Carlos Suso-Ribera PhD, Patricia Catalá PhD, Javier Carmona PhD, Cecilia Peñacoba-Puente PhD
Background
Women's dissatisfaction with perinatal health care services is associated with poor postpartum outcomes for the mother and the baby. The Mackey Childbirth Satisfaction Rating Scale is a frequently used measure of women's childbirth satisfaction. However, its factor structure has been inconsistent across investigations. The goal of this study was to evaluate the psychometric properties of the scale (i.e., factor structure and sources of validity evidence).
Methods
This study is a descriptive prospective investigation. Participants included 106 pregnant women (mean age = 31.86, SD = 4.12) recruited from a public university hospital situated in South Madrid. Sources of construct validity of the Mackey were explored with the Women's View of Birth Labor Satisfaction Questionnaire. Sources of criterion validity were investigated with measures of pain (labor, delivery, and just after birth) and post-traumatic stress symptoms.
Results
Minor adaptations in item distribution resulted in an adequate fit of the original six-factor solution of the Mackey scale (i.e., oneself, the partner, the baby, the nurse, the physician, and overall satisfaction). Sources of validity evidence supported the construct and criterion validity of the scale.
Conclusions
Obtaining a psychometrically and conceptually sound factor solution is fundamental when validating a scale. With the present study, researchers and clinicians (e.g., midwives) will be able to measure women's childbirth satisfaction in a more robust manner. Both antecedents and consequences of satisfaction were found to correlate with several satisfaction subscales, which might help guide prevention programs in mother care in a more efficient way.
{"title":"Revisiting the Mackey Childbirth Satisfaction Rating Scale: Spanish adaptation, factor analysis, and sources of construct validity","authors":"Carlos Suso-Ribera PhD, Patricia Catalá PhD, Javier Carmona PhD, Cecilia Peñacoba-Puente PhD","doi":"10.1111/birt.12790","DOIUrl":"10.1111/birt.12790","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Women's dissatisfaction with perinatal health care services is associated with poor postpartum outcomes for the mother and the baby. The Mackey Childbirth Satisfaction Rating Scale is a frequently used measure of women's childbirth satisfaction. However, its factor structure has been inconsistent across investigations. The goal of this study was to evaluate the psychometric properties of the scale (i.e., factor structure and sources of validity evidence).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study is a descriptive prospective investigation. Participants included 106 pregnant women (mean age = 31.86, SD = 4.12) recruited from a public university hospital situated in South Madrid. Sources of construct validity of the Mackey were explored with the Women's View of Birth Labor Satisfaction Questionnaire. Sources of criterion validity were investigated with measures of pain (labor, delivery, and just after birth) and post-traumatic stress symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Minor adaptations in item distribution resulted in an adequate fit of the original six-factor solution of the Mackey scale (i.e., oneself, the partner, the baby, the nurse, the physician, and overall satisfaction). Sources of validity evidence supported the construct and criterion validity of the scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Obtaining a psychometrically and conceptually sound factor solution is fundamental when validating a scale. With the present study, researchers and clinicians (e.g., midwives) will be able to measure women's childbirth satisfaction in a more robust manner. Both antecedents and consequences of satisfaction were found to correlate with several satisfaction subscales, which might help guide prevention programs in mother care in a more efficient way.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 2","pages":"343-352"},"PeriodicalIF":2.5,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12790","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138447109","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}
Women often report being dissatisfied with their childbirth experience, which in turn predicts negative outcomes for themselves and their children. Currently, there is no consensus as to what constitutes a satisfying or positive birth experience. We posit that a useful framework for addressing this question already exists in the form of Basic Psychological Needs Theory, a subtheory of Self-Determination Theory (Deci & Ryan, Can. Psychol., 49, 2008, 182). Specifically, we argue that the degree to which maternity care practitioners support or frustrate women's needs for relatedness, competence, and autonomy predicts their childbirth satisfaction. Using this framework provides a potentially powerful lens to better understand and improve the well-being of new mothers and their infants.
