Women and Birth最新文献_第6页

Psychological implications of attending a birth review: A pre-post observational study of birth experience and post-traumatic stress symptoms 参加出生回顾的心理影响：出生经历和创伤后应激症状的前后观察研究。

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-10-01 DOI: 10.1016/j.wombi.2025.102110

Lucy Jones , Emma Williamson , Hannah Twiddy , Charlotte Krahé , Alison Brodrick , Pauline Slade

Background

Birth reviews provide a space to talk about birth experiences. Women report finding them helpful, but their specific psychological impact has not been explored. This study investigated whether childbirth experience, perception of birth as traumatic, post-traumatic stress symptoms, shame, and self-compassion changed following a birth review. Psychological flexibility was also examined as a potential predictor of any changes.

Method

Women in the postnatal period (N = 211), who had been referred or self-referred for a birth review, were invited to participate in a pre-post observational study. Birth reviews were completed by midwives from the maternal mental health service trained in the five-step model for listening to women after childbirth. Birth reviews form part of an integrated childbirth trauma service with potential for psychological referral. Eighty-five participants completed baseline measures examining childbirth experience, post-traumatic stress symptoms, shame, self-compassion, and psychological flexibility before their birth review. Two to six weeks after their birth review, 70 participants repeated the same measures. Pre-post comparisons from 70 women were analysed, as well as conducting intention-to-treat analyses.

Results

Perception of the birth as traumatic significantly reduced, and perception of childbirth experience, levels of shame, and post-traumatic stress symptoms all significantly improved following birth review. There was no significant change in total self-compassion. Psychological flexibility did not predict post-review scores when controlling for baseline levels.

Conclusions

Midwifery birth reviews using the presented model may improve perceptions of childbirth and reduce traumatic birth perception, post-traumatic stress symptoms, and trauma-related shame. A randomised controlled trial is now required.

背景：出生回顾提供了一个谈论出生经历的空间。女性报告说它们很有帮助，但它们具体的心理影响还没有被研究过。本研究调查了分娩经历、对分娩创伤的感知、创伤后应激症状、羞耻感和自我同情在分娩复查后是否发生了变化。心理灵活性也被视为任何变化的潜在预测因素。方法：产后妇女（N = 211），被推荐或自我推荐进行出生检查，被邀请参加一项前后观察性研究。分娩审查由产妇心理健康服务机构的助产士完成，助产士接受过五步模式的培训，以便在分娩后倾听妇女的意见。分娩复查是综合分娩创伤服务的一部分，具有心理转诊的潜力。85名参与者在分娩前完成了分娩经历、创伤后应激症状、羞耻感、自我同情和心理灵活性的基线测量。在出生后两到六周，70名参与者重复了同样的测量方法。对70名妇女的前后比较进行了分析，并进行了意向治疗分析。结果：分娩创伤性知觉显著降低，分娩经验知觉、羞耻感、创伤后应激症状均显著改善。总的自我同情没有显著的变化。在控制基线水平时，心理灵活性并不能预测回顾后的得分。结论：使用本模型的助产士分娩回顾可以改善分娩感知，减少创伤性分娩感知、创伤后应激症状和创伤相关羞耻感。现在需要进行随机对照试验。

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引用次数: 0

Midwives' preparedness for climate change impacts on maternal and child health: A scoping review 助产士对气候变化对母婴健康影响的准备：范围审查。

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-09-30 DOI: 10.1016/j.wombi.2025.102112

Jutharat Attawet , Pratibha Bhandari , Teresa Lewis , Cong Wang , Yunjing Qiu

Background

Midwives are frontline healthcare providers for pregnant women, yet gaps in their knowledge and training on extreme heat and air pollution limit their ability to provide effective care during these climate-related challenges.

Objective

This scoping review aimed to explore midwives' knowledge, adaptation, and preparedness for caring for pregnant women during climate change-related events, with a focus on extreme heat and air pollution.

Method

A scoping review was conducted using the Joanna Briggs Institute (JBI) methodology. A total of 272 articles were retrieved from multiple databases, of which five studies met the inclusion criteria. The included studies comprised qualitative, quantitative, mixed-method, case study, and review designs.

