Sexual & Reproductive Healthcare最新文献_第5页

Comment on the study by Aanstad et al. “Intrapartum fetal monitoring practices in Norway: A population-based study” 就 Aanstad 等人的研究 "挪威的产前胎儿监护实践：基于人口的研究"

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-08-23 DOI: 10.1016/j.srhc.2024.101018

Katariina Laine , Sari Räisänen , Branka M. Yli , Tiril Tingleff

引用次数: 0

A low cesarean section rate is not a reason for overusing CTG 剖宫产率低不是过度使用 CTG 的理由

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-08-23 DOI: 10.1016/j.srhc.2024.101017

Kristin Jerve Aanstad , Are Hugo Pripp , Rebecka Dalbye , Aase Devold Pay , Anne Cathrine Staff , Anne Kaasen , Ellen Blix

引用次数: 0

A qualitative study of the experience of doula support to women in socially disadvantaged positions in Sweden: The voices of women and doulas 对瑞典处于社会弱势地位的妇女获得朵拉支持的经验进行定性研究：妇女和助产士的声音

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-08-15 DOI: 10.1016/j.srhc.2024.101016

Pia Gudmundsson , Helen Elden , Anna Larsson , Johanna Sundén , Anja Björkman , Helena Tegnér , Karolina Linden

Background

Women in socially disadvantaged positions face increased risk of fear of birth, birth complications, and postpartum depression, highlighting the need for targeted interventions for this group. Doula support is associated with positive emotional and medical outcomes for mother and child. Experience of doula support for women in socially disadvantaged positions in Sweden remains unexplored.

Aim

To describe experiences of doula support within a project for women in socially disadvantaged positions in Sweden.

Methods

In-depth interviews with seven women and focus group discussions with twelve doulas in a Doula support project were conducted. Data was analysed with inductive content analysis.

Results

Women and doulas described experiences of doula support as a significant relationship with challenges, due to unclear boundaries for the support, and the time and trust needed to establish the relationship. The support was perceived as comprehensive, far exceeding traditional doula support, with extensive assistance provided postpartum. The project was regarded as meaningful, and that it led to positive birth experiences.

Conclusions

Women in socially disadvantaged positions may benefit from doula support during the perinatal period. The support fosters feelings of calmness, security and empowerment, and alleviates feelings of isolation, which is crucial for a positive birth experience. Support for these women is complex due to increased social needs, leading to unclear expectations of the doula’s role. Support from colleagues is deemed crucial. Future projects should establish clear frameworks and a supportive structure for doulas.

背景处于社会弱势地位的妇女面临着更高的分娩恐惧、分娩并发症和产后抑郁风险，这突出表明需要对这一群体进行有针对性的干预。朵拉支持与母婴的积极情感和医疗结果相关。目的描述瑞典社会弱势妇女在一个项目中获得朵拉支持的经验。方法在一个朵拉支持项目中对七名妇女进行了深入访谈，并对十二名朵拉进行了焦点小组讨论。结果妇女和朵拉将朵拉支持描述为一种具有挑战性的重要关系，这是因为支持的界限不明确，以及建立这种关系需要时间和信任。朵拉的支持被认为是全面的，远远超过了传统的朵拉支持，并在产后提供了广泛的帮助。结论处于社会弱势地位的妇女在围产期可能会从朵拉支持中受益。朵拉的支持可促进平静感、安全感和力量感，并减轻孤独感，这对积极的分娩体验至关重要。由于社会需求的增加，对这些妇女的支持非常复杂，导致对朵拉角色的期望不明确。来自同事的支持被认为是至关重要的。未来的项目应为朵拉建立明确的框架和支持性结构。

