European Journal of Midwifery最新文献

Introduction: Antenatal education programs aim to prepare expectant mothers for childbirth and early parenthood. This meta-analysis assessed the impact of these programs on maternal psychological outcomes and birth experiences, focusing on childbirth self-efficacy, fear of childbirth, and maternal and neonatal outcomes, including rates of vaginal delivery, cesarean section, Apgar scores, and birth weight.

Methods: A systematic search was conducted in PubMed, Web of Science, SCOPUS, and Cochrane Library until July 2024. Randomized controlled trials (RCTs) comparing antenatal education to standard care were included. Data were synthesized using meta-analysis with standardized mean differences (SMD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes.

Results: Forty studies were reviewed, with 31 eligible for meta-analysis. Among 1116 pregnant women, antenatal education significantly increased childbirth self-efficacy (SMD=2.00; 95% CI: 1.06-2.95, p<0.0001) and decreased fear of childbirth (SMD= -1.26; 95% CI: -1.79 - -0.74, p<0.00001). Maternal outcomes showed higher vaginal delivery rates (RR=1.10; 95% CI: 1.04-1.16, p=0.0004) and lower cesarean rates (RR=0.80; 95% CI: 0.70-0.92, p=0.001). No significant differences were found in episiotomy rates, Apgar scores, or birth weight.

Conclusions: Antenatal education improves maternal psychological outcomes and promotes vaginal delivery. However, high heterogeneity and potential bias in the studies limit generalizability. More research is needed on long-term impacts and effectiveness in low-resource settings.

Introduction: The Bristol Breastfeeding Assessment Tool (BBAT) has gained the interest of healthcare professionals involved in breastfeeding. The aim of this systematic review is to assess the psychometrics of the translated versions of the BBAT.

Methods: The databases PubMed, Scopus, Science Direct, and DOAJ were used to conduct a search for articles published between 2015 and 2023. The PRISMA guidelines were followed for the conduct and reporting of the review, and the COSMIN checklist was utilized to evaluate the psychometrics of the studies that were retrieved.

Results: Of the 117 records initially identified, four studies were included. The analysis of these studies revealed that the scale is available in at least four different languages. The methodological quality of the structural validity reported by three studies was satisfactory. Only two studies provided information on test-retest reliability, while the majority of the studies demonstrated very good quality in terms of internal consistency. All studies examined the construct validity of the BBAT, and the methodological quality produced different outcomes.

Conclusions: The methodological quality of the psychometrics of the translated versions of the BBAT provided mixed results. The continuation of the validation of the scale in more languages is recommended.

Breastmilk is the best source of nutrition for newborns. The World Health Organization recommends exclusive breastfeeding for the first six months of life as it has benefits to mother and child. However, breastfeeding can be challenging. Especially when the newborn is hospitalized, the physical separation of mother and child can make breastfeeding difficult. Hence pre- and post-natal midwife care supporting breastfeeding become more important. The aim of this narrative review is to identify measures taken by midwives in the labor ward, on the postpartum unit and at home that can influence breastfeeding success positively in hospitalized newborns. A literature review was conducted in PubMed and CINAHL and on the website of the European Institute for Breastfeeding and Lactation from April to September 2023. Studies from 2013 to 2023 written in German or English comparing two different measures/groups were considered. Twenty studies were included and five measures, taken by midwives, were identified. Skin-to-skin contact leads to higher (exclusive) breastmilk feeding rates, better sucking behavior and a shorter time to full enteral feeding. Regular breastmilk expression and supervised breastfeeding attempts result in higher breast milk feeding rates. Breastfeeding counselling enables the mothers to access lactation education. Uninterrupted visiting hours lead to higher exclusive breastmilk feeding rates. Midwives play a key role in promoting breastfeeding among hospitalized newborns involving initiating lactation, strengthening the mother-child bond and providing appropriate breastfeeding advice. There is a further need for research, as midwives are rarely involved in studies.

