Birth-Issues in Perinatal Care最新文献

Background: Health care financing is thought to be a driver of health care quality. The purpose of this research was to analyze reimbursement for midwifery-led US birth centers and to evaluate the association between reimbursement ratios and clinical outcomes.

Methods: Secondary analysis of the American Association of Birth Centers Site Survey and the American Association of Birth Centers Perinatal Data Registry was completed. Descriptive statistics and logistic regression were used to analyze reimbursement ratios and their relationship to clinical outcomes.

Results: Between 2012 and 2020, 107 participating birth centers cared for 78,773 enroled pregnant people. Public payors (Medicaid, Tricare, CHIP) were reported to pay less than a third of all charges. Comparing private payors to public payors, lower reimbursement ratios were demonstrated for professional services (77% vs. 43%), facility fees (89% vs. 45%), and newborn care (66% vs. 40%). Core clinical outcomes demonstrated high quality without significant variation between public and private payor groups: cesarean birth (10.2 vs. 9.2%), NICU admissions (0.9% vs. 1.1%). The median reimbursement ratio for public payors was 0.379. For every 1000 dollars increase in reimbursement, the odds of cesarean birth increased by a factor of 1.39 for nulliparous women (aOR 1.39; 95% CI, 1.10-1.75) and 2.15 for multiparous women (aOR 2.15; 95% CI 1.54-3.01).

Discussion: Despite poor reimbursement ratios, birth centers consistently exceeded national quality benchmarks in perinatal outcomes. Low reimbursement ratios for time-intensive, midwifery-led care without consideration of quality outcomes limit the potential for sustainability and spread of the birth center model of care.

Background: Midwifery research is increasingly understood as shaped by the specific social, political, and historical contexts, with scientific practices actively co-producing realities. This recently developed perspective highlights the need for discipline-specific approaches that reflect the diversity and creativity of midwifery care.

Aim: This contribution introduces Midwifery Care Studies as a novel, reflexive approach to studying midwifery as a practice-based science.

Findings: Building on analyses inspired by feminist science studies, Midwifery Care Studies examine midwifery care in practice. Using participatory methods, this approach aimed to investigate midwifery care practices on their own terms.

Discussion: Midwifery Care Studies share the sensitivities and response-abilities that shape everyday midwifery care practices. Acknowledging the relational character of midwifery care, Midwifery Care Studies articulate modes and techniques of becoming-with that involve birth givers, fetuses, midwives, technologies, words, values, and birthing environments. By carving out the material, social, and ethical specificities of situated midwifery care practices, Midwifery Care Studies examine unfolding and shifting "goods" and "bads" in practice, as well as how tensions between them are handled.

Conclusion: Sensitive to the ontological politics of care and research practices, Midwifery Care Studies aim at providing the analytical and conceptual resources needed to foster generative engagements with the multitude of lived realities of being pregnant and giving birth.

Background: Caesarean section (C-section) rates in the United Kingdom continue to increase and are a concern. Births to migrants account for 30.3% of live births in England and Wales. Other international studies have observed varying rates of C-section for migrant populations in comparison to women born within the country itself. Comparison of incidence rates of Caesarean section birth between migrant populations and women born in the United Kingdom (UK) was undertaken to inform the UK context and address an existing dearth of data.

Methods: This study included analysis of 11,361 records from the Born in Bradford cohort study. Binomial logistic regression analysis was performed to estimate crude and adjusted odd ratios (aOR) with 95% confidence intervals (CI) for the incidence of total, elective, and emergency C-section births between migrant populations and UK-born women.

Results: Women from "South Asia" and "Central Europe, Eastern Europe, and Central Asia" demonstrate lower incidences of total C-section with a significantly lower elective C-section. Women from Sub-Saharan Africa demonstrate significantly high rates of total C-section (38% increased odds).

Discussion: High variation in the incidence of C-section amongst migrant populations was observed, replicating findings from the few other international studies. Further in-depth exploration is required to understand the impact of this variation on maternal and neonatal health disparities, and to assess the contribution of potential pathophysiological and sociocultural factors on related decision-making processes.

Background: Although anxiety is a well-established risk factor for depression during pregnancy, the mechanisms through which prenatal anxiety affects depression remain unclear. This study aims to investigate: (a) whether perceived stress acts as a mediator between anxiety and depression, and (b) whether social support plays a moderating role in this relationship.

Method: This cross-sectional study used a questionnaire-based design. Between April 2022 and June 2023, we surveyed pregnant women in their second trimester, collecting 521 valid questionnaires. The survey measured perceived stress, social support, depression, anxiety, as well as demographic characteristics. Data were processed and analyzed using SPSS 26.0 and PROCESS 4.1.

Result: Anxiety was significantly associated with depression (β = 0.42, p < 0.001), and perceived stress mediated this relationship (β = 0.13, p < 0.001). Social support significantly moderated the effect of anxiety and depression, influencing both indirect (β = -0.25, p < 0.001) and direct pathways (β = -0.16, p < 0.001). Specifically, anxiety affected perceived stress and depression at both high and low levels of social support, but the effects were attenuated at higher levels of social support for perceived stress (simple slope = 0.11 vs. 0.37) and depression (simple slope = 0.3 vs. 0.47).

Conclusion: Anxiety not only directly served as a risk factor for depression but also indirectly contributed to depression through perceived stress. Social support moderated both the initial (anxiety → perceived stress) and direct (anxiety → depression) paths of this mediation. Early screening and targeted interventions for anxiety-particularly among pregnant women experiencing high perceived stress and low social support-may help reduce the risk of depression.

Background: Women's perceived safety during childbirth contributes to their childbirth experience, which can impact mental health and the experience of future pregnancies. Unexpected birth events may predict negative experiences of childbirth, but there is limited evidence about the role of demographic, health, and psychological factors known during pregnancy. The aim of this paper was to model pregnancy predictors of women's perceived safety during childbirth.

Methods: Women (n = 313) < 20 weeks' gestation were recruited from a large maternity hospital in Melbourne, as part of the Mercy Pregnancy and Childbirth Study (MPEWS). The dependent variable was the Perceived Safety Scale score from the Childbirth Experience Questionnaire, administered at 6 months postpartum. Hierarchical linear regression was conducted to determine factors significantly associated with scores, in two steps: (1) Step 1: demographic and health factors, depression, anxiety symptoms, recalled childhood trauma, and sense of coherence in pregnancy and (2) Step 2: birth events and complications.

Results: Step 1 (p < 0.001) explained 20% and Step 2 (p < 0.001) an additional 3% of the variance in Perceived Safety scores. Higher trait anxiety (β = -0.255, p = 0.004), smoking during pregnancy (β = -0.124, p = 0.027), and emergency Caesarean births (β = -0.133, p = 0.048) predicted lower Perceived Safety. Multiparity was associated with significantly greater Perceived Safety (β = 0.116, p = 0.035).

Conclusion: Although emergency Caesarean births contribute to poorer perceived safety during childbirth, other factors, which are known during pregnancy, can also impact negatively on women's perceived safety during childbirth. Targeted support during pregnancy may therefore facilitate higher perceived safety during childbirth.

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.