Midwifery最新文献_第5页

Effects of an mHealth intervention on maternal and infant outcomes from pregnancy to early postpartum for women with overweight or obesity: A randomized controlled trial 移动保健干预对超重或肥胖妇女从怀孕到产后早期的母婴结果的影响：随机对照试验

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-11 DOI: 10.1016/j.midw.2024.104143

Background

Women with overweight (OW) and those with obesity (OB) tend to gain excessive weight during pregnancy, often resulting in adverse outcomes. The long-term effects of mobile health (mHealth) interventions on maternal and infant outcomes remain unclear.

Aims

To examine the effects of an mHealth intervention on OW and OB from the course of their pregnancy to six months postpartum.

Methods

A randomized controlled trial was conducted in northern Taiwan. Ninety-two pregnant women with a body mass index (BMI)of ≥25 kg/m² were recruited from prenatal clinics at <17 weeks of gestation. Prepregnancy weight was baseline maternal weight, with data collected subsequently at the last assessment before childbirth and six months postpartum. The intervention group (IG) received the mHealth intervention, while the control group (CG) received standard antenatal care. The trial was registered on ClinicalTrials.gov (identifier: NCT04553731) with the initial registration date of September 16, 2020.

Findings

The IG tended to have a lower mean body weight than the CG at the last assessment before childbirth (82.23 kg vs 84.35 kg) and at six months postpartum (72.55 Kg vs 72.58 Kg). IG's newborn birth weight was significantly lower than CG's (3074.8 vs. 3313.6 g; p = 0.009). Regression analysis revealed that OB in IG had a significant reduction in weight before childbirth (β = -7.51, p = 0.005) compared to OB in CG. Compared to OW in CG, both OW in IG (β = -243.59, p = 0.027) and OB in IG (β = -324.59, p = 0.049) were associated with decreased newborn birth weight.

Conclusions

mHealth helped women with obesity to successfully manage their GWG and body weight before childbirth and newborns’ birth weight, despite this effect not persisting to reduce weight retention at six months postpartum.

背景超重（OW）妇女和肥胖（OB）妇女在怀孕期间往往体重增加过多，常常导致不良后果。移动医疗干预对母婴结果的长期影响仍不清楚。目的研究移动医疗干预对孕期至产后六个月的超重和肥胖妇女的影响。在妊娠 17 周时，从产前诊所招募了 92 名体重指数 (BMI) ≥25 kg/m2 的孕妇。孕前体重是孕妇的基准体重，随后在分娩前最后一次评估和产后六个月收集数据。干预组（IG）接受移动医疗干预，对照组（CG）接受标准产前护理。该试验已在 ClinicalTrials.gov 上注册（标识符：NCT04553731），初始注册日期为 2020 年 9 月 16 日。研究结果在产前最后一次评估（82.23 千克 vs 84.35 千克）和产后六个月评估（72.55 千克 vs 72.58 千克）时，干预组的平均体重往往低于对照组。IG 的新生儿出生体重明显低于 CG（3074.8 克 vs. 3313.6 克；P = 0.009）。回归分析显示，IG 中的产妇在分娩前的体重比 CG 中的产妇明显降低（β = -7.51，p = 0.005）。与 CG 中的 OW 相比，IG 中的 OW（β = -243.59，p = 0.027）和 IG 中的 OB（β = -324.59，p = 0.049）均与新生儿出生体重的下降有关。

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引用次数: 0

The maternal and child health record book: Time to separate? 母婴健康记录本：是时候分开了吗？

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-10 DOI: 10.1016/j.midw.2024.104134

引用次数: 0

Investigating the role of women's education status and empowerment on accessing skilled birth attendance in Bangladesh: A structural equation modelling approach 调查孟加拉国妇女的教育状况和赋权对获得熟练助产护理的作用：结构方程模型法

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-10 DOI: 10.1016/j.midw.2024.104140

Background

The objective of this study was to investigate the associations between women's education and access to skilled birth attendant (SBA) services mediated by factors of women's empowerment and sociodemographic characteristics using a path analysis through a structural equation (SEM) modelling approach.