Findings

The review revealed two key areas. First, midwives demonstrated varying levels of knowledge and preparedness regarding climate change-related events, particularly extreme heat and air pollution, with implications for maternal and child health. Second, barriers and enablers were identified: limited training, weak institutional support, and inadequate policies hindered practice, whereas professional development initiatives and supportive leadership acted as enablers.

Conclusion

The findings highlight an urgent need to integrate education on such climate change-related events into midwifery training. Strengthening midwives' knowledge and preparedness is essential to empower them in safeguarding maternal and child health amidst growing climate-related challenges.

背景：助产士是孕妇的一线医疗保健提供者，但他们在极端高温和空气污染方面的知识和培训方面的差距限制了他们在这些与气候相关的挑战中提供有效护理的能力。目的：本综述旨在探讨助产士在气候变化相关事件期间照顾孕妇的知识、适应和准备情况，重点是极端高温和空气污染。方法：采用乔安娜布里格斯研究所（JBI）的方法进行范围审查。从多个数据库中共检索到272篇文章，其中5篇研究符合纳入标准。纳入的研究包括定性、定量、混合方法、案例研究和回顾设计。研究结果：综述揭示了两个关键领域。首先，助产士对与气候变化有关的事件，特别是对影响孕产妇和儿童健康的极端高温和空气污染，表现出不同程度的知识和准备。其次，确定了障碍和促成因素：有限的培训、薄弱的制度支持和不充分的政策阻碍了实践，而专业发展倡议和支持性领导则是促成因素。结论：研究结果强调了将此类气候变化相关事件的教育纳入助产培训的迫切需要。加强助产士的知识和准备工作对于增强她们在日益严峻的气候相关挑战中保护孕产妇和儿童健康的能力至关重要。

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引用次数: 0

Economic evaluation and budget impact analysis of midwifery-led care for low-risk pregnancies in Portugal 葡萄牙助产士主导的低风险妊娠护理的经济评价和预算影响分析。

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-09-29 DOI: 10.1016/j.wombi.2025.102109

Andreia Soares Goncalves , Ana Paula Prata , Christine McCourt , Richard Ssegonja , Filipa Sampaio

Background

Midwifery-led models of care for low-risk pregnancies are associated with improved outcomes for mothers and babies, without additional adverse effects. These models are also considered more cost-effective than doctor-led or shared-care approaches.

Problem

In Portugal, midwifery-led antenatal care is not widely implemented, and its economic impact remains unexplored.

Aim

To estimate the cost implications of implementing a midwifery-led antenatal care model for low-risk pregnancies in Portugal, compared to standard doctor-led care, from the perspective of the Portuguese National Health Service.

Methods

A decision-tree model was developed to simulate the antenatal period through birth, comparing midwifery-led and doctor-led care. The eligible population included low-risk pregnant women. Outcomes included preterm birth, spontaneous vaginal birth, instrumental birth, and caesarean section. A budget impact analysis estimated the financial implications for the national health service. Sensitivity and scenario analyses tested the robustness of findings by varying key parameters and assumptions.

Findings

Midwifery-led care was estimated to cost €23.08 million, compared to €39.35 million for doctor-led care, resulting in projected savings of €16.27 million. Lower rates of preterm birth, instrumental deliveries, and caesarean sections, alongside increased spontaneous vaginal births, accounted for €10.07 million in cost-offsets. Total savings were estimated at €26.34 million, or €340 per pregnancy/birth, representing a 25.8 % reduction in maternity-related expenditure.

Discussion and conclusion

Midwifery-led care presents a promising, cost-saving alternative to the current standard of care in Portugal, with the potential to improve clinical outcomes and optimize resource use.

Further research is needed to evaluate long-term economic and health impacts beyond birth.

背景：助产士主导的低风险妊娠护理模式与母亲和婴儿的预后改善有关，没有额外的不良反应。这些模式也被认为比医生主导的或共享的医疗方式更具成本效益。问题：在葡萄牙，助产士主导的产前保健没有得到广泛实施，其经济影响仍未得到探索。目的：从葡萄牙国家卫生服务的角度，与标准的医生主导的护理相比，估计在葡萄牙实施助产士主导的低风险妊娠产前护理模式的成本影响。方法：建立决策树模型，模拟产前至分娩过程，比较助产士主导和医生主导的护理。符合条件的人群包括低风险孕妇。结果包括早产、自然阴道分娩、器械分娩和剖腹产。一项预算影响分析估计了对国家保健服务的财政影响。敏感性和情景分析通过改变关键参数和假设来检验结果的稳健性。研究结果：助产士主导的护理费用估计为2308万欧元，而医生主导的护理费用为3935万欧元，预计可节省1627万欧元。较低的早产、器械分娩和剖腹产率，以及自然阴道分娩的增加，抵消了1007万欧元的成本。节省的总费用估计为2634万欧元，即每次怀孕/分娩340欧元，与产妇有关的开支减少了25.8% %。讨论和结论：助产士主导的护理提出了一个有前途的，节省成本的替代方案，目前的护理标准在葡萄牙，具有改善临床结果和优化资源利用的潜力。需要进一步的研究来评估出生以外的长期经济和健康影响。

