Appropriate weight gain reduces the risk of fetal macrosomia and large for gestational age (LGA) in women with gestational diabetes mellitus (GDM), especially in the second and third trimester. This study aims to identify the optimal weight g–ain for such women across several pre-pregnancy body mass index (BMI) categories to lower the risk of macrosomia and LGA.
Methods
This retrospective cohort study enrolled women with GDM in north Taiwan who delivered between January 2012 and July 2022. BMI cut-offs were based on Chinese-specific guidelines and used to classify the participants as underweight (<18.5 kg/m2), normal weight (18.5–24.0 kg/m2), overweight (24.0–28.0 kg/m2), or obese (>28 kg/m2). Receiver operator curve analysis was used to determine the optimum GWG cut-off ranges to predict macrosomia / LGA, and uni- and multivariate analyses were used to analyze risk factors. In addition, a multivariable model predicting macrosomia and LGA in infants was developed.
Results
A total of 963 participants was included in our analysis. Optimal mean weekly rates of GWG in the second and third trimesters were 0.43 kg/week and 0.61 kg/week, respectively, in the underweight and normal weight group, and 0.33 kg/week and 0.32 kg/week, respectively, in the overweight and obesity group.
Conclusion
The 2009 IOM guidelines, offering weight gain recommendations for pregnant women, appear to be applicable to Asian women diagnosed with GDM. This indicates that it is essential for such women to maintain an adequate total GWG throughout pregnancy. Physicians should address GWG using the IOM guidelines and trigger intervention when it is required to reduce macrosomia and LGA occurrence.
{"title":"Prediction of the ideal gestational weight gain for reducing the risk of macrosomia/large for gestational age in women with gestational diabetes mellitus in northern Taiwan","authors":"Tzu-Ling Chen , Chia-Hsun Wu , Meei-Ling Gau , Su-Fen Cheng","doi":"10.1016/j.midw.2024.104211","DOIUrl":"10.1016/j.midw.2024.104211","url":null,"abstract":"<div><h3>Background</h3><div>Appropriate weight gain reduces the risk of fetal macrosomia and large for gestational age (LGA) in women with gestational diabetes mellitus (GDM), especially in the second and third trimester. This study aims to identify the optimal weight g–ain for such women across several pre-pregnancy body mass index (BMI) categories to lower the risk of macrosomia and LGA.</div></div><div><h3>Methods</h3><div>This retrospective cohort study enrolled women with GDM in north Taiwan who delivered between January 2012 and July 2022. BMI cut-offs were based on Chinese-specific guidelines and used to classify the participants as underweight (<18.5 kg/m<sup>2</sup>), normal weight (18.5–24.0 kg/m<sup>2</sup>), overweight (24.0–28.0 kg/m<sup>2</sup>), or obese (>28 kg/m<sup>2</sup>). Receiver operator curve analysis was used to determine the optimum GWG cut-off ranges to predict macrosomia / LGA, and uni- and multivariate analyses were used to analyze risk factors. In addition, a multivariable model predicting macrosomia and LGA in infants was developed.</div></div><div><h3>Results</h3><div>A total of 963 participants was included in our analysis. Optimal mean weekly rates of GWG in the second and third trimesters were 0.43 kg/week and 0.61 kg/week, respectively, in the underweight and normal weight group, and 0.33 kg/week and 0.32 kg/week, respectively, in the overweight and obesity group.</div></div><div><h3>Conclusion</h3><div>The 2009 IOM guidelines, offering weight gain recommendations for pregnant women, appear to be applicable to Asian women diagnosed with GDM. This indicates that it is essential for such women to maintain an adequate total GWG throughout pregnancy. Physicians should address GWG using the IOM guidelines and trigger intervention when it is required to reduce macrosomia and LGA occurrence.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"140 ","pages":"Article 104211"},"PeriodicalIF":2.6,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/j.midw.2024.104209
Susanne Grylka-Baeschlin , Michael Gemperle , Ilaria Mariani , Alessia Abderhalden-Zellweger , Céline Miani , Christoph Zenzmaier , Antonia Nathalie Mueller , Stephanie Batram-Zantvoort , Martina Koenig-Bachmann , Claire De Labrusse , Maryse Arendt , Stefano Delle Vedove , Anouck Pfund , Imola Simon , Emanuelle Pessa Valente , Marzia Lazzerini , IMAgiNE Euro Study Group
Problem
Restrictions during the COVID-19 pandemic compromised maternal and newborn care.
Background
Countries in the German speaking area share several clinical care guidelines but differed significantly in the strictness of COVID-19 protective measures.
Aim
To investigate the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic in the German-speaking area and explore associations between the reorganisational changes due to COVID-19 and QMNC, as described with WHO Standards-based Quality Measures.
