European Journal of Midwifery最新文献

Introduction: The world needs skilled, well educated, and confident midwives, but there is a lack of instruments to measure confidence in the Swedish context. The aim was to psychometrically test and adapt the COMICE (Confidence Of Midwifery students on selected midwifery Competencies at completion of Education) questionnaire on Swedish midwifery students.

Methods: This is a national cross-sectional study of midwifery students from all 13 universities in Sweden in 2016-2017. The questionnaire comprised antenatal, intrapartum, postpartum and newborn care and underwent a principal component analysis. Analysis of variance was used to study associations with students' background characteristics.

Results: A total of 238 students (78% response rate) completed the questionnaire. For antenatal care, two components were identified: performing routine midwifery assessments during pregnancy and identifying fetal and maternal risk factors while educating parents (KMO=0.895, p<0.001; Cronbach's alpha=0.848 and 0.827, respectively). For intrapartum care, three components emerged: managing physiological birth and providing support, managing complicated labor and birth, and identifying and providing lifesaving measures (KMO=0.905, p<0.001; Cronbach's alpha=0.917, 0.809, and 0.777, respectively). Postnatal and newborn care included managing uncomplicated care while educating parents and managing complications (KMO=0.941, p<0.001; Cronbach's alpha=0.993 and 0.558, respectively). Younger students (<31 years) reported greater confidence in routine antenatal assessments compared to older students (mean: 27.43 vs 26.01, p=0.004), managing physiological births (mean: 65.41 vs 62.85, p=0.01), and handling complicated labors (mean: 20.37 vs 19.05, p=0.046).

Conclusions: This study supports the Swedish version of the COMICE questionnaire as a tool to measure confidence among midwifery students in a Swedish context.

Introduction: This study highlights the significant stress faced by nursing and midwifery students stemming from the rigorous requirements of their curriculum, which includes both demanding theoretical and practical elements. This study aims to identify the causes and manifestations of learning environment stress among midwifery and nursing students.

Methods: A cross-sectional study in Lithuania, Poland and Latvia was employed to evaluate students' learning challenges and neurodiversity using 40 different questions assessed on a Likert scale. Data were gathered through online surveys in February-April 2024, distributed to nursing and midwifery students from three international institutions.

Results: The findings reveal significant correlations (p<0.05) between anxiety and stress levels in students with neurodiversity, underscoring the critical impact of stress on the mental health and well-being of nursing students. These results demonstrate significant associations (ρ=0.2; p<0.05) with shifts in life meaning, health issues, emotional and cognitive challenges, and mobbing.

Conclusions: Anxiety and stress are significantly related to the presence of neurodisability among students, highlighting the necessity for targeted mental health interventions to address these critical issues.

Introduction: Intrapartum ultrasound (IPUS) allows for a more reliable and reproducible assessment of fetal head station and position during labor. This study aimed to investigate how an online education module on IPUS impacts midwives' knowledge, attitudes, and practices (KAP) regarding this topic.

Methods: Midwives working in the labor ward of the University Hospital of Leuven (Belgium) were invited to participate in an educational program on IPUS in April 2023. A baseline KAP survey was completed upon enrolment, followed by an online education module on the intrapartum sonographic assessment of head station and position. Afterwards, a second KAP survey was completed. Score were compared using a two-sided Wilcoxon signed-rank test. A p<0.05 was considered significant. Statistical analyses were conducted using SPSS (version 29.0.2.0).

Results: A total of 45 midwives were eligible for inclusion and invited to participate. From these, 46.7% (21/45) agreed to take part. Attitudes towards IPUS were positive, as most perceived it as safe, time-efficient, and beneficial for medical-decision making. However, only two midwives (9.1%) sometimes used IPUS themselves during the second stage, whereas none used it during the first stage. A significant improvement in knowledge scores was recorded after the online education module for both the sections on fetal head station (median score 0/5 to 2.75/5, p=0.01) and position (median score 2.5/5 to 3.5/5, p=0.04). No significant differences were observed in the overall attitude scores, as they remained overall positive (4.5/5 to 5/5, p=0.18).