{"title":"A qualitative study of the experience of doula support to women in socially disadvantaged positions in Sweden: The voices of women and doulas","authors":"Pia Gudmundsson , Helen Elden , Anna Larsson , Johanna Sundén , Anja Björkman , Helena Tegnér , Karolina Linden","doi":"10.1016/j.srhc.2024.101016","DOIUrl":"10.1016/j.srhc.2024.101016","url":null,"abstract":"<div><h3>Background</h3><p>Women in socially disadvantaged positions face increased risk of fear of birth, birth complications, and postpartum depression, highlighting the need for targeted interventions for this group. Doula support is associated with positive emotional and medical outcomes for mother and child. Experience of doula support for women in socially disadvantaged positions in Sweden remains unexplored.</p></div><div><h3>Aim</h3><p>To describe experiences of doula support within a project for women in socially disadvantaged positions in Sweden.</p></div><div><h3>Methods</h3><p>In-depth interviews with seven women and focus group discussions with twelve doulas in a Doula support project were conducted. Data was analysed with inductive content analysis.</p></div><div><h3>Results</h3><p>Women and doulas described experiences of doula support as a significant relationship with challenges, due to unclear boundaries for the support, and the time and trust needed to establish the relationship. The support was perceived as comprehensive, far exceeding traditional doula support, with extensive assistance provided postpartum. The project was regarded as meaningful, and that it led to positive birth experiences.</p></div><div><h3>Conclusions</h3><p>Women in socially disadvantaged positions may benefit from doula support during the perinatal period. The support fosters feelings of calmness, security and empowerment, and alleviates feelings of isolation, which is crucial for a positive birth experience. Support for these women is complex due to increased social needs, leading to unclear expectations of the doula’s role. Support from colleagues is deemed crucial. Future projects should establish clear frameworks and a supportive structure for doulas.</p></div>","PeriodicalId":54199,"journal":{"name":"Sexual & Reproductive Healthcare","volume":"41 ","pages":"Article 101016"},"PeriodicalIF":1.4,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1877575624000715/pdfft?md5=81182be8bffc98986fbcc7c3782c1741&pid=1-s2.0-S1877575624000715-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142002371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

“But I’m not a professional” − How women with high-risk pregnancies voice the experiences of home-based telemonitoring; a qualitative interview study "但我不是专业人员"--高危妊娠妇女如何表达家庭远程监控的体验；定性访谈研究

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-08-10 DOI: 10.1016/j.srhc.2024.101015

Jane M. Bendix , Mikala Heinsen , Mette G. Backhausen

Objectives

Telemonitoring of high-risk pregnancy complications is a new approach that offers remote obstetric caregiving using mobile and wireless technologies. New evidence shows that home-based obstetric telemonitoring is not only feasible but also a safe alternative to inpatient or frequent outpatient care. As little is known how performing obstetric telemonitoring is perceived, this study examined how women with pregnancy complications experienced performing home-based telemonitoring.

Methods

A qualitative, semi-structured interview study was conducted with women with ongoing experience in performing home-based telemonitoring procedures for high-risk pregnancy complications. Purposeful sampling strategy and data saturation were applied followed by verbatim transcription. The data were analyzed using systematic text condensation.

Results

Fifteen informants participated in the study and four major themes emerged. The study revealed that performing telemonitoring was overall positively experienced as an ‘Empowering yet challenging responsibility’ as well as an ‘Extended patient-clinician partnership.’ There were pros and cons as to the influence of telemonitoring in everyday life; ‘Tele-comfort yet ambivalence’ and that it could be accompanied by annoying practical issues; ‘Accompanying remote issues.’

Conclusions

Performing obstetric telemonitoring was experienced as an empowering yet challenging responsibility as well as an extended partnership between the clinician and the pregnant woman. Pros and cons were voiced as to the influence and ambivalence of telemonitoring in everyday life, and that it could be accompanied by annoying practical issues. Patient aspects and experiences of telemonitoring are important clinical knowledge that must be considered when a telemonitoring plan is tailored preferably in a shared decision-making process.

目的远程监测高危妊娠并发症是一种新方法，它利用移动和无线技术提供远程产科护理。新的证据表明，基于家庭的产科远程监护不仅可行，而且是住院或频繁门诊护理的安全替代方案。由于人们对实施产科远程监护的看法知之甚少，本研究探讨了患有妊娠并发症的妇女在实施家庭远程监护过程中的体验。研究方法：本研究采用半结构式定性访谈的方式，采访了在实施高危妊娠并发症家庭远程监护过程中具有丰富经验的妇女。采用了有目的的抽样策略和数据饱和，然后进行逐字记录。结果15 位信息提供者参与了研究，并提出了四大主题。研究显示，进行远程监控总体上是一种积极的体验，被认为是一种 "赋权而又具有挑战性的责任 "以及一种 "病人与医生之间的扩展合作关系"。对于远程监护在日常生活中的影响；"远程舒适感与矛盾感"，以及可能伴随着恼人的实际问题；"伴随着远程问题"，既有优点也有缺点。人们对远程监护在日常生活中的影响和矛盾性提出了利弊意见，并认为远程监护可能伴随着恼人的实际问题。患者对远程监护的看法和体验是重要的临床知识，在制定远程监护计划时必须加以考虑，最好是在共同决策过程中加以考虑。

