European Journal of Midwifery最新文献

Introduction: Early labor is critical in shaping birth experiences, and women seek midwifery care to manage challenges during this stage. A salutogenic attitude, focusing on positive experiences and health promotion, is needed instead of the current pathogenic maternity model. This study aimed to understand how midwives support women's positive early labor experience and to identify key elements contributing to salutogenic midwifery care practices during early labor.

Methods: We employed a qualitative study design, conducting nine focus group discussions (FGDs) with 39 women in Denmark, Sweden, and Switzerland. First, data were analyzed thematically using an inductive approach to capture codes. Second, a salutogenic best-fit framework guided the analysis, structuring the data into three domains: comprehensibility, manageability, and meaningfulness. Within domains, sub-themes were identified to elucidate how midwifery care might contribute to positive early labor experiences.

Results: Comprehensibility was achieved when women trusted midwives to provide accessible, high-quality care tailored to individual needs to help them comprehend the maternity system. Manageability was experienced when midwives guided women through the uncertainties of early labor and provided plans when needed. Meaningfulness was created through availability, accessibility, and emotional support. Continuity of care was an underlying foundation for a positive experience of all three domains.

Conclusions: A salutogenic midwifery approach, centering on flexibility and individualization, was essential to women's positive experiences cross-nationally. Salutogenic midwifery care during early labor reduced anxiety and enhanced emotional resilience. Our findings underscore the importance of salutogenic midwifery care for women in early labor, which should be recognized and implemented in maternity care settings.

Introduction: Traumatic events experienced during midwifery internships can have a significant impact on students, leading to emotional distress and doubts about continuing their studies. The aim of this study was to explore whether the experience of traumatic events influences motivation to continue studying and affects the professional expectations associated with the role of the midwife.

Methods: A qualitative descriptive phenomenological approach was used, focusing on the lived experiences of midwifery students in Italy. Data were collected through open-ended questionnaires administered to 36 third-year students from a midwifery Bachelor's degree program during the 2023-2024 academic year. Thematic analysis, following the Braun and Clarke six-step framework, was used to identify and interpret patterns in the data.

Results: The analysis revealed 21 codes, eight subthemes, and three main themes: 'Discovering the elements that shape the perception of the event', 'Suffer the consequences of the event', and 'Engage in a dynamic process to acquire the professional dimension'. Students described the factors that shape their perception of events, such as inadequate preparation, emergencies, and negative professional behaviors. Emotional consequences included fear, frustration, and doubts about their professional abilities. Despite these challenges, students showed resilience, often seeking support from mentors and external resources, ultimately reaffirming their commitment to the profession of midwifery.

Conclusions: Traumatic events during internships significantly impact the experiences of midwifery students. Effective clinical tutoring and emotional support are crucial to mitigate negative effects and foster professional growth. Understanding these dynamics can help educators better prepare students for the emotional demands of the profession.

Introduction: Interprofessional education (IPE) positively influences students' attitudes toward interprofessional collaboration, as demonstrated by multiple studies. However, few studies have examined IPE effects across more than two disciplines. Further investigation is needed to assess its impact on students' attitudes across diverse healthcare fields. This study aimed to evaluate shifts in students' attitudes toward interprofessional collaboration and their perceptions of the intervention's educational value and satisfaction.

Methods: The IPE intervention took place at Erasmus Brussels University of Applied Sciences in Brussels, Belgium between 2021 and 2022. Final-year nursing and midwifery students, along with fourth-year medical students, were randomly assigned to heterogeneous teams to address topics such as Basic and Advanced Life Support. The study used a quasi-experimental design with pre- and post-test evaluations, employing the Interprofessional Education Perception Scale (IEPS) to measure attitude shifts. Additionally, qualitative assessment was conducted using an open-ended question.

Results: A total of 269 healthcare students participated. Significant improvements in competence, autonomy, and perception of collaboration were found post-intervention (p<0.001). Positive attitude shifts were consistent across age, gender, and educational backgrounds. Qualitative data highlighted strong student support for the intervention and recognition of its educational value.

Conclusions: This study underscores the need for structured IPE pathways and early integration into healthcare curricula. It also highlights existing gaps in IPE and offers recommendations for enhancing midwifery education and practice.

Introduction: Vaginal birth after cesarean (VBAC) is associated with a lower risk of maternal morbidity, fewer complications in future pregnancies, and a reduced overall cesarean section (C-section) rate at the population level. Despite these benefits, a woman's decision for VBAC is shaped by multiple factors. This review aims to identify elements perceived by women as influential in the VBAC decision-making process.

Methods: We conducted a systematic review between 1 June and 12 July 2024, using PubMed, CINAHL, Embase and PsycINFO. We included English-language studies (2014-2024) on women eligible for VBAC with ≥1 previous C-sections. Study quality was appraised using CASP. Findings were narratively and thematically synthesized.