Conclusions: Although having little experience with IPUS themselves, most participating midwives perceive it as an acceptable, time-efficient, and safe imaging modality. A short online education module resulted in a significant improvement in their knowledge of these topics. Further implementation research is needed to investigate how the uptake of IPUS amongst midwives can be improved, and how this can improve overall labor care.

In France, breastfeeding prevalence is high at birth, but its continuation remains low compared with other high-income countries, despite worldwide public health recommendations. Midwives offer parenting classes in an experimental manner without considering the importance of education in their interventions. The objectives of this study were to identify the teaching strategies and learning environments offered by midwives and their effect on women's perception of usefulness and their breastfeeding competence, to assess midwives' perception of usefulness and their pedagogical competencies. A comparative mixed study of 20 hospital midwives and 53 breastfeeding women (at 3 and 30 days postpartum) was conducted between January and August 2022 in two maternity units in France. Comparing the two periods, positive effects were found about breastfeeding women's level of knowledge: usefulness of learning theoretical (p=0.01) and practical (p=0.00) knowledge; and their breastfeeding management: signs of lactation (p=0.00), breast engorgement (p=0.04), and behavior (p=0.04). It positively reinforced the development of self-esteem (p=0.00) and commitment to breastfeeding (p=0.00). Midwives expressed strong motivation to use an appropriate teaching strategy and provide a supportive learning environment for women to improve their educational interventions (mean motivation score 7.7/10). The study results can promote research to examine educational interventions modeled according to the theories in education. Critical realism can be used to evaluate these interventions to elucidate how a program based on educational engineering can contribute to breastfeeding promotion and achieving the 2030 goals of WHO.

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

Identifier: ID NCT05271812.

Introduction: Women with a migration background face significant barriers to accessing perinatal mental health support. This study aims to explore the needs, barriers and facilitators regarding perinatal mental health support in women with a first-generation migration background and how they experience support within their own community.

Methods: We conducted qualitative in-depth face-to-face interviews with mothers who gave birth within 12 months preceding the interview, recruited from an Antwerp maternity ward between August and September 2022. Three midwife researchers conducted interviews at the participants' home, using an interpreter if needed. A midwife researcher with relevant expertise reviewed the final manuscript. Two researchers independently performed qualitative inductive content analysis and constant comparison of audio transcripts using NVIVO.

Results: Of the 11 participants, none reported mental health issues at the time of the interview. However, four mothers shared experiences indicative of postnatal depression, highlighting significant challenges such as isolation, language barriers, and a lack of awareness about mental health support. Recurring themes included the importance of professionals taking the time and making efforts to provide accessible information, navigating language barriers, differences in participants' openness toward discussing mental health, the importance of having a close network available for psychological support, and practical aspects inhibiting access. Overall, participants reported a desire for more culturally sensitive care and information about available support.

Conclusions: Findings underscore the urgent need for tailored perinatal mental health support that is easy to access, emphasizing awareness and training for professionals, especially midwives, to meet diverse needs. Recognizing this population's variety is essential.

Introduction: Pain self-management among women who begin child-rearing after a cesarean section (CS) has not been ascertained. This study aimed to explore the relationship among pain intensity, self-management, and self-efficacy on post-operative day (POD) 5 after CS in postpartum women.

Methods: A cross-sectional online survey was conducted on POD5 after CS. Participants were recruited through convenience sampling in Mie Prefecture, Japan, from August 2023 to April 2024. Pain was assessed using a numerical rating scale (NRS), both during activity and at rest, with higher scores indicating greater pain. Pain self-efficacy was assessed using the Japanese version of the Pain Self-Efficacy Questionnaire (PSEQ-J), and pain self-management was investigated. SPSS version 29.0 was used for data analysis, and p<0.05 was set as the significance level.

