Journal of midwifery & women's health最新文献_第3页

Trauma Exposure and Posttraumatic Stress Disorder in a Rural Perinatal Population 农村围产期人群的创伤暴露与创伤后应激障碍。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-11-12 DOI: 10.1111/jmwh.70051

Michelle L. Miller PhD, Emma N. Cleary BA, Mahogany A. Monette MS, Rachel E. Emery MSN, FNP-BC, PMH-C, Anushay Ansari BA, Rilyn Wonnell, David M. Haas MD

Introduction

There is very limited information on the rates of trauma exposure and posttraumatic stress disorder (PTSD) symptoms for perinatal individuals who live in rural settings. Increasing understanding of traumatic experiences among rural-dwelling pregnant individuals may be an important avenue through which midwives can help address the care disparities and poor outcomes in this population. This study aimed to implement screening and estimate prevalence rates of trauma exposure and perinatal PTSD symptoms among individuals at a Midwestern rural obstetric clinic.

Methods

Participants completed a brief screening measure that assessed demographics, trauma exposure, mental health knowledge and experience, and PTSD symptoms.

Results

Of the 421 patients screened, the mean age was 26.8 years, and 69.6% identified as White and 11.9% identified as Latina. Over half endorsed trauma exposure (53.0%). The most common types of traumatic events were death of a close family member or friend (36.1%) and childhood sex abuse (14.3%). About 1 in 4 trauma-exposed patients (25.6%) scored above the clinical threshold for probable PTSD (≥3 on the Primary Care PTSD Screen for DSM-5). The most endorsed PTSD symptom type was internal and external avoidance of trauma-related stimuli (32.4%).

Discussion

A history of trauma exposure and perinatal PTSD symptoms were more common than expected when compared with both overall perinatal and rural population PTSD prevalence rates. Specific considerations were identified that facilitated successful screening in our rural population. Future clinical research with rural populations should consider: (1) broad implementation of PTSD symptom screening of perinatal patients and creation of a workflow that establishes follow-up steps for patients who screen positive; (2) development of training and psychoeducational materials for health care providers and patients to facilitate connection with brief trauma interventions; and (3) support of trauma-informed, stepped care models with a range of disciplines and provider types to help manage perinatal PTSD symptoms.

关于生活在农村环境中的围产期个体的创伤暴露率和创伤后应激障碍（PTSD）症状的信息非常有限。增加对农村孕妇创伤经历的了解可能是助产士帮助解决这一人群护理差异和不良结果的重要途径。本研究的目的是在中西部农村产科诊所实施筛查和估计创伤暴露和围产期创伤后应激障碍症状的患病率。方法：参与者完成了一项简短的筛查措施，评估人口统计学、创伤暴露、心理健康知识和经验以及PTSD症状。结果：在筛选的421例患者中，平均年龄为26.8岁，其中69.6%为白人，11.9%为拉丁裔。超过一半（53.0%）支持创伤暴露。最常见的创伤事件类型是亲密家庭成员或朋友的死亡（36.1%）和童年性虐待（14.3%）。大约1 / 4的创伤暴露患者（25.6%）在可能的PTSD中得分高于临床阈值（在DSM-5的初级保健PTSD筛查中得分≥3）。最被认可的PTSD症状类型是内外逃避创伤相关刺激（32.4%）。讨论：与总体围产儿和农村人口PTSD患病率相比，创伤暴露史和围产期PTSD症状比预期的更常见。确定了促进我国农村人口成功筛查的具体考虑因素。未来农村人群的临床研究应考虑：(1)在围产期患者中广泛实施PTSD症状筛查，并为筛查阳性患者建立随访步骤的工作流程；(2)为卫生保健提供者和患者开发培训和心理教育材料，以促进与简短创伤干预的联系；(3)支持创伤知情的阶梯式护理模式，包括一系列学科和提供者类型，以帮助管理围产期创伤后应激障碍症状。

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引用次数: 0

Masaje Perineal En El Embarazo 孕期会阴按摩

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-11-07 DOI: 10.1111/jmwh.70047