Results: Twenty-one studies met the inclusion criteria. Fifteen recurring factors were identified. 'Facilitators' of VBAC included: mother-newborn bonding; support from partner and family; desire for vaginal birth; previous VBAC experience; shorter postpartum recovery; partner and family support; social support from other women; healthcare professionals' attitudes; communication and respectful maternity care; and counseling. 'Barriers' included: anxiety and fear of the unknown; healthcare professional's misinformation and attitudes; coercive counseling; pain related to labor; loss of control; and perceived risk to mother or newborn.

Conclusions: VBAC decision-making is influenced by past birth experiences, perceived support, and current concerns. Healthcare professionals' attitudes and high-quality counseling are key to informed, unbiased choices. Continuity of care, midwifery care and education can empower women and reduce unnecessary C-sections. However, as most studies are from high-income, English-speaking countries, findings may not generalize globally.

Introduction: The Baby-Friendly Hospital Initiative (BFHI) by WHO and UNICEF promotes exclusive breastfeeding and enhances maternal and child health. Introduced in Qatar in 2016, its accreditation and implementation remain incomplete. This study evaluates the knowledge, attitudes, and practices (KAP) of clinical staff regarding BFHI at Al-Wakra Hospital.

Methods: A cross-sectional study was conducted among clinical staff in Obstetrics, Gynecology, and Pediatrics at Al-Wakra Hospital, using a convenience sampling method from April 2022 to January 2023. An online questionnaire based on the WHO/UNICEF Competency Verification Toolkit gathered data on sociodemographic, WHO BFHI course participation, and KAP levels. Statistical analysis was performed using t-tests and ANOVA in STATA 17.0, with significance at p<0.05.

Results: The study involved 141 participants, predominantly female (87.2%) with an average age of 38.4 years; most were nurses (85.1%). Knowledge scores were higher in males (8.0 ± 1.3) than females (7.1 ± 1.8, p=0.051), and specialists scored better than nurses (8.0 ± 1.4 vs 7.1 ± 1.8, p=0.033). A weak correlation was found between age and KAP scores.

Conclusions: The study highlights the need for continued BFHI education, especially for head nurses and midwives, to enhance implementation and ensure consistent competency among healthcare professionals.

Introduction: Postpartum anxiety affects approximately 1 in 4 women, with significant implications for both mothers and newborns. This study aimed to identify factors associated with postpartum anxiety and to assess its prevalence.

Methods: A cross-sectional study was carried out with women in the postpartum period in Spain. To measure attachment (VAMF bonding and VAMF attachment), the Maternal-Child Bond and Attachment - VAMF tool was used. Purpose sampling method was used to collect data from postpartum and postnatal consultations in medical centers. Sociodemographic and obstetric variables, anxiety level (GAD-7), risk of intimate partner violence (WAST), and risk of postpartum depression (EPDS) were obtained. Odds ratios (ORs) and adjusted odds ratios (AORs) with their respective 95% confidence intervals (CIs) were calculated.

Results: A total of 820 women participated, 36.1% (296) experienced mild anxiety, 8.5% (70) moderate anxiety, and 2.7% (22) severe anxiety. Key risk factors for anxiety included higher EPDS scores (adjusted odds ratio, AOR=1.68; 95% CI: 1.55-1.81), smoking (AOR=1.97; 95% CI: 1.01-3.82), a history of mental health issues (AOR=1.77; 95% CI: 1.13-2.79), and challenges related to the baby's health (AOR=2.70; 95% CI: 1.34-5.47). Additionally, a high-risk score on the WAST was linked to increased anxiety (AOR=1.53; 95% CI: 1.01-2.31). Conversely, protective factors included a positive mother-baby bonding score (AOR=0.90; 95% CI: 0.85-0.96) and a monthly income of 1000-1999 € (AOR=0.55; 95% CI: 0.31-0.95). For moderate to severe anxiety, a high EPDS score remained a notable risk factor (AOR=1.35; 95% CI: 1.26-1.44), while positive bonding (AOR=0.92; 95% CI: 0.85-0.98), higher income (>2000 €) (AOR=0.35; 95% CI: 0.15-0.80), and favorable treatment by healthcare providers significantly reduced anxiety risk (AOR=0.21; 95% CI: 0.07-0.70).

Conclusions: The prevalence of anxiety in women after childbirth is high. Depression, poor bonding, and economic status are factors that influence the onset of postpartum anxiety.

Introduction: There is limited research on the impact of music intervention during the non-stress test. More investigation is required on whether and how music impacts non-stress test results and pregnant women's mood. The current study aimed to examine the effect of the non-stress test on pregnant women's anxiety levels and the effect of music on maternal anxiety levels, pregnant women's vital signs, and fetal parameters.

