Women and Birth最新文献

The transition to motherhood among first-time mothers in China during the first six months postpartum: A qualitative study based on the transition shock model 中国产后6个月初为人母的过渡：基于过渡休克模型的定性研究

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2026-02-02 DOI: 10.1016/j.wombi.2026.102170

Yuyang Zhu , Yue Zhao , Yulu Zhu , Qianfeng Zhang , Ting Li , Ying Mao , Xiaojun Shen , Xia Wang

Problem

Little is known about the transition to motherhood of first-time mothers in China within the first six months postpartum, particularly the multidimensional shock encountered.

Background

The transition to motherhood is a multidimensional and dynamic process encompassing physical, emotional, intellectual, and sociocultural and developmental changes, profoundly influenced by sociocultural contexts and directly impacting maternal and infant health outcomes.

Aim

To explore the multidimensional transition experiences of first-time mothers in China during the first six months postpartum using the Transition Shock Model.

Methods

A descriptive qualitative study design was employed. Using purposive sampling, 16 first-time mothers were recruited for semi-structured interviews. Data were analysed using the framework method.

Findings

Four main themes and ten sub-themes emerged: 1) Inevitable physiological burden; 2) Complex emotional turbulence; 3) Knowledge and skills dilemma; 4) Structural dilemma of motherhood within sociocultural frameworks.

Discussion

The findings validate the applicability of the Transition Shock Model in the Chinese context and reveal culturally specific stressors, such as “cognitive conflicts in intergenerational parenting cultures” and “intergenerational power imbalances and role encroachment”.

Conclusion

The transition to motherhood presents first-time mothers with a series of multidimensional and complex challenges in the postpartum period.

问题在中国，人们对产后6个月内首次生育的母亲转变为母亲的过程知之甚少，尤其是所遇到的多方面的冲击。向母亲的过渡是一个多方面的动态过程，包括身体、情感、智力、社会文化和发展变化，深受社会文化背景的影响，并直接影响孕产妇和婴儿的健康结果。目的运用过渡休克模型探讨中国产后6个月初为人母的多维度过渡体验。方法采用描述性定性研究设计。采用有目的的抽样方法，我们招募了16位首次生育的母亲进行半结构化访谈。采用框架法对数据进行分析。研究发现：1)生理负担不可避免；2)复杂的情绪动荡；3)知识技能困境；4)社会文化框架下母性的结构性困境。研究结果验证了过渡冲击模型在中国情境下的适用性，并揭示了“代际教养文化中的认知冲突”和“代际权力失衡和角色侵占”等文化特异性压力源。结论初为人母在产后面临着一系列多方面的复杂挑战。

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引用次数: 0

Evaluating midwife-led continuity of care and breastfeeding outcomes: A quasi-experimental study 评估助产士主导的护理和母乳喂养结果的连续性：一项准实验研究

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2026-02-01 DOI: 10.1016/j.wombi.2026.102167

Emma V. Shipton , Nigel Lee , Katie Foxcroft , Susan de Jersey , Leonie Callaway

Background

Midwife-led continuity of care is associated with many positive health outcomes for women and babies. However, little is known about the relationship between model of care and breastfeeding rates or duration.

Aim

The primary aim of this study was to compare breastfeeding outcomes for women within midwife-led continuity of care and standard care models across postnatal timepoints. The secondary aim was to assess breastfeeding education received during pregnancy between groups.

Methods

A quasi-experimental, prospective longitudinal study was conducted, with women from midwife-led continuity of care and standard care enrolled. Questionnaires were administered at five time points across the pregnancy and postnatal continuum (second trimester, third trimester, and one week, one month, and four months postnatal).

Results

In total, 383 women consented to participate, with 214 completing the questionnaire at the final postnatal timepoint (94 in midwife-led continuity of care, 120 in standard care). Across postnatal time points, breastfeeding rates (exclusive and any breastfeeding) were statistically similar between groups. During pregnancy, women who received midwife-led continuity of care reported less comprehensive breastfeeding discussions than those cared for within standard care.