<p>El perineo es la zona entre la abertura vaginal y el recto. Esta zona se estira al dar a luz y, en ocasiones, el perineo o la vagina se desgarran durante el nacimiento del bebé. Si su proveedor médico realiza una episiotomía durante el parto, es esta zona la que corta. Es posible que necesite puntos de sutura después del nacimiento del bebé si tiene un desgarro o si se le realiza una episiotomía.</p><p>Aproximadamente entre 4 y 8 de cada 10 mujeres que dan a luz por vía vaginal presentan algún desgarro en el perineo. Aproximadamente dos tercios de estas mujeres necesitarán puntos de sutura.</p><p>La mayoría de las mujeres no necesitan una episiotomía. Aunque eran comunes antes de la década de 1990, hoy en día rara vez se realizan. Sin embargo, en ocasiones, el profesional de la salud puede recomendar una episiotomía justo cuando nace el bebé. Por ejemplo, una episiotomía puede ser útil si es necesario que un bebé nazca pronto. Puede pedirle a su proveedor de atención médica que hable con usted sobre la episiotomía durante una visita prenatal.</p><p>Se han realizado numerosas investigaciones acerca la prevención del desgarro perineal durante el parto. Diversos estudios de investigación han demostrado que el masaje perineal durante las últimas semanas del embarazo puede reducir la probabilidad de un desgarro en las mujeres primerizas. Este masaje, en el que se utilizan dos dedos para estirar los tejidos perineales, se realiza por la mujer o su pareja en casa una o dos veces por semana durante las últimas 4 a 6 semanas del embarazo. En la siguiente página se explica cómo realizarlo. Por cada 15 mujeres que se realizan un masaje perineal, una evitará una episiotomía y un desgarro perineal que requiera puntos de sutura. Mientras se masajea, puede practicar la relajación de los músculos del perineo. Esto puede ayudarla a prepararse para la sensación de estiramiento y ardor que podría sentir cuando nazca la cabeza de su bebé. Relajar esta zona durante el parto puede ayudar a prevenir el desgarro.</p><p>El masaje parece funcionar mejor en algunas mujeres que en otras. Las mujeres primerizas, las mayores de 30 años y las que se han sometido a episiotomías presentan menos desgarros y desgarros menos graves cuando se realiza el masaje perineal durante las últimas semanas del embarazo.</p><p>¡Sí! A muchas mujeres les resulta más fácil que sus parejas les realicen este masaje. Consulte las instrucciones para el masaje perineal a continuación para obtener más información.</p><p>No que sepamos. Es gratis. No duele. Es fácil de hacer. Y a la mayoría de las mujeres no les molesta hacerlo. No se debe estirar el perineo hasta el punto de que duela ni masajearlo con demasiada frecuencia ya que puede lastimar la piel de esa zona. No se realice el masaje perineal más de una o dos veces por semana. Las mujeres que lo realizan con más frecuencia no tienen un menor riesgo de desgarro perineal. Consulte con su médico antes de comenzar el masaje perineal. Y si cree que

围产期是阴道开口和直肠之间的区域。这个区域在分娩时被拉伸，有时围产期或阴道在婴儿出生时被撕裂。如果你的医生在分娩时做了会阴切开术，这个区域就会被切除。出生后，如果你有撕裂或外阴切开术，你可能需要缝针。大约每10名通过阴道分娩的妇女中就有4到8人在围产期出现撕裂。这些妇女中大约有三分之二需要缝针。大多数女性不需要外阴切开术。虽然在20世纪90年代之前，它们很常见，但今天很少实施。然而，有时卫生保健专业人员可能会建议在婴儿出生时进行会阴切除术。例如，如果婴儿需要早产，外阴切开术可能是有用的。你可以让你的卫生保健提供者在产前检查期间与你讨论会阴切开术。关于预防分娩期间的围产期撕裂，已经进行了许多研究。几项研究表明，在怀孕的最后几周进行会阴按摩可以降低早期妇女撕裂的可能性。在怀孕的最后4 - 6周，女性或她的伴侣每周在家里进行一到两次这种按摩，用两根手指拉伸会阴组织。下一页解释了如何做到这一点。每15名接受会阴按摩的女性中，就有1人可以避免会阴切开术和需要缝合的会阴撕裂。在按摩的同时，你可以练习放松会阴肌肉。这可以帮助你为宝宝出生时可能感受到的拉伸和灼烧感做好准备。在分娩过程中放松这个区域可以帮助防止撕裂。按摩似乎对某些女性比其他女性更有效。在怀孕的最后几周进行会阴按摩时，30岁以上的首次女性和接受过会阴切开术的女性会出现较少的撕裂和不那么严重的撕裂。许多女性发现她们的伴侣做这种按摩更容易。更多信息请参阅下面的会阴按摩说明。不是我们所知道的。是免费的。这不会伤害。这很容易做到。大多数女性并不介意这样做。不要把会阴拉伸到疼痛的程度，也不要太频繁地按摩会阴，因为这会伤害该区域的皮肤。会阴按摩每周不要超过一到两次。经常这样做的女性并没有降低会阴撕裂的风险。在开始会阴按摩之前，请咨询你的医生。如果你认为你失去了羊水（水袋），在把任何东西插入阴道之前咨询你的医生。2025年10月批准。本手册可由医疗保健专业人员复制作非商业用途，与患者分享，但不允许对手册进行修改。本手册中的信息和建议不能取代医疗保健。在你的医疗保健提供者那里了解你和你的健康的具体信息。本文件中的信息和建议不能替代医疗保健。向您的医疗服务提供者咨询针对您和您的健康的具体信息

