There is no international consensus on advanced midwifery practice in intrapartum care.
Background
Evidence suggests that advanced practice midwives improve maternal and neonatal clinical outcomes, access to care, resource efficiency and staff satisfaction. However, specific literature on advanced midwifery skills in intrapartum care is lacking.
Aim
To map advanced midwifery skills in intrapartum care.
Methods
A scoping review was conducted using electronic databases including Medline, Scopus, CINAHL, Cochrane Library, Google from inception to April 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.
Findings
A systematic search of the literature identified 6932 studies, and 17 met inclusion criteria. The advanced intrapartum skills identified relate to perineal care, instrumental vaginal birth, breech vaginal birth, perineal repair, cesarean section, emergencies procedures, intrapartum ultrasound, counseling and mediation, labour techniques, advanced clinical assessment, intangible skills, external cephalic version.
Discussion
Two main trends emerge: the skills practiced in midwifery-led units are oriented to promote and respect the physiology of childbirth and, in more under-resourced contexts, the development of midwifery follows an overlapping path with that of medical skills. The advancement of intrapartum practice involves the exercise of technological and emotional skills. The practice of counseling skills contributes to the professional development of the whole team.
Conclusion
This review suggests the need to develop advanced skills in the area of birth physiology through the promotion of organisational models such as midwifery-led units. It is important to focus on how advanced profiles can be implemented and how advancement in practice affects maternal and neonatal outcomes.
{"title":"Advanced intrapartum midwifery practice: a scoping review","authors":"Grazia Martano , Elisa Ambrosi , Stefania Poggianella , Claudia Paoli","doi":"10.1016/j.midw.2025.104687","DOIUrl":"10.1016/j.midw.2025.104687","url":null,"abstract":"<div><h3>Problem</h3><div>There is no international consensus on advanced midwifery practice in intrapartum care.</div></div><div><h3>Background</h3><div>Evidence suggests that advanced practice midwives improve maternal and neonatal clinical outcomes, access to care, resource efficiency and staff satisfaction. However, specific literature on advanced midwifery skills in intrapartum care is lacking.</div></div><div><h3>Aim</h3><div>To map advanced midwifery skills in intrapartum care.</div></div><div><h3>Methods</h3><div>A scoping review was conducted using electronic databases including Medline, Scopus, CINAHL, Cochrane Library, Google from inception to April 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.</div></div><div><h3>Findings</h3><div>A systematic search of the literature identified 6932 studies, and 17 met inclusion criteria. The advanced intrapartum skills identified relate to perineal care, instrumental vaginal birth, breech vaginal birth, perineal repair, cesarean section, emergencies procedures, intrapartum ultrasound, counseling and mediation, labour techniques, advanced clinical assessment, intangible skills, external cephalic version.</div></div><div><h3>Discussion</h3><div>Two main trends emerge: the skills practiced in midwifery-led units are oriented to promote and respect the physiology of childbirth and, in more under-resourced contexts, the development of midwifery follows an overlapping path with that of medical skills. The advancement of intrapartum practice involves the exercise of technological and emotional skills. The practice of counseling skills contributes to the professional development of the whole team.</div></div><div><h3>Conclusion</h3><div>This review suggests the need to develop advanced skills in the area of birth physiology through the promotion of organisational models such as midwifery-led units. It is important to focus on how advanced profiles can be implemented and how advancement in practice affects maternal and neonatal outcomes.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"153 ","pages":"Article 104687"},"PeriodicalIF":2.5,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733983","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}
<div><h3>Introduction</h3><div>There is a lack of studies documenting the utilisation of different views of person-centred maternity care (PCMC), such as maternal perceptions, views of health professionals, and women’s advocates, to co-create interventions to improve the quality of care (QoC) in Sri Lanka.</div></div><div><h3>Methods</h3><div>The study was conducted at a referral maternity care centre in Colombo. It involved 87 stakeholders in four phases. We conducted the study in phases to optimize logistics and feasibility. Therefore, it was conducted in a phase wise manner. Phase I: Perceptions of PCMC among 39 mothers who delivered vaginally were explored through focus group discussions (FGDs). Phase II: Delphi rounds with 25 healthcare providers were conducted to identify and prioritise interventions. Phase III: Intervention priorities were revised based on feedback from a group of 23 women’s advocacy group (WAG), using the Nominal Group Technique. Phase IV: the Nominal Group Technique was utilised to obtain the views and consensus of the women included in Phase I.