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

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。

{"title":"Community-Based Initiatives to Improve Maternal and Newborn Health in High-Income Settings: A Mixed-Methods Systematic Review","authors":"Elise Robinson RM, MPH, Aradhna Kaushal PhD, MSc, BSc, Joanna Drazdzewska MSc, BA","doi":"10.1111/jmwh.70023","DOIUrl":"10.1111/jmwh.70023","url":null,"abstract":"<p><b>Introduction</b>: 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.</p><p><b>Methods</b>: 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.</p><p><b>Results</b>: 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.</p><p><b>Discussion</b>: 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.</p>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"71 1","pages":"54-69"},"PeriodicalIF":2.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194295","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}

引用次数: 0

Women's Interest in Midwifery Continuity of Care During and After Pregnancy and Childbirth in Sweden: “As a Matter of Course” 瑞典妇女在怀孕和分娩期间和之后对助产护理的连续性的兴趣：“理所当然”。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-09-27 DOI: 10.1111/jmwh.70035

Hanna Fahlbeck PhL, RN, RM, Ingegerd Hildingsson PhD, RN, RM, Birgitta Larsson PhD, RN, RM, Margareta Johansson PhD, RN, RM

Introduction

The midwifery continuity of care model is well-established internationally, but it is rarely offered in Sweden. Pregnant women's interest in midwifery continuity of care has not been investigated in recent years. This study aimed to investigate the interest of pregnant women and new mothers in Sweden regarding midwifery continuity of care and to identify factors associated with this interest.

Methods

A national longitudinal digital questionnaire was conducted to collect background information, pregnancy-related variables, and childbirth-related variables, as well as to measure interest in midwifery continuity of care among women in Sweden. Odds ratios with 95% CIs and logistic regression analyses were used.

Results

Of 1697 women who responded, 68.1% expressed a strong interest in midwifery continuity of care during pregnancy, and 74.2% during postpartum. Fear of childbirth was associated with a higher interest in midwifery continuity of care during pregnancy (adjusted odds ratio [aOR] 1.75; 95% CI, 1.34-2.27). Women who had mixed or negative experiences with the care they received were also more likely to be interested in the model (aOR, 2.33; 95% CI, 1.43-3.97).

Discussion

Pregnant women and new mothers in Sweden show a high level of interest in midwifery continuity of care. However, current maternity services do not adequately meet these preferences, indicating a need to scale up continuity of care models, particularly for women who experience fear of childbirth and dissatisfaction with their care. Therefore, antenatal, intrapartum, and postpartum care in Sweden should be enhanced to better align with the needs and preferences of pregnant women and new mothers.

导言：助产连续性护理模式在国际上是公认的，但在瑞典很少提供。近年来，孕妇对助产护理连续性的兴趣尚未进行调查。本研究旨在调查瑞典孕妇和新妈妈对助产护理连续性的兴趣，并确定与此兴趣相关的因素。方法：通过全国纵向数字问卷收集背景信息、妊娠相关变量和分娩相关变量，并测量瑞典妇女对助产护理连续性的兴趣。采用95% ci的优势比和logistic回归分析。结果：在1697名接受调查的妇女中，68.1%的人对怀孕期间助产护理的连续性表达了强烈的兴趣，74.2%的人对产后护理表示了强烈的兴趣。对分娩的恐惧与怀孕期间助产士护理连续性的较高兴趣相关（调整后优势比[aOR] 1.75; 95% CI, 1.34-2.27）。接受过混合或负面护理的女性也更有可能对该模型感兴趣（aOR, 2.33; 95% CI, 1.43-3.97）。讨论：瑞典的孕妇和新妈妈对助产护理的连续性表现出高度的兴趣。然而，目前的产妇服务并不能充分满足这些偏好，这表明需要扩大护理模式的连续性，特别是对那些害怕分娩和对护理不满意的妇女。因此，瑞典应加强产前、产时和产后护理，以更好地满足孕妇和新妈妈的需求和偏好。

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引用次数: 0

Development, Implementation, and Evaluation of Implicit Bias Skill Building Sessions for Maternal Health Care Professionals 孕产妇保健专业人员内隐偏见技能建设课程的发展、实施和评估。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-09-27 DOI: 10.1111/jmwh.70027

Nicole Warren CNM, PhD, MPH, Briana E. Kramer CNM, MS, MPH, Cheri Wilson MA, MHS, CPHQ, Nikki Akparewa MSN, MPH, RN, Kelly M. Bower PhD, MSN, MPH

Introduction

Maternal mortality and morbidity in the United States are marked by gross disparities linked to individual bias and systems-level factors. Implicit bias training is one strategy to address these disparities, and several states now require such education. Although evidence-based strategies to mitigate bias exist, these are not commonly integrated into training opportunities in clinical settings or evaluated for their impact on learners. We designed and evaluated an implicit bias skill building training program to address this gap.