{"title":"Basic psychological needs: A framework for understanding childbirth satisfaction","authors":"Rebecca J. Brand PhD, Casey A. Gartland BS","doi":"10.1111/birt.12795","DOIUrl":"10.1111/birt.12795","url":null,"abstract":"<p>Women often report being dissatisfied with their childbirth experience, which in turn predicts negative outcomes for themselves and their children. Currently, there is no consensus as to what constitutes a satisfying or positive birth experience. We posit that a useful framework for addressing this question already exists in the form of Basic Psychological Needs Theory, a subtheory of Self-Determination Theory (Deci & Ryan, <i>Can. Psychol.</i>, <i>49</i>, 2008, 182). Specifically, we argue that the degree to which maternity care practitioners support or frustrate women's needs for <i>relatedness</i>, <i>competence</i>, and <i>autonomy</i> predicts their childbirth satisfaction. Using this framework provides a potentially powerful lens to better understand and improve the well-being of new mothers and their infants.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 2","pages":"395-404"},"PeriodicalIF":2.5,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138300699","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}
Abdur Razzaque Sarker PhD, Irfat Zabeen MSS, Zakir Hossain MPH, Nausad Ali MSS, Jahangir A. M. Khan PhD
Background
Cesarean birth (CB) rates have been increasing rapidly globally, including in Bangladesh. This study aimed to assess national trends in CB rates and to investigate associated factors in Bangladesh.
Methods
We analyzed data from the five most recent Bangladesh Demographic and Health Surveys (BDHS) between 2003 and 2018. A total of 27,328 ever-married women aged 15–49 who had a live birth in the 2 years preceding the survey were included in this study. We estimated the prevalence of CB from 2003 to 2018, as well as changes in the prevalence. Logistic regression analysis was used to measure the association between dependent and independent variables.
Results
The overall prevalence of CB among Bangladeshi mothers was 3.99% in 2003–04; this rate increased to 33.22% in 2017–18. The annual percentage change in CB rate was 16.34% from 2004 to 2017–18, which is alarming relative to the World Health Organization's cesarean birth recommended threshold. Several factors, such as maternal age, maternal and paternal education, working status of the mother, maternal BMI, age at first pregnancy, antenatal care (ANC) use, administrative division, and wealth status, had a significant influence on the rising rate of CB in Bangladesh.
Conclusions
This study documents the alarming rate of CB increase in Bangladesh since 2003. It is critical that authorities implement more effective national monitoring measures to identify the causes of this dramatic increase and work to mitigate the rate of unnecessary CB in Bangladesh.
{"title":"Increasing rates of cesarean birth in Bangladesh: A household-level pooled analysis","authors":"Abdur Razzaque Sarker PhD, Irfat Zabeen MSS, Zakir Hossain MPH, Nausad Ali MSS, Jahangir A. M. Khan PhD","doi":"10.1111/birt.12789","DOIUrl":"10.1111/birt.12789","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cesarean birth (CB) rates have been increasing rapidly globally, including in Bangladesh. This study aimed to assess national trends in CB rates and to investigate associated factors in Bangladesh.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from the five most recent Bangladesh Demographic and Health Surveys (BDHS) between 2003 and 2018. A total of 27,328 ever-married women aged 15–49 who had a live birth in the 2 years preceding the survey were included in this study. We estimated the prevalence of CB from 2003 to 2018, as well as changes in the prevalence. Logistic regression analysis was used to measure the association between dependent and independent variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall prevalence of CB among Bangladeshi mothers was 3.99% in 2003–04; this rate increased to 33.22% in 2017–18. The annual percentage change in CB rate was 16.34% from 2004 to 2017–18, which is alarming relative to the World Health Organization's cesarean birth recommended threshold. Several factors, such as maternal age, maternal and paternal education, working status of the mother, maternal BMI, age at first pregnancy, antenatal care (ANC) use, administrative division, and wealth status, had a significant influence on the rising rate of CB in Bangladesh.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study documents the alarming rate of CB increase in Bangladesh since 2003. It is critical that authorities implement more effective national monitoring measures to identify the causes of this dramatic increase and work to mitigate the rate of unnecessary CB in Bangladesh.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 2","pages":"326-342"},"PeriodicalIF":2.5,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138296623","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}
Karen Milligan PhD, Lesley A. Tarasoff PhD, Erica R. Rodrigues MA, Tomisin Iwajomo MPH, Tara Gomes PhD, Claire de Oliveira PhD, Hilary K. Brown PhD, Karen A. Urbanoski PhD
Background
Substance use in pregnancy raises concern given its potential teratogenic effects. Given the unique needs of parenting people and the potential impact for developing children, specialized substance use treatment programs are increasingly being implemented for this population. Substance use treatment is associated with more positive neonatal outcomes compared with no treatment, however treatment models vary limiting our understanding of key treatment components/modelsFew studies have explored the influence of treatment model type (i.e., integrated treatments designed for pregnant clients compared with standard treatment models) and no studies have examined the influence of treatment model on neonatal outcomes using Canadian data.