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引用次数: 0

Policy Knowledge and Abortion Access for US Active-Duty Servicewomen: A Mixed-Methods Study 美国现役妇女的政策知识和堕胎途径：一项混合方法研究。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-11-05 DOI: 10.1111/jmwh.70049

Caitlin Russell PhD, MBE, MSHP, WHNP-BC, Tiara Walz PhD, MHA, MBA, MSEd, FACHE, Laura Manzo PhD, MBA, MSN, CCRN, Shelby Mueller BSN, Sharon Messina, Sharon Arana, Keira Feng, Holly Harner PhD, MBA, MPH, RN, WHNP-BC, FAAN

Introduction

More than 80,000 US military servicewomen are stationed in states enforcing abortion bans. US Department of Defense (DOD) policies must adhere to the Hyde Amendment, which restricts abortion coverage. Little research exists regarding active-duty servicewomen's (ADSW) knowledge of these policies or their experiences accessing abortion care. This study examines the reproductive health policy knowledge and lived experiences of ADSW who have accessed abortion care.

Methods

A 24-item questionnaire was designed to measure reproductive health policy knowledge and explore reproductive health experiences among ADSW. Via secondary analysis, a subset of 178 participants self-reported obtaining an abortion while on active duty. A convergent mixed-methods design (quantitative and qualitative) was used.

Results

Most participants (65%; n = 115) did not know TRICARE covered abortion costs in cases of rape or incest; 77% (n = 137) erroneously believed they required leadership permission to get an abortion; and 87% (n = 155) did not know they were entitled to convalescent leave to recover after an elective abortion. More than half (53%; n = 94) took personal leave to access abortion care; 46% (n = 82) traveled more than one hour; 48% experienced financial difficulties; 31% (n = 55) experienced negative professional repercussions; 16% (n = 29) received convalescent leave; 92% (n = 164) were not offered mental health counseling; and 77% (n = 137) felt they would have benefited from mental health counseling postabortion. Qualitative themes included a systemic lack of DOD abortion policy knowledge and lived experiences of accessing abortion care (eg, financial burdens, stigma).

Discussion

Given the systemic lack of policy knowledge reported among study participants, the DOD should develop and implement a standardized abortion policy and access training for military health care professionals, leadership, and service members. Policies ensuring access to abortion should be adopted, codified, and implemented uniformly across all branches of service.

简介：超过8万名美国女兵驻扎在执行堕胎禁令的州。美国国防部的政策必须遵守海德修正案，该修正案限制了堕胎的覆盖范围。关于现役妇女对这些政策的了解或她们获得堕胎护理的经历的研究很少。本研究考察了获得堕胎护理的未成年未成年人的生殖健康政策知识和生活经历。方法：设计一份24题的调查问卷，对非裔美国妇女的生殖健康政策知识进行调查，并探讨她们的生殖健康经验。通过二次分析，178名参与者自我报告在服役期间堕胎。采用收敛混合方法设计（定量和定性）。结果：大多数参与者（65%,n = 115）不知道TRICARE包括强奸或乱伦案件的堕胎费用；77% （n = 137）的人错误地认为他们需要领导的许可才能堕胎；87% （n = 155）不知道他们有权在选择性堕胎后享受康复假。超过一半（53%,n = 94）的人请事假接受堕胎护理；46% （n = 82）的旅行时间超过1小时；48%的人经历过财务困难；31% （n = 55）经历了负面的职业影响；16% （n = 29）获得康复假；92% （n = 164）未接受心理健康咨询；77% （n = 137）的人认为他们会从堕胎后的心理健康咨询中受益。定性主题包括系统性地缺乏国防部堕胎政策知识和获得堕胎护理的生活经验（例如，经济负担，耻辱）。讨论：鉴于研究参与者报告的系统性政策知识缺乏，国防部应制定和实施标准化的堕胎政策，并为军事卫生保健专业人员、领导层和服务人员提供培训。应在所有服务部门采用、编纂和统一实施确保获得堕胎服务的政策。