Introduction: European countries have recently received many migrants from Ukraine. Women's life experiences and expectations shape their perception of maternity care and childbirth. Our study aimed to explore how newly arrived Ukrainian refugee women experience their maternity care in Norway.

Methods: Social media were used to recruit eight women meeting the criteria of being newly arrived Ukrainian refugee women. Semi-structured interviews, three face-to-face and five video-calls, were performed between December 2023 and January 2024. We used Braun and Clarke for thematic analysis.

Results: Three main themes were identified: healthcare in country of origin, high-quality care in the new country, and challenges as a refugee. Women reported that in their home country, the cost of maternity care had a significant impact on the quality of care they received with a tendency toward overmedicalization, as access to certain services often depended on payment. Participants described instances of feeling disrespected by healthcare staff in their home country, in contrast to their experiences in Norway. Women reported that in Norway they experienced a high level of professionalism among healthcare staff and a well-functioning healthcare system with good physical conditions. Challenges that the women struggled with were communication and barriers to accessing services.

Conclusions: Being treated professionally and with respect played a central role in creating a positive experience and mitigated the negative experiences of problems with communication and navigation in an unfamiliar healthcare system. Future research could investigate the use of written information to aid migrants in understanding the maternity services and some of the vocabulary.

Introduction: The well-being of midwives impacts the quality of care provided during labor and birth, influencing maternal and neonatal outcomes. It is crucial that newly qualified midwives (NQMs) feel confident in managing labor and childbirth, to foster positive experiences for both mother and child. This study aims to explore and understand the lived experiences of NQMs caring for women during labor and birth.

Methods: A Heideggerian hermeneutic phenomenological approach was used to explore the experiences of ten NQMs within two years post-qualification, working in the Central Delivery Suite (CDS) of Malta's main public hospital. Purposive sampling identified participants, and data were collected through one-time, semi-structured, in-depth interviews conducted in private settings with the first author (JG) between December 2021 and January 2022. The interviews followed a self-designed schedule in English (JG, RPP) and were audio-recorded. Reflective journaling was maintained throughout. Analysis was guided by van Manen's six-step method, with hermeneutic philosophy and Willian Bridges' transition model informing the interpretation.

Results: Two main themes emerged: 1) 'Baptism of fire' and 2) 'Containing the fire'. 'Baptism of fire' encapsulates the initial challenges NQMs faced, including feelings of being overwhelmed and unprepared. 'Containing the fire' highlights how NQMs developed strategies to adapt, growing more confident and effective in their roles. These experiences were shaped by their training exposure to CDS and the level of support from colleagues during their transition.

Conclusions: The findings highlight the need for supportive environments, extended CDS placements and structured guidance through preceptorship. Enhancing NQMs' transition to practice has implications for midwifery education, policy, and practice.

Introduction: During pregnancy, women rely on a variety of sources to obtain information. However, not all of these sources are equally reliable, and there is the concern that especially online information-seeking may increase pregnancy-related anxiety. This study examines to what extent different sources of pregnancy information are associated with concurrent pregnancy-related anxiety (RQ1) and changes in pregnancy-related anxiety throughout the pregnancy (RQ2).

Methods: This study was integrated into the ongoing Swedish Mom2B study (sub-study data collection: December 2022-April 2024), where women complete weekly questionnaires via a research app. Each trimester, they received questions about their use of information sources and pregnancy-related anxiety.

Results: Our sample consisted of 751 pregnant women (273 with at least two waves of data). Using the midwife (β= -0.14, p<0.001; 95% CI: -3.32 - -1.13) or social circle (β= -0.08, p<0.05; 95% CI: -2.83 - -0.07) as a source of pregnancy-and childbirth-related information was associated with lower levels of pregnancy-related anxiety. In contrast, reliance on online sources for information was associated with higher levels of anxiety (β=0.14, p<0.001; 95% CI: 1.52-5.03). Except for (e-)books, which lowered the odds of improving anxiety (OR=0.62, p<0.01; 95% CI: 0.45-0.85), none of the information sources predicted changes in pregnancy-related anxiety over time.