Discussion

Breastfeeding support and education are part of a midwife’s role and may encourage continuation and exclusivity. However, decisions surrounding breastfeeding are complex and can be influenced by other internal and external factors.

Conclusion

Midwife-led continuity of care was not associated with a statistically significant difference in breastfeeding rates up to four months postnatal. Further investigation to better understand how midwives can support women to improve breastfeeding outcomes is required.

助产士主导的连续性护理与妇女和婴儿的许多积极健康结果有关。然而，人们对护理模式与母乳喂养率或持续时间之间的关系知之甚少。目的本研究的主要目的是比较在助产士主导的连续性护理和标准护理模式下，妇女在产后时间点的母乳喂养结果。第二个目的是评估各组之间在怀孕期间接受的母乳喂养教育。方法采用准实验、前瞻性纵向研究，纳入助产士主导的连续性护理和标准护理的妇女。问卷调查在怀孕和产后连续的五个时间点进行（妊娠中期，妊娠晚期，以及产后一周，一个月和四个月）。结果共有383名妇女同意参与，其中214名妇女在产后最后时间点完成问卷调查（94名妇女接受助产士主导的持续护理，120名妇女接受标准护理）。在整个产后时间点，各组之间的母乳喂养率（纯母乳喂养和任何母乳喂养）在统计学上相似。在怀孕期间，接受助产士领导的持续护理的妇女报告说，与接受标准护理的妇女相比，接受母乳喂养的全面讨论较少。母乳喂养支持和教育是助产士角色的一部分，可能会鼓励母乳喂养的延续和排他性。然而，围绕母乳喂养的决定是复杂的，可能受到其他内部和外部因素的影响。结论助产士主导的连续性护理与产后4个月母乳喂养率无统计学差异。需要进一步调查以更好地了解助产士如何支持妇女改善母乳喂养结果。

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引用次数: 0

‘Making it up as we go’: Midwives’ perceptions of preparedness and role clarity in surrogacy birth care “我们去做”：助产士对代孕分娩护理的准备和角色清晰度的看法

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2026-02-01 DOI: 10.1016/j.wombi.2026.102168

Jutharat Attawet , Leo Ng , Yunjing Qiu , Evie Kendal , Myles Ojabo , Sarah Jefford , Micah DJ Peters

Background

Surrogacy poses unique clinical, psychosocial, and organisational challenges. Midwives, often with limited experience, education, and guidance, may feel uncertain about providing appropriate care, potentially affecting the quality of care and experiences of surrogates, intended parents, and newborns.

Objective

This study explored how midwives navigate surrogacy birth care, with a focus on role clarity, involvement of intended parents, and preparedness across the intrapartum and postnatal continuum.

Method

An interpretative phenomenological design was adopted. Five midwives with experience in surrogacy births were recruited through professional networks and the Australian College of Midwives newsletter. In-depth interviews were conducted and analysed using reflexive thematic analysis.

Findings

Four interrelated themes were identified. Navigating uncertainty without guidance described midwives’ reliance on personal judgement in the absence of surrogacy-specific policies. Balancing multiple parents in the birthing space highlighted tensions when surrogates, their partners, and intended parents all sought presence and recognition during labour and birth. Carrying the emotional labour of ethical tensions captured the moral strain midwives experienced when negotiating competing rights and expectations. Finally, gaps in education and professional development reflected participants’ limited preparation for surrogacy care, compounded by the rarity of such cases.

Conclusion

This study highlights how midwives navigate surrogacy birth care without clear guidance, relying on personal judgement while balancing expectations of surrogates and intended parents. Their experiences reveal uncertainty, ethical strain, and limited preparedness, underscoring the need for surrogacy-specific education and organisational guidance to support equitable, inclusive, and women-centred care.

