Midwifery最新文献

Background: High-risk pregnancies contribute disproportionately to maternal and perinatal mortality, particularly in low- and middle-income countries (LMICs). Digital health technologies (DHTs), including mobile applications and web-based platforms, have emerged as tools to enhance continuity and personalization of care. Yet, little is known about how healthcare professionals in resource-constrained settings perceive and adopt these innovations, particularly in the context of continuing care for high-risk pregnancy (HRP). This study aimed to explore healthcare professionals' perspectives on the acceptability and adoption of DHTs to support continuing care in HRP.

Methods: This qualitative descriptive approach was guided by the Technology Acceptance Model (TAM) and conducted in four tertiary hospitals in Lao PDR. In-depth, semi-structured interviews were held with 16 participants (obstetricians, nurses, and midwives). Data were analyzed using reflexive thematic analysis. Rigor was ensured through COREQ-based procedures.

Results: Four major themes emerged: (1) Perceived Usefulness-digital tools facilitated early detection, holistic monitoring, and communication; (2) Perceived Ease of Use-participants found mobile platforms familiar but cited device limitations and digital literacy gaps; (3) Attitude Toward Use-providers appreciated patient-centered benefits but expressed concern over workload; and (4) Behavioral Intention to Use-adoption was conditional on leadership endorsement, workflow alignment, and training availability.

Conclusions: Healthcare professionals viewed digital platforms as promising tools for supporting continuing care in high-risk pregnancies. However, sustained adoption will depend on addressing infrastructure barriers, institutional readiness, and professional development. These findings underscore the need for context-sensitive implementation strategies that integrate user experience with systemic support.

Problem: Infant readmissions within the first 28 days of life have risen significantly over the past decade.

Background: Postnatal care is often described as under-resourced, with many women reporting a lack of sufficient support after birth.

Objective: To explore parents' experiences in the lead-up to infant readmission within the first four weeks of life.

Methods: Twenty-eight parents of 18 infants unexpectedly admitted to a large urban paediatric referral hospital in England within four weeks of birth were interviewed face to face. Data were analysed using thematic analysis.

Findings: Parents valued being united in their role as protectors. Mothers struggling with breastfeeding often felt intense responsibility, being their baby's sole source of nutrition. When concerns arose, some parents were unsure who to contact. Seeking advice from family sometimes delayed professional help. Others felt dismissed by health professionals offering false reassurance. Many were comforted upon arriving at the hospital and receiving a diagnosis, which validated their concerns and reinforced their protective instincts.

Discussion: This study highlights parents' need to be together post-birth, their decision-making when their baby became unwell, and their interactions with health professionals during readmission.

Conclusion: Services should support shared caregiving early on by improving partner access to postnatal wards and enhancing community support for families returning home. The care pathway for unwell infants is often unclear and should be made more accessible to avoid unnecessary emergency visits. Health professionals must prioritise women's emotional wellbeing, especially during breastfeeding challenges, and respond seriously to parental concerns with clear escalation routes.

Background: Despite its serious consequences, there is still a limited body of literature on suicidal ideation during the perinatal period, particularly among women with postpartum depression.

Aim: The aim of this study was to determine the prevalence of suicidal ideation in women with postpartum depression, to identify associated risk and protective factors, and to explore moderating variables in the relationship between suicidal ideation and postpartum depression.

Methods: A cross-sectional study was conducted with 91 Spanish postpartum women, recruited via social media and midwives. All participants scored ≥ 11 on the Edinburgh Postnatal Depression Scale (EPDS) and had given birth within the past year. Suicidal ideation was assessed using item 10 of the EPDS.

Findings: 27.5 % of women with postpartum depression reported suicidal ideation. Number of children, postpartum depression and bonding difficulties with the baby were identified as explanatory factors for suicidal ideation. Furthermore, lack of emotional support from family, economic difficulties, anxiety symptoms during pregnancy and baby's irritable temperament were found to moderate the relationship between postpartum depression and suicidal ideation.

Conclusion: These findings contribute to a deeper understanding of perinatal suicidal ideation and suggest potential screening and intervention strategies aimed at preventing its onset. Identifying both risk and protective factors is crucial for midwives and mental health professionals to support maternal well-being and prevent adverse psychological outcomes.