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引用次数: 0

Coping strategies and interventions to prevent and alleviate work-related burnout in midwives: A rapid scoping review of quantitative and qualitative research 应对策略和干预措施，以防止和减轻助产士工作倦怠：定量和定性研究的快速范围审查

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-09-25 DOI: 10.1016/j.wombi.2025.102107

Hannah M. Brennan , Hannah A. Long , Catherine Chmiel , Debbie M. Smith

Problem

Work-related burnout in healthcare is a public health crisis. It is particularly prevalent in midwives, due to high workloads, staff shortages, and the emotional demands of providing care for birthing women. Burnout affects midwives’ wellbeing and ability to provide high-quality care, exacerbating workforce challenges.

Background

Coping strategies and interventions to prevent and alleviate work-related burnout in midwives have been described in the literature.

Aim

Identify and describe the evidence on coping strategies and interventions to prevent and alleviate work-related burnout in midwives.

Methods

A rapid scoping review was conducted with systematic searches in four electronic databases. Three reviewers screened and extracted the data on reported coping strategies and interventions, which were collated and presented in a narrative format.

Findings

7379 articles were identified, and twenty-one articles were included. Five overarching types of coping strategies to prevent and alleviate burnout in midwives were present in the included studies: Support and understanding from colleagues; Structured support from the workplace; Support from friends and family; Ability to reflect and learn professionally and personally from events; Awareness of self-care techniques for use in practice and after events.

Discussion and conclusion

Maternity services must prioritise workforce wellbeing by increasing the focus on preventing and alleviating burnout to support the retention of midwives and ensure the safe, effective care of women. Future research could focus on exploring how practical support for midwives, such as supervision and debriefing could be implemented effectively, and identify realistic, sustainable ways to integrate psychology-informed approaches into midwifery practice.

医疗保健行业的工作倦怠是一场公共卫生危机。由于工作量大、人员短缺以及为分娩妇女提供护理的情感需求，这种情况在助产士中尤为普遍。职业倦怠影响助产士的健康和提供高质量护理的能力，加剧了劳动力的挑战。在文献中描述了应对策略和干预措施，以预防和减轻助产士的工作倦怠。目的确定和描述有关应对策略和干预措施的证据，以预防和减轻助产士的工作倦怠。方法系统检索4个电子数据库，进行快速范围综述。三名审稿人筛选并提取了报告的应对策略和干预措施的数据，并将其整理并以叙述形式呈现。共发现7379篇文献，纳入21篇文献。在纳入的研究中，有五种主要的应对策略可以预防和缓解助产士的职业倦怠：同事的支持和理解；来自工作场所的结构化支持；来自朋友和家人的支持；从事件中反思和学习的能力；意识到在实践和事件后使用的自我护理技巧。讨论和结论：产科服务必须优先考虑员工的福祉，增加对预防和减轻职业倦怠的关注，以支持助产士的保留，并确保对妇女的安全、有效护理。未来的研究可以集中在探索如何有效地实施对助产士的实际支持，如监督和汇报，并确定现实的、可持续的方法，将心理知情方法整合到助产实践中。

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引用次数: 0

The psychological impacts of climate change on pregnant women in Türkiye 气候变化对日本孕妇的心理影响。

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-09-24 DOI: 10.1016/j.wombi.2025.102111

Merve Işık , Pınar Akbaş , Sultan Özkan Şat

Background

Climate change poses serious risks to both physical and mental health. Pregnant women are especially vulnerable, as the stress and anxiety associated with this period may be intensified by climate-related challenges, potentially affecting maternal well-being and pregnancy outcomes.