Results: Data from 124 participants (valid response rate: 73.8%) were analyzed. The median (IQR) of the NRS was 4.5 (3-6) during activity and 2.0 (1-4) at rest. There were significant differences according to method of oral analgesia during activity (p<0.049) and at rest (p<0.015). Multiple regression analysis revealed that NRS scores at maximum pain after CS significantly influenced pain on POD5. However, the number of oral analgesics and PSEQ-J scores were not influenced (during activity: R²=0.21, p<0.001, at rest: R²=0.12, p<0.001).

Conclusions: Pain intensity during activity on POD5 was moderate and required pain-management. Acute post-operative pain-management was related to pain intensity on POD5, suggesting the importance of early post-operative pain control. Future studies are needed to examine the association between pain self-efficacy and other psychological factors.

Introduction: This study assessed the knowledge, awareness, and acceptability of antenatal perineal massage (APM) among pregnant women in Saudi Arabia.

Methods: This cross-sectional study included 240 pregnant women who met the predefined inclusion criteria and attended the Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, from 1 October to 31 December 2023. Participants answered seven knowledge questions, classified as having good knowledge if they answered ≥4 correctly and poor knowledge if <4 were correct.

Results: Most women (46.25%) reported it was their first encounter with APM. Common sources of information included the internet (39.58%), physicians/midwives (7.92%), and friends/family (3.75%). Nearly half (47.5%) had heard of APM, but only 8.75% had practiced it, and 3.75% attended related classes. Only 17.5% knew that APM could be performed by the woman or her partner, while 25.83% knew it should start at 34 weeks, and 17.92% recognized the recommended duration of 5 to 10 minutes daily. Additionally, 22.5%, 15.83%, and 35.42% acknowledged APM's benefits for labor duration, anal sphincter dysfunction, and perineal injuries, respectively. The average knowledge score was 1.39±1.84, with 84.17% classified as having poor knowledge. No significant differences were found between knowledge levels (p>0.05). Low acceptability was noted, with only 58% of patients and 37% of their partners willing to engage in APM. No significant differences in acceptability were found between poor and good knowledge groups (p>0.05).

Conclusions: The study revealed low awareness, poor knowledge, and weak acceptability of APM among pregnant patients. Targeted education for patients and healthcare providers could enhance knowledge and improve maternal-fetal health outcomes.

Introduction: Women in Poland, despite having access to publicly-funded medical care during pregnancy, childbirth and the postpartum period, frequently use private care. Women's experience and satisfaction with childbirth have been considered one of the key indicators of the quality of care. In this study we explore whether and how paying for private childbirth services affects women's experiences and satisfaction with care. The qualitative portion seeks to understand how individual women construct meaning around their childbirth experiences, including their relationships with healthcare personnel, medical interventions, birth environment, and professionalism.

Methods: This mixed-methods study is based on data from 951 online questionnaires completed by women who gave birth between June 2017 and June 2022, in Poland. This study is part of the international Babies Born Better Survey project. The project used simultaneous quantitative and qualitative data collection, it was exploratory with equivalent status of qualitative and quantitative data. Quantitative data were analyzed descriptively and chi-squared tests were conducted to compare women who used private and public care. Qualitative data were analyzed using inductive thematic analysis. The quantitative and qualitative results were integrated, in accordance with the chosen mixed-methods design.

Results: There were no major differences in sociodemographic characteristics (except living standards), health status and satisfaction with labor between women who paid for private services during childbirth and those who used only publicly-funded care. For both groups of women, healthcare personnel and their behavior were the most frequently mentioned aspect shaping childbirth experiences. Other important aspects were: medical interventions, birth environment, and staff professionalism.

Conclusions: Although accessing private perinatal services care did not provide women with care consistent with their expectations, women put a lot of trust into private services as a means to receive more attentive care. Further research investigating the interplay between private and public services is needed to explore the question how private services may impact the care women receive and why women put so much trust in these services.

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.