</div></div><div><h3>Results</h3><div>Phase I revealed five key topics:1) care and attention; 2) companions in labour; 3) respect, dignity, privacy, and communication; 4) awareness of autonomy; and 5) general safety and cleanliness. In Phase II, ten possible interventions to improve PCMC were identified, with improving staff communication skills and empowering women on their rights being the highest priorities. In Phase III, the WAG revised the priority list, with the top priorities being improving infrastructure and the organisation of care and appointing more staff. In Phase IV, the majority (94 %) of the women agreed that the proposed prioritised interventions would improve maternal healthcare services.</div></div><div><h3>Conclusion</h3><div>This study revealed gaps in PCMC but demonstrated that in a setting like Sri Lanka, views of service users, healthcare providers, and advocacy groups can be successfully used to co-create context-specific interventions for improving QoC. We recommend further implementation research to obtain data on the feasibility, sustainability, and challenges of the identified interventions.</div></div><div><h3>What is already known on this topic</h3><div>There is limited evidence documenting the utilisation of different views in improving person-centred maternity care in LMIC.</div></div><div><h3>What this study adds</h3><div>A participatory approach involving care seekers, WAG representing the public, and healthcare providers was useful in co-creating a list of prioritised interventions to improve the quality of maternity care services in a low-resource setting.</div></div><div><h3>How this study might affect research, practice, or policy</h3><div>The findings highlight the importance of further exploration and engagement with local stakeholders, including healthcare users, providers, and advocacy groups, to co-create context-specific interventions t
{"title":"Improving person-centred maternity care in Sri Lanka through co-creation: Utilising women's perceptions and stakeholder opinions","authors":"Mohamed Rishard , Aysha Fathima Ziyad Mohamed , Ashwini De Abrew , Hemantha Senanayake , Millawage Supun Dilara Wijesinghe , Marzia Lazzerini","doi":"10.1016/j.midw.2025.104689","DOIUrl":"10.1016/j.midw.2025.104689","url":null,"abstract":"<div><h3>Introduction</h3><div>There is a lack of studies documenting the utilisation of different views of person-centred maternity care (PCMC), such as maternal perceptions, views of health professionals, and women’s advocates, to co-create interventions to improve the quality of care (QoC) in Sri Lanka.</div></div><div><h3>Methods</h3><div>The study was conducted at a referral maternity care centre in Colombo. It involved 87 stakeholders in four phases. We conducted the study in phases to optimize logistics and feasibility. Therefore, it was conducted in a phase wise manner. Phase I: Perceptions of PCMC among 39 mothers who delivered vaginally were explored through focus group discussions (FGDs). Phase II: Delphi rounds with 25 healthcare providers were conducted to identify and prioritise interventions. Phase III: Intervention priorities were revised based on feedback from a group of 23 women’s advocacy group (WAG), using the Nominal Group Technique. Phase IV: the Nominal Group Technique was utilised to obtain the views and consensus of the women included in Phase I.</div></div><div><h3>Results</h3><div>Phase I revealed five key topics:1) care and attention; 2) companions in labour; 3) respect, dignity, privacy, and communication; 4) awareness of autonomy; and 5) general safety and cleanliness. In Phase II, ten possible interventions to improve PCMC were identified, with improving staff communication skills and empowering women on their rights being the highest priorities. In Phase III, the WAG revised the priority list, with the top priorities being improving infrastructure and the organisation of care and appointing more staff. In Phase IV, the majority (94 %) of the women agreed that the proposed prioritised interventions would improve maternal healthcare services.</div></div><div><h3>Conclusion</h3><div>This study revealed gaps in PCMC but demonstrated that in a setting like Sri Lanka, views of service users, healthcare providers, and advocacy groups can be successfully used to co-create context-specific interventions for improving QoC. We recommend further implementation research to obtain data on the feasibility, sustainability, and challenges of the identified interventions.</div></div><div><h3>What is already known on this topic</h3><div>There is limited evidence documenting the utilisation of different views in improving person-centred maternity care in LMIC.</div></div><div><h3>What this study adds</h3><div>A participatory approach involving care seekers, WAG representing the public, and healthcare providers was useful in co-creating a list of prioritised interventions to improve the quality of maternity care services in a low-resource setting.</div></div><div><h3>How this study might affect research, practice, or policy</h3><div>The findings highlight the importance of further exploration and engagement with local stakeholders, including healthcare users, providers, and advocacy groups, to co-create context-specific interventions t","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"153 ","pages":"Article 104689"},"PeriodicalIF":2.5,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733985","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 : 2025-12-04DOI: 10.1016/j.midw.2025.104688
Hannah M Brennan , Christine Furber
Problem
Midwives have a pivotal role in supporting excellence in care through research. However, in the UK, very few midwives lead research. It has been estimated that <0.1 % of clinical midwives are employed in clinical academic careers, where they pursue a joint role working clinically and conducting research, and only 12 % of midwives working in academia hold a PhD.
