European Journal of Midwifery最新文献

Introduction: Cesarean section is the most common surgery performed on women. The enhanced recovery recommendations are early urinary catheter removal and early mobilization, as essential elements of post-operative care. This study aimed to analyze the association between these elements and whether limiting the catheter treatment duration affects the timing of post-operative mobilization.

Methods: This retrospective case-control study compared the mobilization of healthy elective cesarean patients under different instructions on urinary catheter removal: cases with a preset catheter removal time (8-12 hours) and controls with catheter removal based on midwife considerations. Apart from the preset time of catheter removal, the routine post-operative care was given by the same personnel without any advice on patient mobilization. Data on patient demographics, surgery details, post-operative medication, first upright mobilization, the length of hospital stay, and patient satisfaction were analyzed.

Results: The study comprised 52 cases and one control for each case (N=104). The mean duration of urinary catheterization was 20.15 ± 6.59 and 11.30 ± 4.20 hours in the control and intervention groups, respectively (p<0.001). A linear regression analysis showed a significant association between the catheter removal time and patient mobilization, when adjusted for maternal background parameters (age, BMI, fear of childbirth diagnosis, prior uterine scar), duration and timing of the surgery, bleeding and post-operative analgesic use (R²=0.444, p<0.001). No difference was detected in the length of hospital stay, or patient satisfaction.

Conclusions: Limiting the duration of urinary catheter therapy is associated with shorter time to post-operative mobilization. A prospective randomized trial would provide more detailed information.

Introduction: Breastfeeding establishment can be challenging due to several factors including women's emotional and physical perception of breastfeeding. This study examines the bodily experiences of healthy women performing antenatal breastmilk expression (aBME) from gestational week 34 until term and whether aBME can support women during breastfeeding establishment.

Methods: A qualitative phenological-hermeneutic approach was applied. In-depth semi-structured interviews were conducted from December 2022 to March 2023, and women were recruited from the Express-MOM Study, which examined aBME before term. Interviews were conducted 2-4 weeks after birth. Questions concerned body image, bodily experience of aBME, and whether aBME supported their confidence during breastfeeding establishment. Interviews were audio recorded, verbatim transcribed, coded by the first and last author, and subjected to thematic analysis.

Results: Seven women participated in the interviews. Three themes were identified: 1) A desire to be prepared, which identified how women had a deep-felt wish to provide their infants with their milk; 2) Bodily confident, which covered how women trusted their body when expressing milk through aBME, and how this increased their confidence in breastfeeding; and 3) Being confident in the storm, which addressed how knowledge about women's own body obtained from aBME was valuable in the vulnerable breastfeeding establishment.

Conclusions: aBME from 34 weeks of gestation can contribute to women feeling more bodily confident and prepared for breastfeeding establishment. This study provides a basis for future research on aBME in women at risk of breastfeeding difficulties (e.g. preterm delivery) to identify if aBME can increase breastfeeding confidence and also breastfeeding initiation and rates.

Clinical trial registration: The study is registered on the official website of ClinicalTrials.gov.

Identifier: ID NCT05516199.

Introduction: Vaginal delivery can cause genital tract trauma and lacerations of different severity. This study aims to establish if routinary use of Ritgen's maneuver decreases the prevalence and severity of perineal lacerations compared to the traditional manual perineal protection (MPP).

Methods: This prospective case-control study was conducted in the labor ward of Fondazione Policlinico A. Gemelli, Rome, Italy. One hundred sixteen women who met inclusion criteria were included. The study group (n=58) consisted of women who were assisted using the Ritgen maneuver, whereas the women who gave birth immediately afterward were selected as the control group (n=58). All information was retrieved through electronic medical records.

Results: In all, 22% women of the study group reported no perineal lacerations compared with 5% of the control group (p=0.007). Regarding the degree of lacerations, the study group exhibited more first-degree lacerations and fewer second-degree lacerations, while the control group exhibited the opposite trend. Among women who received epidural analgesia, 24% of the study group did not experience perineal lacerations, compared to 4.5% of the control (OR=0.15; 95% CI: 0.03-0.72; p=0.008). Similarly, 23.4% of cases in the study group with oxytocin-enhanced labor, experienced no perineal trauma while none in the control group had no perineal trauma in cases of oxytocin augmentation (p=0.005).