Method
We conducted a population-based cohort study of clients who were pregnant when initiating integrated (n = 564) and standard (n = 320) substance use treatment programs in Ontario, Canada.
Results
Neonatal outcomes did not significantly differ by treatment type (integrated or standard), with rates of adverse neonatal outcomes higher than published rates for the general population, despite receipt of adequate levels of prenatal care. While this suggests no significant impact of treatment, it is notable that as a group, clients engaged in integrated treatment presented with more risk factors for adverse neonatal outcomes than those in standard treatment. While we controlled for these risks in our analyses, this may have obscured their influence in relation to treatment type.
Conclusion
Findings underscore the need for more nuanced research that considers the influence of client factors in interaction with treatment type. Pregnant clients engaged in any form of substance use treatment are at higher risk of having children who experience adverse neonatal outcomes. This underscores the urgent need for further investment in services and research to support maternal and neonatal health before and during pregnancy, as well as long-term service models that support women and children beyond the perinatal and early childhood periods.
{"title":"Neonatal outcomes of pregnant women attending integrated and standard substance use treatment programs in Ontario, Canada","authors":"Karen Milligan PhD, Lesley A. Tarasoff PhD, Erica R. Rodrigues MA, Tomisin Iwajomo MPH, Tara Gomes PhD, Claire de Oliveira PhD, Hilary K. Brown PhD, Karen A. Urbanoski PhD","doi":"10.1111/birt.12784","DOIUrl":"10.1111/birt.12784","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Substance use in pregnancy raises concern given its potential teratogenic effects. Given the unique needs of parenting people and the potential impact for developing children, specialized substance use treatment programs are increasingly being implemented for this population. Substance use treatment is associated with more positive neonatal outcomes compared with no treatment, however treatment models vary limiting our understanding of key treatment components/modelsFew studies have explored the influence of treatment model type (i.e., integrated treatments designed for pregnant clients compared with standard treatment models) and no studies have examined the influence of treatment model on neonatal outcomes using Canadian data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We conducted a population-based cohort study of clients who were pregnant when initiating integrated (<i>n</i> = 564) and standard (<i>n</i> = 320) substance use treatment programs in Ontario, Canada.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Neonatal outcomes did not significantly differ by treatment type (integrated or standard), with rates of adverse neonatal outcomes higher than published rates for the general population, despite receipt of adequate levels of prenatal care. While this suggests no significant impact of treatment, it is notable that as a group, clients engaged in integrated treatment presented with more risk factors for adverse neonatal outcomes than those in standard treatment. While we controlled for these risks in our analyses, this may have obscured their influence in relation to treatment type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Findings underscore the need for more nuanced research that considers the influence of client factors in interaction with treatment type. Pregnant clients engaged in any form of substance use treatment are at higher risk of having children who experience adverse neonatal outcomes. This underscores the urgent need for further investment in services and research to support maternal and neonatal health before and during pregnancy, as well as long-term service models that support women and children beyond the perinatal and early childhood periods.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 2","pages":"284-294"},"PeriodicalIF":2.5,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12784","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138178001","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}
David Nadav Sabag BMSc, Gali Pariente MD, Eyal Sheiner MD, PhD, Shayna Miodownik MSc, Tamar Wainstock PhD
Purpose
The association between birth order and adverse perinatal outcomes has been well studied in twin pregnancies. However, little is known about the differences in immediate perinatal outcomes as well as long-term hospitalization of the offspring in triplet pregnancies according to their birth order. As such, we aimed to assess the differences in immediate perinatal outcomes and long-term hospitalizations among triplets by their birth order.
Methods
In a retrospective hospital-based cohort study, immediate perinatal outcomes and long-term hospitalizations were compared among triplet siblings according to their birth order. Deliveries occurred between the years 1991 and 2021 in a tertiary medical center. The study groups were followed until 18 years of age for cardiovascular, respiratory, neurological, and infection-related hospitalizations. Generalized estimation equation (GEE) models were used to control for confounders. Kaplan–Meier survival curves were used to compare cumulative long-term hospitalization incidences and Cox proportional hazards models were performed to control for confounders.