{"title":"“But I’m not a professional” − How women with high-risk pregnancies voice the experiences of home-based telemonitoring; a qualitative interview study","authors":"Jane M. Bendix , Mikala Heinsen , Mette G. Backhausen","doi":"10.1016/j.srhc.2024.101015","DOIUrl":"10.1016/j.srhc.2024.101015","url":null,"abstract":"<div><h3>Objectives</h3><p>Telemonitoring of high-risk pregnancy complications is a new approach that offers remote obstetric caregiving using mobile and wireless technologies. New evidence shows that home-based obstetric telemonitoring is not only feasible but also a safe alternative to inpatient or frequent outpatient care. As little is known how performing obstetric telemonitoring is perceived, this study examined how women with pregnancy complications experienced performing home-based telemonitoring.</p></div><div><h3>Methods</h3><p>A qualitative, semi-structured interview study was conducted with women with ongoing experience in performing home-based telemonitoring procedures for high-risk pregnancy complications. Purposeful sampling strategy and data saturation were applied followed by verbatim transcription. The data were analyzed using systematic text condensation.</p></div><div><h3>Results</h3><p>Fifteen informants participated in the study and four major themes emerged. The study revealed that performing telemonitoring was overall positively experienced as an ‘Empowering yet challenging responsibility’ as well as an ‘Extended patient-clinician partnership.’ There were pros and cons as to the influence of telemonitoring in everyday life; ‘Tele-comfort yet ambivalence’ and that it could be accompanied by annoying practical issues; ‘Accompanying remote issues.’</p></div><div><h3>Conclusions</h3><p>Performing obstetric telemonitoring was experienced as an empowering yet challenging responsibility as well as an extended partnership between the clinician and the pregnant woman. Pros and cons were voiced as to the influence and ambivalence of telemonitoring in everyday life, and that it could be accompanied by annoying practical issues. Patient aspects and experiences of telemonitoring are important clinical knowledge that must be considered when a telemonitoring plan is tailored preferably in a shared decision-making process.</p></div>","PeriodicalId":54199,"journal":{"name":"Sexual & Reproductive Healthcare","volume":"41 ","pages":"Article 101015"},"PeriodicalIF":1.4,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1877575624000703/pdfft?md5=d1833e7cdc6659071f25be21941639e3&pid=1-s2.0-S1877575624000703-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Optimizing the role of midwives in humanitarian and developmental settings 优化助产士在人道主义和发展环境中的作用

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-08-08 DOI: 10.1016/j.srhc.2024.101014

Tewodros Seyoum, Jama Ali Egal

引用次数: 0

Discrimination against Roma women during childbirth? Unraveling the underlying effects of ethnic and socio-economic factors 罗姆妇女在分娩时受到歧视？解读种族和社会经济因素的潜在影响。

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-08-05 DOI: 10.1016/j.srhc.2024.101013

Laura Szabó, Zsuzsanna Veroszta

Objective

This study aims to identify discrimination in maternity care experienced by Roma women in Hungary, due to ethnic and socio-economic factors.

Methods

We used data from the Cohort’18 Hungarian Birth Cohort Study, covering births in 2018–2019 (n = 7805). Face-to-face interviews were conducted by health visitors during pregnancy and six months postpartum. Differences in obstetric care were tested using Welch’s ANOVA. Logistic regression models estimated the influence of Roma ethnicity on birth position, adjusting for socio-economic variables. Odds ratios with 95 % confidence intervals and adjusted predictions were calculated.

Results

Roma mothers had a lower rate of caesarean section due to fewer planned interventions (13.3% vs. 19.1% for non-Roma mothers). Roma women were less likely than non-Roma women to have a birth attended by a private obstetrician (15% vs. 52.6%) and less likely to have a family member present at the birth (40% vs. 65.5%). For vaginal births, 61.3% of Roma women had their birth position dictated by hospital staff, compared with 40.6% of non-Roma women. Ethnic background significantly influenced the choice of birth position, but these associations were attenuated after adjustment for socio-economic and territorial factors. Variables such as the presence of a private obstetrician, family support, and residence in Central Hungary reduced the likelihood of giving birth in a fixed position.

Conclusion

Roma women face significant disadvantages in maternity care in Hungary. Ethnic background has a negative impact on the quality of care, but it is also significantly influenced by adverse socio-economic and regional factors.