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引用次数: 0

Strengthening Perinatal Services Through Social Care: Outcomes of a Quality Improvement Initiative for a Health Center-Based Perinatal Care Program 通过社会关怀加强围产期服务：以保健中心为基础的围产期护理方案质量改进倡议的成果。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-10-29 DOI: 10.1111/jmwh.70042

Rebecca L. Emery Tavernier PhD, LP, PMH-C, Peyton Rogers MPH, Mia Shenkman, Aaliyah Moore BA, Briana Sailor BA, Veena Channamsetty MD, Yvette Highsmith MM, Margaret Flinter PhD, NP

Introduction

Given the prevalence and consequences of unmet social needs in perinatal populations, there is a critical demand for perinatal care that addresses social needs. To better support health systems in providing comprehensive social and perinatal care services, this quality improvement initiative uses the Donabedian model for care quality to describe the structure, process, and outcomes of embedding an innovative perinatal care program with integrated social care into an established primary care center.

Process

The Improving Maternal Outcomes Now! (IMON) program was designed to address the clinical and health-related social needs of patients at highest risk of maternal health disparities. The IMON program offers holistic prenatal and postpartum care through the provision of midwifery services, obstetrician support, intensive social needs support, and around-the-clock virtual care. Program implementation began in June 2023 at a federally qualified health center.

Outcomes

During the first 18 months of implementation, 102 pregnant patients received prenatal care. Forty-four percent of patients identified as Hispanic, with more than half (54%) reporting Spanish as their preferred language. Patients were highly engaged with program services. Nearly two-thirds of IMON patients (65%) initiated prenatal care in their first trimester, and most (91%) were assisted with social needs during or after pregnancy. A majority (88%) enrolled to receive adjunctive virtual care services. Among the 61 patients who gave birth, 77% did so vaginally, whereas the remaining 23% did so via cesarean birth. On average, patients gave birth at 39 weeks’ gestation, with only 5% giving birth preterm and 3% having a newborn that was small for gestational age.

Discussion

Preliminary findings suggest that IMON can be implemented within a safety-net setting, with high patient engagement and social needs support. Early outcomes show promising maternal and neonatal health indicators.

引言：鉴于未满足围产期人群社会需求的普遍性和后果，围产期护理的关键需求是解决社会需求。为了更好地支持卫生系统提供全面的社会和围产期护理服务，这一质量改进倡议使用多纳伯迪安护理质量模型来描述将具有综合社会护理的创新围产期护理方案嵌入已建立的初级保健中心的结构、过程和结果。过程：改善产妇结局现在！（IMON）方案旨在解决产妇保健差异风险最高的患者的临床和与健康有关的社会需求。IMON计划通过提供助产服务、产科医生支持、强化社会需求支持和全天候虚拟护理，提供全面的产前和产后护理。该计划于2023年6月在一家获得联邦认证的医疗中心开始实施。结果：在实施的前18个月，102名孕妇接受了产前护理。44%的患者被确定为西班牙裔，超过一半（54%）的患者报告西班牙语是他们的首选语言。患者对项目服务的参与度很高。近三分之二的IMON患者（65%）在妊娠早期开始产前护理，大多数（91%）在怀孕期间或之后得到了社会需求方面的帮助。大多数（88%）登记接受辅助虚拟护理服务。在61名分娩的患者中，77%是顺产，而剩下的23%是剖腹产。平均而言，患者在妊娠39周分娩，只有5%的人早产，3%的人的新生儿比胎龄小。讨论：初步研究结果表明，IMON可以在安全网设置中实施，患者参与度高，社会需求支持。早期结果显示，孕产妇和新生儿健康指标令人鼓舞。

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引用次数: 0

Barriers and Facilitators to Colposcopy Follow-up After Abnormal Cervical Cancer Screening: Qualitative Insights From an Urban Health Care Setting 异常宫颈癌筛查后阴道镜随访的障碍和促进因素：来自城市卫生保健机构的定性见解。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-10-29 DOI: 10.1111/jmwh.70041

Jaqueline Serrano Aguilar MD, Hunter K. Holt MD, MAS, Caroline Beshers MD, Kelley Baumann MPH, Maria Valle Coto MD, Gelila Goba MD, MPH, Priyanka Gokhale MD

Introduction

Delays to colposcopy increase the risk for cervical cancer development. Our study sought to understand the barriers and facilitators to follow-up after an abnormal cervical cancer screening test result.