Methods
As part of the IMAgiNE EURO study (ClinicalTrials.gov: NCT04847336), we conducted an online survey on the QMNC in the German-speaking area, including women who gave birth in Germany, Switzerland, and Austria. Descriptive statistics, Spearman rank correlation coefficient and multivariable quantile regression were used.
Findings
Out of a total of 70,721 women accessing the online questionnaire, 1,875 were included (Germany: n = 1,053, Switzerland: n = 494, Austria: n = 328). Significant differences across countries were found in Quality Measures. In Switzerland, women scored Quality Measures more favourable than in Germany and Austria in all four sub-indexes of QMNC. In Austria, Quality Measures gaps in the sub-index ‘Experience of care’ were higher. The sub-index ‘Reorganisational changes due to COVID-19′ correlated weakly to strongly with the other sub-indexes (between r = 0.33 and r = 0.62, p < 0.001 for all correlations).
Discussion
Midwives and other health professional should pay particular attention to the provision of respectful, high-quality care.
Conclusion
To effectively improve QMNC, further research is essential to monitor the quality of care and develop targeted interventions beyond the COVID-19 pandemic addressing inherent challenges in the organisation and delivery of care.
{"title":"Women ‘s perception on the quality of maternal and newborn care during the COVID-19 pandemic in German-speaking countries: Findings from the IMAgiNE EURO project comparing data from Germany, Switzerland and Austria","authors":"Susanne Grylka-Baeschlin , Michael Gemperle , Ilaria Mariani , Alessia Abderhalden-Zellweger , Céline Miani , Christoph Zenzmaier , Antonia Nathalie Mueller , Stephanie Batram-Zantvoort , Martina Koenig-Bachmann , Claire De Labrusse , Maryse Arendt , Stefano Delle Vedove , Anouck Pfund , Imola Simon , Emanuelle Pessa Valente , Marzia Lazzerini , IMAgiNE Euro Study Group","doi":"10.1016/j.midw.2024.104209","DOIUrl":"10.1016/j.midw.2024.104209","url":null,"abstract":"<div><h3>Problem</h3><div>Restrictions during the COVID-19 pandemic compromised maternal and newborn care.</div></div><div><h3>Background</h3><div>Countries in the German speaking area share several clinical care guidelines but differed significantly in the strictness of COVID-19 protective measures.</div></div><div><h3>Aim</h3><div>To investigate the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic in the German-speaking area and explore associations between the reorganisational changes due to COVID-19 and QMNC, as described with WHO Standards-based Quality Measures.</div></div><div><h3>Methods</h3><div>As part of the IMAgiNE EURO study (ClinicalTrials.gov: NCT04847336), we conducted an online survey on the QMNC in the German-speaking area, including women who gave birth in Germany, Switzerland, and Austria. Descriptive statistics, Spearman rank correlation coefficient and multivariable quantile regression were used.</div></div><div><h3>Findings</h3><div>Out of a total of 70,721 women accessing the online questionnaire, 1,875 were included (Germany: <em>n</em> = 1,053, Switzerland: <em>n</em> = 494, Austria: <em>n</em> = 328). Significant differences across countries were found in Quality Measures. In Switzerland, women scored Quality Measures more favourable than in Germany and Austria in all four sub-indexes of QMNC. In Austria, Quality Measures gaps in the sub-index ‘Experience of care’ were higher. The sub-index ‘Reorganisational changes due to COVID-19′ correlated weakly to strongly with the other sub-indexes (between <em>r</em> = 0.33 and <em>r</em> = 0.62, <em>p</em> < 0.001 for all correlations).</div></div><div><h3>Discussion</h3><div>Midwives and other health professional should pay particular attention to the provision of respectful, high-quality care.</div></div><div><h3>Conclusion</h3><div>To effectively improve QMNC, further research is essential to monitor the quality of care and develop targeted interventions beyond the COVID-19 pandemic addressing inherent challenges in the organisation and delivery of care.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"140 ","pages":"Article 104209"},"PeriodicalIF":2.6,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/j.midw.2024.104204
Helen Janiszewski , Jane Coad , Joanne Cooper , Gordon W Moran , Debra Bick , Lisa Younge , Claire Greenaway , Elizabeth Bailey
Background
Inflammatory Bowel Disease (IBD) is a long-term condition affecting the digestive tract and is an umbrella term for two main conditions: ulcerative colitis (UC) and Crohn's Disease (CD), which can cause diarrhoea, anaemia, weight loss, rectal bleeding and abdominal pain. Approximately 500,000 people live with IBD in the UK, with half being diagnosed before the age of 35 years (Ferguson, Mahsud-Dornan, and Patterson 2008). IBD increases the risk of pregnancy complications, with symptoms being unpredictable during pregnancy.
