European Journal of Midwifery最新文献

Introduction: Sleep disturbances are common in pregnancy and linked to adverse maternal and fetal outcomes. Physical activity is a promising non-pharmacological strategy to improve sleep; however, few studies have objectively examined this relationship during early pregnancy. This pilot study examined whether participation in an eight-week, online, participant-centered physical activity program (Healthy Mamas Program) was associated with changes in objectively measured sleep among pregnant Australian women in their first trimester.

Methods: A prospective intervention study was conducted between March 2021 and November 2022. Eleven women who were not regularly active at baseline (<75 minutes/week) wore Fitbit Charge 2 devices to track daily physical activity and sleep. Participants completed a seven-day baseline assessment, followed by the eight-week intervention and a seven-day post-program assessment. Sleep and physical activity variables were transformed as appropriate. Descriptive statistics, Pearson correlations, and linear mixed-effects models were used to assess associations and changes over time.

Results: Participants engaged in 244.50 minutes of total physical activity per day, primarily of light intensity. No significant change in physical activity was observed over time (p=0.17). Participants averaged 5.9 hours of sleep per night, with 23.18 nightly awakenings and a mean sleep efficiency of 78.91%. There were no significant associations between physical activity and sleep duration (p=0.130) or efficiency.

Conclusions: Findings suggest that, while feasible, the intervention did not significantly improve physical activity or sleep. Both behaviors remained below recommended levels. These results highlight the need for trimester-sensitive, accessible interventions to promote physical activity and improve sleep quality during pregnancy.

Introduction: In Spain, midwifery students receive limited education on and remain unfamiliar with the physiology and safety of planned home births. The aim of the study was to explore midwifery students' experiences of clinical training in planned home birth and how to improve the quality of care based on identified barriers.

Methods: A descriptive qualitative study was carried out. This research was conducted at the Nursing Faculty of the University of University of Almeria, involving 13 midwifery students. Data were collected using semi-structured interview between December and April 2025. Data were analyzed using thematic content analysis and themes generated that addressed the research objective.

Results: A total of 13 midwifery students enrolled in the education program. Two main themes were developed that reflect the meaning patterns constructed through the data analysis: 1) 'Attend a planned home birth', with the subthemes 'Fear of giving birth outside delivery', 'The unknown physiological process' and 'Recognizing stereotypes around the naturalization of birth'; and 2) 'Promoting resources that integrate planned home birth', with the subthemes 'Learning as a catalyst for change' and 'The need for institutional support'.

Conclusions: The results reveal the need to integrate content about planned home births into midwifery curricula. High-fidelity simulation can help bring planned home birth to midwifery students and midwives with a dynamic, safe, and reflective approach, ensuring optimal care for women who choose a planned home birth. Additionally, the results identify resources that could promote the visibility of planned home birth attention within academic, clinical, and social environment.

Introduction: Inclusive reproductive and perinatal midwifery care for LGBTQ+ individuals requires adequate knowledge and positive attitudes. This study evaluated the impact of a structured educational intervention on Greek midwives' short- and long-term knowledge, and attitudes toward LGBTQ+ individuals and related health issues.

Methods: A longitudinal pre- and post-intervention study was conducted within the ATHENA Study in Greece. Seventy midwives attended a 3-hour, small-group session combining lecture, case-based discussion, and group dialogue on inclusive and gender-affirming care. Knowledge and attitude scores (reflecting attitudes toward LGBTQ+ individuals and patients) were assessed at baseline, post-intervention, and follow-up at 6 months, using the Greek PKSGMH survey. Analyses used Friedman's test with Bonferroni correction (p<0.05).

Results: Data from 70 midwives (mean age 42.1 years, 97.1% women) were analyzed. Most were heterosexual (87.1%), married (62.9%), and had LGBTQ+ acquaintances (75.7%); only 18.6% had prior training. Post-intervention attitude scores toward gay men and lesbians decreased significantly (p=0.016 and p=0.011), indicating more positive attitudes, with improvements sustained at 6 months (p>0.999). Attitudes toward transgender people improved (p=0.034), remaining stable (p>0.999). Total and patient specific attitude scores decreased post-intervention (p=0.003 and p<0.001), sustained at follow-up (p>0.999). Knowledge scores increased (p=0.048 and p<0.001) and remained higher at 6 months (p=0.011 and p<0.001). Affirmative practice scores improved post-intervention (p=0.043) but not long-term (p=0.189).