Methods

We used a quasiexperimental, multimethod evaluation to assess the outcomes of our program: reach, participant satisfaction, knowledge and acknowledgment of bias and its impacts, as well as behaviors to mitigate one's own and others’ biases. Survey and qualitative data from internal hospital facilitators provided added details about program satisfaction.

Results

People who participated in didactic implicit bias training reported being more aware of their own and others’ biases and reported using more mitigation strategies than those who did not participate in any such training. Participants in the didactic training and at least one implicit bias skill building session reported using more mitigation strategies than people who completed the didactic training alone. Participants agreed that the training was relevant and motivated them to change their behavior.

Discussion

Our results suggest there is potential value in adding skill building activities to maximize the impact of implicit bias training efforts.

在美国，孕产妇死亡率和发病率的显著差异与个人偏见和系统层面的因素有关。内隐偏见培训是解决这些差异的一种策略，现在有几个州要求进行此类教育。尽管存在以证据为基础的减轻偏见的策略，但这些策略通常没有纳入临床环境中的培训机会，也没有评估它们对学习者的影响。我们设计并评估了一个内隐偏见技能培养培训项目来解决这一差距。方法：我们使用准实验、多方法评估来评估我们项目的结果：覆盖面、参与者满意度、对偏见及其影响的认识和承认，以及减轻自己和他人偏见的行为。来自医院内部辅导员的调查和定性数据提供了更多关于项目满意度的细节。结果：参加说教式内隐偏见培训的人报告说，与没有参加任何此类培训的人相比，他们更了解自己和他人的偏见，并报告说使用了更多的缓解策略。与单独完成说教式培训的人相比，参加说教式培训和至少一次内隐偏见技能建设课程的参与者报告使用了更多的缓解策略。参与者一致认为培训是相关的，并激励他们改变自己的行为。讨论：我们的研究结果表明，增加技能建设活动，以最大限度地提高内隐偏见培训工作的影响，是有潜在价值的。

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引用次数: 0

Midwifery's Moment: Medicaid Partnerships Open Doors for Expansion and Integration 助产的时刻：医疗补助伙伴关系为扩张和整合打开了大门。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-09-25 DOI: 10.1111/jmwh.70034

Melissa D. Avery CNM, PhD, Amy M. Kohl

<p>The Centers for Medicare & Medicaid Services (CMS) has officially launched new funding to assist a group of state Medicaid agencies in improving maternal and newborn health for individuals enrolled in Medicaid and the Children's Health Insurance Program (CHIP). Announced in December 2023, proposals were submitted in Fall 2024. The Transforming Maternal Health (TMaH) Model has opportunities for midwives and freestanding birth centers right at the top of the list.<span><sup>1</sup></span></p><p>The 15 states selected to receive funding were announced in January 2025. Those selected are Alabama, Arkansas, California, District of Columbia, Illinois, Kansas, Louisiana, Maine, Minnesota, Mississippi, New Jersey, Oklahoma, South Carolina, West Virginia, and Wisconsin. The 10-year, $17,000,000 funding provided to each of these states and the District of Columbia includes a 3-year preimplementation period for states to develop their model followed by 7 years of implementation.<span><sup>1</sup></span></p><p>The overall goal of the TMaH project is to help states improve perinatal outcomes while supporting health equity to reduce maternal and newborn health disparities within the Medicaid program. The project also aims to improve access, quality, and the experience for patients while reducing costs. It is well known that the United States spends more on perinatal and newborn health care than any other developed country and yet ranks at the bottom on health outcomes. It is also well known that countries with a well-integrated and robust midwifery workforce as part of their care system demonstrate better outcomes than the United States. Experts have commented that it will take much more funding plus coordination nationally and among states to make the strides needed for meeting the full TMaH objectives.<span><sup>2</sup></span> Others have offered a formal <i>Playbook</i> to support state Medicaid agencies in working toward the TMaH goals and implementing proposed solutions.<span><sup>3</sup></span></p><p>Why should midwives be excited about this project? The TMaH program is centered around 3 pillars: (1) access, infrastructure, workforce; (2) quality improvement and safety; and (3) whole-person care delivery. The proposed solution to the lack of access to all care providers identified in pillar 1 is to increase access to midwives and freestanding birth centers. The pillars provide many opportunities for midwives in the 15 states to engage the project teams in their state Medicaid offices and take actions to remove barriers to midwifery practice and birth centers.<span><sup>1</sup></span></p><p>Midwives, birth centers, and midwifery-led care models are central to the success of the TMaH program. Midwives must promote midwifery-led care into the broader, whole-person approach to pregnancy and postpartum care. Related to pillar 1, reimbursement for all licensed midwives at the same rate as physicians for the same type of care is essential. Paying freesta