Results
The study included 117 triplet deliveries. Rates of small for gestational age (SGA) infants increased linearly by birth order (6.0%, 7.7%, and 15.4% for the first, second, and third siblings, respectively; p-value for trends = 0.035). Using a GEE model controlling for maternal age, being born third in a triplet pregnancy was independently associated with SGA (third vs. first sibling, adjusted OR 3.0, 95% CI 1.38–6.59, p = 0.005). No significant differences in cardiovascular, respiratory, neurological, and infection-related hospitalizations were noted among the first, second, and third siblings. Likewise, using Kaplan–Meier survival analyses, no significant differences in the cumulative incidence of long-term pediatric hospitalizations were noted between the siblings. In Cox proportional hazards models, controlling for weight and gender, birth order in a triplet pregnancy did not exhibit an association with long-term hospitalizations of the offspring.
Conclusion
Despite the association between birth order and SGA, birth order in triplets does not seem to have an impact on the risk for long-term offspring hospitalization.
目的:在双胎妊娠中，出生顺序与不良围产期结局之间的关系已经得到了很好的研究。然而，根据出生顺序，对三胞胎妊娠的后代的即时围产期结局以及长期住院治疗的差异知之甚少。因此，我们的目的是根据三胞胎的出生顺序来评估其即时围产期结局和长期住院治疗的差异。方法:在一项以医院为基础的回顾性队列研究中，根据出生顺序比较三胞胎兄弟姐妹的即时围产期结局和长期住院情况。1991年至2021年期间在三级医疗中心分娩。研究人员对这些研究组的心血管、呼吸系统、神经系统和感染相关的住院情况进行了随访，直到18岁。采用广义估计方程(GEE)模型控制混杂因素。Kaplan-Meier生存曲线用于比较累积长期住院率，Cox比例风险模型用于控制混杂因素。结果:本研究包括117例三胞胎分娩。胎龄小(SGA)婴儿的比例随出生顺序线性增加(第一、第二和第三兄弟姐妹分别为6.0%、7.7%和15.4%);趋势的p值= 0.035)。使用控制母亲年龄的GEE模型，在三胞胎妊娠中第三个出生与SGA独立相关(第三个vs第一个兄弟姐妹，调整OR 3.0, 95% CI 1.38-6.59, p = 0.005)。在第一、第二和第三兄弟姐妹中，心血管、呼吸、神经系统和感染相关的住院治疗没有显著差异。同样，使用Kaplan-Meier生存分析，兄弟姐妹之间长期儿科住院的累积发生率没有显著差异。在控制体重和性别的Cox比例风险模型中，三胞胎妊娠的出生顺序与后代的长期住院治疗没有关联。结论:尽管出生顺序与SGA之间存在关联，但三胞胎出生顺序似乎对后代长期住院的风险没有影响。
{"title":"Perinatal outcome and long-term hospitalization of triplets according to birth order","authors":"David Nadav Sabag BMSc, Gali Pariente MD, Eyal Sheiner MD, PhD, Shayna Miodownik MSc, Tamar Wainstock PhD","doi":"10.1111/birt.12798","DOIUrl":"10.1111/birt.12798","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The association between birth order and adverse perinatal outcomes has been well studied in twin pregnancies. However, little is known about the differences in immediate perinatal outcomes as well as long-term hospitalization of the offspring in triplet pregnancies according to their birth order. As such, we aimed to assess the differences in immediate perinatal outcomes and long-term hospitalizations among triplets by their birth order.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In a retrospective hospital-based cohort study, immediate perinatal outcomes and long-term hospitalizations were compared among triplet siblings according to their birth order. Deliveries occurred between the years 1991 and 2021 in a tertiary medical center. The study groups were followed until 18 years of age for cardiovascular, respiratory, neurological, and infection-related hospitalizations. Generalized estimation equation (GEE) models were used to control for confounders. Kaplan–Meier survival curves were used to compare cumulative long-term hospitalization incidences and Cox proportional hazards models were performed to control for confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 117 triplet deliveries. Rates of small for gestational age (SGA) infants increased linearly by birth order (6.0%, 7.7%, and 15.4% for the first, second, and third siblings, respectively; <i>p</i>-value for trends = 0.035). Using a GEE model controlling for maternal age, being born third in a triplet pregnancy was independently associated with SGA (third vs. first sibling, adjusted OR 3.0, 95% CI 1.38–6.59, <i>p</i> = 0.005). No significant differences in cardiovascular, respiratory, neurological, and infection-related hospitalizations were noted among the first, second, and third siblings. Likewise, using Kaplan–Meier survival analyses, no significant differences in the cumulative incidence of long-term pediatric hospitalizations were noted between the siblings. In Cox proportional hazards models, controlling for weight and gender, birth order in a triplet pregnancy did not exhibit an association with long-term hospitalizations of the offspring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite the association between birth order and SGA, birth order in triplets does not seem to have an impact on the risk for long-term offspring hospitalization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 2","pages":"424-431"},"PeriodicalIF":2.5,"publicationDate":"2023-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136400484","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}
Robyn Schafer PhD, CNM, FACNM, Mary S. Dietrich PhD, Holly Powell Kennedy PhD, CNM, FACNM, FAAN, Shelagh Mulvaney PhD, Julia C. Phillippi PhD, CNM, FACNM, FAAN
Introduction
Although current recommendations support vaginal breech birth as a reasonable option, access to breech birth in US hospitals is limited. This study explored the experiences of decision-making and perceptions of access to care in people who transferred out of the hospital system to pursue home breech birth.