Background: Improving pregnant women's birth preparedness to influence their choice of institutional birth is crucial for reducing pregnancy-related mortality in Tanzania. Attending antenatal care (ANC) may benefit birth preparedness, as women could learn how to prepare better for giving birth during the ANC. However, the epidemiological data is limited in Tanzania. This study aimed to investigate the association between ANC utilization and birth preparedness among Tanzanian pregnant women.

Methods: We performed a cross-sectional analysis using baseline data of 656 pregnant women who participated in an educational app intervention study from November 2021 to February 2022 in Dar es Salaam, Tanzania. High utilization of ANC was defined as ANC visits ≥ 4 and initiating ANC in the first trimester. Birth preparedness was evaluated using the 24-item Birth Preparedness Questionnaire, with a pre-defined cut-off point of the top 20 percentile to indicate a high level of birth preparedness. We used multivariable logistic regression models to examine the association between ANC utilization and birth preparedness.

Results: The mean (SD) age of participants was 27 (5) years old. The proportion of high utilization of ANC was 66.5 %, and the median (IQR) birth preparedness total score was 68 (68-70) points. Compared with women who had low ANC utilization, those who had high ANC utilization were significantly associated with an increased likelihood of a high level of birth preparedness (unadjusted OR=1.70, 95 % CI = 1.20 - 2.40). This association remained statistically significant after adjustment for potential covariates (adjusted OR=1.76, 95 % CI= 1.23 - 2.52). Subgroup analysis revealed that the association between ANC utilization and birth preparedness didn't vary by parity.

Conclusion: High utilization of ANC was associated with increased birth preparedness, independent of parity, suggesting the importance of addressing barriers to accessing ANC and promoting early and active ANC attendance for planned institutional birth with skilled birth attendants (SBAs).

Problem: Knowledge is scarce on how transfer from a freestanding midwifery-led unit to an obstetric unit during childbirth may affect women's experiences in a Norwegian context.

Background: There are six freestanding midwifery-led units in Norway, mainly situated in rural areas with long transfer distances and harsh weather conditions. International research is not directly applicable in the Norwegian context.

Aim: The aim was to explore how women experience being transferred to a higher level of care during labour or early postpartum.

Methods: Seventeen in-depth interviews of women with various transfer experiences were recorded, transcribed, and analysed using reflexive thematic analysis.

Findings: We found one overarching theme: The feeling of being seen, heard, and taken care of by caring and qualified healthcare professionals throughout the whole process. Four main themes describe the most important for women's experiences: 1) Consistency in communication prior to transfer, 2) Safety and comfort during transfer, 3) Arrival at the obstetric unit, 4) The journey home and processing the experience.

Conclusion: Effective and sensitive communication, safe transport, and competent and compassionate midwives with necessary equipment is essential for a positive transfer experience.

Background: Mistreatment during childbirth by healthcare professionals is a recognized global issue, yet evidence from formal reporting systems such as patient insurance claims in high‑income settings like Finland remains limited.

Aim: To describe mothers' experiences of mistreatment during childbirth in Finland as documented in patient insurance claims submitted to the Patient Insurance Centre.

Methods: This qualitative descriptive study analyzed 48 obstetric patient insurance claims in which mothers reported mistreatment during childbirth between 2012 and 2022. None of these claims resulted in compensation. In these claims, mothers provided self-authored narratives describing mistreatment as a contributing factor to the alleged patient injury. Data were analyzed using inductive content analysis. Background variables were summarized descriptively.

Findings: The unifying category, "Disrespectful maternity care and the violation of personhood," encompassed two forms of mistreatment identified in the claims: disrespectful and controlling staff behavior and objectification and dismissal. Most mothers reported psychological harm, while some also described physical injuries such as perineal tears and infections attributed to mistreatment.

Discussion: Mistreatment emerged as a concern within a high-performing health system, with mothers describing disrespectful maternity care that they perceived as violating their personhood. Mistreatment alone is not compensable without a legally defined patient injury. This gap highlights the need for mechanisms that better address relational and emotional harm in maternity care.

Conclusion: Mistreatment should be recognized as a quality-of-care issue, and systemic efforts, including education and organizational support, are needed to ensure respectful, supportive, and safe childbirth experiences for all mothers.