Midwifery最新文献

Background

Poor mental health in health students is a major public health issue, impacting personal quality of life and functioning, curriculum and care quality to patients.

Problem

Few studies to date have examined mental health in midwifery students.

Aim

To evaluate the midwifery students'mental health.

Methods

An online cross-sectional survey was performed between 02/11/2023 and 11/12/2023. Anonymous questionnaires were sent to midwife students via academic emails by all midwife faculties in France. We assessed the prevalence of current depressive symptoms, current generalised anxiety symptoms, burnout for students in internship, 12-month major depressive disorder and 12-month suicidal ideation, humiliation, sexual harassment, and sexual aggression during their curriculum with specific questions. Multivariate logistic regression was performed to identify the main factors associated with major depressive disorder and suicidal ideation.

Findings

Among midwifery students, 1920 (response rate: 51.9 %) were included. The prevalences of current depressive symptoms, anxiety symptoms, burnout, 12-month major depressive disorder, and 12-month suicidal ideation were 62 %, 47 %, 44 %, 13 % and 14 %, respectively. Humiliation, sexual harassment and sexual aggression were reported by 19 %, 1.8 % and 0.7 %, respectively. In multivariable analyses, having important financial difficulties and sexual violence were associated with higher rates of major depressive episodes and suicidal ideation.

Discussion

>1 in 10 students suffered from 12-month depression and/or suicidal ideation, and almost half of them expressed various distressing symptoms.

Conclusion

These alarming results highlighted the need for interventions to improve mental health in midwifery students, including safer conditions of education and living.

Problem

There is a limited knowledge base available to midwives, obstetricians and women planning vaginal birth after caesarean (VBAC), impeding their ability to make informed choices regarding planned place of birth.

Background

A VBAC is associated with fewer complications for both mother and baby, but little is known on the safety and success of planning a VBAC in midwifery led settings such as birth centres and home birth, compared to obstetric led settings.

Aim

To synthesise the findings of published studies regarding maternal and neonatal outcomes with planned VBAC in midwifery setting compared to obstetric units.

Methods

PubMed, EMBASE, CINAHL complete, Maternity and Infant Care, PsycINFO, and Science Citation Index databases were systematically searched on 16/08/2022 for all quantitative research on the outcomes for women planning VBAC in midwifery led settings compared to obstetric led settings in high income countries. Included studies were quality assessed using the CASP Checklist. Binary outcomes are incorporated into pairwise meta-analyses, effect sizes reported as risk ratios with 95 % confidence intervals. A τ² estimate of between-study variance was performed for each binary outcome analysis. Other, more heterogeneous outcomes are narratively reported.

Findings

Two high-quality studies, out of 420 articles, were included. VBAC planned in a midwifery-led setting was associated with a statistically significant increase in unassisted vaginal birth (RR=1.42 95 % CI 1.37 to 1.48) and decrease in emergency caesarean section (RR= 0.46 95 % CI 0.39 to 0.56) and instrumental birth (RR= 0.33 95 % CI 0.23 to 0.47) compared with planned VBAC in an obstetric setting. There were no significant differences in uterine rupture (RR= 1.03 95 % CI 0.52 to 2.07), admission to special care nursery (RR= 0.71 95 % CI 0.47 to 1.23) or Apgar score of 7 or less at 5 min (RR= 1.16 95 % CI 0.66 to 2.03).

Conclusion

Planning VBAC in midwifery led settings is associated with increased vaginal birth and a reduction in interventions such as instrumental birth and caesarean section. Adverse perinatal outcomes are rare, and further research is required to draw conclusions on these risks.

Background

Providing smoking cessation care has not successfully prevented women who quit smoking during pregnancy from relapsing due to multi-level barriers.

Aim

This paper explores systemic barriers to providing smoking cessation care, focusing on relapse prevention among pregnant and postpartum Aboriginal and Torres Strait Islander women (hereafter Aboriginal).

