The COVID-19 pandemic led to changes in the provision of pregnancy and postpartum care. The purpose of this study was to describe changes in access to prenatal and postpartum care over time, from early in the pandemic (July 2020) to mid-pandemic (January 2021) and to explore socioeconomic and COVID-19-related economic factors associated with experiencing barriers to care.
Methods
We recruited two cross sections of women and birthing people in the US in July 2020 (N = 4645) and January 2021 (N = 3343) using Facebook and Instagram Ads.
Results
Three out of four women in the prenatal period and four out of five women in the postpartum period reported barriers to scheduling a visit. The likelihood of not having a visit (OR = 4.44, 95% CI 2.67–7.40), being unable to schedule a visit (OR = 2.73, 95% CI 1.71–4.35), and not being offered visits (OR = 4.26, 95% CI 2.32–7.81) increased over time. Participants were more likely to report barriers attending scheduled prenatal or postpartum appointments over time (OR = 2.72, 95% CI 2.14–3.45). Women who experienced more economic impacts from COVID-19 were older, less educated, and were Black, Indigenous, or a person of color, and were more likely to have barriers to attending appointments.
Conclusions
Certain subgroups are more at risk during COVID-19, and around 9 months into the pandemic, women were not only still facing barriers to care, but these had been amplified. Additional research using other data sources is needed to identify and ameliorate barriers and inequalities in access to prenatal and postpartum care that appear to have persisted throughout the pandemic.
{"title":"Prenatal and postpartum care during the COVID-19 pandemic: An increase in barriers from early to mid-pandemic in the United States","authors":"Nadia Diamond-Smith PhD, MSc, Rachel Logan PhD, MPH, Aliza Adler BA, MPH, Sirena Gutierrez MPH, Cassondra Marshall DrPH, MPH, Jennifer L. Kerns MD, MS, MPH","doi":"10.1111/birt.12800","DOIUrl":"10.1111/birt.12800","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The COVID-19 pandemic led to changes in the provision of pregnancy and postpartum care. The purpose of this study was to describe changes in access to prenatal and postpartum care over time, from early in the pandemic (July 2020) to mid-pandemic (January 2021) and to explore socioeconomic and COVID-19-related economic factors associated with experiencing barriers to care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We recruited two cross sections of women and birthing people in the US in July 2020 (<i>N</i> = 4645) and January 2021 (<i>N</i> = 3343) using Facebook and Instagram Ads.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three out of four women in the prenatal period and four out of five women in the postpartum period reported barriers to scheduling a visit. The likelihood of not having a visit (OR = 4.44, 95% CI 2.67–7.40), being unable to schedule a visit (OR = 2.73, 95% CI 1.71–4.35), and not being offered visits (OR = 4.26, 95% CI 2.32–7.81) increased over time. Participants were more likely to report barriers attending scheduled prenatal or postpartum appointments over time (OR = 2.72, 95% CI 2.14–3.45). Women who experienced more economic impacts from COVID-19 were older, less educated, and were Black, Indigenous, or a person of color, and were more likely to have barriers to attending appointments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Certain subgroups are more at risk during COVID-19, and around 9 months into the pandemic, women were not only still facing barriers to care, but these had been amplified. Additional research using other data sources is needed to identify and ameliorate barriers and inequalities in access to prenatal and postpartum care that appear to have persisted throughout the pandemic.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 2","pages":"450-458"},"PeriodicalIF":2.5,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12800","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138566618","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}
Ian Koorn MD, MSC, Linda C. Vis MSC, Kim J. C. Verschueren MD, PhD, Ageeth N. Rosman PhD, Thomas van den Akker MD, PhD
Background
Globally, cesarean birth rates are rising, and while it can be a lifesaving procedure, cesarean birth is also associated with increased maternal and perinatal risks. This study aims to describe changes over time about the mode of birth and perinatal outcomes in second-pregnancy women with one previous cesarean birth in the Netherlands over the past 20 years.
Methods
We conducted a nationwide, population-based study using the Dutch perinatal registry. The mode of birth (intended vaginal birth after cesarean (VBAC) compared with planned cesarean birth) was assessed in all women with one previous cesarean birth and no prior vaginal birth who gave birth to a term singleton in cephalic presentation between 2000 and 2019 in the Netherlands (n = 143,146). The reported outcomes include the trend of intended VBAC, VBAC success rate, and adverse perinatal outcomes (perinatal mortality up to 7 days, low Apgar score at 5 min, asphyxia, and neonatal intensive care unit admission ≥24 h).
Results
Intended VBAC decreased by 21.5% in women with one previous cesarean birth and no prior vaginal birth, from 77.2% in 2000 to 55.7% in 2019, with a marked deceleration from 2009 onwards. The VBAC success rate dropped gradually, from 71.0% to 65.3%, across the same time period. Overall, the cesarean birth rate (planned and unplanned) increased from 45.2% to 63.6%. Adverse perinatal outcomes were higher in women intending VBAC compared with those planning a cesarean birth. Perinatal mortality initially decreased but remained stable from 2009 onwards, with only minimal differences between both modes of birth.
Conclusions
In the Netherlands, the proportion of women intending VBAC after one previous cesarean birth and no prior vaginal birth has decreased markedly. Particularly from 2009 onwards, this decrease was not accompanied by a synchronous reduction in perinatal mortality.