Methods

A sample of 4946 mothers from the most recent Bangladesh Demographic and Health Survey of 2017–18 was used in the SEM analysis. Accessing SBA service at childbirth was operationalized as utilizing SBA during last childbirth. After extracting the relevant variables and cleaning the original survey data, a subsample of 4,946 women were eligible for analysis in the current study.

Results

The SEM model revealed strong evidence of direct, indirect, and mediating effects of both education and empowerment of women in accessing SBA services. Educated women have more autonomy in decision making and are less susceptible to family violence and consequently are more likely to access SBA services during childbirth ( $β$ = 0.094, p < 0.001). In addition, age at first marriage, media exposure, husband's education, healthcare accessibility, decision marking, and household wealth index mediated the relationship between education and SBA service use.

Conclusion

Bangladesh, a country that needs to improve several societal and health indices to achieve the Sustainable Development Goals, need to prioritize women's education to increase accessibility to maternal healthcare services. Health education and mass-media-driven awareness may be potential interventions for LMICs to increase SBA coverage.

研究背景本研究旨在通过结构方程（SEM）建模方法进行路径分析，调查妇女受教育程度与获得熟练助产士（SBA）服务之间的关联，这种关联由妇女赋权因素和社会人口特征介导：SEM 分析采用了 2017-18 年最新孟加拉国人口与健康调查中的 4946 位母亲样本。分娩时获得 SBA 服务被操作为在最后一次分娩时使用 SBA。在提取相关变量并清理原始调查数据后，4946 名妇女的子样本符合本研究的分析条件：SEM 模型有力地证明了教育和妇女赋权对获得 SBA 服务的直接、间接和中介效应。受过教育的妇女在决策方面有更大的自主权，不易受到家庭暴力的侵害，因此更有可能在分娩时获得 SBA 服务（β = 0.094，p < 0.001）。此外，初婚年龄、媒体接触、丈夫的教育程度、医疗保健的可及性、决策标记和家庭财富指数也是教育与使用 SBA 服务之间关系的中介因素：孟加拉国需要改善多项社会和健康指数，以实现可持续发展目标，因此需要优先考虑妇女教育，以提高孕产妇医疗保健服务的可及性。健康教育和大众传媒的宣传可能会成为低收入国家提高孕产妇保健服务覆盖率的潜在干预措施。

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引用次数: 0

Meta-synthesis of the experiences of midwives providing care during the COVID-19 pandemic 助产士在 COVID-19 大流行期间提供护理的经验元综述

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-08 DOI: 10.1016/j.midw.2024.104142

Problem

During the COVID-19 pandemic, midwives faced emotional and physical risks while on the frontlines providing care.

Background

To maintain a healthy midwifery workforce, it is necessary to understand midwives’ pandemic challenges and successes, including how they personally and professionally faced changes to care provision.

Aim

The aim of this meta-synthesis was to understand the experiences of midwives working during the COVID-19 pandemic.

Methods

Noblit and Hare's (1988) approach to synthesising qualitative research studies was followed. Fifteen qualitative research reports were identified using PRISMA guidelines, producing a sample of 588 midwives from 12 countries.

Findings

The synthesis revealed three overarching themes: (1) Turmoil and confusion: a spectrum of emotions due to ever-changing protocols, (2) COVID-19 stripped the “being with” out of midwifery care, and (3) Finding our way: midwifery resilience and growth. Analysed together, these three themes contribute to understanding the experiences of midwives working during the COVID-19 pandemic.

Discussion

Midwives experienced fear, stress, and anxiety. They felt they couldn't physically be with women during the pandemic. They were frustrated by being left out of institutional decision-making regarding COVID-19 protocols that impacted the women they served. Professional growth as a midwife, and personal resilience were ultimately realised.

Conclusions

The COVID-19 pandemic disrupted the routine ways in which midwives provide care in all settings. Understanding the complete experience of midwives during the pandemic allows for midwifery organizations to be aware of their members’ needs, as well as for institutions to ensure supports are in place for midwives in the event of future pandemics.