Methods: A quasi-experimental study of two phases, involving one group, with a pre-and post-test, was performed at a private maternity and birth preparation center in Greece. Thirty-eight participants completed a scale for anxiety measurement (STAI) during their late third trimester; their vital signs were obtained, and the fetal parameters were recorded during the two phases of the study. During Phase 2, the music intervention, which referred to the exposure of pregnant women to musical stimuli during the non-stress test (NST), was carried out.

Results: Participants' state anxiety with (mean=27.87, SD=4.55) or without music intervention (mean=31.16, SD=7.74) showed a significant score reduction after the completion of the NST (p=0.009), which was significantly greater with the music intervention (p<0.001). Levels of trait anxiety before the NST (mean=39.66, SD=5.44) and after its completion (mean=38.00, SD=5.39) showed a significant score reduction when there was music intervention (p<0.001). At the NST's twelfth minute, participants' systolic blood pressure was significantly lower when there was the music intervention (mean=93.2, SD=16.4 vs mean=99.5, SD=10.7, p=0.030), as well as at twenty minutes (mean=93, SD=8 vs mean=100, SD=9.7, p<0.001). Participants' heart rate did not differ significantly between the examination with music (mean=85.9, SD=10.4) or without music (mean=84.9, SD=11.4) at baseline (p=0.506) or at other periods. Fetal movements increased significantly more in the last ten minutes of the NST compared to the first ten minutes, only when the NST was performed without music intervention (p=0.048). Accelerations were similar regardless of the presence or absence of music in the first ten minutes (p=0.235) and the last ten minutes (p=0.128), but they were increased significantly more in the last ten minutes of the NST compared to the first ten minutes, only when the NST was performed without music intervention (p=0.019).

Conclusions: Maternal anxiety levels decreased following both the music intervention and the completion of the non-stress test. Music affected blood pressure and maintained stable fetal movements and accelerations. The preliminary findings of the present nonrandomized, quasi-experimental study, with one pre- and post-test group, indicate that music may be a potentially available option in midwifery.

Introduction: This scoping review aimed to identify effective methods used for decision-making support and their effects on women considering choosing epidural analgesia in labor.

Methods: A literature search was conducted using CHNAHL, the Web version of the Central Medical Journal, and PubMed, and articles were extracted based on the eligibility criteria in September 2024. The PRISMA-ScR was followed. Studies that compared two groups of women considering epidural anesthesia for labor (subject), decision-making support (intervention), and standard care (control) were eligible.

Results: The search identified a total of 732 articles, of which 15 were eligible. Among these, 10 were randomized controlled trials (RCTs), 1 was a non-RCT, and 4 were cohort studies. The most common decision support approach was the distribution of leaflets, which were often given in the second to third trimester of pregnancy. Outcome measurements varied, limiting the identification of the most effective approach. However, most interventions, including controls, showed some effect on improving satisfaction and knowledge. Specifically, interventions incorporating shared decision-making (SDM) influenced satisfaction with the intervention, satisfaction with the birth experience, the feeling of being supported by others, and controlling emotions and attitudes.

Conclusions: This study found that decision support methods include both expert intervention and media-based approaches. However, given the scarcity of related studies and the variability in evaluation measures, the most effective method could not be identified. Nevertheless, an SDM approach may enhance effectiveness. These findings may help those who support pregnancy and childbirth in choosing more effective decision support methods.

Introduction: Historically, national and international policies have focused more on care during pregnancy and childbirth rather than on the postnatal period. To solve the necessity of ensuring continuity of care after childbirth, the role of Family and Community Midwives (FaCM) was established permanently. The aim of the study is to explore the experiences and perspectives of the FaCM working in the Lombardy region of Northern Italy.

Methods: The method used in this qualitative study design is a descriptive phenomenological approach. The data collection was conducted through semi-structured interviews with FaCM who voluntarily indicated their willingness to participate in the study from January to March 2024. The interviews followed a topic guide based on available literature.

Results: Fifteen FaCM participated in the interviews. Two main themes emerged: 1) The contribution of a committed midwife in the community setting; and 2) The relationship between midwives, women, and other professionals. The contribution of a committed midwife in the community setting emphasized the novel role played by FaCM and their experience staying in connection with women after childbirth. Furthermore, midwives are the designated professionals responsible for ensuring continuity of care during the postnatal period. Relationships between midwives, women, and other professionals involved the challenge of collaborating within a team instead of working alone in a local service.

Conclusions: The findings reflect the experience of FaCM in an entirely new postnatal community care setting. Enhancing the contribution of midwives alongside mothers and other professionals positively impacts the health of mothers and infants throughout the whole postnatal experience.