医疗保险和医疗补助服务中心（CMS）正式启动了新的资金，以帮助一组州医疗补助机构改善参加医疗补助和儿童健康保险计划（CHIP）的个人的孕产妇和新生儿健康。提案于2023年12月公布，并于2024年秋季提交。产妇保健转型（TMaH）模式为助产士和独立分娩中心提供了机会。被选中接受资助的15个州于2025年1月宣布。被选中的是阿拉巴马州、阿肯色州、加利福尼亚州、哥伦比亚特区、伊利诺伊州、堪萨斯州、路易斯安那州、缅因州、明尼苏达州、密西西比州、新泽西州、俄克拉荷马州、南卡罗来纳州、西弗吉尼亚州和威斯康星州。向这些州和哥伦比亚特区提供的10年1700万美元的资金包括3年的预实施期，供各州开发他们的模式，然后是7年的实施期。TMaH项目的总体目标是帮助各州改善围产期结果，同时支持医疗公平，以减少医疗补助计划内孕产妇和新生儿的健康差距。该项目还旨在改善患者的可及性、质量和体验，同时降低成本。众所周知，美国在围产期和新生儿保健方面的花费比任何其他发达国家都要多，但在健康结果方面却排名垫底。众所周知，在医疗体系中拥有完善和强大的助产人员队伍的国家比美国表现出更好的结果。专家们评论说，需要更多的资金以及国家间和国家间的协调，才能取得实现tma全部目标所需的进展其他人则提供了一个正式的剧本，以支持州医疗补助机构朝着TMaH的目标努力，并实施拟议的解决方案。为什么助产士应该对这个项目感到兴奋？TMaH计划围绕三个支柱展开：(1)访问、基础设施、劳动力；(2)质量改进和安全；(3)全人护理服务。针对支柱1中确定的无法获得所有护理提供者服务的问题，建议的解决办法是增加助产士和独立分娩中心的服务。这些支柱为15个州的助产士提供了许多机会，让他们在州医疗补助办公室参与项目团队，并采取行动消除助产士执业和生育中心的障碍。助产士、分娩中心和助产士主导的护理模式是TMaH项目成功的关键。助产士必须促进助产士主导的护理进入更广泛的，全人的方法，以怀孕和产后护理。与第一支柱相关的是，所有有执照的助产士必须按照与医生相同的费率报销相同类型的护理。以与医院相同的报销费率支付独立生育中心的妊娠、分娩和新生儿费用，并涵盖生育中心护理的所有方面，包括医院转院，这对于生育中心的可持续性是必要的。激励卫生系统增加助产服务是支柱2的一个重要方面，也是获得分娩友好称号的一个组成部分，这是TMaH为所有参与者制定的目标。质量指标应包括对助产士敏感的措施，如助产士接生的比例和获得24/7助产服务的机会。最后，支柱3是探索创新护理模式的保护伞，促进有助产士、护士和助产师的护理模式，如产后家庭护理服务和激励措施，以增加获得团体产前护理的机会。个性化将有助于确保为每个妇女计划和量身定制的服务和护理得以实现。最近的研究提供了与州医疗补助官员分享的证据，以支持TMaH的工作。由CMS资助的“母亲和新生儿强势起步计划”（Strong Start for Mothers and新生儿Initiative），在2013年至2017年期间，研究了3种旨在改善医疗补助和CHIP保险个人结果的护理模式。与在产科医院或团体产前护理中接受医疗补助的参保者相比，参加“强启动”增强分娩中心护理模式的参保者的早产和低出生体重率较低，剖宫产率较低，剖宫产后阴道分娩率较高。3 .婴儿出生后第一年的围产期护理费用每名母婴死亡少花费2000美元CMS发布了一份两页的研究背景和结果摘要，便于与同事和政策制定者分享。