Methods

English-speaking adult patients who did not attend at least one of their scheduled appointments at an urban academic colposcopy clinic between June 2021 and June 2023 were eligible. Semistructured interviews were conducted, and thematic analyses using inductive and deductive coding were completed.

Results

Twenty women were interviewed. The mean (SD) age was 34 (10) years, and participants mainly identified as non-Hispanic Black (60%). The mean (SD) time to colposcopy was 12.5 (11.9) months. Seven participants did not have a follow-up colposcopy at the time of the interview. Five categories of themes emerged at the individual, interpersonal, clinic, and system level, including (1) fear of pain and/or pelvic examinations, (2) patient-provider communication (including result communication), (3) clinic interactions (including presence of trainees and lack of continuity), (4) scheduling difficulties, and (5) system-level barriers such as loss of insurance coverage.

Discussion

Barriers to follow-up care exist across multiple levels. A one-size-fits-all approach may be ineffective for facilitating follow-up; rather, a multipronged approach may be needed to improve adherence and reduce delays to follow-up care after an abnormal cervical cancer screening test result.

引言：阴道镜检查的延迟增加了宫颈癌发展的风险。我们的研究旨在了解宫颈癌筛查结果异常后随访的障碍和促进因素。方法：在2021年6月至2023年6月期间没有在城市学术阴道镜诊所至少参加一次预定预约的英语成年患者符合条件。进行了半结构化访谈，并使用归纳和演绎编码完成了主题分析。结果：对20名女性进行了访谈。平均（SD）年龄为34（10）岁，参与者主要是非西班牙裔黑人（60%）。平均（SD）阴道镜检查时间为12.5（11.9）个月。7名参与者在随访时没有进行阴道镜检查。在个人、人际、诊所和系统层面出现了五类主题，包括(1)对疼痛和/或骨盆检查的恐惧，(2)患者-提供者沟通（包括结果沟通），(3)诊所互动（包括学员的存在和缺乏连续性），(4)安排困难，(5)系统层面的障碍，如保险覆盖范围的丧失。讨论：后续护理的障碍存在于多个层面。一刀切的做法可能不利于促进后续行动；相反，可能需要多管齐下的方法来提高依从性，减少宫颈癌筛查结果异常后随访护理的延误。

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引用次数: 0

Development of the Preparation for Community-Based Labor and Birth Instrument Centering Black Perspectives in the United States: A Participatory Adaptation 以黑人视角为中心的美国社区分娩工具准备的发展——参与式适应。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-10-28 DOI: 10.1111/jmwh.70040

Ashley Mitchell MPH, CPE, Nikia Grayson CNM, DNP, MSN, MPH, MA, FNP-C, Patience A. Afulani PhD, MBChB, MPH, Kimberly Baltzell RN, PhD, MS, Carrie Neerland CNM, PhD, APRN, Alden Hooper Blair PhD, MS, Alexis Dunn Amore CNM, PhD

Introduction

Community-based birth supported by midwives and nurses is increasing in the United States amid stark racial disparities in maternal outcomes and worsening access to pregnancy care. Although studies examining prenatal confidence have shown that persons with higher confidence are more likely to give birth vaginally, reporting less pain, anxiety, and dissatisfaction, existing measurement tools have focused on hospital births. Accordingly, we adapted the previously validated Preparation for Labor and Birth (P-LAB) instrument, which measures third-trimester confidence for physiologic birth, for community-based births, centering the perspectives of Black populations.

Methods

Expert stakeholders (N = 5) including practicing midwives and maternal health researchers assessed the relevance and completeness of the P-LAB. Following individual reviews, stakeholders adapted the tool during a group review session. Virtual cognitive interviews were then conducted with community stakeholders (N = 10), prenatal and newly postpartum persons, to test comprehensibility, informing further adaptation of P-LAB items. Findings were summarized and analyzed using an abbreviated framework method. A subset of community stakeholders (N = 5) pretested the final instrument for redundancy and appropriateness.

Results

The iterative adaptation process informed removal of irrelevant items (N = 6), further clarification of existing items (N = 12), and the generation of additional items (N = 7). The final instrument, the Preparation for Community-Based Labor and Birth (P-CLAB), is a 23-item, Likert-response survey. Expert stakeholder engagement resulted in replacing medication-focused measures with items related to safety, dignity, and racial concordance while incorporating language aligning with the midwifery model of care. Community stakeholder engagement highlighted unclear items and opportunities to improve relevance.