Background
Increasing midwifery-led research and building research capacity for midwives has long been on the UK national agenda. Due to their experience, midwives can address clinically important questions and research solutions to problems that they have observed in their practice. However, midwives face many barriers to commencing and sustaining a career where they engage in midwife-led research.
Aim
This critical discussion paper aims to explore and understand the factors acting as barriers to UK midwives embarking on and maintaining a career leading research.
Discussion
This paper presents a critical discussion of the barriers for UK-based midwives to pursue research careers based on four main key points. The paper draws from UK-based reports and international contemporary literature. Four key barriers were identified from the literature: Lack of opportunities, awareness and knowledge of research among midwives; Lack of role models and mentorship; Lack of NHS and Approved Education Institution (AEI) organisational support; Lack of a clear pathway of progression.
Conclusion and recommendations
Significant barriers exist for UK midwives to engage in midwife-led research, which must be addressed to enable midwife-led research capacity to be improved and establish a workforce of leading midwifery researchers. Key recommendations have been identified to improve the accessibility of conducting midwife-led research.
{"title":"Understanding the barriers UK midwives face in leading research: A critical discussion paper","authors":"Hannah M Brennan , Christine Furber","doi":"10.1016/j.midw.2025.104688","DOIUrl":"10.1016/j.midw.2025.104688","url":null,"abstract":"<div><h3>Problem</h3><div>Midwives have a pivotal role in supporting excellence in care through research. However, in the UK, very few midwives lead research. It has been estimated that <0.1 % of clinical midwives are employed in clinical academic careers, where they pursue a joint role working clinically and conducting research, and only 12 % of midwives working in academia hold a PhD.</div></div><div><h3>Background</h3><div>Increasing midwifery-led research and building research capacity for midwives has long been on the UK national agenda. Due to their experience, midwives can address clinically important questions and research solutions to problems that they have observed in their practice. However, midwives face many barriers to commencing and sustaining a career where they engage in midwife-led research.</div></div><div><h3>Aim</h3><div>This critical discussion paper aims to explore and understand the factors acting as barriers to UK midwives embarking on and maintaining a career leading research.</div></div><div><h3>Discussion</h3><div>This paper presents a critical discussion of the barriers for UK-based midwives to pursue research careers based on four main key points. The paper draws from UK-based reports and international contemporary literature. Four key barriers were identified from the literature: Lack of opportunities, awareness and knowledge of research among midwives; Lack of role models and mentorship; Lack of NHS and Approved Education Institution (AEI) organisational support; Lack of a clear pathway of progression.</div></div><div><h3>Conclusion and recommendations</h3><div>Significant barriers exist for UK midwives to engage in midwife-led research, which must be addressed to enable midwife-led research capacity to be improved and establish a workforce of leading midwifery researchers. Key recommendations have been identified to improve the accessibility of conducting midwife-led research.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"153 ","pages":"Article 104688"},"PeriodicalIF":2.5,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733586","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 : 2025-12-02DOI: 10.1016/j.midw.2025.104685
Richard Pascal , Fatch Kalembo , Lesley Kuliukas , Alka Kothari , Garth Kendall , Rikki Priest , Mary Steen
Problem
Research about first-time fathers’ inclusion in, and engagement with, perinatal primary care is limited.
Background
Globally, fathers’ engagement with perinatal healthcare services is low. First-time fathers experience more distress, have unique support needs and are more willing to engage with perinatal healthcare than experienced fathers. Yet, primary care’s role in supporting perinatal first-time fathers has received little research attention.
Aim
To examine first-time fathers’ inclusion in, and engagement with, perinatal primary care and the feasibility of engaging them through primary care pathways.
Methods
Integrative review of international peer-reviewed and grey literature.
Findings
Thirty-three studies (16 quantitative, 13 qualitative, 4 mixed-methods) were included, comprising 3712 first-time fathers. Almost half (46 %) of the fathers in 19 suitable studies were first-time fathers. Parents’ perceived barriers to father engagement included providers being mother-focused and fathers’ mistrust of providers. Provider barriers included father absence, perceived father disinterest, workload and low managerial support. Promising strategies for engagement included provider-initiated interactions with fathers and postnatal home visits. Systemic barriers received limited attention.
Discussion
The lack of complete father-specific data in several studies hindered the review process and limited the strength of conclusions. Since first-time fathers may comprise about half of fathers in perinatal primary care, universal services risk overlooking their specific needs. While strategies like postnatal home visits show promise for father engagement, limited consensus about engagement strategies and unaddressed systemic issues may limit their effectiveness.
Conclusion
Further research exploring parents’ and providers’ views is required to guide more effective father-inclusive care. Engaging first-time fathers in primary care must go beyond practical strategies and address deeper systemic issues.