Methods

Twenty-six interviews were conducted between October 2020 and July 2021 with health professionals, health promotion workers and managers working in Aboriginal smoking cessation across six Australian states and territories. Data were thematically analysed.

Findings

Themes emerging from the data included: (a) limited time, competing priorities and shortage of health professionals; (b) a need for more knowledge and skills for health professionals; (c) influences of funding allocations and models of smoking cessation care; (d) lack of relevance of anti-tobacco messages to pregnancy and postpartum relapse; and (e) ways forward. Several barriers emerged from policies influencing access to resources and approaches to smoking cessation care for Aboriginal women. Individual-level maternal smoking cessation care provision was often under-resourced and time-constrained to adequately meet Aboriginal women's needs. Identified needs for health professionals included more time, knowledge and skills, better cultural awareness for non-Indigenous health professionals, and salient anti-tobacco messages for pregnant women related to long-term cessation.

Conclusion

To drive smoking cessation in pregnant and postpartum Aboriginal women, we recommend adequately reimbursing midwives and Aboriginal Health Workers/Professionals to allow them to provide intensive support, build confidence in Quitline, continue health professionals’ capacity-building and allocate consistent funding to initiatives that have been efficacious with Aboriginal women.

Background

The number of people living in a different place from their place of birth is increasing year by year. Although women have always been involved in migratory movements, today they are increasingly doing so independently. Women are migrating from the Global South to higher-income countries. One of the challenges they face is access to sexual and reproductive health (SRH) services.

Aim

To identify the policy-level barriers that limit the access of migrant women to SRH services, their consequences, and strategies implemented to overcome these barriers.

Methods

A systematic review of the literature was undertaken in accordance with the PRISMA statement. A search was undertaken for articles published between 2018 and 2023 focusing on migrant women's experiences of SRH services. In total, 462 articles were retrieved from PubMed (n = 135), Scopus (n = 94) and Web of Science (n = 233); of these, 28 articles were included in this review.

Findings

The most common barrier to SRH services identified in the reviewed articles was lack of information (57 %), followed by language issues (43 %), cultural differences (39 %), economic status (25 %), administrative barriers (25 %) and discrimination (14 %). These barriers led to under-utilisation of maternity services and contraceptive methods. Strategies used by migrant women to overcome these barriers were primarily based on seeking help within their own community or family settings.

Conclusion

Strategies at institutional level to improve the access of migrant women to SRH services need to reduce existing barriers, promote health literacy, and train health workers to be culturally sensitive and responsive to the needs of migrant women.

Background: Diet during pregnancy is a key factor in the success of pregnancy. However, several studies have found pregnant women have low adherence to dietary recommendations. The midwife is a key health professional to provide nutrition education for pregnant women. Thus, it is important to know in detail her role in this respect. Aim: To explore how Spanish midwives undertake nutrition education in order to assess the need for specific interventions aimed at improving the health of pregnant women. Methods: A cross-sectional descriptive observational study was undertaken using an online questionnaire (466 responses). Findings: Spanish midwives recognise the importance of nutrition in pregnancy and that advising pregnant women in this regard is part of their role. In fact, all community midwives discuss nutrition to pregnant women, although they recognise that they do not feel particularly comfortable in dealing with certain topics, which could be related to a lack of mastery of the subjects. Midwives (56.5 %) rated the nutrition training their received as poor. Conclusion: In order to guarantee the quality in the nutrition education provided by Spanish midwives to promote the health of pregnant women, our results demonstrate the importance of strengthening both the nutrition content of midwives' training programmes and the ongoing support they receive throughout their professional life.

Problem

Globally medical management of labour and birth has significantly increased, with epidurals attributed to the cascade of interventions.

Background

There are few randomised control trials that evaluate the effectiveness of antenatal education programs. A previous trial at two Australian hospitals found an antenatal program of integrative complementary therapies significantly reduced rates of interventions for low-risk primiparous women.

Aim

To reduce rates of intervention in labour and birth, with a primary outcome of decreased epidural use during labour.