问题在 COVID-19 大流行期间，助产士在第一线提供护理服务时面临着情感和身体风险。背景为了保持一支健康的助产士队伍，有必要了解助产士在大流行期间所面临的挑战和取得的成功，包括她们如何从个人和专业角度面对护理服务的变化。方法采用 Noblit 和 Hare（1988 年）的定性研究综述方法。综述揭示了三个重要主题：(1) 动荡与困惑：因协议不断变化而产生的各种情绪；(2) COVID-19 使助产护理中的 "陪伴 "消失了；(3) 找到我们的方向：助产士的复原力与成长。综合分析这三个主题，有助于理解助产士在 COVID-19 大流行期间的工作经历。助产士们经历了恐惧、压力和焦虑。她们感到在大流行期间无法亲身陪伴妇女。她们感到沮丧的是，在影响她们所服务的妇女的 COVID-19 协议方面，她们被排除在机构决策之外。结论 COVID-19 大流行扰乱了助产士在所有环境中提供护理的常规方式。了解助产士在大流行期间的全部经历有助于助产士组织了解其成员的需求，也有助于机构确保在未来发生大流行时为助产士提供支持。

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引用次数: 0

Maternal birthplace and experiences of perinatal healthcare in Belgium: Evidence from a cross-sectional survey 比利时产妇的出生地和围产期保健经历：横断面调查证据

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-08 DOI: 10.1016/j.midw.2024.104139

Background

Patient experience is an important part of perinatal care quality. Migrant women in high-income countries often report more negative experiences than non-migrants, but evidence in Europe is patchy. In this study, we compared the experiences of two migrant populations with non-migrants, taking into account socioeconomic characteristics.

Methods

We surveyed mothers born in Belgium, North-Africa, and Sub-Saharan Africa (n = 877) using an adapted version of the Migrant-Friendly Maternity Care Questionnaire. Two patient experience scores were created using multiple correspondence analyses: a) information and communication with healthcare professionals and overall satisfaction with pregnancy care, and b) patient-centred aspects and satisfaction with delivery care. Through descriptive analyses and multivariable logistic regressions we estimated the associations of maternal characteristics with each score.

Results

Overall, positive experiences were reported in terms of communication (83 %) and patient-centred care (86 %). North African immigrants with low language proficiency had higher odds of negative communication experience (especially problems understanding information) (ORa: 2.30, 95 %CI 1.17–4.50), regardless of socioeconomic position. Among women with language barriers, 88 % were never offered a professional interpreter, relying on family members for translation. Patient-centred care was not associated with maternal birth region but was rated more negatively by older mothers, those with longer residence in Belgium, and higher majority-language proficiency.

Conclusion

In Belgium, perinatal care experiences were generally positive, although communication with immigrants was suboptimal. Language barriers, single motherhood, and unstable housing increased communication issues. Our findings underline the necessity to improve information-exchange with immigrants and socioeconomically vulnerable women.

背景患者体验是围产期护理质量的重要组成部分。高收入国家的移民妇女通常会比非移民妇女报告更多的负面经历，但欧洲的证据并不充分。在这项研究中，我们比较了两个移民群体与非移民群体的经历，并考虑了社会经济特征。方法我们使用改编版的移民友好孕产妇护理问卷调查了在比利时、北非和撒哈拉以南非洲出生的母亲（n = 877）。通过多重对应分析得出了两个患者体验评分：a）与医护人员的信息和沟通以及对孕期护理的总体满意度；b）以患者为中心的方面以及对分娩护理的满意度。通过描述性分析和多变量逻辑回归，我们估算了孕产妇特征与每项评分之间的关联。结果总体而言，孕产妇在沟通（83%）和以患者为中心的护理（86%）方面都有积极的体验。无论社会经济地位如何，语言能力较低的北非移民有较高的负面沟通经历（尤其是理解信息方面的问题）（ORa：2.30，95 %CI 1.17-4.50）。在有语言障碍的妇女中，88%的人从未获得过专业翻译服务，只能依靠家人翻译。以病人为中心的护理与产妇的出生地无关，但年龄较大、在比利时居住时间较长、多数民族语言水平较高的产妇对以病人为中心的护理的评价较低。语言障碍、单亲母亲和住房不稳定增加了沟通问题。我们的研究结果表明，有必要改善与移民和社会经济弱势妇女的信息交流。