Discussion

In addition to promising utility for research, measuring prenatal confidence may equip midwives and nurses to further engage in person-centered care by addressing maternal fears and empowering patients according to their specific needs. The participatory P-CLAB adaptation enhances the instrument's utility and applicability to community-based care settings.

导言：在美国，由于孕产妇结局存在明显的种族差异，妊娠护理的可及性日益恶化，助产士和护士支持的社区分娩正在增加。尽管调查产前信心的研究表明，信心较高的人更有可能顺产，报告的疼痛、焦虑和不满较少，但现有的测量工具主要集中在医院分娩。因此，我们调整了先前验证的准备劳动和分娩（P-LAB）仪器，该仪器测量生理分娩的第三个月的信心，以社区为基础的分娩，以黑人人口为中心。方法：包括执业助产士和孕产妇保健研究人员在内的专家利益相关者（N = 5）评估P-LAB的相关性和完整性。在个人评审之后，涉众在小组评审会议期间调整了该工具。然后对社区利益相关者（N = 10）、产前和产后新手进行虚拟认知访谈，以测试可理解性，为P-LAB项目的进一步适应提供信息。结果总结和分析使用一个简短的框架方法。社区利益相关者子集（N = 5）预先测试了最终工具的冗余和适当性。结果：在迭代适应过程中，剔除了不相关的项目（N = 6），进一步澄清了现有的项目（N = 12），生成了额外的项目（N = 7）。最后一个工具，准备社区分娩（P-CLAB），是一个23个项目，李克特反应调查。专家利益相关者的参与导致以安全、尊严和种族一致性相关的项目取代以药物为重点的措施，同时纳入与助产护理模式一致的语言。社区利益相关者的参与突出了不明确的项目和提高相关性的机会。讨论：除了有希望的实用研究，测量产前信心可以装备助产士和护士进一步参与以人为本的护理，解决产妇的恐惧，并根据患者的具体需求赋予他们权力。参与式P-CLAB适应提高了仪器的效用和适用性，以社区为基础的护理设置。

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引用次数: 0

Journal Award Winners Ad 2025 杂志获奖广告2025

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-10-16 DOI: 10.1111/jmwh.70045

引用次数: 0

What Indigenous Women Want in Pregnancy and Birth: Perspectives on Care Preferences Across the United States 土著妇女在怀孕和分娩中想要什么：美国各地护理偏好的观点。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-10-15 DOI: 10.1111/jmwh.70037

Karina Bañuelos MA, Mona Zuffante PhD, Paul Masotti PhD, Cheyenne Seneca MA, Shannon Maloney PhD

Introduction

Although awareness of respectful maternity care is increasing, international maternal and newborn care standards often overlook culture as a key component of respectful care. Indigenous communities may have unique pregnancy care needs due to cultural and lived experience differences from the broader US population, yet little is known about Indigenous preferences for pregnancy care. We must articulate a vision for positive pregnancy care among Indigenous people in the United States.

Methods

In partnership with Indigenous academic researchers, a Tribal Health Department, and a Native-serving health center, the research team conducted a qualitative descriptive study informed by Indigenous research methodologies to explore the care preferences of Indigenous persons throughout pregnancy. We recruited participants from all 12 Indian Health Service regions, including Hawai'i. The senior author conducted semi-structured interviews with 27 Indigenous women to gather insights on their aspirations related to place, people, and the provision of pregnancy care.

Results

We identified 3 overarching themes that describe Indigenous women's preferences for pregnancy care: rights and validity; safety, dignity, and humanity; and pregnancy care options. Although we identified common themes that Indigenous women share with the broader population, there are specific and unique preferences for comprehensive wraparound services, for the ability to incorporate Indigenous birthing practices, and for health systems to reposition themselves to be emotionally, spiritually, and physically safe institutions for Indigenous women.

Discussion

Our findings highlight the need for a culturally centered approach to maternity care, urging health systems to adopt policies and practices that better support Indigenous women.