代孕带来了独特的临床、社会心理和组织方面的挑战。助产士的经验、教育和指导往往有限，可能对提供适当的护理感到不确定，这可能会影响代孕母亲、准父母和新生儿的护理质量和体验。目的：本研究探讨了助产士如何进行代孕护理，重点是角色明确，准父母的参与，以及在产中和产后连续体中的准备。方法采用解释性现象学设计。通过专业网络和澳大利亚助产士学院通讯招募了五名具有代孕经验的助产士。使用反身性主题分析进行深度访谈和分析。发现确定了四个相互关联的主题。在没有指导的情况下导航不确定性描述了助产士在没有代孕具体政策的情况下依赖个人判断。当代孕母亲、她们的伴侣和准父母都在分娩和分娩过程中寻求存在和认可时，在分娩空间中平衡多个父母凸显了紧张关系。承担伦理紧张的情感劳动捕捉到了助产士在谈判相互竞争的权利和期望时所经历的道德压力。最后，教育和专业发展方面的差距反映了参与者对代孕护理的有限准备，加上这种情况的罕见。结论本研究突出了助产士如何在没有明确指导的情况下进行代孕分娩护理，依靠个人判断，同时平衡代孕母亲和准父母的期望。她们的经历揭示了不确定性、伦理压力和有限的准备，强调需要针对代孕的教育和组织指导，以支持公平、包容和以妇女为中心的护理。

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引用次数: 0

Improving care in pregnancies after perinatal loss: A national survey of maternity services in Australia 改善围产期流产后的妊娠护理：澳大利亚全国孕产妇服务调查。

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2026-01-20 DOI: 10.1016/j.wombi.2026.102162

Siobhan A. Loughnan , Aleena M. Wojcieszek , Ida Stevia Diget , Jacinda Wilson , Christine Andrews , Frances M. Boyle , Adrienne Gordon , Alexander E.P. Heazell , Amy Cooper , Vanessa Postle , Anne Sneddon , Elizabeth McCarthy , Susannah Hopkins Leisher , Barbara Vernon , Sean Seeho , Kathina Ali , Sailesh Kumar , Vicki Flenady , David Ellwood

Problem

Pregnancy following perinatal loss is associated with significant parental anxiety and potential increased risks of adverse perinatal outcomes.

Background

Standard antenatal care often fails to meet the needs of these families. As care provision varies widely across services, the most effective care model remains unclear.

Aim

To gain an overview of current pregnancy after perinatal loss practice across Australian maternity services.

Methods

National web-based survey administered to hospital-based maternity services, completed by a senior clinician or administrator from each service. Data were analysed descriptively.

Findings

Sixty-one maternity services responded. Obstetrician involvement was the most consistent element of care, reported “always” by 83 % of services and “sometimes” by 17 %. Specialist midwives were absent in 51 % of services, and 70 % did not offer antenatal classes for pregnancy after loss. While 44 % of services had a written policy/guideline for pregnancy after loss care – which appeared to emphasise medical over psychosocial care – 77 % lacked a dedicated model or specialised service. The most common barrier to providing pregnancy after loss care was the absence of a specialist bereavement role (52 %), with only 7 % reporting a lack of support from clinical staff.

Discussion

Despite high levels of clinician support for better meeting the needs of women during pregnancies after perinatal loss, dedicated services were infrequently reported and appeared to focus on medical components of care over psychosocial support.

Conclusion

Addressing policy, administrative, and workforce barriers may be an important step towards improving care for women and families during pregnancies after perinatal loss.

