Birth-Issues in Perinatal Care最新文献

Background: Growing evidence highlights maternal risk factors that can increase the likelihood of traumatic childbirth experience. Yet little is known about the availability of primary antenatal intervention for childbirth trauma to facilitate optimal maternal and infant outcomes. The aim of this study was to conduct a systematic review of the literature and empirical evidence to identify antenatal interventions and their effectiveness for treatment of childbirth trauma, post-traumatic stress disorder (PTSD), subthreshold PTSD, or post-traumatic stress (PTS) from childbirth.

Methods: Four databases were accessed: PUBMED, CINAHL, ProQuest, and EBSCOHOST. PRISMA guidelines were followed for screening and reporting. Inclusion criteria were as follows: (1) peer reviewed articles; (2) samples of pregnant women; (3) published in English; (4) measure of PTSD, PTSD symptoms, PTS or fear of childbirth; (5) variable of childbirth trauma or childbirth experience; (6) antenatal intervention; and (7) human studies.

Results: We identified 2034 articles, with 12 articles in the final sample. The most common antenatal intervention in four studies was childbirth plans, which were associated with an increase in positive childbirth experience, childbirth control, mastery, and participation, as well as increased self-efficacy and reduced PTSD symptoms (p < 0.01). Other interventions included antenatal counseling and psychoeducation; eye movement desensitization and reprocessing; counseling; haptotherapy; trauma-informed care; cognitive behavioral therapy; and hypnosis for childbirth trauma.

Conclusions: Methodological limitations as well as a lack of inclusion of women with perinatal mental health difficulties represent gaps in knowledge. Findings suggest promising evidence for the implementation of antenatal interventions in clinical and hospital contexts to treat childbirth trauma.

Objective: Weight bias is a source of stigma in healthcare, and obesity is disproportionately prevalent among Black and Hispanic individuals of reproductive age. However, relationships between body size and other forms of discrimination in perinatal settings remain poorly understood. Our objective was to examine the association between body mass index (BMI) and gendered racial microaggressions (GRM)-everyday discriminatory experiences related to race and gender-during perinatal care.

Methods: We studied a prospective cohort of Asian, Black, and Hispanic ("Global Majority") individuals who gave birth in four New York City and Philadelphia hospitals from March 2022-March 2023. Early pregnancy BMI was ascertained from weight and height recorded at first prenatal visit. Participants completed the validated GRM Scale, adapted for perinatal context by a community working group, during the birth hospitalization. We examined mean ± standard deviation (SD) GRM Scale score by BMI class and measured associations between BMI and GRM using multivariable Tweedie regression.

Results: Of 368 participants, 27.2% had normal weight (18.5 kg/m² ≤ BMI < 25), 29.9% overweight (25 ≤ BMI < 30), 32.6% class I-II obesity (30 ≤ BMI < 40), and 10.3% class III obesity (BMI ≥ 40). Thirty-seven percent of participants reported experiencing at least one instance of GRM during perinatal care. Mean ± SD GRM Scale score (higher = more frequent) increased with BMI class, from 1.7 ± 3.8 among those with normal weight to 4.8 ± 9.3 with class III obesity; associations persisted after adjusting for age, education, parity, and late prenatal care.

Conclusion: BMI is associated with perinatal GRM among Global Majority individuals. Intersectional research on weight bias and discrimination, incorporating patient and provider perspectives, is warranted for inclusive, respectful perinatal care.

Introduction: The third stage of labour occurs between the birth of the foetus and the expulsion of the placenta. A major complication during this stage is postpartum hemorrhage, which poses a significant concern for maternal health. To mitigate this risk, active management strategies have emerged, raising concerns about the safety of physiological management following a physiological birth. Midwives play a vital role in ensuring a safe third stage of labour by minimizing medical intervention and preventing postpartum hemorrhage. This scoping review aims to map the evidence on midwifery practices that support a physiological third stage of labour.