目的：本研究旨在确定匈牙利罗姆妇女因种族和社会经济因素而在孕产妇护理方面遭受的歧视：本研究旨在确定匈牙利罗姆妇女因种族和社会经济因素而在产科护理方面遭受的歧视：我们使用了 Cohort'18 匈牙利出生队列研究的数据，涵盖了 2018-2019 年的新生儿（n = 7805）。健康访视员在孕期和产后六个月进行了面对面访谈。产科护理的差异采用韦尔奇方差分析进行检验。逻辑回归模型估算了罗姆族对胎位的影响，并对社会经济变量进行了调整。计算出了带有 95 % 置信区间的比率和调整后的预测值：结果：罗姆产妇的剖腹产率较低（13.3%，非罗姆产妇为 19.1%），原因是计划干预较少。与非罗姆妇女相比，罗姆妇女由私人产科医生接生的几率较低（15% 对 52.6%），由家人陪伴分娩的几率也较低（40% 对 65.5%）。对于阴道分娩，61.3%的罗姆妇女的分娩姿势由医院工作人员决定，而非罗姆妇女的这一比例为 40.6%。种族背景对分娩体位的选择有很大影响，但在对社会经济和地域因素进行调整后，这些相关性有所减弱。有私人产科医生、家庭支持和居住在匈牙利中部等变量降低了以固定体位分娩的可能性：结论：在匈牙利，罗姆妇女在产科护理方面面临严重的不利因素。种族背景对护理质量有负面影响，但不利的社会经济和地区因素也对其有重大影响。

{"title":"Discrimination against Roma women during childbirth? Unraveling the underlying effects of ethnic and socio-economic factors","authors":"Laura Szabó, Zsuzsanna Veroszta","doi":"10.1016/j.srhc.2024.101013","DOIUrl":"10.1016/j.srhc.2024.101013","url":null,"abstract":"<div><h3>Objective</h3><p>This study aims to identify discrimination in maternity care experienced by Roma women in Hungary, due to ethnic and socio-economic factors.</p></div><div><h3>Methods</h3><p>We used data from the Cohort’18 Hungarian Birth Cohort Study, covering births in 2018–2019 (n = 7805). Face-to-face interviews were conducted by health visitors during pregnancy and six months postpartum. Differences in obstetric care were tested using Welch’s ANOVA. Logistic regression models estimated the influence of Roma ethnicity on birth position, adjusting for socio-economic variables. Odds ratios with 95 % confidence intervals and adjusted predictions were calculated.</p></div><div><h3>Results</h3><p>Roma mothers had a lower rate of caesarean section due to fewer planned interventions (13.3% vs. 19.1% for non-Roma mothers). Roma women were less likely than non-Roma women to have a birth attended by a private obstetrician (15% vs. 52.6%) and less likely to have a family member present at the birth (40% vs. 65.5%). For vaginal births, 61.3% of Roma women had their birth position dictated by hospital staff, compared with 40.6% of non-Roma women. Ethnic background significantly influenced the choice of birth position, but these associations were attenuated after adjustment for socio-economic and territorial factors. Variables such as the presence of a private obstetrician, family support, and residence in Central Hungary reduced the likelihood of giving birth in a fixed position.</p></div><div><h3>Conclusion</h3><p>Roma women face significant disadvantages in maternity care in Hungary. Ethnic background has a negative impact on the quality of care, but it is also significantly influenced by adverse socio-economic and regional factors.</p></div>","PeriodicalId":54199,"journal":{"name":"Sexual & Reproductive Healthcare","volume":"41 ","pages":"Article 101013"},"PeriodicalIF":1.4,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Women’s experiences of maternal near miss: Qualitative findings from Malawi 妇女对孕产险情的经历：马拉维的定性研究结果。

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-07-31 DOI: 10.1016/j.srhc.2024.101012

Monica Patricia Malata , Alisa Jenny , Dilys Walker , Luis Aaron Gadama

Objective

This study explored the experiences of women with maternal near miss and their perceptions of the quality of care they received in three facilities in Malawi.

Methods

This study employed a qualitative phenomenological approach. Data were collected using in depth interviews and analysed using thematic content analysis. The data were collected in three hospitals between September and November 2020. The purposively selected participants were 18 women meeting criteria for maternal near miss related to obstetric haemorrhage (6), hypertensive disorders (7), sepsis (2) and ruptured ectopic pregnancy (3).

Results

Women’s experiences of maternal near miss fell under four broad themes; (a) realisation of the near miss; (b) religious beliefs and interpretation of near miss; (c) social and economic aspects of maternal near miss; and d) perceptions of quality of care. Women’s initial emotional responses were fear and anxiety but were soon overshadowed by the fear for their babies’ wellbeing. Most women perceived the care they received as timely, adequate, and respectful, yet many women also expressed that their service providers did not provide an opportunity to openly discuss their condition.

Conclusions

The experience of near miss goes beyond the immediate physical discomforts and has psychological, economic, and social consequences for women and their families. Despite women’s perception of care as respectful, there are still communication gaps with their service providers. Campaigns to improve the communication between providers and patients and their families in situation of severe morbidity warrant consideration.