Methods
A mixed methods study was undertaken exploring what shaped the experiences of pregnancy for women living with IBD, including an on-line survey and one-to-one interviews. Data from the interviews were analysed using Interpretative Phenomenological Analysis.
Findings
Expectations, control and care emerged as key themes which shape the experiences of pregnancy. These included expectations about pregnancy and of those providing care during pregnancy, the positive and negative impact of experienced lack of control and the effects of primary care providers during pregnancy.
Conclusion
This novel study enabled women living with IBD to share what shaped their experiences of pregnancy and recommendations about midwifery care to be made. Midwives need to be mindful of the additional risks for women and their babies, and ensure care involves multidisciplinary specialists.
{"title":"What are the experiences of pregnancy for women living with Inflammatory Bowel Disease?","authors":"Helen Janiszewski , Jane Coad , Joanne Cooper , Gordon W Moran , Debra Bick , Lisa Younge , Claire Greenaway , Elizabeth Bailey","doi":"10.1016/j.midw.2024.104204","DOIUrl":"10.1016/j.midw.2024.104204","url":null,"abstract":"<div><h3>Background</h3><div>Inflammatory Bowel Disease (IBD) is a long-term condition affecting the digestive tract and is an umbrella term for two main conditions: ulcerative colitis (UC) and Crohn's Disease (CD), which can cause diarrhoea, anaemia, weight loss, rectal bleeding and abdominal pain. Approximately 500,000 people live with IBD in the UK, with half being diagnosed before the age of 35 years (Ferguson, Mahsud-Dornan, and Patterson 2008). IBD increases the risk of pregnancy complications, with symptoms being unpredictable during pregnancy.</div></div><div><h3>Methods</h3><div>A mixed methods study was undertaken exploring what shaped the experiences of pregnancy for women living with IBD, including an on-line survey and one-to-one interviews. Data from the interviews were analysed using Interpretative Phenomenological Analysis.</div></div><div><h3>Findings</h3><div>Expectations, control and care emerged as key themes which shape the experiences of pregnancy. These included expectations about pregnancy and of those providing care during pregnancy, the positive and negative impact of experienced lack of control and the effects of primary care providers during pregnancy.</div></div><div><h3>Conclusion</h3><div>This novel study enabled women living with IBD to share what shaped their experiences of pregnancy and recommendations about midwifery care to be made. Midwives need to be mindful of the additional risks for women and their babies, and ensure care involves multidisciplinary specialists.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"140 ","pages":"Article 104204"},"PeriodicalIF":2.6,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.midw.2024.104208
Silvia Rodrigues , Paulo Silva , Margarida Esperança , Ramon Escuriet
Objectives
To determine the effect of using tailored and multifaceted strategies on the acceptability, appropriateness, feasibility and adoption of a perineal massage and warm compress intervention by midwives in a maternity ward of a tertiary hospital in Portugal.
Methods
The complex intervention in health was developed based on the Medical Research Council framework and guided by the Theory of Change. Tailored and multifaceted strategies, including dissemination, integration and implementing process strategies, were applied. A mixed-methods approach was adopted, with a combination of qualitative (semi-open interviews) and quantitative (surveys, audits and electronic health records) methods. Surveys were applied to assess the acceptability, appropriateness and feasibility of the intervention. In order to evaluate adoption of the intervention, data from interviews were introduced into NVivo Version 10 to perform thematic analysis, and each audit checklist criterion was analysed using McNemar's exact test to determine differences in paired proportion.
Results
This study found high acceptability (mean±standard deviation 4.28±0.45), high appropriateness (4.32±0.47) and high feasibility (4.26±0.43) of the intervention by midwives. Differences were reported for most topics between interviews conducted before and after implementation of the intervention. Pre-intervention, the midwives reported that the main factor affecting the application of perineal protection techniques was the lack of continuous presence of the midwife. The birth position was the alternative birth position (hands and knees, side-lying, squatting and semi-sitting), avoiding the lithotomy position. Techniques used for perineal protection were warm compresses, hands-on techniques, hands-off techniques and spontaneous pushing; and the reasons given for performing an episiotomy were large (high-birthweight) baby, Kristeller manoeuvre, tense perineum and previous obstetric sphincter injury. Post-intervention, the midwives reported that the presence of a second person increases the safety of professionals and women and improves working relations. The technique used for perineal protection was autonomy to adapt the intervention with perineal massage and warm compresses. A comfortable birth position for woman was used, and the rate of episiotomy reduced (only performed in the case of fetal distress). Regarding audits, significant differences (p < 0.05) were found for all audit criteria (pre- and post-intervention), which means that midwives adopted the intervention into their clinical practice.