Aim

This study was conducted to determine the repercussions of climate change on the mental health of pregnant women.

Methods

This study utilized a descriptive qualitative design. The data were collected by holding individual semi-structured interviews with pregnant women (n = 17). Thematic analysis was used to analyse the data.

Results

The main themes of this study were ‘anxiety and insecurity about the future,’ ‘psychological burdens caused by climate change,’ ‘coping with psychological burdens associated with the impact of climate change,’ and ‘expectations from healthcare professionals’. The main themes consist of six sub-themes: ‘concerns about the future of children,’ ‘uncertainty about the future,’ ‘climate anxiety and stress,’ ‘sense of ecological loss and sadness,’ ‘avoidance,’ and ‘spiritual practices’.

Conclusion

Climate change adversely affects the quality of life of pregnant women and imposes a significant burden on their mental health. Healthcare professionals should integrate climate-related awareness and coping strategies into their practice and promote broader public awareness. Such efforts can contribute to policies that safeguard the rights of pregnant women and their families to live in a healthy and sustainable environment.

背景：气候变化对身心健康都构成严重风险。孕妇尤其脆弱，因为与此相关的压力和焦虑可能会因气候相关的挑战而加剧，从而可能影响孕产妇福祉和妊娠结果。目的：本研究旨在确定气候变化对孕妇心理健康的影响。方法：本研究采用描述性定性设计。数据是通过对孕妇进行单独的半结构化访谈收集的（n = 17）。采用主题分析法对数据进行分析。结果：本研究的主题为“对未来的焦虑和不安全感”、“气候变化引起的心理负担”、“应对与气候变化影响相关的心理负担”和“医疗保健专业人员的期望”。主题由六个子主题组成：“对儿童未来的担忧”、“对未来的不确定性”、“气候焦虑和压力”、“生态损失和悲伤感”、“回避”和“精神实践”。结论：气候变化对孕妇的生活质量产生不利影响，并对其心理健康造成重大负担。卫生保健专业人员应将与气候有关的意识和应对策略纳入其实践，并促进更广泛的公众意识。这种努力有助于制定政策，保障孕妇及其家庭在健康和可持续环境中生活的权利。

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引用次数: 0

Midwives' perceptions of support for new graduates: A survey that compared support from midwives who provide continuity of care with midwives from other models of care 助产士对新毕业生支持的看法：一项比较提供连续性护理的助产士与其他护理模式助产士支持的调查

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-09-23 DOI: 10.1016/j.wombi.2025.102108

Virginia M. Stulz , Linda Sweet , Deborah Davis , Vanessa Scarf , Michelle Gray , Marnie Griffiths , Lois McKellar , Athena Sheehan , Carolyn Hastie , Elaine Jefford , Allison Cummins

Problem

It is unknown if graduate midwives receive similar support from midwives providing continuity of care and midwives not working in continuity models.

Background

All new graduate midwives require support as they transition from student to practitioner regardless of model of care in which they work. New graduate midwives are keen to work in continuity of care models but require good mentorship.

Aim

To compare the perceptions of support provided by midwives to new graduates between those working in continuity of care models and those not working in those models.

Methods

A cross-sectional study design with an online survey was undertaken. Quantitative analyses included descriptive statistics and independent t-tests. Content analysis was used for the open-ended questions data.

Findings

Both groups of midwives reported it was important for new graduates to have knowledge and continue lifelong learning. Both groups of midwives also reported the importance of new graduates being involved in decision-making. Midwives working in continuity of care models were more likely to role model desirable behaviours of self-care, provide supportive environments, and think that new graduates should have more opportunities to work in continuity of care with a reduced workload than midwives not in continuity models.

Conclusion

Midwives thought that it was important to listen to new graduates’ opinions and to value their opinions as an integral part of care. Mentoring and supporting new graduates with ongoing educational support and being inclusive is important for all regardless of model of care.