问题：围产期流产后怀孕与显著的父母焦虑和潜在的围产期不良结局风险增加有关。背景：标准的产前保健往往不能满足这些家庭的需要。由于各服务部门提供的护理差别很大，最有效的护理模式尚不清楚。目的：获得当前怀孕后围产期损失实践在澳大利亚孕产妇服务的概述。方法：对以医院为基础的产科服务进行全国网络调查，由每个服务的高级临床医生或管理人员完成。对数据进行描述性分析。调查结果：61家产科服务机构做出了回应。产科医生的参与是最一致的护理因素，83% %的服务报告“总是”，17% %的服务报告“有时”。在51% %的服务中没有专业助产士，70% %的服务没有提供流产后怀孕的产前课程。虽然44% %的服务机构有关于流产后怀孕护理的书面政策/指导方针——似乎强调医疗而不是心理社会护理——77% %缺乏专门的模式或专门的服务。提供产后妊娠护理的最常见障碍是缺乏专业的丧亲角色（52% %），只有7% %的人报告缺乏临床工作人员的支持。讨论：尽管临床医生对更好地满足围产期流产后怀孕期间妇女的需求提供了很高的支持，但很少有专门的服务报告，而且似乎侧重于护理的医疗部分，而不是心理社会支持。结论：解决政策、行政和劳动力障碍可能是改善围产儿流产后怀孕期间妇女和家庭护理的重要一步。

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引用次数: 0

“Pulling through”: Women’s experiences of vacuum‑assisted birth at a rural Tanzanian hospital—A qualitative study “渡过难关”：坦桑尼亚农村医院妇女吸尘助产的经历——一项定性研究。

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2026-01-19 DOI: 10.1016/j.wombi.2026.102166

Sara Rivenes Lafontan , Sabina S. Mmao , Fortunata Francis , Estomih Mduma , Jorgen Linde , Magnus Hagland , Hege Ersdal , Benjamin Kamala , Yuda Munyawu , Anna Sand

Introduction

Vacuum-assisted birth (VAB) is a vital obstetric intervention to expedite delivery and prevent unnecessary cesarean sections (CS). Despite its benefits, little is known about women’s experiences and perceptions of VAB in low-resource settings. This study aimed to explore women's experiences of VAB in a rural hospital in Tanzania, identifying factors shaping their emotional responses and future birth preferences.

Methods

A qualitative design using semi-structured interviews was conducted at a tertiary rural hospital. Thirteen women who had undergone VAB within the previous six months participated. Interviews in Kiswahili were transcribed, translated into English, and analyzed using reflexive thematic analysis by Braun and Clarke.

Results

Four themes were generated: Making sense of the unexpected; Balancing fears and necessity; Feeling seen versus feeling ignored; and Redefining future childbearing plans post-VAB. Positive postpartum explanations and reassurance encouraged some women to view VAB favourably in future pregnancies, whereas unresolved concerns led others to prefer elective CS.

Conclusion

Women's experiences of VAB were shaped by the quality of antenatal preparation, provider communication, respectful intrapartum care, and postpartum support. Embedding antenatal education, effective communication, shared decision-making, and postpartum debriefing into training and supervision may enhance acceptability and sustainable use of VAB in low-resource settings.

简介：真空辅助分娩（VAB）是一项重要的产科干预措施，可加快分娩和防止不必要的剖宫产（CS）。尽管它有好处，但人们对低资源环境中妇女对VAB的经历和看法知之甚少。本研究旨在探讨妇女在坦桑尼亚农村医院VAB的经验，确定影响其情绪反应和未来生育偏好的因素。方法：采用半结构化访谈法进行定性设计。13名在过去6个月内接受过VAB的女性参加了这项研究。采访用斯瓦希里语进行转录，翻译成英语，并使用Braun和Clarke的反身性主题分析进行分析。结果：产生了四个主题：让意外变得有意义；平衡恐惧和需要；感觉被看到vs .感觉被忽视；以及重新定义vab后的未来生育计划。积极的产后解释和保证鼓励一些妇女在未来怀孕中积极地看待VAB，而未解决的担忧导致其他人更倾向于选择性CS。结论：产前准备、医护人员沟通、尊重的产中护理和产后支持的质量决定了妇女VAB的经历。将产前教育、有效沟通、共同决策和产后汇报纳入培训和监督中，可以提高VAB在资源匮乏环境中的可接受性和可持续性。

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引用次数: 0

A critical crisis persists: Updated estimate of global midwife shortage requires urgent action 一场严重的危机持续存在：对全球助产士短缺的最新估计需要采取紧急行动

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2026-01-16 DOI: 10.1016/j.wombi.2026.102161

Martin R. Boyce , Andrea Nove , Daniela Drandić , Jessica White , Jacqueline Dunkley-Bent , Anna af Ugglas

Introduction

Midwives are widely recognised as an integral element of the strategy to achieve the health-related Sustainable Development Goals. This article provides updated global and regional midwife shortage estimates and future projections.