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引用次数: 0

A qualitative study of postpartum practices and social support of Chinese mothers following childbirth in Switzerland 关于中国母亲在瑞士产后的做法和社会支持的定性研究。

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-08 DOI: 10.1016/j.midw.2024.104137

Background

Asian migrants follow many traditional postpartum beliefs and practices after childbirth to protect both mother and child. Chinese mothers are often expected to stay at home for 4-6 weeks while observing certain restrictions known as postpartum confinement, or “Zuo Yue Zi.”

Aim

To explore how Chinese mothers followed postpartum practices and the social support they needed while in Switzerland.

Methods

Twenty-seven Chinese mothers and their families were interviewed at an average of six months postpartum. Thematic analysis was performed on the data.

Results

Chinese mothers in Switzerland continued following postpartum practices, including home confinement, cold avoidance, a minimum involvement in household chores, and hot dietary consumption. Meanwhile, they modified and abandoned certain restrictions, such as avoiding prolonged bed rest or excessive high-protein diets and preserving personal hygiene. Family members were their primary supporters, while mothers from “cross-cultural” families faced difficulties obtaining substantial support from their foreign partners or in-laws. Social support from independent midwives (sage femmes), privately paid helpers (yue sao), and Chinese migrant communities was important during this transitional period.

Conclusion

The conventional concept of “confinement” has evolved into a more supportive approach that prioritises physical and psychological comfort. It plays a crucial role in postpartum recovery and serves as a connection with cultural identity and an opportunity for family reunions for Chinese women living abroad. There is a need for Western maternity caregivers to understand and recognise the postpartum traditions of Asian migrants and to provide them with culturally sensitive care and professional support.

背景：亚洲移民在分娩后会遵循许多传统的产后信仰和习俗，以保护母亲和孩子。目的：探讨中国母亲在瑞士如何遵循产后习俗以及她们所需的社会支持：对 27 位中国母亲及其家人进行了访谈，访谈时间平均为产后 6 个月。对数据进行了主题分析：结果：在瑞士的中国母亲在产后仍然坚持在家待产、避免受凉、尽量少做家务和吃热食等做法。同时，她们改变或放弃了某些限制，如避免长期卧床休息或过量高蛋白饮食，以及保持个人卫生。家庭成员是她们的主要支持者，而来自 "跨文化 "家庭的母亲则很难从她们的外国伴侣或姻亲那里获得实质性的支持。在这一过渡时期，来自独立助产士（贤妇）、私人付费帮工（月嫂）和中国移民社区的社会支持非常重要：传统的 "产褥期 "概念已演变为一种更注重身心舒适的支持性方法。它在产后恢复中起着至关重要的作用，是与文化身份的联系，也是旅居海外的中国妇女与家人团聚的机会。西方孕产妇护理人员需要理解和认识亚洲移民的产后传统，并为她们提供具有文化敏感性的护理和专业支持。

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引用次数: 0

How to promote midwives' recognition and professional autonomy? A document analysis study 如何促进助产士的认可和专业自主？文件分析研究

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-08 DOI: 10.1016/j.midw.2024.104138

Objective

To identify challenges associated with midwives' professional autonomy in Belgium and develop recommendations to promote midwives’ recognition and professional autonomy.

Design

Through a document analysis study we identified challenges, categorized them into themes and linked them with Greenwood's sociological criteria for a profession. This involved an in-depth synthesis of findings from our published studies to comprehensively examine the challenges to optimizing midwifery autonomy and to develop corresponding recommendations.