目前尚不清楚毕业生助产士是否从提供连续性护理的助产士和不从事连续性模式工作的助产士那里得到类似的支持。所有新毕业的助产士都需要支持，因为他们从学生过渡到从业者，无论他们工作的护理模式如何。新毕业的助产士热衷于在护理模式的连续性中工作，但需要良好的指导。目的比较在连续性护理模式下工作的助产士和不在连续性护理模式下工作的助产士对新毕业生提供支持的看法。方法采用在线调查的横断面研究设计。定量分析包括描述性统计和独立t检验。开放式问题数据采用内容分析。两组助产士都表示，对应届毕业生来说，掌握知识并继续终身学习很重要。两组助产士还报告了新毕业生参与决策的重要性。在连续性护理模式下工作的助产士更有可能成为自我护理理想行为的榜样，提供支持性环境，并认为新毕业生应该有更多机会在工作量减少的情况下从事连续性护理工作，而不是在连续性模式下的助产士。结论助产士认为倾听新毕业生的意见并重视他们的意见是护理工作的重要组成部分。指导和支持新毕业生的持续教育支持和包容性对所有人都很重要，无论护理模式如何。

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引用次数: 0

Postnatal care and pathways for childbirth-related perineal trauma in England: A qualitative study of healthcare professionals' experiences and perspectives on future development 产后护理和途径分娩相关的会阴创伤在英格兰：卫生保健专业人员的经验和未来发展的观点的定性研究

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-09-20 DOI: 10.1016/j.wombi.2025.102106

Amy Delicate , Sarah Hillman , Victoria Hodgetts Morton , R.Katie Morris , Rebecca Man , Laura Jones

Background

Perineal trauma is a common outcome of vaginal birth, affecting 8/10 women in the UK. While many injuries heal without issue, complications such as infection, wound breakdown, and pain can impact maternal recovery, daily functioning, and wellbeing. Despite the burden of complications, postnatal wound management remain inconsistent, with limited evidence to guide optimal care.

Purpose

To examine the current postnatal care provision and care pathways used by healthcare professionals to address childbirth-related perineal trauma in England and explore their views on enhancing care. Methods: The study was guided by an interpretive descriptive approach. Data was collected using semi-structured interviews with national health service healthcare professionals providing care to women following childbirth-related perineal trauma. Demographic data were analysed using descriptive statistics. Interview data were analysed by hybrid codebook thematic analysis.

Results

Healthcare professionals were interviewed in 2024 (N = 36). The current care provided for childbirth-related perineal trauma is described and represented visually, indicating that multiple care pathways and healthcare services are used. Healthcare professionals reported that improvements to childbirth-related perineal trauma care could come from enhancements to maternal awareness and information; healthcare professional education and training; and standardised evidence-based care pathways both for universal postnatal care and specialist childbirth-related perineal trauma care.

Conclusions

This study offers a unique insight postnatal care for women following childbirth-related perineal trauma in England, revealing a complex and regionally variable landscape. Healthcare professionals highlighted the need for greater standardisation and targeted improvements in care pathways to enhance outcomes for women.

背景会阴创伤是阴道分娩的常见后果，影响了英国8/10的女性。虽然许多伤口可以毫无问题地愈合，但感染、伤口破裂和疼痛等并发症会影响产妇的康复、日常功能和健康。尽管有并发症的负担，产后伤口管理仍然不一致，指导最佳护理的证据有限。目的探讨英国医疗保健专业人员处理分娩相关会阴创伤的产后护理和护理途径的现状，并探讨他们对加强护理的看法。方法：本研究采用解释性描述方法。数据收集采用半结构化访谈与国家卫生服务保健专业人员提供护理的妇女分娩相关的会阴创伤。人口统计数据采用描述性统计进行分析。访谈数据采用混合代码本主题分析方法进行分析。结果2024年受访卫生专业人员（N = 36）。目前提供的护理分娩相关的会阴创伤是描述和视觉表示，表明多种护理途径和医疗服务的使用。医疗保健专业人员报告说，改善与分娩有关的会阴创伤护理可以通过提高产妇的意识和信息来实现；医疗保健专业教育和培训；以及标准化的循证护理途径，用于普遍的产后护理和与分娩相关的会阴创伤专科护理。结论：本研究为英国分娩相关会阴创伤妇女的产后护理提供了独特的见解，揭示了一个复杂的地区差异景观。保健专业人员强调，需要加强标准化和有针对性地改进护理途径，以提高妇女的治疗效果。

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引用次数: 0

Shaping a sustainable future: Climate-related stress and violence among women of reproductive age: A systematic review 塑造可持续未来：育龄妇女的气候相关压力和暴力：系统综述

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-09-13 DOI: 10.1016/j.wombi.2025.102092

Yasmine M. Osman , Marwa Mamdouh Shaban , Mostafa Shaban

Problem

Climate change is an escalating global crisis with disproportionate effects on women, particularly regarding exposure to gender-based violence (GBV). Yet, the intersection between climate-related stressors and GBV among women of reproductive age remains underexplored.

