European Journal of Midwifery最新文献

Introduction: Postpartum women commonly experience interrelated unpleasant physical symptoms and negative emotions, necessitating a comprehensive approach that addresses both physiological and psychological well-being. In this study, we aimed to assess the effectiveness of massage therapy in alleviating unpleasant symptoms and improving mood and emotional states in the early postpartum period.

Methods: A randomized controlled trial was conducted in 2024 at a single-center facility involving 112 women aged ≥18 years who had undergone vaginal delivery, could read and write Japanese, and had no musculoskeletal or psychiatric disorders. Participants were randomly assigned to either an intervention group, which received massage therapy on the second postpartum day, or a control group undergoing bed rest. Both groups completed pre- and post-intervention assessments on physical symptoms and mood/emotions, while demographic and clinical data were obtained from medical records.

Results: A comparative analysis of using t-tests pre- and post-intervention changes between the two groups revealed statistically significant differences in four physical symptoms, five negative mood/emotion subscales, and two positive mood/emotion subscales (p<0.05). Multiple regression analysis was adopted, adjusting for six key variables: intervention status, primiparity, duration of labor, blood loss during delivery, weeks postpartum, and mother-infant separation. The results identified massage therapy as the factor for improving early postpartum discomfort and emotional well-being (p<0.05).

Conclusions: This study demonstrated that massage therapy in the early postpartum period is effective in alleviating unpleasant symptoms. Additionally, massage was found to reduce negative mood states, while simultaneously enhancing positive emotions.

Clinical trial registration: The study is registered on the official website of UMIN Clinical Trials Registry.

Identifier: UMIN000052795.

Preeclampsia (PE) is a potentially life-threatening pregnancy complication characterized by new-onset hypertension and proteinuria. Although multiple risk factors have been associated with its development, the underlying etiology remains incompletely understood. Among the mechanisms most strongly linked to hypertensive disorders of pregnancy, oxidative stress (OS) has emerged as a central contributor. Excessive production of reactive oxygen species (ROS) contributes to DNA damage, apoptosis, endothelial dysfunction, increased release of pro-inflammatory cytokines, and impaired anti-inflammatory responses. This narrative review summarizes current evidence regarding the role of OS in the pathophysiology of PE and explores the potential impact of antioxidant-based strategies for its prevention and management. A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science, published in English, up to December 2025. Priority was given to clinical studies involving women with PE, particularly those evaluating antioxidant supplementation or related therapeutic interventions. Although it remains unclear whether OS represents a primary cause or secondary consequence of PE, accumulating evidence suggests that reduced antioxidant capacity and increased OS markers contribute to disease development and progression. Studies evaluating antioxidant-based interventions report biologically relevant effects; however, clinical outcomes remain heterogeneous. Overall, OS appears to play a key role in PE, highlighting the need for well-designed longitudinal and interventional studies to clarify causality and define the true therapeutic value of targeting redox pathways.

Introduction: Postpartum depression (PPD) is common maternal mental health disorder, while postpartum anxiety (PPA) has recently increased. Comprehensive reviews on PPA psychosocial risk factors in Europe remain limited. This scoping review examines shared and distinct psychosocial risk factors for PPD and PPA among European postpartum women.

Methods: The review followed PRISMA guidelines, and Arksey and O'Malley's scoping framework. ProQuest, Web of Science, Scopus, MEDLINE, Sage Journals were searched on 24 October 2025. Eligibility criteria were defined a priori using the Population-Concept-Context framework, and study selection was conducted using the Rayyan platform. Study quality was assessed using Mixed-Methods Appraisal, AMSTAR-2 tools, with relevance ensured through inclusion criteria and reviewer triangulation. An inductive, reflexive thematic analysis was applied to synthesize the identified factors.

Results: Following screening of 1219 records, 30 studies published between 2019 and 2024 were included. Of these, 21 examined PPD, three focused on PPA, and six addressed both conditions. Shared psychosocial risk factors included problematic partner relationships (n=13), insufficient support (n=9), and stressful life events (n=7). Risk factors more commonly associated with PPD were older maternal age (n=3), difficulties in emotion recognition (n=2), and isolation or loneliness (n=2). PPA-specific risk factors included lack of information and unpreparedness (n=2), unrealistic expectations (n=1), and internal or external stigma (n=1).

Conclusions: Key psychosocial risk factors for PPD and PPA in Europe include problematic partner relationships, low support, stressful life events. Early identification and targeted interventions are crucial.

Problem-Based Learning (PBL) has emerged as a promising educational approach for developing Evidence-Based Practice (EBP) competencies in nursing and midwifery education. PBL is a student-centered educational approach that uses authentic, ill-structured clinical problems as the starting point for learning, where small groups of students work collaboratively under facilitator guidance to identify learning objectives and apply knowledge to solve real-world problems. However, there is limited synthesized evidence on PBL's effectiveness specifically for teaching EBP to nursing and midwifery professionals globally. This systematic review aims to evaluate the efficacy of PBL approaches in teaching EBP to nursing and midwifery students and professionals. A comprehensive search will be conducted in MEDLINE, CINAHL, PubMed, EMBASE, Web of Science, ERIC, PsycINFO, and Cochrane CENTRAL, covering studies from 2001 to October 2024. Studies will be included if they evaluate PBL interventions for teaching EBP to nursing or midwifery students or professionals. Two independent reviewers will screen studies, extract data, and assess methodological quality using JBI-SUMARI tools. Due to anticipated heterogeneity, narrative synthesis will be the primary approach, with meta-analysis conducted if sufficient homogeneity exists. This review will provide evidence on PBL's effectiveness for EBP education and inform curriculum development and educational policy in nursing and midwifery programs globally.

Introduction: The objective of this investigation was to evaluate the interobserver agreement between different investigators on selected cardiotocogram (CTG) parameters.

Methods: Medical records were selected from birth histories of cephalic deliveries with meconium-stained amniotic fluid. A total of 84 CTGs were recorded and analyzed by six clinicians. Agreement metrics such as proportion of agreement (Pa) with corresponding 95% confidence intervals (95% CIs) and reliability indices calculated via the Fleiss kappa statistic, were employed to quantify interobserver consistency.

Results: CTG parameters baseline rate, variability, presence or absence of decelerations, and total time of decelerations demonstrated good or moderate interobserver agreement, kappa ranged 0.47-0.80, indicating fairly high consistency in estimating these parameters. The kappa coefficients for these features ranged from moderate to very good levels. The assessment of accelerations exhibited only weak to moderate concordance (kappa: 0.29-0.47). Evaluation of the deceleration type yielded the lowest agreement. The overall categorization of CTGs into categories exhibited only poor to moderate interobserver concordance (Fleiss kappa: 0.19-0.44).

Conclusions: CTG parameters - baseline rate, variability, presence/absence of decelerations, and total width of decelerations in a 30-minute CTG interval - are features that can be interpreted with a high degree of objectivity and agreement with appropriate training, even without clinical experience. Since the categorization of CTGs into separate categories (normal, suspicious, and pathological) has a poor to moderate level of agreement, it indicates a need for discussion on whether it is worth continuing to rely on such CTG categorical stratification or base CTG judgements on more objective and high agreement parameters.

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.