Methods

This study estimates the global midwife shortage as the difference between the number of midwives needed globally to provide universal coverage of essential midwifery interventions and the number of midwives currently in the workforce. Two scenarios are presented: Scenario 1 uses the most recent data in the World Health Organization’s National Health Workforce Accounts platform, and Scenario 2 adds data from United Nations Population Fund regional midwifery workforce reports.

Results

Scenario 1 includes 135 countries (45 % of the world’s women of reproductive age (wra)) and estimates a global shortage of 710,000 midwives. Scenario 2 includes 181 countries (82 % of wra) and estimates a global shortage of 980,000 midwives. Under both scenarios, a small reduction is forecast by 2030 but strong inequities remain, with most of the shortage in the African region and in low-resource settings.

Conclusions

Significant population growth in Africa and Eastern Mediterranean regions will bring extra need for midwifery services. The current estimate and projections indicate that the production of new midwife graduates in these regions has increased, but is only just keeping pace with the increased need, so the large shortages will not decrease by much before 2030. Further substantial increases in midwife availability are required to ensure that all mothers and newborns have access to midwives who can provide essential care.

助产士被广泛认为是实现与卫生有关的可持续发展目标战略的一个组成部分。本文提供了最新的全球和地区助产士短缺估计和未来预测。方法本研究估计全球助产士短缺是指全球提供基本助产干预措施普遍覆盖所需的助产士数量与目前在职助产士数量之间的差额。提出了两种情景：情景1使用世界卫生组织国家卫生人力账户平台中的最新数据，情景2添加了联合国人口基金区域助产人力报告中的数据。结果情景1包括135个国家（占世界育龄妇女（wra）的45% %），并估计全球短缺71万名助产士。情景2包括181个国家（82% %的世界卫生组织），并估计全球短缺98万名助产士。在这两种情况下，预计到2030年将小幅减少，但严重的不平等现象仍然存在，大部分短缺发生在非洲地区和资源匮乏地区。结论非洲和东地中海地区人口的显著增长将带来对助产服务的额外需求。目前的估计和预测表明，这些地区的新助产士毕业生的数量有所增加，但只是与增加的需求保持同步，因此，在2030年之前，巨大的短缺不会减少太多。需要进一步大幅增加助产士的可用性，以确保所有母亲和新生儿都能获得能够提供基本护理的助产士。

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引用次数: 0

The State of Asia’s Midwifery 2024 report: Implications for regional and national midwifery workforce policy and practice 《2024年亚洲助产状况报告：对区域和国家助产劳动力政策和实践的影响》。

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2026-01-12 DOI: 10.1016/j.wombi.2026.102165

Andrea Nove , Boe Calvert , Federica Maurizio , Caroline SE Homer , Megan Wylie , Catherine Breen Kamkong

Background

Investment in the midwifery workforce is a key element of strategies to improve sexual, reproductive, maternal, newborn and adolescent health outcomes. To document progress and identify challenges in Asia, United Nations Population Fund (UNFPA) recently published a regional midwifery workforce report. The aim of this paper is to make the findings, and their policy and strategy implications, more visible and accessible.

Methods

The report contained information from 21 Asian countries. The two main data reporting mechanisms were the World Health Organization National Health Workforce Accounts platform and a survey of stakeholders in participating countries, facilitated by UNFPA.

Results

Policy and regulatory frameworks are strong, but often restrict the services that midwives are authorised to provide. Most countries have enough midwives to meet population need for essential care, but some have shortages and/or structural barriers to midwives meeting that need. Most midwife education programs meet global standards for course duration and have curricula guided by national standards, but few align fully to global quality standards. Few countries deploy midwives strategically through data-driven workforce planning, have retention strategies, or midwives in senior leadership positions responsible for setting strategic directions for midwifery.