Conclusions: Not all information sources play an equal role in relation to pregnancy-related anxiety. Interpersonal sources in particular may help mitigate anxiety. However, future research with more nuanced methodologies and shorter measurement intervals could clarify possible causal relationships and refine our understanding of how various information sources affect pregnancy-related anxiety over time.

Introduction: Cesarean section rates continue to increase worldwide. In 2021, one in every five deliveries was delivered by cesarean section. This is particularly alarming in resource-limited countries such as Kosovo, where the rates continue to increase and vary considerably between hospitals. Understanding the underlying factors that drive the increase and variation of cesarean section rates may help to change these trends. This study investigates how emotional intelligence and emotional labor impact cesarean section decision-making among midwives and obstetricians in Kosovo, along with clinical factors.

Methods: We employed a conjoint analysis using a cross-sectional study design to assess preferences that drive decisions for cesarean section. We used the Dutch questionnaire on Emotional Labor, the Assessing Emotions Scale, and the Quality of Decision-making questionnaire, and designed a conjoint questionnaire with 28 hypothetical scenarios. We invited all midwives and obstetricians employed at the Gynecology and Obstetrics Clinic of the University Clinical Centre of Kosovo to participate in the study. The data were collected from January to the end of March 2023. Stata 18 BE was used for statistical computing and data visualization.

Results: A gestational age of 42 weeks decreased CS likelihood among midwives (OR=0.75; 95% CI: 0.62-0.90, p=0.002). Previous cesarean sections (OR=1.42; 95% CI: 1.11-1.81, p=0.005) and hypertension (OR=1.23; 95% CI: 1.01-1.51, p=0.042) raised CS odds for midwives. A pelvic size of 8 cm significantly increased CS likelihood for midwives (OR=1.70; 95% CI: 1.37-2.09, p<0.001), while a size of 11 cm was protective for both groups (midwives: OR=0.73; 95% CI: 0.57-0.93, p=0.010; obstetricians: OR=0.70; 95% CI: 0.52-0.94, p=0.019). Maternal age of 40 years was significant only for obstetricians (OR=1.43; 95% CI: 1.00-2.06, p=0.052), and university education was significant for midwives (OR=1.19; 95% CI: 1.03-1.37, p=0.020). Non-clinical factors and emotional measures showed no significant or consistent trends in either group.

Conclusions: Various clinical and non-clinical factors shape the decision to recommend a cesarean section, with obstetricians and midwives prioritizing these factors differently. These findings underscore the importance of implementing evidence-based practices to enhance maternal and newborn health outcomes in Kosovo and similar settings, while optimizing cesarean decision-making.

[This corrects the article DOI: 10.18332/ejm/195830.].

[This corrects the article DOI: 10.18332/ejm/195831.].

Introduction: Pregnancy is a critical period marked by vast changes, with a pivotal role in healthcare. The Mothers on Respect (MOR) index measures and ensures respect in maternal care, impacting health-seeking behaviors and postpartum outcomes vital for individual and healthcare system well-being. This study aims to validate the Greek version of the MOR index to enhance respectful maternity care and contribute to positive childbirth experiences.

Methods: A retrospective, cross-sectional, descriptive, and analytical online survey collected data from Greek women with home childbirth experience. We utilized a self-administered questionnaire and the Greek version of the Mothers on Respect (MOR) index.

Results: The MOR index, assessing knowledge and awareness, showed a median score of 78 points, with a significant association between higher scores and living in Attica or being a healthcare professional (p=0.027 and p=0.024, respectively). Confirmatory factor analysis indicated the questionnaire had an acceptable fit, and reliability was confirmed with Cronbach's α exceeding 0.7 across all dimensions.

Conclusions: The Greek MOR index validation advances respectful maternity care, enhances maternal health in Greece, and contributes to regional efforts for positive childbirth experiences.