Methods
We conducted a mixed methods study of people with a singleton, term breech fetus who transferred out of the US hospital system to pursue home breech birth. Twenty-five people completed an online demographic and psychosocial survey, and 23 (92%) participated in semi-structured interviews. We used an interpretive description approach informed by situational analysis to analyze qualitative data about participants' experiences and perceived access to care.
Results
Of 25 individuals who left the hospital system to pursue a home breech birth, most felt denied informed choice (64%) and threatened or coerced into cesarean (68%). The majority reported low or very low autonomy in decision-making (n = 20, 80%) and high decisional satisfaction using validated measures. Many participants felt safer in a hospital setting but were not able to access care for planned vaginal breech hospital birth, despite extensive efforts. Participants felt “backed into a corner” and “forced into homebirth,” perceiving a lack of access to safe and respectful care in the hospital system.
Conclusion
Some service users believe that home birth is their only option when they cannot access hospital-based care for vaginal breech birth. Current barriers to care for breech birth limit birthing people's autonomy and may be placing them and their infants at increased risk.
{"title":"“I had no choice”: A mixed-methods study on access to care for vaginal breech birth","authors":"Robyn Schafer PhD, CNM, FACNM, Mary S. Dietrich PhD, Holly Powell Kennedy PhD, CNM, FACNM, FAAN, Shelagh Mulvaney PhD, Julia C. Phillippi PhD, CNM, FACNM, FAAN","doi":"10.1111/birt.12797","DOIUrl":"10.1111/birt.12797","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although current recommendations support vaginal breech birth as a reasonable option, access to breech birth in US hospitals is limited. This study explored the experiences of decision-making and perceptions of access to care in people who transferred out of the hospital system to pursue home breech birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a mixed methods study of people with a singleton, term breech fetus who transferred out of the US hospital system to pursue home breech birth. Twenty-five people completed an online demographic and psychosocial survey, and 23 (92%) participated in semi-structured interviews. We used an interpretive description approach informed by situational analysis to analyze qualitative data about participants' experiences and perceived access to care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 25 individuals who left the hospital system to pursue a home breech birth, most felt denied informed choice (64%) and threatened or coerced into cesarean (68%). The majority reported low or very low autonomy in decision-making (<i>n</i> = 20, 80%) and high decisional satisfaction using validated measures. Many participants felt safer in a hospital setting but were not able to access care for planned vaginal breech hospital birth, despite extensive efforts. Participants felt “backed into a corner” and “forced into homebirth,” perceiving a lack of access to safe and respectful care in the hospital system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Some service users believe that home birth is their only option when they cannot access hospital-based care for vaginal breech birth. Current barriers to care for breech birth limit birthing people's autonomy and may be placing them and their infants at increased risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 2","pages":"413-423"},"PeriodicalIF":2.5,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12797","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650485","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}
Maeve E. Wallace PhD, MPH, Dovile Vilda PhD, Lauren Dyer MPH, Iman Johnson MPH, Lillian Funke CMN, MPH
Background
Recent years have brought substantial declines in geographic access to abortion facilities and maternity care across the US. The purpose of this study was to identify the reproductive health consequences of living in a county without access to comprehensive reproductive health care services.
