European Journal of Midwifery最新文献

Introduction: As midwifery shifts to a holistic, women-centered model, assessing care quality from the patient's perspective is crucial. The lack of standardized tools in Poland forces reliance on invalidated ad hoc measures. This study bridges the gap by translating and validating the QPP-I questionnaire.

Methods: The Polish QPP-I was adapted and validated through a cross-cultural study. A pilot (25 women) and a multicenter study (153 women) were conducted 2-3 days postpartum, with a test-retest after 2-4 weeks. Convenience sampling was used, with data collected via online and paper questionnaires. The pilot ran in late 2019, and the main study (February 2020-March 2021) spanned five maternity wards. Internal consistency, test-retest reliability, and criterion relevance were analyzed.

Results: The questionnaire was well-received by the target group, requiring minimal cultural adaptation. QPP-I PL demonstrated high internal consistency (α=0.935 for the 1st testing, α=0.95 for the test-retest) and good validity (mean Kendall W=0.65). Reliability was assessed using Cronbach's alpha. Most items showed good reliability (α >0.70). The Perceived Reality (PR) subscale had high reliability (α=0.90), while the Subjective Importance (SI) subscale reached α=0.93, confirming the appropriateness of all items. However, indicators related to participation in decision-making and midwifery attendance showed poor internal consistency. The mean alpha coefficient in the test-retest further supported good reliability (α=0.65).

Conclusions: The Polish version of the QPP-I questionnaire demonstrates good validity and reliability for assessing the quality of perinatal care from the patient's perspective. The questionnaire reflects the Polish perinatal care context while maintaining the original tool's integrity.

Introduction: The midwife community of Québec, expressed the need to revisit the identity markers of the profession after been integrated for over twenty years into a medical and hospital-centered healthcare system. There was a need to identify meaningful concepts and principles that allow them to practice in coherence with their uniqueness and in continuity with their historical roots.

Methods: Qualitative research with a cooperative inquiry approach was chosen. A total of 65 midwives from various practice settings met during two days of reflection. Focus groups of parents (15) where added in order to enrich midwives' discussions.

Results: Five themes emerged: the concept of becoming a mother as a process of transformation, the accompaniment of this process, the concept of giving birth, the professional posture, and distinctive aspects from the medical paradigm. Parents emphasized the importance of a family-centered approach, trusting relationship, choices, and continuity.

Conclusions: A reflective and collective process has allowed to reconnect with the meaning of being a midwife and practicing in coherence with its specificity. Some questions remained in relation to feminism, the spiritual dimension of birth and the community engagement. Moreover, the abundant use of the term 'physiology' for childbirth does not correspond to the richness of practice narratives and obscure the ineffable sacred character of birth. Midwives face the challenge of integration and inter-professionalism without losing parts of their autonomy and their professional voice. It would be appropriate to revisit the basic training program and examine the elements put in place to build and reinforce midwifery professional specific identity.

Introduction: Concerns about viral transmission through breast milk may impact breastfeeding recommendations and success. This study examined the changes in maternal knowledge, attitudes, and practices (KAP) related to breastfeeding and COVID-19 transmission during the pandemic.

Methods: A longitudinal survey of Thai mothers was conducted when infants were 2, 12, and aged 24 weeks (March 2022-April 2023). The questionnaire, assessing knowledge of SARS-CoV-2 transmission, attitudes toward breastfeeding, and hygiene practices, was validated using the Item-Objective Congruence index. Good KAP was defined as scoring >60% in each section. Associated factors, including maternal age, education level, occupation, breastfeeding experience, and history of recent COVID-19 illness, were analyzed using multivariable linear regression.

Results: A total of 195 mothers (mean age: 30.6 ± 6 years) completed the survey. One-third had good KAP, with an increasing trend over 24 weeks. Knowledge and practice scores among mothers without a recent history of COVID-19 illness demonstrated a positive change at an infant age of 24 weeks (95% CI: 0.08-0.96 and 0.02-0.76, respectively), while attitude scores remained unchanged. Maternal age at delivery was positively associated with the attitude changes (β=0.19; 95% CI: 0.02-0.20), whereas maternal education level and monthly family income were negatively associated. Better knowledge and attitudes about COVID-19 transmission during breastfeeding at 2 and 12 weeks were linked to a higher likelihood of predominant breastfeeding at 24 weeks postpartum.

Conclusions: Maternal knowledge, attitudes, and practices (KAP) improved over 24 weeks, with significant gains in knowledge and practice among mothers who had not recently contracted COVID-19. Early knowledge and attitude were linked to sustained predominant breastfeeding, highlighting the importance of targeted education.