Conclusions: Our results suggest that using Ritgen's maneuver in childbirth care may reduce the incidence and severity of perineal lacerations, even in the presence of known risk factors for perineal lacerations such as oxytocin augmentation and epidural analgesia.

Introduction: Sexual dysfunction in women is usually associated with the menopausal transition and menopause; however, there are factors that can also influence the sexual function of women in menopause. The aim of this study is to determine the association between pelvic floor disorders and sexual dysfunction in women in menopause.

Methods: A cross-sectional study was carried out in Spain with menopausal women recruited by convenience sampling. Data were collected on background and health status. To evaluate the presence of pelvic floor problems, the Pelvic Floor Distress Inventory (PFDI-20) was used. Regarding the evaluation of female sexual function, the validated Sexual Function of Women (FSM-2) tool was used. Crude (OR) and adjusted odds ratios (AOR) were obtained using the SPSS 28.0 statistical program.

Results: A total of 197 women participated. The mean age was 57.7 years (SD=8.4), 51.3% (101 women) reported experiencing some form of sexual dysfunction. Despite this, the majority (79.5%; 155 women) indicated that they were satisfied with their sexual health. However, 25.5% (50 women) mentioned they faced difficulties when trying to initiate sexual intercourse. Additionally, 22.9% (45 women) reported having moderate to severe issues achieving orgasm. Furthermore, 29% (57 women) stated that they had never or only occasionally felt arousal in the past month. Women who experienced urinary incontinence and pelvic pain had a higher frequency of sexual dysfunction. The main associated factor observed was the risk of pelvic floor dysfunction through the PFDI-20 scale. For each point of this instrument, there was a small but increased risk of sexual dysfunction (OR=1.01; p<0.001). Type of birth or maternal disorders, such mental illness or gastrointestinal disorder, did not show any statistical association with sexual dysfunction.

Conclusions: Pelvic floor dysfunctions symptoms in menopausal women are associated with their sexual health. Pelvic floor dysfunctions that influence sexual function are colorectal, urinary, and prolapse. Pelvic floor disorders such as urinary incontinence and pelvic pain are those that most influence sexual function.

Introduction: Collecting women's views and suggestions for improving quality of maternal-newborn care (QMNC) is a crucial aspect of maternity care evaluation often overlooked in Italy and globally. Childbearing women experienced numerous challenges during the COVID-19 pandemic including the rapid and significant reorganization of maternity services and care. Their perspective on what to prioritize for QMNC improvement is hence pivotal. The aim of this study was to explore maternal suggestions for QMNC improvement from women who gave birth during the two years of the COVID-19 pandemic.

Methods: Data were collected from an open-ended question included in a validated online questionnaire administered to mothers who gave birth in an Italian hospital between November 2020 to March 2022. The responses were analyzed using thematic analysis and mapped against the WHO Standards for improving QMNC and the WHO Framework of QMNC.

Results: The thematic analysis identified five main themes from the 2017 responses: 1) Support for mothers during the postnatal period; 2) Better use of resources; 3) Improvement of the maternity environment; 4) Reconsideration of organizational aspects; and 5) Guarantee of respectful practices. Women commented on all dimensions of the WHO framework except for two provision of care subdomains 'actionable information and functional referral systems'.

Conclusions: This is the first qualitative study in Italy focusing on women's suggestions for improving QMNC during the COVID-19 pandemic. Its findings can be used to inform what aspects of QMNC need improvement in Italy. Collection of women's views should be incorporated in routine monitoring of the QMNC, and data should be used for quality improvement purposes.

Introduction: Spinning Babies® procedures and the Rebozo technique have been recently implemented as additional interventions in laboring women with a fetus in occiput posterior position (OPP) to favor the rotation to an anterior position, which improve birth experience and health outcomes. Our study aimed to compare the probability of occurrence of persistent OPP (POPP) of the fetal head at the second stage of labor between retrospective and prospective cohorts and to assess associated sociodemographic, obstetric and intrapartum factors.

Methods: We conducted a combined prospective and retrospective cohort study including 1500 women giving birth in 2017 (retrospective cohort) and 779 between 15 May and 15 December 2023 (prospective cohort). Each cohort was divided into two sub-cohorts depending on presence of OPP. Primary outcomes were compared the probability of occurrence of POPP in the two OPP sub-cohorts by a log binomial regression and logistic regression. A p<0.05 was considered statistically significant. Data analysis was performed using Stata/MP18.0.