导语：虽然尊重产妇护理的意识正在提高，但国际孕产妇和新生儿护理标准往往忽视文化作为尊重护理的关键组成部分。由于文化和生活经验与更广泛的美国人口的差异，土著社区可能有独特的怀孕护理需求，但对土著对怀孕护理的偏好知之甚少。我们必须在美国土著人民中阐明积极怀孕护理的愿景。方法：研究小组与土著学术研究人员、部落卫生部门和为土著服务的卫生中心合作，采用土著研究方法进行了定性描述性研究，以探索土著人在整个怀孕期间的护理偏好。我们从包括夏威夷在内的所有12个印第安人健康服务地区招募了参与者。资深作者对27名土著妇女进行了半结构化访谈，以了解她们对地方、人民和提供怀孕护理的愿望。结果：我们确定了3个总体主题，描述了土著妇女对怀孕护理的偏好：权利和有效性；安全、尊严和人道；以及孕期护理选择。虽然我们确定了土著妇女与更广泛人群共有的共同主题，但对于全面的一揽子服务，对于纳入土著分娩实践的能力，以及对卫生系统重新定位为土著妇女在情感上，精神上和身体上安全的机构，都有具体而独特的偏好。讨论：我们的研究结果强调了以文化为中心的产妇护理方法的必要性，敦促卫生系统采取更好地支持土著妇女的政策和做法。

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引用次数: 0

Plan de Parto

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-10-04 DOI: 10.1111/jmwh.70003

Un plan de parto es una declaración escrita de sus metas y de lo que es importante para usted durante su trabajo de parto y cuando esté dando a luz. Un plan de parto describe la experiencia que espera tener y cómo desea recibir apoyo de quienes le atienden.

Durante una de las consultas de seguimiento prenatal puede compartir y revisar su plan de parto con su partera u otro proveedor de atención prenatal. Cuando el plan esté completo, es posible que su proveedor querrá colocar una copia en su expediente prenatal. Usted también debería conservar una copia para compartirla con los proveedores que la cuiden cuando esté en trabajo de parto.

Ventajas: Desarrollar un plan de parto le permite aprender acerca de sus opciones antes de estar en trabajo de parto y comunicar con sus proveedores y familia sus objetivos e ideas acerca de estas opciones. El revisar con su partera/proveedor de atención medica el plan de parto durante una visita prenatal le brinda la oportunidad de informarse acerca de los procedimientos de rutina en el lugar donde dará a luz antes del parto, lo cual le permite estar mejor preparada.

Desventajas: Puede sentirse decepcionada si las cosas que enumera en su plan de parto no suceden. No hay certeza que su plan se llevará a cabo en todos los aspectos porque muchas cosas inesperadas pueden suceder durante el trabajo de parto y el nacimiento. Si su trabajo de parto se complica, puede necesitar intervenciones que quizás esperaba evitar.

Asistir a clases de preparación al parto, hablar con familiares o amigos que hayan dado a luz en el lugar donde usted dará a luz, hablar con una doula (persona de apoyo durante el embarazo y el parto), leer libros y buscar información en sitios web sobre el embarazo son algunas de las maneras de informarse acerca de las opciones disponibles para usted. También puede platicar con su proveedor y con amigos o familiares que tengan valores similares a los suyos mientras considera sus opciones. Puede visitar el hospital o centro de parto donde planea dar a luz para que le puedan explicar los procedimientos de rutina que puede anticipar.

Approved July 2025.

This handout may be reproduced for noncommercial use by health care professionals to share with patients, but modifications to the handoutare not permitted. The information and recommendations in this handout are not a substitute for health care. Consult your health careprovider for information specific to you and your health.

La información y las recomendaciones en este documento no sustituyen la atención médica. Consulte con su proveedor de atención médicapara obtener información específica para usted y su salud.

分娩计划是一份书面声明，说明你的目标，以及在分娩和分娩过程中对你重要的事情。一份分娩计划描述了你期望的经历，以及你希望如何从护理人员那里得到支持。在一次产前随访中，你可以与助产士或其他产前保健提供者分享和审查你的分娩计划。当你的计划完成后，你的医疗服务提供者可能想要在你的产前档案中放置一份副本。你也应该保留一份副本，以便在分娩时与照顾你的提供者分享。好处：制定一个分娩计划可以让你在分娩前了解你的选择，并与你的提供者和家人沟通你的目标和关于这些选择的想法。在产前检查期间与助产士/卫生保健提供者一起检查分娩计划，可以让你有机会了解分娩地点的常规程序，从而更好地做好准备。缺点：如果你的分娩计划中列出的事情没有发生，你可能会感到失望。你的计划是否能全面实施还不确定，因为在分娩和分娩过程中可能会发生很多意想不到的事情。如果你的分娩变得复杂，你可能需要你希望避免的干预。分娩参加预备课程,跟家人或朋友中有人在你的地方,她怀孕了,跟一个douala妊娠和分娩期间支助(人),阅读书籍和网站上搜集关于怀孕都是如何找出的一些关于你可用选项。你也可以和你的提供者以及价值观相似的朋友或家人讨论你的选择。你可以去你计划分娩的医院或分娩中心，这样他们就可以解释你可能预料到的常规程序。2025年7月批准。本手册可由医疗保健专业人员复制作非商业用途，与患者分享，但不允许对手册进行修改。本手册中的信息和建议不能取代医疗保健。与你的医疗保健提供者讨论你和你的健康的具体信息。本文件中的信息和建议不能替代医疗保健。向你的医疗服务提供者咨询针对你和你的健康的信息。