Background

Environmental disruptions such as droughts, heatwaves, and floods are increasingly linked to violence against women. These stressors often intensify economic hardship, displacement, and psychosocial stress—factors known to elevate GBV risk.

Aim

To systematically examine the association between climate-related stressors and experiences of GBV, including intimate partner violence (IPV), sexual violence, and child marriage among women aged 15–49 years.

Methods

A systematic review was reported in accordance with PRISMA 2020. Six databases were searched for peer-reviewed studies (2010–2024) reporting empirical data on climate stressors and GBV. Eligible studies included quantitative or mixed-methods research focused on women of reproductive age. Data were extracted and assessed for risk of bias using the ROBVIS tool.

Findings

Seventeen studies met inclusion criteria. Most were from low- and middle-income countries. Droughts and extreme heat were consistently associated with increased IPV, child marriage, and sexual violence. Mediating factors included displacement, food insecurity, and mental health challenges.

Discussion

Climate-related stressors amplify GBV risks via multiple pathways. Displacement, economic strain, and disrupted social protection mechanisms heighten women's vulnerability during environmental crises.

Conclusion

Climate adaptation efforts must incorporate gender-responsive strategies to prevent and respond to GBV. Addressing this intersection is essential to safeguard women’s health, rights, and resilience in a warming world.

气候变化是一场不断升级的全球危机，对妇女的影响尤为严重，尤其是在遭受性别暴力方面。然而，与气候相关的压力因素与育龄妇女的性别暴力之间的交叉关系仍未得到充分探讨。干旱、热浪和洪水等环境破坏日益与针对妇女的暴力行为联系在一起。这些压力源通常会加剧经济困难、流离失所和已知会增加性别暴力风险的社会心理压力因素。目的系统地研究15-49岁妇女中与气候相关的压力源与性别暴力经历之间的关系，包括亲密伴侣暴力（IPV）、性暴力和童婚。方法按照PRISMA 2020进行系统评价。在六个数据库中检索了同行评议的研究（2010-2024），这些研究报告了气候压力源和GBV的经验数据。符合条件的研究包括以育龄妇女为重点的定量或混合方法研究。使用ROBVIS工具提取数据并评估偏倚风险。17项研究符合纳入标准。大多数来自低收入和中等收入国家。干旱和极端高温一直与IPV、童婚和性暴力的增加有关。中介因素包括流离失所、粮食不安全和心理健康挑战。气候相关压力因素通过多种途径放大性别暴力风险。流离失所、经济紧张和社会保护机制中断加剧了妇女在环境危机中的脆弱性。气候适应工作必须纳入促进性别平等的战略，以预防和应对性别暴力。解决这一交叉问题对于在变暖的世界中保障妇女的健康、权利和复原力至关重要。

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引用次数: 0

Implementation of midwifery units in the Portuguese context: Barriers and facilitators 葡萄牙助产单位的实施：障碍和促进因素

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-09-11 DOI: 10.1016/j.wombi.2025.102096

Sara D.C. Paz , Andreia S. Goncalves , Filipa Sampaio , Ana Paula Prata

Background

In Portugal, childbirth predominantly occurs in Obstetric Units, even for low-risk pregnancies, often resulting in excessive medical interventions. Midwifery Units, successfully integrated into health systems comparable to the Portuguese National Health System may be a viable alternative.

Aim

This study explores stakeholders’ perceptions of the barriers and facilitators to the implementation of Midwifery Units in Portugal.

Methods

A qualitative, descriptive-exploratory study was conducted using semi-structured interviews for data collection.

Findings

Two overarching themes emerged: implementation readiness and implementation strategies. The first encompasses cultural, organizational, professional, and political dimensions. The second focuses on the professional positioning of midwifery in Portugal, its hierarchical relationship with other healthcare professions, and the structural characteristics of the health system.

Discussion

The primary barriers to implementing Midwifery Units are deeply rooted in the prevailing physician-led maternity care model in Portugal. However, the current challenges within the National Health System, along with ongoing restructuring efforts, create an opportunity for change. Key facilitators include the aim of reducing unnecessary interventions, promoting humanized care, expanding women's autonomy in childbirth, and aligning practices with contemporary scientific evidence.