Clinical trial registration: The study was part of the study entitled 'Infant feeding survey during COVID-19 pandemic' registered on the official website of Thaiclinicaltrials.org.

Identifier: ID TCTR20220215012.

Introduction: The proportion of cesarean section (CS) deliveries has increased worldwide. This study aimed to analyze CS trends in Estonia from 1992 to 2023 in total and according to Robson 1+2 (nulliparous, single cephalic, ≥37 weeks, spontaneous labor, induced or CS before labor) and 5 (previous CS, single, cephalic, ≥37 weeks) criteria.

Methods: Data of all deliveries (n=446536) in Estonia from 1992 to 2023 were obtained from the Estonian Medical Birth Registry. During the study period, 73960 births ended in CS. Descriptive characteristics of the study population were divided into two periods (1992-2007 increasing trend; 2008-2023 stable trend). Robson 1+2 and 5 sub-groups were analyzed. Joinpoint regression was used to estimate the change in CS trends in Robson groups over time.

Results: The total proportion of CS increased from 6.5% in 1992 to 20.9% in 2007 and remained stable after that. Robson 1+2 proportion increased from 5% to 21% in 2023, and Robson 5 decreased from 73% to 56%. In 2023, R1+R2 combined with R5 accounted for more than half (63%) of all CSs.

Conclusions: The increase in CS occurred primarily due to the increase in CS rates among nulliparous women with a singleton pregnancy at term. More attention must be given to nulliparous women to prevent CS and maintain vaginal births after CS. To improve the quality of maternity care, it is essential to monitor the indicators of CS based on Robson's criteria.

Introduction: Postpartum hemorrhage (PPH) is a serious complication following childbirth and the most common cause of maternal mortality globally. Women who survive PPH have an increased risk of enduring long-term physical and psychological consequences. This meta-ethnography aimed to investigate women's experiences of postpartum hemorrhage to develop new insights and understanding of women's needs for care and follow-up after a PPH.

Methods: A meta-ethnography was carried out in accordance with Noblit and Hare's seven phases and the eMERGe reporting guidance. Comprehensive literature searches were conducted in MEDLINE, CINAHL, and Maternity and Infant Care, in January 2024. A PRISMA flowchart was used to illustrate the search process and quality assessment was performed according to CASP.

Results: Eight studies were included based on specific inclusion criteria. The analysis and synthesis led to the overarching metaphor of 'Being touched by death while giving birth to life' encompassing three main themes. The first theme, 'When death roams by' described women's experiences with PPH as an encounter with death, leading to fear and severe pain. The second theme 'Living on with an emotional scar' indicated how PPH was an experience leaving deep impact in a person. The final theme, 'Healthcare providers as anchors amid the chaos', described that women valued healthcare professionals who demonstrated empathy and good communication skills.

Conclusions: Our study emphasizes the importance of healthcare providers, particularly midwives, providing empathetic care to aid women in recovering from postpartum hemorrhage.

Introduction: There is a growing global concern about contemporary behavior regarding fertility and fertility awareness. This study investigated the knowledge, attitudes and practices regarding conception and fertility among Greek women of reproductive age.

Methods: An online survey of Greek women (aged 18-40 years) was conducted. The questionnaire included 57 questions regarding childbearing intention, knowledge about fertility, aging, ovulation, sources of information about fertility, attitudes and knowledge regarding assisted reproductive techniques (ART).

Results: The survey included 817 women (aged 18-25 years: 33.2%, 26-30 years: 24.8%, 31-35 years: 18%, and 36-40 years: 24%). The participants were married (24.7%) or in a stable relationship (38.3%); 90.1% intended to have children. Regarding knowledge related to fertility, 59.5% of the responses were correct, 19.3% incorrect and 21.2% were 'unaware'. The average score was 19.6 ± 4.8 (range: 0-32). High fertility awareness was recorded for the topic 'how woman's aging affects conception and pregnancy' (73.7%). Moderate and low fertility awareness was recorded for the topics 'ovulation, folic acid and conception' (51.5%) and 'how man's aging affects conception and pregnancy' (38.7%), respectively. Regarding attitudes and practices, 59.1% reported intention to undergo ART if they failed to achieve pregnancy, and 53.4% had never discussed fertility problems with a healthcare professional.

Conclusions: The knowledge of Greek women aged 18-40 years regarding reproductive health and conception is moderate to high. Significant knowledge gaps and misconceptions were identified in certain fertility topics. Central planning on fertility education in Greece is needed to improve fertility awareness.