Methods
We analyzed National Center for Health Statistics data on all live births occurring in the US in 2020. We used data on locations of abortion facilities and availability of maternity care in order to classify counties by level of access to comprehensive reproductive health care services and defined comprehensive reproductive health care deserts as counties that did not have an abortion facility in the county or in any neighboring county and did not have any maternity care practitioners. We fit modified Poisson regression models with generalized estimating equations to estimate the degree to which living in a comprehensive reproductive health care desert was associated with receipt of timely and adequate prenatal care and risk of preterm birth, controlling for individual-level and county-level characteristics.
Results
In 2020, one third of counties in the US were comprehensive reproductive health care deserts (n = 1082), and 136,272 births occurred in these counties. In adjusted models, there was no difference in prenatal health care use (timeliness or adequacy of care) between persons in comprehensive reproductive health care deserts and those with full access to care, but the risk of preterm birth was significantly elevated (aRR =1.09, 95% CI = 1.06, 1.13).
Conclusions
Lack of access to comprehensive reproductive health care services may increase the incidence of preterm birth.
背景:近年来，美国各地获得堕胎设施和产科护理的地理位置大幅下降。这项研究的目的是确定生活在一个无法获得全面生殖保健服务的县的生殖健康后果。方法:我们分析了美国国家卫生统计中心2020年所有活产婴儿的数据。我们使用了堕胎设施的位置和产科护理的可用性数据，以便根据获得综合生殖保健服务的水平对县进行分类，并将综合生殖保健沙漠定义为在本县或任何邻近县没有堕胎设施，也没有任何产科护理从业人员的县。我们用广义估计方程拟合修正泊松回归模型，以估计生活在综合生殖保健沙漠中与接受及时和充分的产前护理和早产风险相关的程度，控制了个人水平和县级特征。结果:2020年，美国三分之一的县是综合生殖保健沙漠(n = 1082)，这些县的出生人数为136272人。在调整后的模型中，接受综合生殖保健服务的人和完全获得保健服务的人在产前保健使用(护理的及时性或充足性)方面没有差异，但早产的风险显著升高(aRR =1.09, 95% CI = 1.06, 1.13)。结论:缺乏全面的生殖保健服务可能会增加早产的发生率。
{"title":"Health care use and health consequences of geographic lack of access to abortion and maternity care","authors":"Maeve E. Wallace PhD, MPH, Dovile Vilda PhD, Lauren Dyer MPH, Iman Johnson MPH, Lillian Funke CMN, MPH","doi":"10.1111/birt.12792","DOIUrl":"10.1111/birt.12792","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent years have brought substantial declines in geographic access to abortion facilities and maternity care across the US. The purpose of this study was to identify the reproductive health consequences of living in a county without access to comprehensive reproductive health care services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed National Center for Health Statistics data on all live births occurring in the US in 2020. We used data on locations of abortion facilities and availability of maternity care in order to classify counties by level of access to comprehensive reproductive health care services and defined comprehensive reproductive health care deserts as counties that did not have an abortion facility in the county or in any neighboring county and did not have any maternity care practitioners. We fit modified Poisson regression models with generalized estimating equations to estimate the degree to which living in a comprehensive reproductive health care desert was associated with receipt of timely and adequate prenatal care and risk of preterm birth, controlling for individual-level and county-level characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2020, one third of counties in the US were comprehensive reproductive health care deserts (<i>n</i> = 1082), and 136,272 births occurred in these counties. In adjusted models, there was no difference in prenatal health care use (timeliness or adequacy of care) between persons in comprehensive reproductive health care deserts and those with full access to care, but the risk of preterm birth was significantly elevated (aRR =1.09, 95% CI = 1.06, 1.13).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Lack of access to comprehensive reproductive health care services may increase the incidence of preterm birth.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 2","pages":"363-372"},"PeriodicalIF":2.5,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650486","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}
Laura Manns-James PhD, CNM, WHNP-BC, Shaughanassee Vines DNP, CNE, CNM, FACNM, Jill Alliman DNP, CNM, Lauren Hoehn-Velasco PhD, Susan Stapleton DNP, CNM, Jennifer Wright MA, Diana Jolles PhD, CNM
Background
Racial and ethnic disparities in cesarean rates in the United States are well documented. This study investigated whether cesarean inequities persist in midwife-led birth center care, including for individuals with the lowest medical risk.
Methods
National registry records of 174,230 childbearing people enrolled in care in 115 midwifery-led birth center practices between 2007 and 2022 were analyzed for primary cesarean rates and indications by race and ethnicity. The lowest medical risk subsample (n = 70,521) was analyzed for independent drivers of cesarean birth.