Conclusion

The Asian region has made considerable progress in advancing midwifery as a profession, but sustained action is needed to build on that progress, including: accelerate midwife production in countries with a shortage, align education curricula with global quality standards, expand the midwife’s scope of practice to align with global standards, and invest in data-driven workforce planning, deployment, and retention.

背景：对助产人员队伍的投资是改善性健康、生殖健康、孕产妇健康、新生儿健康和青少年健康结果战略的关键要素。为了记录亚洲的进展和确定挑战，联合国人口基金（人口基金）最近发布了一份区域助产人员报告。本文的目的是使研究结果及其对政策和战略的影响更加明显和容易获得。方法：该报告包含来自21个亚洲国家的信息。两个主要的数据报告机制是世界卫生组织国家卫生人力账户平台和在人口基金的协助下对参与国的利益攸关方进行的调查。结果：政策和监管框架是强有力的，但往往限制助产士被授权提供的服务。大多数国家有足够的助产士来满足人口对基本保健的需求，但有些国家存在助产士短缺和/或结构性障碍，无法满足这一需求。大多数助产士教育项目在课程时长上符合全球标准，并以国家标准为指导，但很少有项目完全符合全球质量标准。很少有国家通过数据驱动的劳动力规划战略性地部署助产士，制定保留战略，或让助产士担任负责制定助产战略方向的高级领导职位。结论：亚洲地区在促进助产作为一种职业方面取得了相当大的进展，但需要在这一进展的基础上继续采取持续行动，包括：在助产士短缺的国家加快助产士的生产，使教育课程与全球质量标准保持一致，扩大助产士的实践范围以与全球标准保持一致，并投资于数据驱动的劳动力规划、部署和保留。

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引用次数: 0

Effects of a visual and animation-based non-pharmacological pain relief approach on childbirth: A quasi-experimental study 基于视觉和动画的非药物镇痛方法对分娩的影响：一项准实验研究。

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2026-01-12 DOI: 10.1016/j.wombi.2026.102163

Pei-Jung Yu , Laing-Kai Wang , Jung-Mei Tsai

Problem

Digital formats targeting non-pharmacological strategies during the intrapartum period remain limited.

Background

Antenatal education can reduce labour pain and improve childbirth satisfaction, yet traditional methods have time, cost, and accessibility barriers.

Aim

To evaluate the effects of visualised and animated digital antenatal education on women’s perceived control, support, and satisfaction with childbirth, as well as the willingness to adopt and the effectiveness of non-pharmacological pain relief strategies during labour.

Methods

This study used a quasi-experimental design and recruited 84 pregnant women at a medical centre in northern Taiwan. Participants were randomly assigned to the digital intervention (visual booklet and animation) or control (text-based materials) group. Outcomes were measured within 72 h postpartum using the Support and Control in Birth and Mackey Satisfaction scales. Data were analysed by independent t-tests and Kruskal–Wallis tests.

Findings

The intervention participants showed significantly higher scores in internal control, external control and perceived support, and satisfaction with self, partner, and nursing staff. Among non-pharmacological pain relief users, the Kruskal–Wallis subgroup analysis revealed significant differences in internal control, partner-related satisfaction, self-related satisfaction, overall childbirth satisfaction, and satisfaction with nursing staff.

Discussion

Digital antenatal education effectively enhanced positive birth experiences and filled the gaps left by the conventional instruction, especially for those who do not use pharmacological pain relief.

Conclusion

This study supports the World Health Organization’s priorities on digital health literacy and woman-centred care. Further research should validate the cross-cultural applicability of digital health literacy and its integration into interprofessional practice.