Conclusion
Acceptability, appropriateness, feasibility and adoption of the intervention by midwives were high. Thus, tailored and multifaceted strategies were effective to achieve the implementation outcomes.
{"title":"Perineal massage and warm compresses–Implementation study of a complex intervention in health","authors":"Silvia Rodrigues , Paulo Silva , Margarida Esperança , Ramon Escuriet","doi":"10.1016/j.midw.2024.104208","DOIUrl":"10.1016/j.midw.2024.104208","url":null,"abstract":"<div><h3>Objectives</h3><div>To determine the effect of using tailored and multifaceted strategies on the acceptability, appropriateness, feasibility and adoption of a perineal massage and warm compress intervention by midwives in a maternity ward of a tertiary hospital in Portugal.</div></div><div><h3>Methods</h3><div>The complex intervention in health was developed based on the Medical Research Council framework and guided by the Theory of Change. Tailored and multifaceted strategies, including dissemination, integration and implementing process strategies, were applied. A mixed-methods approach was adopted, with a combination of qualitative (semi-open interviews) and quantitative (surveys, audits and electronic health records) methods. Surveys were applied to assess the acceptability, appropriateness and feasibility of the intervention. In order to evaluate adoption of the intervention, data from interviews were introduced into NVivo Version 10 to perform thematic analysis, and each audit checklist criterion was analysed using McNemar's exact test to determine differences in paired proportion.</div></div><div><h3>Results</h3><div>This study found high acceptability (mean±standard deviation 4.28±0.45), high appropriateness (4.32±0.47) and high feasibility (4.26±0.43) of the intervention by midwives. Differences were reported for most topics between interviews conducted before and after implementation of the intervention. Pre-intervention, the midwives reported that the main factor affecting the application of perineal protection techniques was the lack of continuous presence of the midwife. The birth position was the alternative birth position (hands and knees, side-lying, squatting and semi-sitting), avoiding the lithotomy position. Techniques used for perineal protection were warm compresses, hands-on techniques, hands-off techniques and spontaneous pushing; and the reasons given for performing an episiotomy were large (high-birthweight) baby, Kristeller manoeuvre, tense perineum and previous obstetric sphincter injury. Post-intervention, the midwives reported that the presence of a second person increases the safety of professionals and women and improves working relations. The technique used for perineal protection was autonomy to adapt the intervention with perineal massage and warm compresses. A comfortable birth position for woman was used, and the rate of episiotomy reduced (only performed in the case of fetal distress). Regarding audits, significant differences (<em>p</em> < 0.05) were found for all audit criteria (pre- and post-intervention), which means that midwives adopted the intervention into their clinical practice.</div></div><div><h3>Conclusion</h3><div>Acceptability, appropriateness, feasibility and adoption of the intervention by midwives were high. Thus, tailored and multifaceted strategies were effective to achieve the implementation outcomes.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"140 ","pages":"Article 104208"},"PeriodicalIF":2.6,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.midw.2024.104203
Xiaojun Liu , Lina Wang , Zhongyan Du , Qiyang Huai , Jiaqi Tian , Ling Zhang , Lijuan Yang
Background
Hypertensive disorders of pregnancy is associated with increased risk of cardiovascular disease later in life, but studies suggest that women with previous hypertensive disorders of pregnancy are not aware of this. Little is known about how these women perceive the condition and the associated long-term risks.
Objectives
This study aims to examine and synthesize qualitative evidence on the perceptions and awareness of women with hypertensive disorders of pregnancy following perceived cardiovascular disease risk.
Methods
Computer searches of Pub Med, Embase, Web of Science, Cochrane Library, CINAHL, CNKI, Wanfang database, Vip and SinoMed for all qualitative studies that met the inclusion criteria. The time frame for the search was from the establishment of the database to April 2024. Literature quality was assessed using the Australian Joanna Briggs Institute Centre for Evidence-Based Health Care Qualitative Research quality assessment criteria, and results were summarised and integrated using a pooled integration approach.
Results
Eleven studies that fulfilled the inclusion criteria and quality assessment were included in the meta synthesis. Three themes were identified during the analysis: (1)Factors affecting perceived cardiovascular risk in women with hypertensive disorders of pregnancy; (2)Women with hypertensive disorders of pregnancy use different strategies to cope with cardiovascular risk; (3)Needs and expectations for coping with cardiovascular disease risk.