{"title":"First-time fathers’ inclusion in, and engagement with, perinatal primary care: An integrative review","authors":"Richard Pascal , Fatch Kalembo , Lesley Kuliukas , Alka Kothari , Garth Kendall , Rikki Priest , Mary Steen","doi":"10.1016/j.midw.2025.104685","DOIUrl":"10.1016/j.midw.2025.104685","url":null,"abstract":"<div><h3>Problem</h3><div>Research about first-time fathers’ inclusion in, and engagement with, perinatal primary care is limited.</div></div><div><h3>Background</h3><div>Globally, fathers’ engagement with perinatal healthcare services is low. First-time fathers experience more distress, have unique support needs and are more willing to engage with perinatal healthcare than experienced fathers. Yet, primary care’s role in supporting perinatal first-time fathers has received little research attention.</div></div><div><h3>Aim</h3><div>To examine first-time fathers’ inclusion in, and engagement with, perinatal primary care and the feasibility of engaging them through primary care pathways.</div></div><div><h3>Methods</h3><div>Integrative review of international peer-reviewed and grey literature.</div></div><div><h3>Findings</h3><div>Thirty-three studies (16 quantitative, 13 qualitative, 4 mixed-methods) were included, comprising 3712 first-time fathers. Almost half (46 %) of the fathers in 19 suitable studies were first-time fathers. Parents’ perceived barriers to father engagement included providers being mother-focused and fathers’ mistrust of providers. Provider barriers included father absence, perceived father disinterest, workload and low managerial support. Promising strategies for engagement included provider-initiated interactions with fathers and postnatal home visits. Systemic barriers received limited attention.</div></div><div><h3>Discussion</h3><div>The lack of complete father-specific data in several studies hindered the review process and limited the strength of conclusions. Since first-time fathers may comprise about half of fathers in perinatal primary care, universal services risk overlooking their specific needs. While strategies like postnatal home visits show promise for father engagement, limited consensus about engagement strategies and unaddressed systemic issues may limit their effectiveness.</div></div><div><h3>Conclusion</h3><div>Further research exploring parents’ and providers’ views is required to guide more effective father-inclusive care. Engaging first-time fathers in primary care must go beyond practical strategies and address deeper systemic issues.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"153 ","pages":"Article 104685"},"PeriodicalIF":2.5,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733984","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}
Hypertensive disorders of pregnancy (HDP) is a group of diseases that coexist with pregnancy and hypertension and it will affect the health of mothers and babies. The primary objective of this study was to identify the relevant factors for HDP and to briefly assess its impact on pregnancy outcomes.
Methods
660 pregnant women who gave birth in a hospital of Northeast China were included as the study subjects. The basic information of the pregnant woman was provided via the medical record system. Statistical analyses including logistic regression analysis and receiver operating characteristic (ROC) curves was used.
Results
The prevalence of overweight/obesity, high gestational weight gain (GWG) and diabetes was higher in HDP group (P < 0.05), whereas multiparity and uterine fibroids was lower (P < 0.05). Multifactorial analysis shown that overweight/obesity and high GWG might increase risk of HDP while multiparity and having uterine fibroids might reduce risk of HDP in pregnant women (P < 0.001). The ROC curve indicated that pre-pregnancy BMI demonstrated the highest predictive value for the occurrence of HDP. A comparison of pregnancy outcomes revealed that the caesarean section was higher in HDP group than in CON group (P < 0.001).
Conclusions
The findings of this study reaffirmed overweight/obesity and high GWG as risk factors for HDP, while multiparity and uterine fibroids might be protective. HDP was strongly associated with increased caesarean section rates.
{"title":"Risk factors and pregnancy outcomes of hypertensive disorders of pregnancy: a case-control study","authors":"Qingyan Yu , Lin Xie , Wenhui Xu , Shutong Chen , Xue Chen , Xinhong Jiang , Qi Chu , Haitao Yu","doi":"10.1016/j.midw.2025.104684","DOIUrl":"10.1016/j.midw.2025.104684","url":null,"abstract":"<div><h3>Objectives</h3><div>Hypertensive disorders of pregnancy (HDP) is a group of diseases that coexist with pregnancy and hypertension and it will affect the health of mothers and babies. The primary objective of this study was to identify the relevant factors for HDP and to briefly assess its impact on pregnancy outcomes.</div></div><div><h3>Methods</h3><div>660 pregnant women who gave birth in a hospital of Northeast China were included as the study subjects. The basic information of the pregnant woman was provided via the medical record system. Statistical analyses including logistic regression analysis and receiver operating characteristic (ROC) curves was used.</div></div><div><h3>Results</h3><div>The prevalence of overweight/obesity, high gestational weight gain (GWG) and diabetes was higher in HDP group (<em>P</em> < 0.05), whereas multiparity and uterine fibroids was lower (<em>P</em> < 0.05). Multifactorial analysis shown that overweight/obesity and high GWG might increase risk of HDP while multiparity and having uterine fibroids might reduce risk of HDP in pregnant women (<em>P</em> < 0.001). The ROC curve indicated that pre-pregnancy BMI demonstrated the highest predictive value for the occurrence of HDP. A comparison of pregnancy outcomes revealed that the caesarean section was higher in HDP group than in CON group (<em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>The findings of this study reaffirmed overweight/obesity and high GWG as risk factors for HDP, while multiparity and uterine fibroids might be protective. HDP was strongly associated with increased caesarean section rates.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"153 ","pages":"Article 104684"},"PeriodicalIF":2.5,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145622369","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 : 2025-11-24DOI: 10.1016/j.midw.2025.104683
Seham Al Khatri , Iman Al Hashmi , Omar Al Omari
Background
Primary postpartum hemorrhage (PPH) remains a major contributor to maternal morbidity and mortality globally. Despite improvements in maternal healthcare across the Middle East, the burden of PPH persists, and regional data on its predictors remain limited. This study aimed to examine the maternal and health service-related predictors of primary PPH among Middle Eastern women with vaginal delivery in Oman.