Introduction: Being notified that the fetus has died in utero is an extremely challenging situation for parents, involving emotional chaos, shock, and despair. Healthcare professionals also find it challenging to cope with these situations. The purpose of this study was to explore parents' experiences of fetal death and the care they received between diagnosis and birth induction.

Methods: We conducted a meta-ethnography in accordance with Noblit and Hare's seven phases and the eMERGe reporting guidance. Literature searches were conducted in CINAHL, MEDLINE, PubMed and PsycInfo in October and November 2022 and updated in August 2024. A PRISMA flowchart was used to illustrate the search process and quality assessment was performed according to CASP.

Results: Seven studies were included in the meta-ethnography. 'Realizing the unreal by taking control of the uncontrollable' emerged as an overarching metaphor through a reciprocal translation of the data. The metaphor illustrated four main themes: 1) Falling into the unknown, 2) Needing care during vulnerable times, 3) Communicating the meaningless, and 4) Navigating the terrain. Receiving the diagnosis resulted in feelings of chaos. However, healthcare providers possessing empathetic communication skills helped them to cope with the situation and prepare for birth.

Conclusions: Optimal care performance, where communication is central, is a useful strategy for healthcare professionals in their encounters with parents who experience fetal death. Training is vital in order to provide good care and support for parents throughout the process.

Introduction: Peanut balls, a specific type of positioning aid used during labor, have gained attention for their potential to enhance maternal comfort and facilitate fetal positioning. This meta-analysis aims to evaluate the effect of peanut balls on the duration of the first stage of labor, the rate of cesarean section, and maternal satisfaction.

Methods: A comprehensive literature search was carried out employing electronic databases such as PubMed, Web of Science, and the Cochrane Library. The search included articles published from inception to 11 October 2023 with no language restrictions. Randomized controlled trials or quasi-experimental studies were considered for inclusion if they met the following criteria: participants were pregnant women in labor; intervention involved using a peanut ball during labor; and primary outcome included duration of labor, and the rate of cesarean section and maternal satisfaction were secondary outcomes. The risk of bias in the included studies was assessed using the Risk of Bias 2 (RoB2) tool. Results were synthesized using Review Manager software (RevMan version 5.1), employing both fixed-effect and random-effects models as appropriate, and results were presented as risk ratios for dichotomous outcomes and mean differences and standardized mean differences for continuous outcomes. The quality of the evidence was assessed using GRADEpro GDT (Guideline Development Tool).

Results: Eight studies including 1352 laboring women met the criteria to be included in the systematic review and meta-analysis. The results of the meta-analysis showed that the women with epidural analgesia who used the peanut ball, experienced a shortened duration of the first stage of labor by 52.98 min, which was statistically significant (p=0.003). Heterogeneity evidence was not found among the included studies (χ²=6.83, p=0.15, I2=41%). It was also shown that the risk ratio of cesarean section in women who used peanut balls during childbirth was significantly lower than the control group (RR=0.74; 95% CI: 0.60-0.91, p=0.0004) (χ²=5.72, p=0.45, I2=0%). Compared to the control group, the women in the peanut ball group were found to have a higher satisfaction level, which was statistically significant (p<0.0001).

Conclusions: The peanut birth ball reduces the first stage of labor duration, and lowers cesarean rates in women with epidural analgesia. While effective and non-invasive, the findings are limited by the risk of bias in some included studies.

Introduction: The birth of a premature baby and hospitalization are stressful events for parents. The study aimed to assess the differences in parental stress experienced by parents of preterm infants provided with Kangaroo Mother Care (KMC) during their stay in the hospital.

Methods: The cross-sectional study was conducted among 337 randomly chosen parents of hospitalized babies born in Poland in 2016. As research tools, the Personal Information Form (PIF), Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) and Coping Inventory for Stressful Situations (CISS) were used.

Results: The significant association in every subscale of PSS:NICU (p<0.001 vs p=0.003 vs p<0.001) with the overall stress score (p<0.001) were confirmed. The start time of KMC implementation also turned out to be significantly lower in the group of mothers starting KMC at 1 week of the child's life for the overall stress score and subscales and I and III (p=0.024 vs p=0.024; total: p=0.005), while KMC did not affect the PSS:NICU results in the group of mothers and fathers. Parents' dominant stress management strategy was Task-Oriented Coping (p=0.123), but confronting the reality with Avoidance-Oriented Coping was the basis of their adaptation (p=0.591).

Conclusions: The parental stress level was higher in mothers than in fathers. Mothers' dominant strategy of coping with stress was Seeking Social Contact, and in fathers Emotion-Oriented Coping.