Conclusions: A brief educational intervention significantly improved midwives' knowledge and attitudes toward LGBTQ+ individuals, with most effects sustained for six months. Embedding LGBTQ+-inclusive education in midwifery programs is essential for equitable reproductive and perinatal care.

Introduction: Midwives working at Japanese maternity homes are permitted to manage deliveries of women with group B Streptococcus (GBS), provided there is collaboration with obstetricians, as outlined in the Japanese Midwives Association (JMA) guidelines. However, obstetricians' recognition of the guidelines remains limited, potentially affecting the continuity and safety of perinatal care.

Methods: A nationwide cross-sectional survey was conducted in 2017. Anonymous self-administered questionnaires were mailed to all 2423 obstetric institutions accredited by the Japan Council for Quality Health Care, and responses from obstetricians were analyzed. Analyses used SPSS v23.0; p<0.05 was considered significant. The survey assessed obstetricians' recognition of the JMA guidelines, experience with midwife-led deliveries, and attitudes towards neonatal GBS prevention.

Results: Valid responses from 941 obstetricians from the 2423 institutions (38.8%) were analyzed. Only 31.9% (300/941) of the obstetricians reported being aware of the JMA guidelines, and just 15.1% (142/941) correctly understood that midwives may manage GBS-positive deliveries. Obstetricians with experience as a commissioned doctor for maternity homes demonstrated significantly higher awareness and fewer concerns regarding midwife-led care (chi-squared test, p<0.05). Discrepancies in transfer decisions and neonatal management were observed, particularly when maternal fever or prolonged membrane rupture occurred.

Conclusions: Although the relatively low response rate may limit the generalizability of the findings, we determined that obstetricians' limited recognition of the JMA guidelines may hinder effective interprofessional collaboration in maternity homes. Promoting mutual understanding through interprofessional education and establishing standardized clinical protocols for GBS-related care are essential to improve continuity and safety in maternal and neonatal care in Japan.

Introduction: The association of induction of labor with poor maternal satisfaction on analgesia is retrospectively studied in a cohort of parturients delivering with neuraxial analgesia.

Methods: Satisfaction on analgesia was measured within 1-2 days postpartum and considered as poor (<8/10), fair to good (8-9/10), or excellent (10/10). The incidence of poor maternal analgesia satisfaction was compared by logistic regression following induced (n=2654) or spontaneous onset (n=5222) labors in parturients who delivered with neuraxial analgesia in Helsinki, Finland area hospitals in 2022. Body mass index (BMI), primiparity, diagnosed fear of childbirth (FOC), other modes of labor analgesia, partogram data, and labor outcome were accounted for as cofactors. The association of cofactors within induced cohort was studied by ordinal regression.

Results: The incidence of poor analgesia satisfaction was 24.5% and 19.5% following induction of labor and spontaneous labor, respectively. Adjustment for cofactors (BMI, primiparity, FOC, additional analgesia, cervical dilatation at the time of neuraxial analgesia, intrapartum cesarean delivery) resulted in an AOR for poor satisfaction of 1.19 (95% CI: 1.06-1.34, p<0.001), following induced labor versus spontaneous onset labor. During induced labor, FOC (AOR=1.25; 95% CI: 1.03-1.52), prior opioid labor analgesia (AOR=1.27; 95% CI: 1.09-1.48), cervical dilatation (cm) at the time of neuraxial analgesia (AOR=1.07; 95% CI: 1.02-1.12) and labor resulting in operative vaginal (AOR=1.30; 95% CI: 1.05-1.60) or cesarean delivery (AOR=1.30; 95% CI: 1.06-1.59) were found to be associated with worsening satisfaction, using ordinal regression.

Conclusions: Induction of labor is associated with higher risk of poor satisfaction on analgesia, and in particular with neuraxial analgesia. Earlier provision of neuraxial analgesia may help mitigate the risk, particularly when additional risk factors are present.

[This corrects the article DOI: 10.18332/ejm/203687.].