Conclusions
Both women with hypertensive disorders of pregnancy and healthcare providers lack knowledge of the link between hypertensive disorders of pregnancy and cardiovascular risk. Healthcare professionals should establish a multidimensional support model, pay timely attention to postpartum women's psycho-emotional and risk awareness, and give individualised health education to promote health behaviour change. At the same time, professionals should be given standardised training and personalised follow-up services to reduce the incidence of cardiovascular disease in the future.
{"title":"The women's cardiovascular disease risk perception after hypertensive disorders of pregnancy: A qualitative meta-synthesis","authors":"Xiaojun Liu , Lina Wang , Zhongyan Du , Qiyang Huai , Jiaqi Tian , Ling Zhang , Lijuan Yang","doi":"10.1016/j.midw.2024.104203","DOIUrl":"10.1016/j.midw.2024.104203","url":null,"abstract":"<div><h3>Background</h3><div>Hypertensive disorders of pregnancy is associated with increased risk of cardiovascular disease later in life, but studies suggest that women with previous hypertensive disorders of pregnancy are not aware of this. Little is known about how these women perceive the condition and the associated long-term risks.</div></div><div><h3>Objectives</h3><div>This study aims to examine and synthesize qualitative evidence on the perceptions and awareness of women with hypertensive disorders of pregnancy following perceived cardiovascular disease risk.</div></div><div><h3>Methods</h3><div>Computer searches of Pub Med, Embase, Web of Science, Cochrane Library, CINAHL, CNKI, Wanfang database, Vip and SinoMed for all qualitative studies that met the inclusion criteria. The time frame for the search was from the establishment of the database to April 2024. Literature quality was assessed using the Australian Joanna Briggs Institute Centre for Evidence-Based Health Care Qualitative Research quality assessment criteria, and results were summarised and integrated using a pooled integration approach.</div></div><div><h3>Results</h3><div>Eleven studies that fulfilled the inclusion criteria and quality assessment were included in the meta synthesis. Three themes were identified during the analysis: (1)Factors affecting perceived cardiovascular risk in women with hypertensive disorders of pregnancy; (2)Women with hypertensive disorders of pregnancy use different strategies to cope with cardiovascular risk; (3)Needs and expectations for coping with cardiovascular disease risk.</div></div><div><h3>Conclusions</h3><div>Both women with hypertensive disorders of pregnancy and healthcare providers lack knowledge of the link between hypertensive disorders of pregnancy and cardiovascular risk. Healthcare professionals should establish a multidimensional support model, pay timely attention to postpartum women's psycho-emotional and risk awareness, and give individualised health education to promote health behaviour change. At the same time, professionals should be given standardised training and personalised follow-up services to reduce the incidence of cardiovascular disease in the future.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"140 ","pages":"Article 104203"},"PeriodicalIF":2.6,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142442377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.midw.2024.104207
Marianne Lin-Lewry , Huei-Rong Tu , Heng-Kien Au , Cai Thi Thuy Nguyen , Gabrielle T. Lee , Shu-Yu Kuo
Background
Fear of childbirth profoundly affects women's ability to cope during pregnancy and influences birth outcomes. In Taiwan, there's a lack of validated tools for assessing childbirth fear.
Objective
To evaluate the psychometric properties of the Taiwanese version of the Wijma delivery expectancy/experience questionnaire version A (WDEQ-A) in pregnant women.
Methods
We conducted a cross-sectional study with pregnant women, using the WDEQ-A and a Visual Analogue Scale to assess childbirth fear. We employed the Edinburgh Postpartum Depression Scale, State-Trait Anxiety Inventory, and Mindful Attention Awareness Scale to measure depressive symptoms, anxiety, and mindfulness, respectively. We evaluated internal consistency reliability and construct validity using exploratory factor analysis and Rasch analysis. Pearson correlations measured the association between childbirth fear and psychological variables. The receiver operating characteristic curve was used for determining the sensitivity and specificity indices.
Results
The WDEQ-A demonstrated excellent reliability (Cronbach's alpha = 0.93) and revealed a three-factor structure, including fear, lack of positive anticipation, and isolation. Rasch analysis supported the dimensionality of each of the three revised factors. The total score significantly correlated with depression (r = 0.56), anxiety (r = 0.19), and mindfulness (r = -0.40) (Ps < 0.001). The optimal cut-off for WDEQ-A was established at 55.5, with a sensitivity of 83 % and a specificity of 65 %.
Conclusions
The Taiwanese version of WDEQ-A proved to be a reliable and valid tool for assessing fear of childbirth in pregnant women, demonstrating excellent psychometric properties.
Implication for practice
These findings can assist midwives in Taiwan in identifying and promptly providing effective strategies for women experiencing a high fear of childbirth.