目的本研究探讨了马拉维三家医疗机构中孕产妇险些失手的经历及其对所获医疗质量的看法：本研究采用定性现象学方法。数据收集采用深度访谈法，分析采用主题内容分析法。数据于 2020 年 9 月至 11 月期间在三家医院收集。有目的性地选取了 18 名符合孕产妇险情标准的妇女作为研究对象，她们分别患有产科出血（6 例）、高血压疾病（7 例）、败血症（2 例）和宫外孕破裂（3 例）：妇女对产妇险情的经历分为四大主题：(a) 意识到险情的发生；(b) 宗教信仰和对险情的解释；(c) 产妇险情的社会和经济方面；(d) 对护理质量的看法。妇女最初的情绪反应是恐惧和焦虑，但很快就被对婴儿健康的担忧所掩盖。大多数妇女认为她们得到的护理是及时、充分和受到尊重的，但许多妇女也表示，她们的服务提供者没有提供公开讨论她们病情的机会：险些失手的经历不仅仅是直接的身体不适，还会对妇女及其家庭造成心理、经济和社会影响。尽管妇女认为护理工作是受尊重的，但她们与服务提供者之间的沟通仍然存在差距。应考虑开展活动，改善严重发病情况下服务提供者与患者及其家属之间的沟通。

{"title":"Women’s experiences of maternal near miss: Qualitative findings from Malawi","authors":"Monica Patricia Malata , Alisa Jenny , Dilys Walker , Luis Aaron Gadama","doi":"10.1016/j.srhc.2024.101012","DOIUrl":"10.1016/j.srhc.2024.101012","url":null,"abstract":"<div><h3>Objective</h3><p>This study explored the experiences of women with maternal near miss and their perceptions of the quality of care they received in three facilities in Malawi.</p></div><div><h3>Methods</h3><p>This study employed a qualitative phenomenological approach. Data were collected using in depth interviews and analysed using thematic content analysis. The data were collected in three hospitals between September and November 2020. The purposively selected participants were 18 women meeting criteria for maternal near miss related to obstetric haemorrhage (6), hypertensive disorders (7), sepsis (2) and ruptured ectopic pregnancy (3).</p></div><div><h3>Results</h3><p>Women’s experiences of maternal near miss fell under four broad themes; (a) realisation of the near miss; (b) religious beliefs and interpretation of near miss; (c) social and economic aspects of maternal near miss; and d) perceptions of quality of care. Women’s initial emotional responses were fear and anxiety but were soon overshadowed by the fear for their babies’ wellbeing. Most women perceived the care they received as timely, adequate, and respectful, yet many women also expressed that their service providers did not provide an opportunity to openly discuss their condition.</p></div><div><h3>Conclusions</h3><p>The experience of near miss goes beyond the immediate physical discomforts and has psychological, economic, and social consequences for women and their families. Despite women’s perception of care as respectful, there are still communication gaps with their service providers. Campaigns to improve the communication between providers and patients and their families in situation of severe morbidity warrant consideration.</p></div>","PeriodicalId":54199,"journal":{"name":"Sexual & Reproductive Healthcare","volume":"41 ","pages":"Article 101012"},"PeriodicalIF":1.4,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Social disparities in delivery choice among patients with history of cesarean 有剖腹产史的患者在分娩选择上的社会差异。

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-07-31 DOI: 10.1016/j.srhc.2024.101011

Sara R. Wetzler , Nicola F Tavella , Lily McCarthy , Gabriele Baptiste , Toni Stern , Chelsea DeBolt , Angela Bianco

Objective

Given the call to reduce rates of non-medically indicated cesarean deliveries (CDs) by encouraging trials of labor after cesarean (TOLAC), this study looks at social characteristics of patients choosing a TOLAC versus a scheduled repeat cesarean delivery (SRCD) to determine disparities regarding delivery method choice.

Methods

This was a retrospective cohort study of patients with a history of one CD between April 29, 2015–April 29, 2020. Patients were divided based on type of delivery chosen at admission. Chi-squared tests examined proportional differences between groups and logistic regression models examined odd ratios of choosing TOLAC versus SRCD according to socially dependent categories including race/ethnicity, health insurance, pre-pregnancy body mass index, and Social Vulnerability Index (SVI).

Results

1,983 patients were included. Multivariable logistic regression models revealed that patients with a high SVI (reference: low/medium SVI) (AOR 2.0, CI: 1.5, 2.5), self-identified as Black/ African American (AOR: 2.4, CI: 1.6, 3.6) or Hispanic/Latina (AOR: 2.0, CI: 1.4, 2.8) (reference: White), had public insurance (reference: private insurance) (AOR: 3.7, CI: 2.8, 5.0), and who had an obese BMI (reference: non-obese BMI) were more likely to opt for a TOLAC rather than SRCD.