Methods
A retrospective matched case-control study was conducted among 483 postpartum women who delivered vaginally at three hospitals in Oman between May 2022 and May 2024. Cases (women with PPH, ≥500 mL blood loss) were matched 1:2 with controls based on maternal age, parity, and pregnancy type. Demographic, maternal, and health service–related factors were obtained from medical records and standardized forms in collaboration with unit head nurses.” Data were analyzed using descriptive statistics, univariate analyses, and logistic regression (p < 0.05).
Results
The prevalence of primary PPH was 10.4 %. No significant sociodemographic differences were observed between cases and controls. Logistic regression identified six significant predictors, including retained placenta (OR = 6.484), cervical tears (OR = 48.058), perineal tears (OR = 1.473), episiotomy (OR = 2.056), anticoagulant use (OR = 2.193), and mode of delivery (OR = 1.412). The highest PPH incidence occurred at the AXXX Hospital (28.58 %), which may reflect differences in service capacity and staffing.
Conclusion and Clinical Relevance
This multi-center case–control study strengthens evidence on PPH predictors in this under-researched region. Both maternal and health service-related factors were associated with increased risk of primary PPH. Emphasis on targeted postpartum assessments, preventive measures such as selective episiotomy and perineal support during delivery, and improved clinical documentation is warranted. Policy-level actions, including investments in workforce capacity and service delivery, may further reduce PPH and improve maternal outcomes in Oman and comparable contexts.
{"title":"Predictors of primary postpartum hemorrhage among middle eastern postpartum women with vaginal delivery: A retrospective matched case-control study","authors":"Seham Al Khatri , Iman Al Hashmi , Omar Al Omari","doi":"10.1016/j.midw.2025.104683","DOIUrl":"10.1016/j.midw.2025.104683","url":null,"abstract":"<div><h3>Background</h3><div>Primary postpartum hemorrhage (PPH) remains a major contributor to maternal morbidity and mortality globally. Despite improvements in maternal healthcare across the Middle East, the burden of PPH persists, and regional data on its predictors remain limited. This study aimed to examine the maternal and health service-related predictors of primary PPH among Middle Eastern women with vaginal delivery in Oman.</div></div><div><h3>Methods</h3><div>A retrospective matched case-control study was conducted among 483 postpartum women who delivered vaginally at three hospitals in Oman between May 2022 and May 2024. Cases (women with PPH, ≥500 mL blood loss) were matched 1:2 with controls based on maternal age, parity, and pregnancy type. Demographic, maternal, and health service–related factors were obtained from medical records and standardized forms in collaboration with unit head nurses.” Data were analyzed using descriptive statistics, univariate analyses, and logistic regression (<em>p</em> < 0.05).</div></div><div><h3>Results</h3><div>The prevalence of primary PPH was 10.4 %. No significant sociodemographic differences were observed between cases and controls. Logistic regression identified six significant predictors, including retained placenta (OR = 6.484), cervical tears (OR = 48.058), perineal tears (OR = 1.473), episiotomy (OR = 2.056), anticoagulant use (OR = 2.193), and mode of delivery (OR = 1.412). The highest PPH incidence occurred at the AXXX Hospital (28.58 %), which may reflect differences in service capacity and staffing.</div></div><div><h3>Conclusion and Clinical Relevance</h3><div>This multi-center case–control study strengthens evidence on PPH predictors in this under-researched region. Both maternal and health service-related factors were associated with increased risk of primary PPH. Emphasis on targeted postpartum assessments, preventive measures such as selective episiotomy and perineal support during delivery, and improved clinical documentation is warranted. Policy-level actions, including investments in workforce capacity and service delivery, may further reduce PPH and improve maternal outcomes in Oman and comparable contexts.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"153 ","pages":"Article 104683"},"PeriodicalIF":2.5,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145622370","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 : 2025-11-20DOI: 10.1016/j.midw.2025.104673
Miri Kestler-Peleg
Problem
Childbirth under prolonged cumulative stress and uncertainty conditions poses unique challenges to postpartum psychological well-being, but the underlying mechanisms remain unclear.