Results: The proportion of OPP at the onset of labor was similar between the two cohorts (34.9% vs 35.1%). The probability of occurrence of POPP was significantly lower in the prospective OPP sub-cohort (27.7%, n=65/235) compared to the retrospective OPP sub-cohort (35.8%, n=154/430) (risk difference, RD= -0.081; 95% CI: -0.15 - -0.008; p=0.031). In the retrospective OPP sub-cohort, maternal age ≥35 years (RD=0.096; 95% CI: 0.001-0.190, p=0.044) and nulliparity (RD= -0.100; 95% CI: -0.190 - -0.001, p=0.036) were significantly associated with the probability of POPP.

Conclusions: Our findings suggest a potential benefit of a set of interventions combining Spinning Babies® and the Rebozo technique in decreasing the probability of POPP.

Introduction: The United Nations define violence against women (VAW) as any gender-based violence that causes mental, physical, or economic harm and restricts freedom. The topic has not been studied before in the context of the midwifery curriculum in Estonia. The purpose of the study is to investigate the attitudes of midwife students towards VAW.

Methods: This pilot study followed a mixed-methods approach. The study population consisted of 77 midwifery students at Tallinn Health Care College from 2022-2023. The online survey was distributed to all Tallinn Health Care College midwifery students. The pilot study is used to validate the questionnaire and obtain initial information.

Results: The results show that the midwife students of this study have personal experiences and exposures to different types of violence, and some midwife students had sociocultural misconceptions about VAW. Midwife students have limited knowledge of the impact of violence on women's health and the legislation regarding violence. Midwife students stated that they would not be able to properly help the woman as a victim, as they lack knowledge, skills, and experience, which is an unfortunate factor.

Conclusions: The present pilot study showed that midwife students' attitudes towards VAW need improvement. The study raises the need to investigate midwife students' attitudes towards VAW with a larger sample, better-designed method, and validated questionnaire. Topics related to violence should be included in the midwifery curriculum, along with developing practical skills.

Introduction: Student midwives exposed to effective systems of midwifery care in other countries can consider how aspects of this knowledge can translate into their healthcare system to improve maternal and infant perinatal outcomes. An optional short-term study abroad (STSA) experience was developed for US midwifery graduate students to expose them to the UK healthcare system, where midwives are considered the primary professionals for the care of the childbearing family. This qualitative study explored the influence of an STSA experience on US midwifery graduate students' learning of midwifery in the UK.

Methods: Ten midwife student participants wrote pre- and post-trip narratives in the US and daily diary entries during their week in the UK. A grounded theory approach guided the content analysis. The themes were derived from the NVivo software data by three midwife researchers who value global health learning experiences. Analysis was shared with participants to ensure its trustworthiness.

Results: Themes that emerged included: 'Another viewpoint', encapsulating curiosity and comparison of US and UK midwifery; 'Eye-opening', capturing surprise at noted differences between US and UK midwifery practice; and 'Goals met and influenced', expressing how their learning is anticipated to shape their professional identities and career trajectories going forward.

Conclusions: US student midwives exposed to functional systems in countries where midwifery care is fully integrated, broadened their views of midwifery care and practice. They became inspired to make positive changes in the US. Educational opportunities for midwifery students, such as STSA experiences, can positively influence self-confidence and professional identity.

Introduction: Although the Lithuanian government increases funding for the cervical cancer prevention program every year, the incidence and mortality rates of cervical cancer are among the highest in Europe. In order to improve the prevention policy regarding cervical cancer, it is necessary to investigate the implementation of the cervical cancer prevention policy in one of the regions in Lithuania.

Methods: A quantitative survey method using a questionnaire, was applied in one of the regions of Lithuania. The study was conducted in the period 1-18 April 2022. During the study, 213 residents of the investigating region were interviewed.

Results: Respondents evaluated the cervical cancer prevention program in the investigated region positively, but not all women received invitations to participate in this program. The research revealed that the residents of the city of investigation have received this invitation more often than the women living in other districts.

Conclusions: Women's opinion about the effectiveness of the cervical cancer prevention program is positive. Still, there is an emphasis on the wish that this program could be used from an the age of 25 years and continue to 59 years. The prevention program could be carried out more often than is currently established.