Conclusion

These findings demonstrate differences in delivery method preferences. Specifically, more disadvantaged patients are more likely to choose TOLAC, suggesting that social and economic factors may play a role in delivery preferences. These findings have implications for improving individualized counselling and engaging in shared decision-making around mode of delivery.

研究目的鉴于人们呼吁通过鼓励剖宫产后试产（TOLAC）来降低非医学指征的剖宫产率（CD），本研究调查了选择 TOLAC 与计划内重复剖宫产（SRCD）的患者的社会特征，以确定分娩方式选择上的差异：这是一项回顾性队列研究，研究对象是 2015 年 4 月 29 日至 2020 年 4 月 29 日期间有过一次剖宫产史的患者。患者根据入院时选择的分娩方式进行划分。卡方检验检验了组间的比例差异，逻辑回归模型检验了根据种族/民族、医疗保险、孕前体重指数和社会弱势指数（SVI）等社会依赖类别选择 TOLAC 与 SRCD 的奇数比：共纳入 1,983 名患者。多变量逻辑回归模型显示，高 SVI（参考：低/中 SVI）（AOR：2.0，CI：1.5，2.5）、自我认同为黑人/非裔美国人（AOR：2.4，CI：1.6，3.6）或西班牙裔/拉丁裔（AOR：2.0，CI：1.4，2.8）（参考：白人）、有公共保险（参考：私人保险）（AOR：3.7，CI：2.8，5.0）、BMI 肥胖（参考：非肥胖 BMI）的人更有可能选择 TOLAC 而不是 SRCD：这些研究结果表明了分娩方式偏好的差异。结论：这些研究结果表明了患者对分娩方式的偏好存在差异，特别是弱势患者更倾向于选择 TOLAC，这表明社会和经济因素可能在分娩方式的偏好中起到一定作用。这些发现对改善个体化咨询和围绕分娩方式共同决策具有重要意义。

{"title":"Social disparities in delivery choice among patients with history of cesarean","authors":"Sara R. Wetzler , Nicola F Tavella , Lily McCarthy , Gabriele Baptiste , Toni Stern , Chelsea DeBolt , Angela Bianco","doi":"10.1016/j.srhc.2024.101011","DOIUrl":"10.1016/j.srhc.2024.101011","url":null,"abstract":"<div><h3>Objective</h3><p>Given the call to reduce rates of non-medically indicated cesarean deliveries (CDs) by encouraging trials of labor after cesarean (TOLAC), this study looks at social characteristics of patients choosing a TOLAC versus a scheduled repeat cesarean delivery (SRCD) to determine disparities regarding delivery method choice.</p></div><div><h3>Methods</h3><p>This was a retrospective cohort study of patients with a history of one CD between April 29, 2015–April 29, 2020. Patients were divided based on type of delivery chosen at admission. Chi-squared tests examined proportional differences between groups and logistic regression models examined odd ratios of choosing TOLAC versus SRCD according to socially dependent categories including race/ethnicity, health insurance, pre-pregnancy body mass index, and Social Vulnerability Index (SVI).</p></div><div><h3>Results</h3><p>1,983 patients were included. Multivariable logistic regression models revealed that patients with a high SVI (reference: low/medium SVI) (AOR 2.0, CI: 1.5, 2.5), self-identified as Black/ African American (AOR: 2.4, CI: 1.6, 3.6) or Hispanic/Latina (AOR: 2.0, CI: 1.4, 2.8) (reference: White), had public insurance (reference: private insurance) (AOR: 3.7, CI: 2.8, 5.0), and who had an obese BMI (reference: non-obese BMI) were more likely to opt for a TOLAC rather than SRCD.</p></div><div><h3>Conclusion</h3><p>These findings demonstrate differences in delivery method preferences. Specifically, more disadvantaged patients are more likely to choose TOLAC, suggesting that social and economic factors may play a role in delivery preferences. These findings have implications for improving individualized counselling and engaging in shared decision-making around mode of delivery.</p></div>","PeriodicalId":54199,"journal":{"name":"Sexual & Reproductive Healthcare","volume":"41 ","pages":"Article 101011"},"PeriodicalIF":1.4,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141895029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Associations of physical activity and weight gain during pregnancy with pregnancy-related pelvic girdle pain intensity – A retrospective cohort study 孕期体力活动和体重增加与妊娠相关骨盆腰痛强度的关系 - 一项回顾性队列研究。

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-07-22 DOI: 10.1016/j.srhc.2024.101008

Ragnhild Byberg , Inger Marie Mjølsnes , Ingvild Dalen , Inger Økland , Anne Marie Gausel

Objective

The aims of this study were first, to explore pain trajectories of pelvic girdle pain, and second, to explore if weight gain during pregnancy and/or physical activity before and during pregnancy were associated with the severity of pelvic girdle pain.