Background
Under such extreme conditions, the relationship between perceived childbirth risk and maternal adjustment may be mediated through internal regulatory resources like self-compassion. Personality vulnerability factors such as intolerance of uncertainty may modulate these pathways.
Aim
This study examined how perceived risk during childbirth, self-compassion, and intolerance of uncertainty interact to predict postpartum psychological well-being among women giving birth under extreme conditions.
Methods
Ninety-six women who gave birth during the first year of a security emergency while evacuated from their homes completed validated measures. A moderated mediation model was tested, controlling for maternal age, income, and objective obstetric risk at childbirth.
Findings
Higher perceived risk during childbirth was associated with lower self-compassion, which in turn predicted reduced postpartum psychological well-being. Self-compassion fully mediated the relationship between perceived risk and well-being. Critically, intolerance of uncertainty moderated this mediation pathway, as the indirect effect was significant only among women with high intolerance of uncertainty levels. Women with low or moderate intolerance of uncertainty showed no such relationships, suggesting greater resilience.
Discussion
Self-compassion emerged as a key mechanism linking childbirth appraisals to postpartum adjustment under extreme conditions, while intolerance of uncertainty functioned as a vulnerability factor determining when perceived risk translates into compromised well-being.
Conclusion
Screening for high intolerance of uncertainty during pregnancy may identify women at risk for postpartum difficulties, informing targeted interventions that strengthen self-compassion and address uncertainty intolerance.
{"title":"Childbirth under prolonged and cumulative stress: The roles of perceived risk, self-compassion, and intolerance of uncertainty in predicting postpartum psychological well-being","authors":"Miri Kestler-Peleg","doi":"10.1016/j.midw.2025.104673","DOIUrl":"10.1016/j.midw.2025.104673","url":null,"abstract":"<div><h3>Problem</h3><div>Childbirth under prolonged cumulative stress and uncertainty conditions poses unique challenges to postpartum psychological well-being, but the underlying mechanisms remain unclear.</div></div><div><h3>Background</h3><div>Under such extreme conditions, the relationship between perceived childbirth risk and maternal adjustment may be mediated through internal regulatory resources like self-compassion. Personality vulnerability factors such as intolerance of uncertainty may modulate these pathways.</div></div><div><h3>Aim</h3><div>This study examined how perceived risk during childbirth, self-compassion, and intolerance of uncertainty interact to predict postpartum psychological well-being among women giving birth under extreme conditions.</div></div><div><h3>Methods</h3><div>Ninety-six women who gave birth during the first year of a security emergency while evacuated from their homes completed validated measures. A moderated mediation model was tested, controlling for maternal age, income, and objective obstetric risk at childbirth.</div></div><div><h3>Findings</h3><div>Higher perceived risk during childbirth was associated with lower self-compassion, which in turn predicted reduced postpartum psychological well-being. Self-compassion fully mediated the relationship between perceived risk and well-being. Critically, intolerance of uncertainty moderated this mediation pathway, as the indirect effect was significant only among women with high intolerance of uncertainty levels. Women with low or moderate intolerance of uncertainty showed no such relationships, suggesting greater resilience.</div></div><div><h3>Discussion</h3><div>Self-compassion emerged as a key mechanism linking childbirth appraisals to postpartum adjustment under extreme conditions, while intolerance of uncertainty functioned as a vulnerability factor determining when perceived risk translates into compromised well-being.</div></div><div><h3>Conclusion</h3><div>Screening for high intolerance of uncertainty during pregnancy may identify women at risk for postpartum difficulties, informing targeted interventions that strengthen self-compassion and address uncertainty intolerance.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"153 ","pages":"Article 104673"},"PeriodicalIF":2.5,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145622372","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 : 2025-11-20DOI: 10.1016/j.midw.2025.104674
Emma M Swift , Ása Dóra Gylfadóttir , Ösp Jóhannsdóttir , Valgerður Lísa Sigurðardóttir , Edda Bjork Thordardottir , Arna Hauksdóttir , Gunnar Tomasson , Thor Aspelund , Unnur Anna Valdimarsdóttir , Helga Zoega
Background
Adverse childhood experiences (ACEs) have consistently been associated with adult health complications, including adverse mental and physical health during pregnancy. The aim of this study was to assess the relationship between ACEs and women's birthing experiences leveraging data from a large population-representative cohort of Icelandic women.