5A Strong Start对参与研究的45个生育中心接受护理的人的记录进行了二次数据分析，比较了(1)接受强化Strong Start生育中心护理的医疗补助接受者，(2)接受常规助产士领导的生育中心护理的医疗补助接受者，以及(3)接受常规生育中心护理的私人保险个人。在接受“强势起步”模式的医疗补助接受者和接受私人保险护理的人之间，孕产妇和新生儿的结局没有区别。参加医疗补助计划的孕妇接受普通分娩中心护理的结果也与参加私人保险的孕妇相似。影响生育中心发展和可持续性的障碍最近在新泽西州进行了检查。为医疗补助计划下的投保人报销的生育中心设施费用是扩大生育中心护理机会以及启动和运营成本的主要直接障碍此外，将分娩中心完全整合到围产期护理系统中的障碍包括对护理模式的不熟悉、网络整合问题、许可和医疗补助过程中的困难以及与地理位置有关的问题。助产士独立执照的好处是众所周知的。在实行自主监管的州，助产士的数量是实行限制性监管的州的两倍多，包括没有助产士的县更少更高测量的州一级助产一体化与更高的助产密度和更好的分娩结果相关。这些结果包括更高的自然阴道分娩率和母乳喂养率，以及更低的早产率、低出生体重和新生儿死亡率虽然各州的独立实践立法很重要，但州和卫生系统层面的其他政策举措似乎更直接地增加了获得助产实践的机会，更多的政策特征导致更多的助产机会。这些特征包括独立的助产士处方，助产士医院特权，以及对助产士的公平医疗补助报销。这些研究的关键证据可以帮助州医疗补助机构为他们的个人TMaH计划采取策略。助产士应与世界卫生组织（世卫组织）最近敦促采用助产护理模式的立场文件一起分享简短、简明的研究摘要世卫组织的声明提供了助产保健原则，敦促全球采纳，以提高孕产妇和新生儿保健的质量和成本效益。重要的是，TMaH州的助产士直接与州医疗补助机构接触，教育员工，帮助塑造该州的项目，使其包括助产士和助产护理理念。无论助产士是否居住在指定的TMaH状态，参与关于将所有持牌助产士纳入整个连续体的护理模式的价值和益处的重要对话至关重要。此外，在州一级与政策制定者和围产期利益攸关方就提供持证助产士的执照和监管进行对话，对于增加助产人员队伍和扩大获得孕产妇保健的机会至关重要。根据TMaH倡议，所有有兴趣扩大所有国家认证助产士（例如，CMs和认证的专业助产士）的州都可以从CMs获得技术援助，帮助他们更好地将这些提供者整合到护理团队中。在美国，助产士的利用率仍然严重不足。虽然孕产妇死亡和发病的原因是复杂和多因素的，越来越多的证据表明，助产士可以帮助显著降低孕产妇和新生儿死亡率，降低不必要的干预率，提高患者满意度，并解决卫生保健提供者短缺困扰整个美国社区。扩大能够提供全面护理的强大助产人员队伍，可以显著缓解提供者短缺问题，并解决孕产妇死亡率和发病率问题。联邦政府将在未来10年投资2.5亿美元，通过TMaH改善孕产妇和新生儿护理。助产士、助产护理和独立分娩中心的整合是拟议解决方案的关键部分。尽管解决美国围产期护理问题需要更多资金和国家协调，但15个TMaH州助产士的大力参与至关重要。与盟友、临床医生同事、政策制定者、医院管理者、消费者团体和其他对孕产妇健康有既得利益的人建立现有关系，对于扩大助产服务的足迹至关重要。15个TMaH州以外的助产士也可以使用这些策略在其所在州促进助产。通过协调一致的行动和深入的参与，助产士可以共同影响TMaH项目，并进一步消除助产实践的障碍，同时继续在美国促进以人为本、公平和具有成本效益的围产期护理。让我们创造属于我们的时刻！