Methods: We conducted a scoping review using the Joanna Briggs Institute methodology. We retrieved articles from PUBMED, PsycINFO (via EBSCO), CINAHL (via EBSCO), LILACS, SCOPUS, ClinicalTrials.gov, Open Science Framework, ProQuest Dissertations and Theses, Cochrane Library, and JBI.

Results: The search yielded 2190 articles, with 1779 remaining after duplicates were removed. Screening identified 80 articles for review; 63 were excluded, resulting in 17 articles defining key findings. Two articles contributed to a theoretical framework for a physiological approach. Ten articles further discussed how midwives provide care during this stage to maintain normalcy. Three articles debated the safety of expectant management for low-risk women, while three studies also suggested new risk factors for postpartum hemorrhage.

Conclusion: Midwifery care during the physiological third stage of labour must balance safety and trust in the woman's body. More research is needed to assess expectant management in home births and midwifery-led units, with a focus on individual needs and the long-term impacts of a physiological approach.

Introduction: In recent years, US hospitals have implemented novel interventions to reduce racism, bias, and their effects in perinatal healthcare (e.g., implicit bias training, anti-racism seminars). Healthcare workers may also encounter informal interventions in support of these goals (e.g., peer feedback on microaggressions). There is little scholarship on how equity-focused interventions affect clinicians and clinical teams.

Methods: Using qualitative in-depth interview data from 20 California hospital-based perinatal clinicians, we investigated changes in how perinatal clinicians approached their work following equity-focused interventions.

Results: Sixteen respondents discussed changes they observed in themselves or their colleagues. We categorized these as: (1) cognitive changes (e.g., recognizing one's own biased thinking and behavior; better understanding the role of racism in disparities); (2) individual behavior changes (e.g., speaking up about inequities; assessing and mitigating bias in one's own behavior; acting more intentionally when caring for patients at risk for worse outcomes); and (3) team behavior changes (e.g., greater intra-colleague discussion of equity topics; collective accountability; efforts to reduce the harms of bias in clinical care). Many described interventions that overlapped or even synergized with one another, including combinations of formal and informal efforts.

Conclusions: Our findings suggest that equity-focused interventions can produce observable changes in perinatal patient-care processes. However, it may be challenging for evaluators and healthcare leaders alike to understand what interventions, in what combinations and perinatal settings, produce desired results. Researchers will need innovative methods and a deep understanding of the intervention context to rigorously study these novel interventions-overlapping, multi-level, synergistic-and their effects.

Background: Racial disparities negatively impact health issues, and racism is associated with worse maternal health outcomes. Satisfaction with childbirth is influenced by many factors according to women's preferences and sociocultural beliefs. A positive birth experience allows for improving healthcare and promoting health. The study aim is to evaluate women's satisfaction with the labor and birth experience according to skin color.

Methods: Cross-sectional study with postpartum women who gave birth in a tertiary hospital. To assess satisfaction with childbirth, we applied the Mackey Satisfaction Scale. For statistical analysis, women's skin color was categorized into Black and non-Black. We categorize as Black people all persons who identify as Black and Brown. Sociodemographic and obstetric data were obtained from a collection form. For bivariate analysis, we used chi-square or Fisher's exact and the Mann-Whitney tests. The significance level was 5%, and the software used was SAS 9.4.

Results: A total of 300 postpartum women were included, 182 (60.7%) black skin color. Black women were less satisfied with the ability to deal with contractions (p = 0.046), comfort and well-being during labor (p = 0.035), control of actions during labor (p = 0.003) and delivery (p = 0.03), number of explanations received from the nursing staff (p = 0.039), physician's attitude (p = 0.023), and lower overall satisfaction with the birth experience (p = 0.013) compared to non-Black women. Black women had a lower overall satisfaction score (p = 0.011) and self-subscale score (p = 0.02).

Conclusions: Black women had lower satisfaction scores with birth experience compared to non-Black ones. Reducing racial disparities in health is essential to improving obstetric assistance and care satisfaction.