Findings

We identified challenges related to midwife-led continuity care models, regulation of the midwifery profession, collaboration with stakeholders, professional esteem and professional culture. Based on them, our recommendations include prioritizing midwife-led continuity of care, fostering collaboration, tailoring continuous professional development, increasing public awareness and advocating for policy changes. The attribute of a profession which is lacking the most in midwifery in Belgium is recognized authority, which may result in midwives being undervalued, underutilized and underpaid.

Key conclusions

In this paper we identified challenges in Belgian midwives' recognition and professional autonomy and provided recommendations to address them, emphasizing the importance of recognized authority in midwifery. Implementing these recommendations can positively impact midwives' recognition and autonomy in Belgium and potentially in other countries.

Implications for practice

It is essential for policy makers to address the issue of the lack of recognized authority in midwifery, as it plays a critical role in facilitating decision-making, policy development, and the professionalization of the field. Implementing the outlined recommendations can drive positive changes in midwifery recognition and autonomy in Belgium and beyond.

设计通过文件分析研究，我们确定了挑战，将其归类为主题，并将其与格林伍德的职业社会学标准联系起来。研究结果我们确定了与助产士主导的连续性护理模式、助产士职业的监管、与利益相关者的合作、职业尊严和职业文化相关的挑战。在此基础上，我们提出的建议包括优先考虑助产士主导的持续护理、促进合作、调整持续专业发展、提高公众意识和倡导政策变革。在比利时，助产士最缺乏的职业属性是公认的权威，这可能会导致助产士的价值被低估、利用不足和薪酬过低。对实践的启示政策制定者必须解决助产士缺乏公认权威的问题，因为它在促进决策、政策制定和该领域的专业化方面发挥着至关重要的作用。实施概述的建议可推动比利时及其他国家在助产士认可和自主权方面发生积极变化。

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引用次数: 0

Multilevel modelling of the determinants of low birth weight in frontier, outermost and underdeveloped regions: Evidence from the Indonesian National Socioeconomic Survey (2019–2021) 前沿、最外围和欠发达地区出生体重不足决定因素的多层次建模：印度尼西亚全国社会经济调查（2019-2021年）的证据。

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-06 DOI: 10.1016/j.midw.2024.104136

Background

The prevalence of low-birthweight infants is increasing in Indonesia. A low birth weight can have a negative effect on a child's development. Understanding the factors influencing low birth weight may enable preventative actions.

Aim

To analyse the determinant factors of low-birthweight infants in frontier, outermost and underdeveloped regions in Indonesia.

Methods

A cross-sectional study was conducted using a secondary dataset from the Indonesian National Socioeconomic Survey, 2019–2021. The sample included 27,678 inhabitants aged 16–64 years. The Indonesian regions of Nusa Tenggara Timur, Nusa Tenggara Barat, Sulawesi Tengah, Sulawesi Tenggara, Gorontalo, Maluku, Maluku Utara, Papua and Papua Barat were included. A multilevel logistic regression was conducted to determine the relationship between variables. p < 0.05 was considered to indicate significance in the fixed-effects model findings.

Findings

Women who lived in a rural area [OR 1.176, 95 % confidence interval (CI) 0.088–0.235] and had never used contraception (OR 1.227, 95 % CI 0.096–0.313) were more likely to have low-birthweight infants. In contrast, water resources, social assistance/welfare, maternal age and gross domestic product per capita had no significant effect on the prevalence of low-birthweight infants.

Discussion and conclusion

Living in a rural area and lifetime non-use of contraception were found to be significant risk factors for low birth weight in frontier, outermost and underdeveloped regions in Indonesia. Increasing health facilities in rural areas and establishing programmes on the use of contraception may be positive strategies to reduce the prevalence of low-birthweight infants.