Methods

The study included data from a retrospective cohort study in 2009, with data collection performed via questionnaires. Group-based trajectory modelling was performed on the reported intensity of pelvic girdle pain in each pregnancy month, and associations between the latent classes and physical activity and/or weight gain were assessed.

Results

A total of 569 women were included in the analyses. Five distinct trajectory classes for the course of pelvic girdle pain were identified. A higher body mass index (BMI) increase during pregnancy was negatively associated with the probability of being pain free, with –3.2 percentage points per unit increase in BMI (95 % CI −5.3 to −1.1; p = 0.003), and positively associated with the probability of experiencing early onset moderate to severe pain, +1.1 percentage points per unit increase in BMI (95 % CI 0.2 to 2.1; p = 0.022). Weight gain below recommendations was negatively associated with early onset moderate to severe pain; –10.6 percentage points per unit increase in BMI (95 % CI −18.8 to -2.4; p = 0.011). Physical activity in pregnancy was not significantly associated with pain trajectory classes when adjusting for pre-pregnancy variables.

Conclusions

Our findings suggest that pelvic girdle pain intensity during pregnancy can take multiple courses and is associated with weight gain during pregnancy.

研究目的本研究的目的首先是探索骨盆腰痛的疼痛轨迹，其次是探索孕期体重增加和/或怀孕前和怀孕期间的体力活动是否与骨盆腰痛的严重程度有关：研究包括 2009 年一项回顾性队列研究的数据，通过问卷收集数据。根据每个妊娠月份报告的骨盆腰部疼痛强度进行了基于群体的轨迹建模，并评估了潜在类别与体育锻炼和/或体重增加之间的关联：共有 569 名妇女参与了分析。结果：共纳入了 569 名妇女，对她们的骨盆腰部疼痛过程进行了分析。怀孕期间体重指数（BMI）的增加与无痛的概率呈负相关，BMI每增加一个单位为-3.2个百分点（95 % CI -5.3 to -1.1; p = 0.003），而与早发中度至重度疼痛的概率呈正相关，BMI每增加一个单位为+1.1个百分点（95 % CI 0.2 to 2.1; p = 0.022）。体重增加低于建议值与早发性中度至重度疼痛呈负相关；BMI 每增加一个单位-10.6 个百分点（95 % CI -18.8~-2.4；p = 0.011）。在对孕前变量进行调整后，孕期体育锻炼与疼痛轨迹等级无明显关联：我们的研究结果表明，孕期骨盆腰部疼痛的强度可能会有多种变化，并且与孕期体重增加有关。

{"title":"Associations of physical activity and weight gain during pregnancy with pregnancy-related pelvic girdle pain intensity – A retrospective cohort study","authors":"Ragnhild Byberg , Inger Marie Mjølsnes , Ingvild Dalen , Inger Økland , Anne Marie Gausel","doi":"10.1016/j.srhc.2024.101008","DOIUrl":"10.1016/j.srhc.2024.101008","url":null,"abstract":"<div><h3>Objective</h3><p>The aims of this study were first, to explore pain trajectories of pelvic girdle pain, and second, to explore if weight gain during pregnancy and/or physical activity before and during pregnancy were associated with the severity of pelvic girdle pain.</p></div><div><h3>Methods</h3><p>The study included data from a retrospective cohort study in 2009, with data collection performed via questionnaires. Group-based trajectory modelling was performed on the reported intensity of pelvic girdle pain in each pregnancy month, and associations between the latent classes and physical activity and/or weight gain were assessed.</p></div><div><h3>Results</h3><p>A total of 569 women were included in the analyses. Five distinct trajectory classes for the course of pelvic girdle pain were identified. A higher body mass index (BMI) increase during pregnancy was negatively associated with the probability of being pain free, with –3.2 percentage points per unit increase in BMI (95 % CI −5.3 to −1.1; <em>p</em> = 0.003), and positively associated with the probability of experiencing early onset moderate to severe pain, +1.1 percentage points per unit increase in BMI (95 % CI 0.2 to 2.1; <em>p</em> = 0.022). Weight gain below recommendations was negatively associated with early onset moderate to severe pain; –10.6 percentage points per unit increase in BMI (95 % CI −18.8to-2.4;<!--> <em>p</em> = 0.011). Physical activity in pregnancy was not significantly associated with pain trajectory classes when adjusting for pre-pregnancy variables.</p></div><div><h3>Conclusions</h3><p>Our findings suggest that pelvic girdle pain intensity during pregnancy can take multiple courses and is associated with weight gain during pregnancy.</p></div>","PeriodicalId":54199,"journal":{"name":"Sexual & Reproductive Healthcare","volume":"41 ","pages":"Article 101008"},"PeriodicalIF":1.4,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1877575624000636/pdfft?md5=51763c9a3646bfcd6468642cec8bc57a&pid=1-s2.0-S1877575624000636-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Parent-infant closeness and care practices during therapeutic hypothermia in Swedish neonatal intensive care units 瑞典新生儿重症监护病房治疗性低温期间父母与婴儿的亲密程度和护理方法