Background: One in five births is induced worldwide. There is increasing agreement on the importance of informed decision-making throughout pregnancy and birth. However, research suggests that birthing persons are not fully involved in the decision-making process regarding induction of labor (IOL) or receiving all the necessary information and options regarding the risks, benefits, and alternatives. This study aimed to understand women's experiences of the decision-making process around an IOL and to analyse the demographic factors influencing their experiences and knowledge.

Methods: An online survey collecting quantitative and qualitative data from women who gave birth between 2018 and 2023 in Ireland was conducted. Descriptive, bivariate and multivariate analyses were performed to analyse a subset of data from the survey, focusing on decision-making and knowledge around inductions of labor.

Results: Of 1091 respondents, 49.3% reported not feeling fully involved in the decision around induction, 66.8% felt insufficiently informed about inductions, and 30% did not know that they could decline an induction. Age, parity, and type of maternity care were significantly associated with involvement in decision-making and knowledge of inductions and informed refusal. Involvement in decision-making, knowledge around inductions and informed refusal was significantly higher among women with previous pregnancies, and maternity care in private health care.

Discussion: A significant proportion of women did not feel well-informed on the benefits, risks, and alternatives around IOL. Suggested improvements include promoting care that respects maternal choices, preferences, and autonomy, and remains unbiased and nonjudgemental, while facilitating trusting relationships and open communication between patients and providers as a core foundation for consent and informed decision-making.

Background: Limited medical professionals, particularly in rural community, impedes patient treatment. Rapid prenatal risk assessments are critical for improving pregnancy care under these resource constraints.

Objective: To develop and evaluate an innovative digital system that assists midwives in recognizing prenatal risks and in making clinical decisions in maternity hospitals, especially in rural healthcare setups.

Methods: The technology, which is based on a smartphone application, assesses pregnancy risks and offers potential delivery insights. Researchers used data gathering, firebase integration, and an artificial intelligence model to perform a pilot study in rural health setups. The modified Alberta perinatal risk score is used and validated. Midwives are trained in the app's use and screened 1010 pregnant women at a primary health centres (PHC).

Results: Prenatal mother's data is securely maintained in JSON format, allowing for predictive evaluations of outcomes and intrapartum factors. The AI processes data and generates predictions for the Flutter App. Pilot results show that the app is effective at classifying prenatal cases, with 37.33% classified as low risk, 37.82% as intermediate risk, and 24.85% as high risk. High-risk cases are referred to facility-based centers, and midwives collaborated with medical officers to manage 62.04% of moderate and all low-risk cases. The app efficiently records maternal and neonatal outcomes, demonstrating its potential to improve patient care with a 99.0% accuracy rate in forecasting newborn fatalities using the Gradient Boost algorithm.

Conclusions: An integrated android application with the AI antenatal risk assessment system improves midwives' obstetric risk assessment skills, allowing them to provide timely interventions to pregnant women, thus contributing to positive birthing outcomes.

Background: The objective of this study was to conduct a Turkish validity and reliability study of the Maternal Identity Scale.

Methods: This study employed a methodological approach. The study's sample population comprised 407 women who gave birth to infants between 4 and 12 months of age and who did not experience any postpartum health complications requiring hospitalization.

Results: The scale was found to comprise 23 items and three factors: Attachment to the Infant, Role Competence, and Gratification in the Role. These factors collectively explained 49.7% of the total variance. While the number of factors remains equivalent to the initial version of the scale, it deviates from the original in that the original scale comprises 24 items and accounts for approximately 33%-66% of the total variance. The Confirmatory Factor Analysis (CFA) indicated that the scale demonstrated acceptable model fit, as reflected by GFI = 0.92, AGFI = 0.90, NFI = 0.84, PGFI = 0.76, and RMR = 0.02. The Cronbach's alpha coefficient for the overall scale was calculated to be 0.84. Cronbach's alpha coefficients for the subscales were 0.81 for the attachment to the infant subscale, 0.76 for the role competence subscale, and 0.82 for gratification in the role. The scale evaluation relies on both sub-dimension and total mean scores. As the score on the scale increases, the development of maternal identity correspondingly increases.