{"title":"Psychometric evaluation of the wijma delivery expectancy/experience questionnaire for pregnant women in Taiwan","authors":"Marianne Lin-Lewry , Huei-Rong Tu , Heng-Kien Au , Cai Thi Thuy Nguyen , Gabrielle T. Lee , Shu-Yu Kuo","doi":"10.1016/j.midw.2024.104207","DOIUrl":"10.1016/j.midw.2024.104207","url":null,"abstract":"<div><h3>Background</h3><div>Fear of childbirth profoundly affects women's ability to cope during pregnancy and influences birth outcomes. In Taiwan, there's a lack of validated tools for assessing childbirth fear.</div></div><div><h3>Objective</h3><div>To evaluate the psychometric properties of the Taiwanese version of the Wijma delivery expectancy/experience questionnaire version A (WDEQ-A) in pregnant women.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study with pregnant women, using the WDEQ-A and a Visual Analogue Scale to assess childbirth fear. We employed the Edinburgh Postpartum Depression Scale, State-Trait Anxiety Inventory, and Mindful Attention Awareness Scale to measure depressive symptoms, anxiety, and mindfulness, respectively. We evaluated internal consistency reliability and construct validity using exploratory factor analysis and Rasch analysis. Pearson correlations measured the association between childbirth fear and psychological variables. The receiver operating characteristic curve was used for determining the sensitivity and specificity indices.</div></div><div><h3>Results</h3><div>The WDEQ-A demonstrated excellent reliability (Cronbach's alpha = 0.93) and revealed a three-factor structure, including fear, lack of positive anticipation, and isolation. Rasch analysis supported the dimensionality of each of the three revised factors. The total score significantly correlated with depression (r = 0.56), anxiety (r = 0.19), and mindfulness (r = -0.40) (<em>Ps</em> < 0.001). The optimal cut-off for WDEQ-A was established at 55.5, with a sensitivity of 83 % and a specificity of 65 %.</div></div><div><h3>Conclusions</h3><div>The Taiwanese version of WDEQ-A proved to be a reliable and valid tool for assessing fear of childbirth in pregnant women, demonstrating excellent psychometric properties.</div></div><div><h3>Implication for practice</h3><div>These findings can assist midwives in Taiwan in identifying and promptly providing effective strategies for women experiencing a high fear of childbirth.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"140 ","pages":"Article 104207"},"PeriodicalIF":2.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142442376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-04DOI: 10.1016/j.midw.2024.104194
Tracer J.Q. Tioe , Shi Min Khoo , Julie S.L. Tay , Mei Qi Ang , Serena S.L. Koh , Shefaly Shorey
Problem
Little is known about mothers’ experiences and preferences for maternity services in Singapore. A more nuanced understanding would identify areas for improvement in perinatal care, reducing the burden on healthcare providers in supporting maternity services.
Background
Expecting mothers are typically referred to hospital-based antenatal and postnatal services in Singapore. In recent years, Singapore has made maternity services available in primary care community settings called polyclinics, to improve accessibility of such services.
Aim
To explore the experiences and preferences of Singaporean mothers in receiving maternity services in acute hospitals and polyclinics.
Methods
A descriptive qualitative study design was adopted, and data were collected from September to October 2023. In total, 13 mothers were recruited from a maternity care hospital in Singapore. Individual semi-structured audio-recorded interviews were conducted, and data were analysed using thematic analysis.
Findings
Three themes were identified: (1) Considerations when seeking maternity care, (2) Differing preferences and satisfaction levels, (3) Hopes for better perinatal care for mothers and babies.
Discussion
Most mothers preferred seeking hospital-based antenatal care and were more inclined to do postnatal follow-ups in polyclinics. Factors like accessibility, cost and perceived expertise of healthcare providers influenced the decision-making. Maternal satisfaction with care services also fluctuated based on interpersonal factors and whether their informational needs were met.
Conclusion
Overall, mothers’ perceptions of maternity services were positive. Findings suggest the possibility of further expanding maternity services in community settings to increase professional support for mothers. Future research is needed to ascertain these findings in non-English speaking and non-subsidized settings.