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引用次数: 0

Designing a Statewide Hospital Equity Initiative: A Qualitative Formative Evaluation 设计一个全国性的医院公平倡议：定性的形成性评价。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-09-19 DOI: 10.1111/jmwh.70026

Kelly M. Bower PhD, MSN, MPH, RN, Briana E. Kramer CNM, MPH, MS, RN, Nicole Warren CNM, PhD, MPH, RN

Introduction

Implicit bias training for health professionals is widely recommended as a strategy to mitigate maternal health inequities; however, evidence to support its efficacy is limited. Furthermore, experts recommend that bias training be embedded in a program of systems-level equity interventions. Although frameworks and broad recommendations for hospitals exist, there is limited actionable guidance for operationalizing effective maternal health equity programs in hospitals. This study aimed to gather data to inform the design and implementation of a statewide offering of implicit bias training and systems-level maternal health equity-focused interventions responsive to hospital needs and preferences, and expert input.

Methods

This qualitative formative evaluation consisted of in-depth interviews with maternal health leaders from Maryland birth hospitals and experts in maternal health equity to understand current maternal health equity work, recommended strategies, barriers, and facilitators of hospital-based implicit bias training and systems-level maternal health equity initiatives.

Results

Seventeen interviews were conducted with birth hospital representatives and experts in maternal health equity. Hospital representatives reported limited prior work providing implicit bias training or implementing systems-level interventions. Participants recommended equity-focused interventions that align with existing health care improvement and maternal health equity recommendations. They also suggested implementation approaches aimed at leveraging facilitators and overcoming barriers of hospital-based settings.

Discussion

Formative work in the design of maternal health equity initiatives can offer an expanded understanding of the actual barriers and needed support for hospitals and could improve effectiveness of these interventions.

导言：广泛建议对卫生专业人员进行内隐偏见培训，作为减轻孕产妇保健不公平现象的一项战略；然而，支持其有效性的证据有限。此外，专家建议将偏见培训纳入系统级公平干预计划。虽然存在针对医院的框架和广泛建议，但在医院实施有效的孕产妇保健公平方案方面的可操作指导有限。本研究旨在收集数据，为全州范围内提供内隐偏见培训和系统级孕产妇健康公平干预措施的设计和实施提供信息，以响应医院的需求和偏好，以及专家的意见。方法：本定性形成性评估包括对马里兰州妇产医院的孕产妇健康负责人和孕产妇健康公平专家进行深入访谈，以了解当前孕产妇健康公平工作、推荐策略、障碍和基于医院的隐性偏见培训和系统级孕产妇健康公平倡议的促进因素。结果：对生育医院代表和孕产妇保健公平专家进行了17次访谈。医院代表报告了提供内隐偏见培训或实施系统级干预的有限先前工作。与会者建议采取注重公平的干预措施，与现有的改善保健和孕产妇保健公平建议保持一致。他们还提出了旨在利用促进者和克服医院环境障碍的实施办法。讨论：设计孕产妇保健公平倡议的形成性工作可以使人们更深入地了解医院的实际障碍和所需的支持，并可以提高这些干预措施的有效性。

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引用次数: 0

Raynaud's Phenomenon of the Nipple: A Case Report of Postpartum Recurrence and Treatment 乳头雷诺现象：产后复发1例及治疗。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-09-16 DOI: 10.1111/jmwh.70012

Jennifer Trebbin CNM, Tara A. Singh MD

Raynaud phenomenon is a well-known condition that is characterized by episodic vasoconstriction of the extremities leading to pain and discoloration. It is more common among women than men and often results from exposure to cold or stress. Raynaud phenomenon can also affect the nipple during breastfeeding, causing severe pain and distress for the lactating individual and newborn, leading to premature cessation of breastfeeding. Raynaud phenomenon of the nipple is often confused with other breastfeeding pain causes, which can result in treatment oversights. The etiology of Raynaud phenomenon of the nipple is complex and thought to be caused by an interplay of hormones and stress in the peripartum period. Literature on this condition is limited, mostly consisting of case reports, and there are very little data about its recurrence in subsequent peripartum periods. Treatment options are similar to those for Raynaud phenomenon and, if initiated in a timely fashion, can allow breastfeeding to continue uninterrupted. This clinical rounds article presents a case report of Raynaud phenomenon of the nipple after a first birth and a reoccurrence during a subsequent (second) postpartum period. Discussion of the pathophysiology, clinical presentation, diagnostic tips, and appropriate treatment options are included.

雷诺现象是一种众所周知的疾病，其特征是四肢间歇性血管收缩，导致疼痛和变色。它在女性中比男性更常见，通常是由于暴露在寒冷或压力下造成的。雷诺现象也会影响母乳喂养期间的乳头，对哺乳期个体和新生儿造成严重的疼痛和痛苦，导致过早停止母乳喂养。乳头雷诺现象经常与其他哺乳疼痛原因混淆，这可能导致治疗疏忽。乳头雷诺现象的病因是复杂的，被认为是由围生期激素和压力的相互作用引起的。关于这种情况的文献是有限的，主要由病例报告组成，并且很少有关于其在随后的围产期复发的数据。治疗方案与雷诺现象类似，如果及时开始，可以使母乳喂养继续不受干扰。这篇临床查房文章提出了一个病例报告雷诺现象的乳头后，第一次生产和在随后的（第二次）产后期间复发。讨论病理生理学，临床表现，诊断提示，并适当的治疗方案包括。

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