Results
Primary cesarean rates among nulliparas (15.5%) and multiparas (5.7%) were low for all enrollees. Among nulliparas in the lowest-risk subsample, non-Latinx Black (aOR = 1.37; 95% CI, 1.15–1.63), Latinx (aOR = 1.51; 95% CI, 1.32–1.73), and Asian participants (aOR = 1.48; 95% CI, 1.19–1.85) remained at higher risk for primary cesarean than White participants. Among multiparas, only Black participants experienced a higher primary cesarean risk (aOR = 1.49; 95% CI, 1.02–2.18). Intrapartum transfers from birth centers were equivalent or lower for Black (14.0%, p = 0.345) and Latinx (12.7%, p < 0.001) enrollees. Black participants experienced a higher proportion of primary cesareans attributed to non-reassuring fetal status, regardless of risk factors. Place of admission was a stronger predictor of primary cesarean than race or ethnicity.
Conclusions
Place of first admission in labor was the strongest predictor of cesarean. Racism as a chronic stressor and a determinant of clinical decision-making reduces choice in birth settings and may increase cesarean rates. Research on components of birth settings that drive inequitable outcomes is warranted.
{"title":"Race, ethnicity, and indications for primary cesarean birth: Associations within a national birth center registry","authors":"Laura Manns-James PhD, CNM, WHNP-BC, Shaughanassee Vines DNP, CNE, CNM, FACNM, Jill Alliman DNP, CNM, Lauren Hoehn-Velasco PhD, Susan Stapleton DNP, CNM, Jennifer Wright MA, Diana Jolles PhD, CNM","doi":"10.1111/birt.12791","DOIUrl":"10.1111/birt.12791","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Racial and ethnic disparities in cesarean rates in the United States are well documented. This study investigated whether cesarean inequities persist in midwife-led birth center care, including for individuals with the lowest medical risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>National registry records of 174,230 childbearing people enrolled in care in 115 midwifery-led birth center practices between 2007 and 2022 were analyzed for primary cesarean rates and indications by race and ethnicity. The lowest medical risk subsample (<i>n</i> = 70,521) was analyzed for independent drivers of cesarean birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Primary cesarean rates among nulliparas (15.5%) and multiparas (5.7%) were low for all enrollees. Among nulliparas in the lowest-risk subsample, non-Latinx Black (aOR = 1.37; 95% CI, 1.15–1.63), Latinx (aOR = 1.51; 95% CI, 1.32–1.73), and Asian participants (aOR = 1.48; 95% CI, 1.19–1.85) remained at higher risk for primary cesarean than White participants. Among multiparas, only Black participants experienced a higher primary cesarean risk (aOR = 1.49; 95% CI, 1.02–2.18). Intrapartum transfers from birth centers were equivalent or lower for Black (14.0%, <i>p</i> = 0.345) and Latinx (12.7%, <i>p</i> < 0.001) enrollees. Black participants experienced a higher proportion of primary cesareans attributed to non-reassuring fetal status, regardless of risk factors. Place of admission was a stronger predictor of primary cesarean than race or ethnicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Place of first admission in labor was the strongest predictor of cesarean. Racism as a chronic stressor and a determinant of clinical decision-making reduces choice in birth settings and may increase cesarean rates. Research on components of birth settings that drive inequitable outcomes is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 2","pages":"353-362"},"PeriodicalIF":2.5,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12791","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71489254","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}
Approximately 3400 infants die suddenly and unexpectedly each year in the United States; many of these deaths include modifiable risk factors (such as a non-supine position, sleeping on a soft surface, or loose bedding or items in the environment). Interventions have been successful at improving parental knowledge about recommendations to reduce risk of sleep-related infant deaths, as well as improving intention to adopt recommendations. However, follow-up studies have found a disconnect between knowledge/intentions to adhere to recommendations and actual practices. Exploring maternal decision-making about infant sleep practices can better elucidate the disconnect between knowledge of infant sleep recommendations and the practice of it, and thus, inform more effective safe sleep interventions. The purpose of this study was to gain a more in-depth understanding of decision-making around infant sleep practices, and barriers and facilitators to adopting safe infant sleep recommendations.
Methods
Semi-structured in-home interviews were conducted with 22 families (20 mothers and 2 mother–father dyads) of infants up to 6 months of age.
Results
Thematic analysis of the transcripts revealed six themes: Plans changed when baby came, Trying things to figure out what works (infant preferences), Safety concerns, What's comfortable for me (maternal preferences), They say…(advice), and Trying to be careful.