Methods
In this retrospective cohort study, we used data from 22,293 births among 10,759 women (8588 primipara, 13,705 multipara) in the Stress-And-Gene-Analysis (SAGA) with a record in the Icelandic Medical Birth Register. At baseline 2018–19, women responded to the ACE-International Questionnaire (ACE-IQ) and then in 2024 to questions on birth experiences in a follow-up questionnaire. Objective markers on birth complications were obtained from the Medical Birth Register. We used Poisson regression to assess the association between ACEs and a negative birth experience, calculating crude and adjusted prevalence ratios (PR) and 95 % confidence intervals (CI).
Findings
The prevalence of a negative birth experience was 22.5 % (n = 1717) and 8.5 % (1021) among primipara and multipara, respectively. Exposure to ACEs was associated with an increased prevalence of a negative birth experience in a dose-dependent manner: exposure to ≥4 ACEs was associated with a 2.1-fold higher prevalence of a negative birth experience (PR = 2.08, 95 %CI 1.81–2.40), with an elevated PR among women experiencing an uncomplicated birth, 3.62 (2.62–4.99), vs uncomplicated birth, 1.66 (1.42–1.95).
Conclusion
Women who experienced four or more ACEs had a two-fold increased prevalence of a negative birth experience compared with women with no ACEs.
Clinical implications
Women with ACEs are a vulnerable group that may benefit from screening and trauma informed antenatal care.
儿童不良经历（ace）一直与成人健康并发症相关，包括怀孕期间不良的身心健康。本研究的目的是评估ace与妇女分娩经历之间的关系，利用冰岛妇女的大型人口代表性队列数据。方法在这项回顾性队列研究中，我们使用了冰岛医学出生登记处记录的压力和基因分析（SAGA）中10,759名妇女（8588名初产妇，13,705名多产妇）的22293例分娩数据。在2018-19年的基线，女性回答了ace -国际问卷（ACE-IQ），然后在2024年回答了一份后续问卷中的生育经历问题。从医学出生登记簿中获得出生并发症的客观标记。我们使用泊松回归来评估ace和负面出生经历之间的关系，计算粗患病率和调整患病率（PR）和95%置信区间（CI）。结果初产妇和多产妇中，不良分娩经历的发生率分别为22.5%（1717）和8.5%（1021）。暴露于不良经历与不良分娩经历的发生率增加呈剂量依赖性相关：暴露于≥4次不良经历与不良分娩经历的发生率增加2.1倍相关（PR = 2.08, 95% CI 1.81-2.40），而在经历无并发症分娩的妇女中，PR升高，为3.62(2.62-4.99)，而在经历无并发症分娩的妇女中，PR升高，为1.66（1.42-1.95）。结论：经历过4次及以上不良经历的妇女分娩不良经历的发生率是无不良经历妇女的2倍。临床意义患有ace的女性是一个弱势群体，可以从筛查和创伤知情的产前护理中受益。
{"title":"Childhood adversities and negative childbirth experiences: A population-based retrospective cohort study","authors":"Emma M Swift , Ása Dóra Gylfadóttir , Ösp Jóhannsdóttir , Valgerður Lísa Sigurðardóttir , Edda Bjork Thordardottir , Arna Hauksdóttir , Gunnar Tomasson , Thor Aspelund , Unnur Anna Valdimarsdóttir , Helga Zoega","doi":"10.1016/j.midw.2025.104674","DOIUrl":"10.1016/j.midw.2025.104674","url":null,"abstract":"<div><h3>Background</h3><div>Adverse childhood experiences (ACEs) have consistently been associated with adult health complications, including adverse mental and physical health during pregnancy. The aim of this study was to assess the relationship between ACEs and women's birthing experiences leveraging data from a large population-representative cohort of Icelandic women.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we used data from 22,293 births among 10,759 women (8588 primipara, 13,705 multipara) in the Stress-And-Gene-Analysis (SAGA) with a record in the Icelandic Medical Birth Register. At baseline 2018–19, women responded to the ACE-International Questionnaire (ACE-IQ) and then in 2024 to questions on birth experiences in a follow-up questionnaire. Objective markers on birth complications were obtained from the Medical Birth Register. We used Poisson regression to assess the association between ACEs and a negative birth experience, calculating crude and adjusted prevalence ratios (PR) and 95 % confidence intervals (CI).</div></div><div><h3>Findings</h3><div>The prevalence of a negative birth experience was 22.5 % (<em>n</em> = 1717) and 8.5 % (1021) among primipara and multipara, respectively. Exposure to ACEs was associated with an increased prevalence of a negative birth experience in a dose-dependent manner: exposure to ≥4 ACEs was associated with a 2.1-fold higher prevalence of a negative birth experience (PR = 2.08, 95 %CI 1.81–2.40), with an elevated PR among women experiencing an uncomplicated birth, 3.62 (2.62–4.99), vs uncomplicated birth, 1.66 (1.42–1.95).</div></div><div><h3>Conclusion</h3><div>Women who experienced four or more ACEs had a two-fold increased prevalence of a negative birth experience compared with women with no ACEs.</div></div><div><h3>Clinical implications</h3><div>Women with ACEs are a vulnerable group that may benefit from screening and trauma informed antenatal care.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"153 ","pages":"Article 104674"},"PeriodicalIF":2.5,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145622371","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 : 2025-11-15DOI: 10.1016/j.midw.2025.104669
Shannon P. Williamson , Robyn L. Moffitt , Jaclyn Broadbent , I-Lynn Lee , Peter S. Hamblin
Objective
Gestational Diabetes Mellitus (GDM) is a prevalent high-risk pregnancy complication that can lead to negative emotional and behavioural consequences for women, and their babies. To investigate emotion regulation strategies to support women through high-risk pregnancy, the current study explored the perceived benefits and drawbacks of cultivating self-compassion during a pregnancy with GDM.