背景在印度尼西亚，低出生体重儿的发病率正在上升。低出生体重会对儿童的发育产生负面影响。目的：分析印尼前沿、最外围和欠发达地区低出生体重儿的决定因素：利用2019-2021年印度尼西亚全国社会经济调查的二级数据集进行了一项横断面研究。样本包括 27678 名 16-64 岁的居民。印度尼西亚的努沙登加拉省、努沙登加拉巴拉特省、苏拉威西腾格里省、苏拉威西腾格里省、戈龙塔罗省、马鲁古省、马鲁古乌塔拉省、巴布亚省和巴布亚巴拉特省均被纳入研究范围。为确定变量之间的关系，进行了多层次逻辑回归。在固定效应模型的研究结果中，P < 0.05 为显著性：居住在农村地区（OR 1.176，95 % 置信区间 (CI)：0.088-0.235）和从未采取避孕措施（OR 1.227，95 % 置信区间 (CI)：0.096-0.313）的妇女更有可能生育低体重儿。相比之下，水资源、社会援助/福利、产妇年龄和人均国内生产总值对低体重儿的发生率没有显著影响：在印度尼西亚的边境地区、最外围地区和欠发达地区，生活在农村地区和终生不使用避孕药具是导致低出生体重儿的重要风险因素。在农村地区增加医疗设施和制定避孕计划可能是降低低出生体重儿发生率的积极策略。

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引用次数: 0

Experiences of workplace conflicts by midwives and implications for their wellbeing in selected hospitals in the Northern Region of Ghana 加纳北部地区部分医院助产士的工作场所冲突经历及其对助产士福祉的影响。

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-04 DOI: 10.1016/j.midw.2024.104133

Aim

Conflicts are ubiquitous in human societies and manifest in varied forms and scales within societies, communities and organisations. While many studies have investigated workplace conflicts, least attention has been paid to how midwives differently experience these conflicts and the impacts of these conflicts on their wellbeing. This study fills this gap by investigating the multifaceted impact of workplace conflicts on the wellbeing of midwives.

Method

The study employed a purely qualitative approach within the analytical framework of the Stress Theory of organisational conflicts. Thirty-five participants were selected for the study through an expert purposive sampling technique. Interviews and Focus Group Discussions were used to collect primary data for the study. Collected data were analysed using an inductive thematic analytical technique.

Results

The findings highlight the multifaceted impact of conflict on both the professional and personal well-being of midwives. Conflicts induce severe physical and psychological strains on midwives, generate fears, angst, and anxieties, and disrupt social harmony prompting exclusion and discrimination among midwives in the hospital.

Conclusion

We argue that apart from task-demand generated stress, workplace conflicts prompt both physical and psychological stress on midwives which culminate into a myriad of physical, emotional, and mental health issues.

Implication for Practice

Initiation of conflict resolution and mediation training programs for midwives so as to equip them with essential skills for effectively managing and resolving workplace conflicts. Setting up internal grievance mechanisms for midwives in their work places and training of midwives on social skills, and stress management skills.

目的：冲突在人类社会中无处不在，并在社会、社区和组织中以不同的形式和规模表现出来。虽然许多研究都对工作场所的冲突进行了调查，但对助产士如何以不同的方式体验这些冲突以及这些冲突对其福祉的影响却关注得最少。本研究通过调查工作场所冲突对助产士福祉的多方面影响，填补了这一空白：本研究在组织冲突压力理论的分析框架内采用了纯粹的定性方法。通过专家目的性抽样技术挑选了 35 名参与者参与研究。研究采用访谈和焦点小组讨论的方式收集原始数据。采用归纳式专题分析技术对收集到的数据进行了分析：研究结果凸显了冲突对助产士职业和个人福祉的多方面影响。冲突给助产士造成了严重的生理和心理压力，产生了恐惧、焦虑和不安，破坏了社会和谐，导致医院中的助产士受到排斥和歧视：我们认为，除了因工作需要而产生的压力外，工作场所的冲突也会给助产士带来生理和心理上的压力，最终导致一系列生理、情感和心理健康问题：为助产士启动冲突解决和调解培训计划，使她们掌握有效管理和解决工作场所冲突的基本技能。在工作场所为助产士建立内部申诉机制，对助产士进行社交技能和压力管理技能培训。

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引用次数: 0

A response to the UK all party parliamentary group (APPG) report on birth trauma 对英国各党派议会小组（APPG）关于出生创伤报告的回应。

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-03 DOI: 10.1016/j.midw.2024.104131

引用次数: 0