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引用次数: 0

Community-Based Initiatives to Improve Maternal and Newborn Health in High-Income Settings: A Mixed-Methods Systematic Review 以社区为基础的改善高收入环境中孕产妇和新生儿健康的举措：一项混合方法的系统评价。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-09-29 DOI: 10.1111/jmwh.70023

Elise Robinson RM, MPH, Aradhna Kaushal PhD, MSc, BSc, Joanna Drazdzewska MSc, BA

Introduction: Although community-based interventions, including Participatory Learning and Action (PLA) groups, have demonstrated significant success in improving maternal and newborn health outcomes and promoting equity in low to middle-income countries, the evidence in high-income settings remains limited. This systematic review, carried out in collaboration with Women and Children First (a UK-based charity focusing on improving the lives of women and children globally), explores community-based initiatives that are currently used in high-income countries (HICs) to enhance maternal and newborn health, as well as the effectiveness of these initiatives in improving maternal and newborn health outcomes. Additionally, the review aims to examine the relationship between community-based initiatives and PLA methodology.

Methods: This is a mixed-method systematic review with a narrative synthesis of results. MEDLINE, Embase, CINAHL, and MIDIRS databases were searched for community-based initiatives for any maternal and neonatal health outcome between 2000 and 2023. Both quantitative and qualitative studies were included and assessed for methodological quality using the Mixed-Methods Appraisal Tool. A convergent results-based synthesis approach was used.

Results: A total of18 studies were included for review. Three main types of community-based interventions were identified: peer support, social support, and health education. Most interventions had beneficial effects on their maternal and neonatal health outcomes of interest. Qualitative analysis revealed 4 main aspects of peer support—connectedness, emotional validation, self-efficacy, and information sharing—which helps to explain the positive effects of peer support, particularly for breastfeeding and maternal mental health. The community-based initiatives linked to PLA methodology in some ways but were lacking in promoting community mobilization since the majority were aimed at the individual or group level, as opposed to engaging whole communities.

Discussion: Community-based initiatives can be effective in HICs for improving aspects of maternal and neonatal health, particularly maternal mental health and breastfeeding. There is very limited research on more participatory community-based initiatives, such as PLA, in HICs that promote community-wide engagement and mobilization. Further research is needed in this area.

导论：虽然以社区为基础的干预措施，包括参与式学习和行动（PLA）小组，在改善孕产妇和新生儿健康结果和促进公平方面取得了重大成功，但在高收入环境中证据仍然有限。这项系统审查是与妇女和儿童优先组织（一家总部设在英国的慈善机构，致力于改善全球妇女和儿童的生活）合作进行的，探讨了目前在高收入国家为加强孕产妇和新生儿健康而采用的基于社区的举措，以及这些举措在改善孕产妇和新生儿健康结果方面的有效性。此外，本综述旨在研究社区倡议与解放军方法之间的关系。方法：这是一个混合方法的系统综述，结果的叙述综合。在MEDLINE、Embase、CINAHL和MIDIRS数据库中搜索2000年至2023年期间任何孕产妇和新生儿健康结果的社区倡议。定量和定性研究均纳入研究，并使用混合方法评估工具评估方法学质量。采用了基于结果的收敛综合方法。结果：共纳入18项研究。确定了三种主要的社区干预措施：同伴支持、社会支持和健康教育。大多数干预措施对他们感兴趣的孕产妇和新生儿健康结果有有益的影响。定性分析揭示了同伴支持的4个主要方面——联系、情感确认、自我效能和信息分享——这有助于解释同伴支持的积极影响，特别是对母乳喂养和母亲心理健康的积极影响。以社区为基础的倡议在某些方面与人民解放军的方法有关，但缺乏促进社区动员，因为大多数是针对个人或团体层面的，而不是让整个社区参与。讨论：基于社区的举措可以有效地改善高卫生保健国家的孕产妇和新生儿健康，特别是孕产妇心理健康和母乳喂养。关于在高收入国家中促进全社区参与和动员的更具参与性的社区倡议（如人民解放军）的研究非常有限。这方面需要进一步的研究。

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引用次数: 0