Methods

Low to moderate risk primiparous women were randomised at 24–36 weeks’ gestation to the intervention group and standard care, or standard care alone. Clinical and psychological measures were analysed by intention-to-treat. Trial registration ACTRN12618001353280

Findings

In total, 178 women participated (n = 88 intervention, n = 90 Standard care), demographic characteristics were similar between groups, almost half (49 %) reported a pre-existing medical condition, and wellbeing scores fell within the average range. Epidural use was lower in the intervention group (47.7% vs 56.7 %) with higher rates of vaginal birth (52.3% vs 42.2 %), however, no statistical differences for birth outcomes were found between groups. Attitude to childbirth scores were statistically higher for women who attended the intervention (59.1 vs 54.3 p00.001).

Discussion

Higher psychometric scores demonstrated women in the intervention group felt an increased sense of coping and control. Antenatal education that includes complementary therapies can reduce fear and improve attitudes about childbirth.

Conclusions

Replicating study protocols enabled the generalisability of findings to a more diverse group of women, and data will contribute to a larger meta-analysis design to detect smaller treatment effects for operative birth.

Problem

Despite increasing interest in Group Care worldwide, implementation is challenging.

Background

Group Care is an evidence-based perinatal care model including three core components: health assessment, interactive learning, and community building. It has several advantages for service users and providers compared to individual perinatal care.

Aim

We aimed to identify anticipated challenges when implementing Group Care, and to develop a supporting tool based on these challenges.

Methods

Context analyses through Rapid Qualitative Inquiries were conducted in 26 sites in seven countries to gain insight into the anticipated challenges when implementing Group Care. Data triangulation and investigator triangulation were applied. The context analyses generated 330 semi-structured interviews with service users and other stakeholders, 10 focus group discussions, and 56 review meetings with the research teams.

Findings

We identified six surface structure anticipated challenges categories (content, materials, facilitators, timing, location, group composition), and five deep structure anticipated challenges categories (health assessment, scheduling Group Care into regular care, enrolment, (possible) partner organisations, financials) occurring in all participating sites, leading to the development of the Anticipated Challenges Framework.

Conclusion

Completing the Anticipated Challenges Framework raises awareness of anticipated challenges if sustainable Group Care implementation is to succeed and encourages the initiation of a concrete action plan to tackle these challenges. Application of the framework may offer important insights to health systems administrators and other key stakeholders before implementing Group Care. In the medium- and long-term, insights gained may lead to greater possibilities for sustainability and to the most cost-effective approaches for implementing Group Care.

Problem

Persons with opioid use disorder (OUD) often lack social support, which is associated with improved recovery outcomes.

Background

In the last two decades, the rate of opioid use disorder (OUD) among pregnant people has quadrupled.

Question

This study aimed to describe the prenatal and postpartum social support networks and needs of persons with OUD and assess perceived acceptability of community-based social supports such as doulas.

Methods

This mixed methods study utilized quantitative and qualitative data to understand social support structures and needs. Data was collected through surveys –demographics and social mapping; Adverse Childhood Experiences (ACE) tool; Connor Davidson Resilience 25-item (CDRS-25) scale– and a semi-structured interview. A total of 34 participants from a single urban opioid treatment program consented to participate.

Findings

Participants were on average 34.9 years old, White (64.7%), and unemployed (91.2%). Participants described small perinatal social support networks, which decreased in size from the prenatal to postpartum period. Only half (52.9%) reported adequate prenatal and postpartum social support. Doulas and peer recovery support specialists were perceived as valuable in perinatal health, social support, and recovery domains, with interest in doulas seen particularly amongst those with fewer reported supports.

Discussion

: The scarcity of prenatal and postpartum social support among persons with OUD is critical to address, given the increased risk of relapse during the postpartum period which has implications for the maternal child dyad.

Conclusion

: Due to multiple disparities in prenatal and postpartum social support (small networks, inadequate support), doulas represent a trusted community-based support to be integrated into healthcare teams to address maternal morbidity/mortality associated with opioid use.