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-07-18 DOI: 10.1016/j.srhc.2024.101010

Pyrola Bäcke , Anna Axelin , Johan Ågren , Ylva Thernström Blomqvist

Objectives

The aim of this study was to investigate care practices among Neonatal Intensive Care Units (NICU) providing Therapeutic hypothermia (TH), and more specific to investigate staff’s experiences of parental participation, presence, and possibilities of being close with their infant during TH.

Methods

A descriptive, qualitative, and quantitative study. All Swedish NICUs providing TH (n = 10) participated. Data were collected during January–April 2021 via a questionnaire followed by a semi-structured interview with the registered nurse and the neonatologist responsible for TH at each unit. Descriptive statistics were calculated, and a qualitative content analysis was performed.

Results

All NICUs allowed parents unlimited stay with their infants and were keen to support parental presence, which was a prerequisite for promoting parent-infant closeness. Standardized routines regarding the infants’ care space and course of action were described as time-efficient and staff-saving, which freed up time to focus on the families.

Conclusion

Standardized routines regarding the care space setup and the medical and caring approach, as well as the NICU environment and practices around the families, can promote or curb the possibilities of parent-infant closeness. Well-established care practices and good environmental conditions with flexibility regarding the family’s needs are therefore required.

本研究旨在调查提供治疗性低温疗法（Therapeutic hypothermia，TH）的新生儿重症监护病房（NICU）的护理实践，更具体地说，是调查工作人员对父母参与、在场以及在治疗性低温疗法期间与婴儿亲近的可能性的体验。所有提供热疗的瑞典新生儿重症监护病房（n = 10）都参与了这项研究。在 2021 年 1 月至 4 月期间，通过问卷调查收集数据，然后对每个病房负责 TH 的注册护士和新生儿科医生进行半结构化访谈。结果所有新生儿重症监护病房都允许父母无限制地陪伴婴儿，并热衷于支持父母陪伴婴儿，这是促进父母与婴儿亲密关系的先决条件。结论有关婴儿护理空间设置和医疗护理方法的标准化常规，以及新生儿重症监护病房的环境和围绕家属的惯例，可以促进或抑制父母与婴儿亲近的可能性。因此，需要有完善的护理措施和良好的环境条件，并能灵活地满足家庭的需求。

{"title":"Parent-infant closeness and care practices during therapeutic hypothermia in Swedish neonatal intensive care units","authors":"Pyrola Bäcke , Anna Axelin , Johan Ågren , Ylva Thernström Blomqvist","doi":"10.1016/j.srhc.2024.101010","DOIUrl":"10.1016/j.srhc.2024.101010","url":null,"abstract":"<div><h3>Objectives</h3><p>The aim of this study was to investigate care practices among Neonatal Intensive Care Units (NICU) providing Therapeutic hypothermia (TH), and more specific to investigate staff’s experiences of parental participation, presence, and possibilities of being close with their infant during TH.</p></div><div><h3>Methods</h3><p>A descriptive, qualitative, and quantitative study. All Swedish NICUs providing TH (n = 10) participated. Data were collected during January–April 2021 via a questionnaire followed by a semi-structured interview with the registered nurse and the neonatologist responsible for TH at each unit. Descriptive statistics were calculated, and a qualitative content analysis was performed.</p></div><div><h3>Results</h3><p>All NICUs allowed parents unlimited stay with their infants and were keen to support parental presence, which was a prerequisite for promoting parent-infant closeness. Standardized routines regarding the infants’ care space and course of action were described as time-efficient and staff-saving, which freed up time to focus on the families.</p></div><div><h3>Conclusion</h3><p>Standardized routines regarding the care space setup and the medical and caring approach, as well as the NICU environment and practices around the families, can promote or curb the possibilities of parent-infant closeness. Well-established care practices and good environmental conditions with flexibility regarding the family’s needs are therefore required.</p></div>","PeriodicalId":54199,"journal":{"name":"Sexual & Reproductive Healthcare","volume":"41 ","pages":"Article 101010"},"PeriodicalIF":1.4,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S187757562400065X/pdfft?md5=2ba2589d7e2e1ceb0325cc939d4d1b9a&pid=1-s2.0-S187757562400065X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0