问题：在分娩期间针对非药物策略的数字格式仍然有限。背景：产前教育可以减少分娩疼痛，提高分娩满意度，但传统方法存在时间、成本和可及性障碍。目的：评价可视化和动画数字产前教育对妇女对分娩的控制、支持和满意度的影响，以及分娩过程中采用非药物缓解疼痛策略的意愿和有效性。方法：本研究采用准实验设计，在台湾北部某医疗中心招募84名孕妇。参与者被随机分配到数字干预（视觉小册子和动画）或控制（基于文本的材料）组。结果在产后72 h内使用分娩支持和控制和麦基满意度量表进行测量。数据分析采用独立t检验和Kruskal-Wallis检验。结果：干预组在内部控制、外部控制和感知支持、自我满意度、伴侣满意度和护理人员满意度方面得分显著提高。在非药物止痛药使用者中，Kruskal-Wallis亚组分析显示，在内部控制、伴侣相关满意度、自我相关满意度、整体分娩满意度和对护理人员的满意度方面存在显著差异。讨论：数字产前教育有效地增强了积极的分娩体验，填补了传统教学留下的空白，特别是对那些不使用药物镇痛的人。结论：本研究支持世界卫生组织关于数字健康素养和以妇女为中心的护理的优先事项。进一步的研究应该验证数字健康素养的跨文化适用性及其与跨专业实践的整合。

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引用次数: 0

Group level changes and differences in midwives’ organisational and psychological work environment in Sweden – A nation-wide ecological prospective study 瑞典助产士组织和心理工作环境的群体水平变化和差异——一项全国范围的生态学前瞻性研究。

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2026-01-12 DOI: 10.1016/j.wombi.2026.102164

Malin Hansson , Lena Henriksen , Rikke Damkjær Maimburg , Marcus Praetorius Björk

Background

National statistics indicate that nearly one-quarter of Swedish midwives are employed outside the healthcare sector, highlighting persistent challenges in recruitment and retention. Although the demanding work conditions faced by midwives within the healthcare sector are documented, there is limited research on how these conditions evolve over time.

Aim

To identify group level changes and differences over time in how midwives assess their organisational and psychosocial work environment and to compare the assessments with Swedish benchmarks

Methods

This study is part of the longitudinal Swedish nation-wide GoodWEM project, using group level survey data from midwives in 2020 (n = 1677) and 2023 (n = 1836). Organisational and psychosocial work environments were assessed with Copenhagen Psychosocial Questionnaire III and compared with national benchmarks. Mean scores were analysed using linear regression and practical significance was evaluated using a predefined Minimal Important score Difference.

Findings

Between 2020 and 2023, Swedish midwives reported modest improvements in organisational and psychosocial work conditions, however, none of these changes met the ±5 point threshold for minimal important score difference, indicating limited clinical relevance. The proportion of midwives engaged in full-time work decreased from 52 % to 47 %. In 2023, midwives reported higher emotional and quantitative demands, role conflicts, and burnout than Swedish benchmarks, alongside more limited influence and poorer self-rated health, indicating persistent systemic challenges within the profession.

Discussion and conclusion

These findings underscore the need for long-term, systemic reforms to support midwives’ professional sustainability. Addressing structural, organisational, and contextual factors will be essential for improving retention, wellbeing, and care quality across diverse practice settings.

背景：国家统计数据表明，近四分之一的瑞典助产士受雇于医疗保健部门以外，突出了招聘和保留方面的持续挑战。虽然记录了医疗保健部门助产士所面临的苛刻工作条件，但关于这些条件如何随时间演变的研究有限。目的：确定助产士如何评估其组织和社会心理工作环境的群体水平随时间的变化和差异，并将评估与瑞典基准进行比较方法：本研究是瑞典全国性纵向GoodWEM项目的一部分，使用2020年（ = 1677）和2023年（ = 1836）助产士的群体水平调查数据。采用哥本哈根社会心理问卷III评估组织和社会心理工作环境，并与国家基准进行比较。使用线性回归分析平均分数，并使用预定义的最小重要分数差评估实际意义。研究结果：在2020年至2023年期间，瑞典助产士报告了组织和社会心理工作条件的适度改善，然而，这些变化都没有达到最小重要评分差异的±5分阈值，表明有限的临床相关性。从事全职工作的助产士比例由52% %下降至47% %。2023年，与瑞典的基准相比，助产士报告的情感和数量需求、角色冲突和倦怠程度更高，同时影响力更有限，自我评估的健康状况更差，这表明该行业存在持续的系统性挑战。讨论和结论：这些发现强调需要进行长期、系统的改革，以支持助产士的专业可持续性。解决结构、组织和环境因素对于提高不同实践环境下的留任率、幸福感和护理质量至关重要。