{"title":"Maternal experiences and preference of maternity services in Singapore: A descriptive qualitative study","authors":"Tracer J.Q. Tioe , Shi Min Khoo , Julie S.L. Tay , Mei Qi Ang , Serena S.L. Koh , Shefaly Shorey","doi":"10.1016/j.midw.2024.104194","DOIUrl":"10.1016/j.midw.2024.104194","url":null,"abstract":"<div><h3>Problem</h3><div>Little is known about mothers’ experiences and preferences for maternity services in Singapore. A more nuanced understanding would identify areas for improvement in perinatal care, reducing the burden on healthcare providers in supporting maternity services.</div></div><div><h3>Background</h3><div>Expecting mothers are typically referred to hospital-based antenatal and postnatal services in Singapore. In recent years, Singapore has made maternity services available in primary care community settings called polyclinics, to improve accessibility of such services.</div></div><div><h3>Aim</h3><div>To explore the experiences and preferences of Singaporean mothers in receiving maternity services in acute hospitals and polyclinics.</div></div><div><h3>Methods</h3><div>A descriptive qualitative study design was adopted, and data were collected from September to October 2023. In total, 13 mothers were recruited from a maternity care hospital in Singapore. Individual semi-structured audio-recorded interviews were conducted, and data were analysed using thematic analysis.</div></div><div><h3>Findings</h3><div>Three themes were identified: (1) Considerations when seeking maternity care, (2) Differing preferences and satisfaction levels, (3) Hopes for better perinatal care for mothers and babies.</div></div><div><h3>Discussion</h3><div>Most mothers preferred seeking hospital-based antenatal care and were more inclined to do postnatal follow-ups in polyclinics. Factors like accessibility, cost and perceived expertise of healthcare providers influenced the decision-making. Maternal satisfaction with care services also fluctuated based on interpersonal factors and whether their informational needs were met.</div></div><div><h3>Conclusion</h3><div>Overall, mothers’ perceptions of maternity services were positive. Findings suggest the possibility of further expanding maternity services in community settings to increase professional support for mothers. Future research is needed to ascertain these findings in non-English speaking and non-subsidized settings.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"140 ","pages":"Article 104194"},"PeriodicalIF":2.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-03DOI: 10.1016/j.midw.2024.104201
Simone M Ormsby, Hazel Keedle, Hannah G Dahlen
Background
Induction of labour (IOL) and birth intervention is increasingly conducted in Australia, and rates of maternal dissatisfaction and birth trauma are also on the rise.
Methods
The Birth Experience Study (BESt) national survey was conducted to explore women's experiences of birthing in Australia. This content analysis categorises components pertaining to IOL, and women's responses to the open-ended question: “Would you do anything different if you were to have another baby?”
Findings
In total, 591 responses on IOL resulted in 819 coded comments being coded into multiple categories/subcategories. In the first main category ‘increasing the chance of a spontaneous labour next time by resisting IOL’ (93.3 %), three subcategories were identified: ‘I would resist the pressure or refuse, especially if not a good indication’ (54.8 %, 419); ‘I will await spontaneous onset or delay the IOL until later’ (25.0 %, 191); and ‘I will be better informed next time’ (20.2 %, 154). In the second main category ‘accepting IOL was necessary or desirable’ (6.7 %), two subcategories were identified: ‘my IOL was justified or desired’ (38.2 %, 21) and ‘my IOL was justified or desired, but if there is a next time, I'd want more say in what happens’ (61.8 %, 34).
Conclusion
Overwhelmingly women expressed a desire to avoid IOL, along with the intention to: resist pressure, allow more time for spontaneous labour onset, and arm themselves with more knowledge to advocate against non-medically indicated justifications. Amongst the minority accepting of their previous IOLs, the majority stated wanting more say regarding when and how IOL was conducted.
{"title":"Womenʼs reflections on induction of labour and birthing interventions and what they would do differently next time: A content analysis","authors":"Simone M Ormsby, Hazel Keedle, Hannah G Dahlen","doi":"10.1016/j.midw.2024.104201","DOIUrl":"10.1016/j.midw.2024.104201","url":null,"abstract":"<div><h3>Background</h3><div>Induction of labour (IOL) and birth intervention is increasingly conducted in Australia, and rates of maternal dissatisfaction and birth trauma are also on the rise.</div></div><div><h3>Methods</h3><div>The Birth Experience Study (BESt) national survey was conducted to explore women's experiences of birthing in Australia. This content analysis categorises components pertaining to IOL, and women's responses to the open-ended question: “Would you do anything different if you were to have another baby?”</div></div><div><h3>Findings</h3><div>In total, 591 responses on IOL resulted in 819 coded comments being coded into multiple categories/subcategories. In the first main category ‘increasing the chance of a spontaneous labour next time by resisting IOL’ (93.3 %), three subcategories were identified: ‘I would resist the pressure or refuse, especially if not a good indication’ (54.8 %, 419); ‘I will await spontaneous onset or delay the IOL until later’ (25.0 %, 191); and ‘I will be better informed next time’ (20.2 %, 154). In the second main category ‘accepting IOL was necessary or desirable’ (6.7 %), two subcategories were identified: ‘my IOL was justified or desired’ (38.2 %, 21) and ‘my IOL was justified or desired, but if there is a next time, I'd want more say in what happens’ (61.8 %, 34).</div></div><div><h3>Conclusion</h3><div>Overwhelmingly women expressed a desire to avoid IOL, along with the intention to: resist pressure, allow more time for spontaneous labour onset, and arm themselves with more knowledge to advocate against non-medically indicated justifications. Amongst the minority accepting of their previous IOLs, the majority stated wanting more say regarding when and how IOL was conducted.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"140 ","pages":"Article 104201"},"PeriodicalIF":2.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-02DOI: 10.1016/j.midw.2024.104202
Nancy I. Stone , Gill Thomson , Dorothea Tegethoff
Aim
To understand and interpret the lived experience of newly qualified midwives in their first year in a free standing birth centre caring for women in early labour.