Introduction: Midwifery students need confidence in recognizing and supporting normal birth, the backbone of the midwifery professional role. Developing this confidence in the face of decreasing rates of physiological birth worldwide is a critical challenge. Midwife researchers from Australia, England, Northern Ireland, Poland, and the USA investigated midwifery student confidence for supporting normal birth and explored enhancing and detracting factors.

Methods: A cross-sectional survey design was undertaken with 570 midwifery students at 8 academic midwifery programs across 5 countries The Student Confidence for Supporting Normal Birth Questionnaire with free text and Likert-type questions on a 1 (least influential) to 4 (most influential) scale was used. The survey was distributed between 2019 and 2023. Quantitative data were analyzed using descriptive statistics and Kruskal-Wallis tests of difference. Free text responses were analyzed thematically.

Results: Overall confidence mean was 2.06/4.00, with Poland (1.67) having the lowest confidence and the USA the highest (2.88). Factors rated most influential were the student-mentor midwife relationship (3.40) and theoretical education (3.09). In addition, birth environment emerged as important in the qualitative themes.

Conclusions: Interacting with a mentor midwife that supports physiological birth and is respectful of students, and repeated exposure to birth environments that privilege women-centered physiological birth are crucial to ensuring midwifery students can transition to confident midwifery professionals who are advocates for physiological birth. Didactic education that emphasizes the basic physiological and psychological principles that underlie midwifery care processes, contributes to midwifery student confidence for supporting normal birth.

Introduction: Menopause can significantly impact women's sexuality and sexual health, yet knowledge gaps among healthcare practitioners is a barrier to adequate support. Research on women's issues is less prioritized and limited funds are invested in studying female sexuality. In addition, women may feel hesitant to seek medical assistance for sexual health concerns during menopause due to lack of knowledge or societal taboos.

Methods: This is a meta-synthesis of qualitative research on women's experiences of their sexuality during the menopausal transition and the support offered by healthcare providers. Data collection was conducted using PubMed, CINAHL, and PsycINFO. A total of 21 qualitative studies from diverse cultural contexts, including Lebanon, Iran, Sweden/Chile, Spain, UK, Ireland, Thailand, Singapore, Australia, USA, China, Malaysia, and Taiwan, were synthesized, encompassing 610 participants.

Results: Women's experiences of sexuality during menopause are highly individualized and influenced by relationship dynamics, sexual autonomy, and personal perceptions of menopause. The synthesis also highlighted a common concern: women reported a lack of adequate healthcare support, knowledge, and targeted treatments to address their sexual well-being during this period.

Conclusions: Menopause can profoundly affect women's health, sexuality, and quality of life. For women to make informed choices regarding menopausal healthcare, extended knowledge, education, destigmatisation, and access to healthcare are essential. This synthesis underscores the critical need for enhanced education and interdisciplinary collaboration within healthcare systems.

Introduction: Despite national efforts, inequalities in maternal and infant health persist. Black, Asian and other ethnic minority, along with those in deprived areas, face disproportionately high complication and mortality rates. Prioritizing research is crucial for improving care experiences for women and families.

Methods: By adopting a qualitative ethnographic approach, we explored priority areas for research regarding Black, Asian, and ethnic minority mothers accessing healthcare in the UK. Data were gathered through focus groups and analyzed inductively and thematically using NVivo. The study sample comprised 55 women from various ethnic backgrounds, with the largest groups identifying as Black African, Arab, and Asian Pakistani.

Results: Women outlined key research priorities stemming from significant challenges in accessing maternity care. These included: 1) Communication barriers such as language difficulties, understanding each other and health literacy; 2) Emotional and psychological support, highlighting a need for further research. Women underscored the value of safe spaces for peer support and social interaction; 3) Participants stressed the importance of comprehensive perinatal education, particularly during the transition to parenthood, along with a strong desire for digital resources, information sharing, and networking; 4) High-quality, compassionate, and well-coordinated maternity care remained a primary concern; and 5) Socioeconomic support, including financial assistance, childcare, and resources for essential postnatal needs.

Conclusions: To tackle these issues, research at both community and individual levels should be commissioned to ensure women's priority concerns are comprehensively addressed. These findings provide valuable insights that can help shape national efforts to improve maternity care and reduce disparities, by informing policy and improving professional training.