Methods
A culturally diverse (the majority of whom identified as Caucasian or Asian) sample of adult women (N = 44, Mage = 33.18), residing in Australia, who recently (within the previous two years) experienced a pregnancy with GDM were invited to complete an online survey. The survey included demographic questions, and validated scales measuring trait self-compassion and fears of self-compassion. Participants also described the perceived benefits and drawbacks of practicing self-compassion during their pregnancy. Data was analysed using flexible deductive template analysis methodology.
Results
Participants reported moderate levels of self-compassion and low fears of self-compassion, on average. Key themes regarding the perceived benefits of practicing self-compassion included enhanced emotion regulation, coping, and flow-on positive effects for the health and wellbeing of the baby. Most women (65 %) reported no perceived drawbacks of self-compassion. However, among those who did report some drawbacks, the themes centred around difficulty with knowledge, understanding, and implementation, and concerns around compassionate practices heightening emotionality or excusing unhelpful behaviours.
Conclusions
Overall, women’s impressions of the benefits of practicing self-compassion during a pregnancy with GDM outweighed the reported drawbacks. Self-compassion was, therefore, perceived to be a viable and valuable emotion regulation approach to use during high-risk pregnancy.
{"title":"Perceived benefits and drawbacks of cultivating self-compassion among women diagnosed with Gestational Diabetes Mellitus (GDM)","authors":"Shannon P. Williamson , Robyn L. Moffitt , Jaclyn Broadbent , I-Lynn Lee , Peter S. Hamblin","doi":"10.1016/j.midw.2025.104669","DOIUrl":"10.1016/j.midw.2025.104669","url":null,"abstract":"<div><h3>Objective</h3><div>Gestational Diabetes Mellitus (GDM) is a prevalent high-risk pregnancy complication that can lead to negative emotional and behavioural consequences for women, and their babies. To investigate emotion regulation strategies to support women through high-risk pregnancy, the current study explored the perceived benefits and drawbacks of cultivating self-compassion during a pregnancy with GDM.</div></div><div><h3>Methods</h3><div>A culturally diverse (the majority of whom identified as Caucasian or Asian) sample of adult women (<em>N</em> = 44, <em>M</em><sub>age</sub> = 33.18), residing in Australia, who recently (within the previous two years) experienced a pregnancy with GDM were invited to complete an online survey. The survey included demographic questions, and validated scales measuring trait self-compassion and fears of self-compassion. Participants also described the perceived benefits and drawbacks of practicing self-compassion during their pregnancy. Data was analysed using flexible deductive template analysis methodology.</div></div><div><h3>Results</h3><div>Participants reported moderate levels of self-compassion and low fears of self-compassion, on average. Key themes regarding the perceived benefits of practicing self-compassion included enhanced emotion regulation, coping, and flow-on positive effects for the health and wellbeing of the baby. Most women (65 %) reported no perceived drawbacks of self-compassion. However, among those who did report some drawbacks, the themes centred around difficulty with knowledge, understanding, and implementation, and concerns around compassionate practices heightening emotionality or excusing unhelpful behaviours.</div></div><div><h3>Conclusions</h3><div>Overall, women’s impressions of the benefits of practicing self-compassion during a pregnancy with GDM outweighed the reported drawbacks. Self-compassion was, therefore, perceived to be a viable and valuable emotion regulation approach to use during high-risk pregnancy.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"153 ","pages":"Article 104669"},"PeriodicalIF":2.5,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578470","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}
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