Conclusion

The study highlights that while structural and cultural barriers persist, a convergence of social, professional, and institutional facilitators may offer a strategic window for integrating Continuity of Midwife Care in Portugal. Tailored implementation strategies, interprofessional collaboration, and policy advocacy are required to translate existing evidence into national practice.

在葡萄牙，分娩主要发生在产科病房，即使是低风险妊娠，也常常导致过度的医疗干预。与葡萄牙国家卫生系统相比，成功地纳入卫生系统的助产单位可能是一个可行的替代方案。目的本研究探讨了利益相关者对在葡萄牙实施助产单位的障碍和促进因素的看法。方法采用半结构化访谈法进行定性、描述性、探索性研究。出现了两个主要主题：实施准备情况和实施战略。第一个包括文化、组织、专业和政治层面。第二个重点是葡萄牙助产的专业定位，其与其他医疗保健专业的等级关系，以及卫生系统的结构特征。实施助产单位的主要障碍深深植根于葡萄牙盛行的医生主导的产妇护理模式。然而，国家卫生系统目前面临的挑战，以及正在进行的改革努力，为变革创造了机会。主要的促进因素包括减少不必要的干预措施，促进人性化护理，扩大妇女在分娩中的自主权，并使实践与当代科学证据保持一致。该研究强调，尽管结构性和文化障碍仍然存在，但社会、专业和机构促进者的融合可能为整合葡萄牙助产士护理的连续性提供战略窗口。要将现有证据转化为国家实践，需要有针对性的实施战略、专业间合作和政策宣传。

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引用次数: 0

‘Still struggling, but there is a small glimmer of light at the end of the tunnel’ – Individual in-depth interviews six-months after stillbirth: A follow-up study in Sweden “仍在挣扎，但隧道尽头有一线曙光”——瑞典的一项随访研究：死产6个月后的个人深度访谈

IF 4.1 2区医学 Q1 NURSING

Women and Birth

Pub Date : 2025-09-09 DOI: 10.1016/j.wombi.2025.102091

Berit Höglund , Ingegerd Hildingsson

Background

Few parents experience stillbirth in Sweden, and their perspectives on the grieving process remain largely unknown.

Objective

To explore parents’ perspectives, memories, reflections and insights in the grieving and recovery process six months after stillbirth.

Methods

A mixed-method study involving nine in-depth interviews and responses to eleven quantitative statements. Data were analysed using descriptive statistics and thematic network analysis.

Results

Two themes were identified ‘Retained indelible deep memories of the loss and increased insights into the tragic life-changing event’ and ‘The continued grieving process, quality of life and new pregnancy’. These themes captured parents’ ongoing grief and reflections. Six months later, parents reported gaining insights into unforeseen pregnancy abnormalities. Some announced new pregnancies, desiring extended medical checks by both midwives and obstetricians. There was a widespread request for tailored psychological support throughout pregnancy. Qualitative findings were reinforced by the quantitative statements.

Conclusions

Stillbirth profoundly affects parents long-term, with deep grief and memories. They develop coping strategies to strengthen their mental health. However, after six months, they begin to see a small glimmer of light at the end of the tunnel.

在瑞典，很少有父母经历过死胎，他们对悲伤过程的看法在很大程度上仍然未知。目的探讨死产6个月后父母在悲痛和恢复过程中的观点、记忆、反思和见解。方法采用混合方法进行研究，包括9个深度访谈和11个定量陈述的回答。数据分析采用描述性统计和专题网络分析。结果确定了两个主题：“保留对失去亲人的不可磨灭的深刻记忆，增加对改变生活的悲惨事件的洞察力”和“持续的悲伤过程，生活质量和新怀孕”。这些主题捕捉到了父母们持续的悲伤和反思。六个月后，父母们报告说，他们发现了意外的妊娠异常。有些人宣布怀孕，希望助产士和产科医生进行更多的医疗检查。在整个怀孕期间，普遍要求提供量身定制的心理支持。定量的陈述加强了定性的发现。结论死产对父母的影响是长期的，具有深刻的悲伤和记忆。他们制定应对策略来加强他们的心理健康。然而，六个月后，他们开始看到隧道尽头的一丝曙光。

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引用次数: 0