecologist or midwife) may also impact care experiences; however, it is unknown how common it is to experience discontinuity of clinician type and what its implications are for the birth experience. We aimed to identify characteristics associated with having a different clinician type for prenatal care than for birth and to compare intrapartum experiences by continuity of clinician type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>For this cross-sectional study, data were from the 2017 <i>Listening to Mothers in California</i> survey. The analytic sample was limited to individuals with vaginal births who had midwifery or obstetrician-gynecologist prenatal care (N = 1384). Bivariate and multivariate analysis examined characteristics of individuals by continuity of clinician type. We then examined associations of clinician type continuity with intrapartum care experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 74.4% of individuals had the same type of clinician for prenatal care and birth. Of individuals with midwifery prenatal care, 45.1% had a different birth clinician type, whereas 23.5% of individuals who had obstetrician-gynecologist prenatal care had a different birth clinician type. Continuity of clinician type was positively associated with having had a choice of perinatal care clinician. There were no statistically significant associations between clinician type continuity and intrapartum care experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Findings suggest individuals with midwifery prenatal care frequently have a different type of clinician attend their birth, even among those with vaginal births. Further research should examine the impact of multiple dimensions of continuity of care on perinatal care quality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 2","pages":"224-235"},"PeriodicalIF":2.7,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139076473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jie Zheng MSc, RN, Rongrong Han MSc, BSc, RN, Lingling Gao PhD, MSc, RN
Introduction
Postpartum depression affects both mothers and fathers. This study aimed to examine the relationships between social support, parenting self-efficacy, and postpartum depression in Chinese mothers and fathers and assess the mediating effect of parenting self-efficacy using a dyadic perspective.
Methods
A cross-sectional study was implemented from December 2020 to July 2021 in Guangzhou, China, with 309 pairs of parents. The Edinburgh Postnatal Depression Scale, Social Support Rating Scale, Parenting Sense of Competence Scale-Efficacy subscale, and sociodemographic data sheet were completed by both parents. Dyadic analysis was conducted using the actor-partner interdependence mediation model. An actor effect is the relationship between variables within an individual, whereas a partner effect is the relationship between variables in the individual and the dyadic partner.
Results
In total, 20.7% of mothers and 11.7% of fathers had elevated postpartum depressive symptoms at 6 weeks postpartum. The model revealed 6 actor effects: social support was positively associated with parenting self-efficacy for mothers (β, 0.39; 95% CI, 0.28-0.49) and fathers (β, 0.39; 95% CI, 0.30-0.48) and negatively associated with postpartum depression for mothers (β, −0.22; 95% CI, −0.32 to −0.12) and fathers (β, −0.37; 95% CI, −0.48 to −0.26). Parenting self-efficacy was negatively associated with postpartum depression in mothers (β, −0.41; 95% CI, −0.53 to −0.29) and fathers (β, −0.24; 95% CI, −0.37 to −0.12). Maternal social support had a partner effect on paternal parenting self-efficacy (β, 0.14; 95% CI, 0.04-0.24). Parenting self-efficacy mediated between social support and postpartum depression for both parents (mothers: β, −0.16; 95% CI, −0.23 to −0.10; fathers: β, −0.10; 95% CI, −0.16 to −0.05).
Discussion
Postpartum depression was a dyadic phenomenon. Increasing mother-centered social support has the potential to improve the parenting self-efficacy of both parents and reduce the likelihood of postpartum depression.
{"title":"Social Support, Parenting Self-Efficacy, and Postpartum Depression Among Chinese Parents: The Actor-Partner Interdependence Mediation Model","authors":"Jie Zheng MSc, RN, Rongrong Han MSc, BSc, RN, Lingling Gao PhD, MSc, RN","doi":"10.1111/jmwh.13588","DOIUrl":"10.1111/jmwh.13588","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Postpartum depression affects both mothers and fathers. This study aimed to examine the relationships between social support, parenting self-efficacy, and postpartum depression in Chinese mothers and fathers and assess the mediating effect of parenting self-efficacy using a dyadic perspective.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study was implemented from December 2020 to July 2021 in Guangzhou, China, with 309 pairs of parents. The Edinburgh Postnatal Depression Scale, Social Support Rating Scale, Parenting Sense of Competence Scale-Efficacy subscale, and sociodemographic data sheet were completed by both parents. Dyadic analysis was conducted using the actor-partner interdependence mediation model. An actor effect is the relationship between variables within an individual, whereas a partner effect is the relationship between variables in the individual and the dyadic partner.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 20.7% of mothers and 11.7% of fathers had elevated postpartum depressive symptoms at 6 weeks postpartum. The model revealed 6 actor effects: social support was positively associated with parenting self-efficacy for mothers (<i>β</i>, 0.39; 95% CI, 0.28-0.49) and fathers (<i>β</i>, 0.39; 95% CI, 0.30-0.48) and negatively associated with postpartum depression for mothers (<i>β</i>, −0.22; 95% CI, −0.32 to −0.12) and fathers (<i>β</i>, −0.37; 95% CI, −0.48 to −0.26). Parenting self-efficacy was negatively associated with postpartum depression in mothers (<i>β</i>, −0.41; 95% CI, −0.53 to −0.29) and fathers (<i>β</i>, −0.24; 95% CI, −0.37 to −0.12). Maternal social support had a partner effect on paternal parenting self-efficacy (<i>β</i>, 0.14; 95% CI, 0.04-0.24). Parenting self-efficacy mediated between social support and postpartum depression for both parents (mothers: <i>β</i>, −0.16; 95% CI, −0.23 to −0.10; fathers: <i>β</i>, −0.10; 95% CI, −0.16 to −0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Postpartum depression was a dyadic phenomenon. Increasing mother-centered social support has the potential to improve the parenting self-efficacy of both parents and reduce the likelihood of postpartum depression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 4","pages":"559-566"},"PeriodicalIF":2.1,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139041152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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