Conclusion
These results suggest that knowledge of infant sleep recommendations alone is not enough to ensure adherence and that decision-making is a dynamic and ongoing process affected by multiple factors. Findings have implications for timing and content of risk reduction efforts, as well as for data collection in research studies.
{"title":"“Things changed very quickly”: Maternal intentions and decision-making about infant sleep surface, location, and position","authors":"Trina C. Salm Ward PhD, MSW","doi":"10.1111/birt.12793","DOIUrl":"10.1111/birt.12793","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Approximately 3400 infants die suddenly and unexpectedly each year in the United States; many of these deaths include modifiable risk factors (such as a non-supine position, sleeping on a soft surface, or loose bedding or items in the environment). Interventions have been successful at improving parental knowledge about recommendations to reduce risk of sleep-related infant deaths, as well as improving intention to adopt recommendations. However, follow-up studies have found a disconnect between knowledge/intentions to adhere to recommendations and actual practices. Exploring maternal decision-making about infant sleep practices can better elucidate the disconnect between knowledge of infant sleep recommendations and the practice of it, and thus, inform more effective safe sleep interventions. The purpose of this study was to gain a more in-depth understanding of decision-making around infant sleep practices, and barriers and facilitators to adopting safe infant sleep recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Semi-structured in-home interviews were conducted with 22 families (20 mothers and 2 mother–father dyads) of infants up to 6 months of age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thematic analysis of the transcripts revealed six themes: <i>Plans changed when baby came, Trying things to figure out what works (infant preferences)</i>, <i>Safety concerns, What's comfortable for me (maternal preferences)</i>, <i>They say…(advice)</i>, and <i>Trying to be careful</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These results suggest that knowledge of infant sleep recommendations alone is not enough to ensure adherence and that decision-making is a dynamic and ongoing process affected by multiple factors. Findings have implications for timing and content of risk reduction efforts, as well as for data collection in research studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 2","pages":"373-383"},"PeriodicalIF":2.5,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429413","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}
Emily J. Callander BA, PhD, Debra Bick OBE, MMedSc, PhD, RM, Hema Mistry BA (Hons), MSc, PhD
Background
Economic evaluations are being conducted with increasing frequency in the maternity care setting, with more randomized controlled trials containing a health economic component. Key emerging criticisms of economic evaluation in maternity care are lack of robust data collection and measurement, inconsistencies in methodology, and lack of adherence to reporting guidelines.
Methods
This article provides a guide to the design of economic evaluations alongside clinical trials in maternal health. We include economic concepts and considerations for the maternity setting and provide examples from the UK and Australia.
Results
There are many important considerations for the design of economic evaluations alongside clinical trials. To be effective, researchers must select types of economic evaluation, which align with their study objectives; choose an appropriate evaluation perspective, time horizon, and discount rate; and identify accurate ways to measure and evaluate health outcomes and costs.
Discussion
This guide is written for noneconomists and can be used for designing economic evaluations to be conducted as a part of clinical trials. We seek to improve the quality, consistency, and transparency of economic evaluations in maternal health.
{"title":"Designing economic evaluations alongside clinical trials in maternal health care: A guide for clinical trial design","authors":"Emily J. Callander BA, PhD, Debra Bick OBE, MMedSc, PhD, RM, Hema Mistry BA (Hons), MSc, PhD","doi":"10.1111/birt.12796","DOIUrl":"10.1111/birt.12796","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Economic evaluations are being conducted with increasing frequency in the maternity care setting, with more randomized controlled trials containing a health economic component. Key emerging criticisms of economic evaluation in maternity care are lack of robust data collection and measurement, inconsistencies in methodology, and lack of adherence to reporting guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This article provides a guide to the design of economic evaluations alongside clinical trials in maternal health. We include economic concepts and considerations for the maternity setting and provide examples from the UK and Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There are many important considerations for the design of economic evaluations alongside clinical trials. To be effective, researchers must select types of economic evaluation, which align with their study objectives; choose an appropriate evaluation perspective, time horizon, and discount rate; and identify accurate ways to measure and evaluate health outcomes and costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This guide is written for noneconomists and can be used for designing economic evaluations to be conducted as a part of clinical trials. We seek to improve the quality, consistency, and transparency of economic evaluations in maternal health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 2","pages":"405-412"},"PeriodicalIF":2.5,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12796","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429415","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}
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