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引用次数: 0

Systematic home visit planning prior to hospital discharge: a propensity-score matched comparative cohort study of over one million mother-infant dyads with one-year follow-up 出院前的系统家访计划：一项对100多万母婴进行为期一年随访的倾向评分匹配的比较队列研究

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2026-01-09 DOI: 10.1016/j.wombi.2026.102160

Alexandre Caron , Anne Rousseau , Anne-Claire Brisacier , Hadia Akkari , Eric Haushalter , Thomas Mondschein , Marianne Simon-Yeou , Florian Thissier , Laurène Courouve , Laurent Gaucher

Problem

Maternal mental health problems are leading causes of morbidity and mortality in high-income countries, yet follow-up after birth remains inconsistent.

Background

Systematic postnatal home visits are recommended but many women do not receive them. clinical and economic impact of a structured scheduling of visits before discharge has not been fully evaluated.

Aim

To determine whether systematically arranged postpartum home visits were associated with reduced maternal rehospitalisations for mental health conditions. Secondary objectives included maternal and infant outcomes and healthcare costs within the first year.

Methods

We conducted a matched cohort study using national administrative data from 1297,646 low risk mother-infant dyads. In the intervention group, a midwife home visit was scheduled before discharge. Controls were matched on demographic and obstetric variables. The main outcome was maternal rehospitalisation for mental health conditions (ICD-10 codes F30–F45, F48, including depression or anxiety) within one year postpartum, excluding psychoses (F20–F29). Secondary outcomes included all-cause rehospitalisation for mothers and/or infants, use of emergency services, mortality, and overall healthcare costs.

Findings

A scheduled home visit occurred in 95 % of cases in the intervention group, compared to 52 % in controls (p < 0.0001). The intervention was associated with fewer maternal mental health-related rehospitalisations (RR=0.82, p < 0.0001) and slightly reduced overall rehospitalisation rates for mothers and infants. Mortality was unchanged. Mean healthcare costs were marginally lower in the intervention group.

Discussion

Systematic discharge planning may improve continuity of care and reduce psychiatric morbidity.

Conclusions

Postpartum home visit scheduling supports better outcomes and may offer modest economic benefits.

产妇心理健康问题是高收入国家发病率和死亡率的主要原因，但分娩后的后续工作仍然不一致。建议进行系统的产后家访，但许多妇女没有接受。出院前结构化就诊安排的临床和经济影响尚未得到充分评估。目的确定系统安排的产后家访是否与减少产妇因精神健康状况再住院有关。次要目标包括第一年的母婴结局和保健费用。方法采用1297,646对低风险母婴的国家行政数据进行匹配队列研究。干预组在出院前安排助产士家访。对照在人口统计学和产科变量上匹配。主要结局是产妇在产后一年内因精神健康状况（ICD-10代码F30-F45， F48，包括抑郁或焦虑）再次住院，不包括精神病（F20-F29）。次要结局包括母亲和/或婴儿的全因再住院、急诊服务的使用、死亡率和总体医疗保健费用。结果：干预组95% %的病例安排了家访，而对照组为52% % （p <； 0.0001）。干预与较少的母亲与精神健康相关的再住院有关（RR=0.82, p <； 0.0001），并略微降低了母亲和婴儿的总体再住院率。死亡率没有变化。干预组的平均医疗费用略低。系统的出院计划可以提高护理的连续性，减少精神疾病的发病率。结论安排产后家访支持较好的治疗效果，并可提供适度的经济效益。

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引用次数: 0