Background
Women who present in hospital labour wards in early labour are encouraged by hospital staff to go home. This leaves women to navigate early labour without professional care, leaving them on their own to manage the transition from early to active labour. However, some women request care for this transition.
Design
This is a Heideggerian hermeneutic phenomenology study.
Methods
Three unstructured interviews were conducted with 15 newly qualified midwives in their first year working in a free-standing birth centre. This paper focuses on the research participants’ lived experience offering care to women in early labour. The study was conducted from 2021-2024.
Findings
Three themes were revealed in analysis: “Paving the way into labour”: Tailoring care to women's needs in early labour; “Perhaps it was intuition.”: Experiencing deeper knowing as a newly qualified midwife; and “She locked the door and wouldn't let me in.”: Navigating uncomfortable situations in early labour.
Conclusions
The lived experience of newly qualified midwives offering care in early labour shows potential for midwives to build trusting relationships with women in this phase.
Relevance to clinical practice
Prioritizing relational care over interventions in early labor can enhance trust and confidence between midwives and birthing women, particularly in settings where policies discourage early admissions.
Issue
Women presenting in hospital labour wards in early labour who are sent home are often discouraged, feeling that their concerns and embodied experiences have not been heard.
What is already known
When labouring women are admitted to hospitals in early labour, they are prone to receive a cascade of interventions.
What this paper adds
When newly qualified midwives began working in free-standing birth centres, they acquired skills and knowledge to accompany women in early labour who requested care. Relational care in early labour builds women's trust in their ability to give birth and does not rely on interventions to augment labour.
{"title":"Tailoring midwifery care to women's needs in early labour: The cultivation of relational care in free-standing birth centres","authors":"Nancy I. Stone , Gill Thomson , Dorothea Tegethoff","doi":"10.1016/j.midw.2024.104202","DOIUrl":"10.1016/j.midw.2024.104202","url":null,"abstract":"<div><h3>Aim</h3><div>To understand and interpret the lived experience of newly qualified midwives in their first year in a free standing birth centre caring for women in early labour.</div></div><div><h3>Background</h3><div>Women who present in hospital labour wards in early labour are encouraged by hospital staff to go home. This leaves women to navigate early labour without professional care, leaving them on their own to manage the transition from early to active labour. However, some women request care for this transition.</div></div><div><h3>Design</h3><div>This is a Heideggerian hermeneutic phenomenology study.</div></div><div><h3>Methods</h3><div>Three unstructured interviews were conducted with 15 newly qualified midwives in their first year working in a free-standing birth centre. This paper focuses on the research participants’ lived experience offering care to women in early labour. The study was conducted from 2021-2024.</div></div><div><h3>Findings</h3><div>Three themes were revealed in analysis: “<em>Paving the way into labour</em>”: Tailoring care to women's needs in early labour; “<em>Perhaps it was intuition</em>.”: Experiencing deeper knowing as a newly qualified midwife; and “<em>She locked the door and wouldn't let me in</em>.”: Navigating uncomfortable situations in early labour.</div></div><div><h3>Conclusions</h3><div>The lived experience of newly qualified midwives offering care in early labour shows potential for midwives to build trusting relationships with women in this phase.</div></div><div><h3>Relevance to clinical practice</h3><div>Prioritizing relational care over interventions in early labor can enhance trust and confidence between midwives and birthing women, particularly in settings where policies discourage early admissions.</div></div><div><h3>Issue</h3><div>Women presenting in hospital labour wards in early labour who are sent home are often discouraged, feeling that their concerns and embodied experiences have not been heard.</div></div><div><h3>What is already known</h3><div>When labouring women are admitted to hospitals in early labour, they are prone to receive a cascade of interventions.</div></div><div><h3>What this paper adds</h3><div>When newly qualified midwives began working in free-standing birth centres, they acquired skills and knowledge to accompany women in early labour who requested care. Relational care in early labour builds women's trust in their ability to give birth and does not rely on interventions to augment labour.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"140 ","pages":"Article 104202"},"PeriodicalIF":2.6,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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