Conclusions: The study demonstrates that the Turkish version of the Maternal Identity Scale is a valid and reliable instrument for assessing maternal identity in mothers with infants aged 4-12 months. Health professionals are advised to utilize the Maternal Identity Scale for the evaluation of maternal identity development in postpartum women.

Purpose: Using a decision-analytic model, we evaluated the outcomes, costs, and cost-effectiveness associated with birthing in the upright position compared to the recumbent position in patients with a low-dose epidural.

Methods: We designed a decision-analytic model using TreeAge Pro software to compare the outcomes and cost-effectiveness of employing the upright versus recumbent position during the first delivery with a low-dose epidural, incorporating the impact of mode of delivery on a subsequent delivery. We used a theoretical cohort of 756,000 patients, representing the approximate number of nulliparous individuals who have a term birth in the United States annually and are given an epidural. Probabilities and costs were derived from the literature.

Results: In our theoretical cohort of 756,000 nulliparous individuals with a low-dose epidural, the recumbent positioning strategy was associated with 18,652 fewer cesarean deliveries in the first pregnancy (66,210 vs. 84,862), which would lead to 11,228 fewer cesarean deliveries in the second pregnancy (135,787 vs. 147,015) in comparison to the upright position. The recumbent position was also associated with four fewer uterine ruptures (15 vs. 19) and one fewer hysterectomy (4 vs. 5) in the second pregnancy, two fewer maternal deaths (23 vs. 25) in the first delivery, and one fewer maternal death in the second delivery (26 vs. 27). Laboring in the recumbent position saved $157 million ($15.526 billion vs. $15.683 billion) and increased maternal QALYs by 2141 QALYs (19.846 million vs. 19.844 million).

Conclusion: Our results show that in a theoretical cohort of 756,000 patients, laboring in the recumbent position may save $157 million annually and improve maternal outcomes. These findings underscore the importance of incorporating evidence-based cost and outcome data into patient counseling about birthing positions to support informed, shared decision-making while accounting for individual patient preferences.

Objective: To compare sonographic, maternal, and clinical estimations of fetal weight in women with severe and morbid obesity (BMI ≥ 35 kg/m²) at term.

Methods: We conducted a prospective study on multiparous women with singleton term pregnancies. We analyzed absolute error, absolute percentage error, and rates of error > 10%, > 15%, and > 20%; and error > 500 g for each method.

Results: Our study included 103 women with a median pre-delivery BMI of 37.9 (35.0-50.4) kg/m². Clinical estimation showed a higher mean error than maternal estimation (140.1 vs. -51.6 g, p < 0.001). The absolute error was comparable for the sonographic and maternal estimations (209 and 210 g, respectively); these values were lower (p = 0.02) than that of clinical estimation (250 g). For sonographic estimation, the absolute percentage error was lower than for the clinical estimation (6.0% vs. 7.5%, p = 0.018). Similarly, for the maternal estimation, the absolute error was lower than for the clinical estimation (6.3% vs. 7.5%, p = 0.005). A greater proportion of women exhibited an absolute percentage rate error exceeding 15% with clinical estimation than with maternal estimation (15.1% vs. 2.9%, p = 0.002). A higher proportion of women displayed an absolute percentage rate error exceeding 20% with clinical estimation than with sonographic estimation (7.8% vs. 1.0%, p = 0.016) and with maternal estimation (7.8% vs. 0%, p = 0.008).

Conclusion: In women with a BMI ≥ 35 kg/m², sonographic weight estimation and maternal estimation showed similar levels of accuracy, and both surpassed that of clinical estimation. Our findings demonstrate the potential utility of maternal estimation as an additional tool supporting the standard use of ultrasound.

Trial registration: ClinicalTrials.gov identifier: NCT05478798.