{"title":"Variations over time in mode of birth and perinatal outcomes in women with one previous cesarean in the Netherlands: A 20-year population-based study","authors":"Ian Koorn MD, MSC, Linda C. Vis MSC, Kim J. C. Verschueren MD, PhD, Ageeth N. Rosman PhD, Thomas van den Akker MD, PhD","doi":"10.1111/birt.12803","DOIUrl":"10.1111/birt.12803","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Globally, cesarean birth rates are rising, and while it can be a lifesaving procedure, cesarean birth is also associated with increased maternal and perinatal risks. This study aims to describe changes over time about the mode of birth and perinatal outcomes in second-pregnancy women with one previous cesarean birth in the Netherlands over the past 20 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a nationwide, population-based study using the Dutch perinatal registry. The mode of birth (intended vaginal birth after cesarean (VBAC) compared with planned cesarean birth) was assessed in all women with one previous cesarean birth and no prior vaginal birth who gave birth to a term singleton in cephalic presentation between 2000 and 2019 in the Netherlands (<i>n</i> = 143,146). The reported outcomes include the trend of intended VBAC, VBAC success rate, and adverse perinatal outcomes (perinatal mortality up to 7 days, low Apgar score at 5 min, asphyxia, and neonatal intensive care unit admission ≥24 h).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Intended VBAC decreased by 21.5% in women with one previous cesarean birth and no prior vaginal birth, from 77.2% in 2000 to 55.7% in 2019, with a marked deceleration from 2009 onwards. The VBAC success rate dropped gradually, from 71.0% to 65.3%, across the same time period. Overall, the cesarean birth rate (planned and unplanned) increased from 45.2% to 63.6%. Adverse perinatal outcomes were higher in women intending VBAC compared with those planning a cesarean birth. Perinatal mortality initially decreased but remained stable from 2009 onwards, with only minimal differences between both modes of birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In the Netherlands, the proportion of women intending VBAC after one previous cesarean birth and no prior vaginal birth has decreased markedly. Particularly from 2009 onwards, this decrease was not accompanied by a synchronous reduction in perinatal mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 2","pages":"459-467"},"PeriodicalIF":2.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12803","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464512","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}
The increasing number of unnecessary cesarean births is a cause for concern and may be addressed by increasing access to midwifery care. The objective of this review was to assess the effect of midwifery care on the likelihood of cesarean births.
Methods
We searched five databases from the beginning of records through May 2020. We included observational studies that reported odds ratios or data allowing the calculation of odds ratios of cesarean birth for births with and without midwife involvement in care or presence at the institution. Standard inverse-variance random-effects meta-analysis was used to generate overall odds ratios (ORs).
Results
We observed a significantly lower likelihood of cesarean birth in midwife-led care, midwife-attended births, among those who received instruction pre-birth from midwives, and within institutions with a midwifery presence.
Conclusions
Care from midwives reduces the likelihood of cesarean birth in all the analyses, perhaps due to their greater preference and skill for physiologic births. Increased use of midwives in maternal care can reduce cesarean births and should be further researched and implemented broadly, potentially as the default modality in maternal care.
{"title":"Systematic review and meta-analysis examining the effects of midwife care on cesarean birth","authors":"Ilir Hoxha MD, PhD, Krenare Grezda MD, Anirudh Udutha MD, Besarta Taganoviq MS, Riaz Agahi PhD, Naime Brajshori PhD, Sharon Schindler Rising MSN, CNM, FACNM","doi":"10.1111/birt.12801","DOIUrl":"10.1111/birt.12801","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The increasing number of unnecessary cesarean births is a cause for concern and may be addressed by increasing access to midwifery care. The objective of this review was to assess the effect of midwifery care on the likelihood of cesarean births.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched five databases from the beginning of records through May 2020. We included observational studies that reported odds ratios or data allowing the calculation of odds ratios of cesarean birth for births with and without midwife involvement in care or presence at the institution. Standard inverse-variance random-effects meta-analysis was used to generate overall odds ratios (ORs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We observed a significantly lower likelihood of cesarean birth in midwife-led care, midwife-attended births, among those who received instruction pre-birth from midwives, and within institutions with a midwifery presence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Care from midwives reduces the likelihood of cesarean birth in all the analyses, perhaps due to their greater preference and skill for physiologic births. Increased use of midwives in maternal care can reduce cesarean births and should be further researched and implemented broadly, potentially as the default modality in maternal care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 2","pages":"264-274"},"PeriodicalIF":2.5,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464511","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}
María Alejandra Aguilar-Rodríguez MD, Lilia V. Castro-Porras DSc
Background
Often marginalized and disadvantaged by systems of oppression, Indigenous populations commonly face significant barriers to accessing adequate antenatal care (ANC). The COVID-19 pandemic had an unprecedented impact on healthcare systems worldwide, including on the provision of antenatal care; this was especially so for Indigenous communities in many regions. As such, our study aimed to estimate the association between the COVID-19 pandemic and adequate ANC received by Indigenous women in Chiapas, Mexico.
Methods
We conducted a retrospective crossover analysis with data collected between June and December 2021 from Indigenous women who attended at least one ANC appointment at one of two health centers in San Cristóbal de las Casas, Chiapas. We used a multinomial logistic regression model considering the time frame (before and during the pandemic) as the primary independent variable. Adequate antenatal care comprised four dimensions: attendance by qualified personnel, timely first visit, sufficient frequency of visits, and adequacy of the content provided during the visits.
Results
During the COVID-19 pandemic, there was a significant drop in ANC adequacy, with 12.7% (95% CI: 8.3, 18.9) of Indigenous women receiving ANC, compared with the pre-pandemic rate of 52.5% (95% CI: 44.7, 60.3), among the 158 participants. The pandemic resulted in a reduction of 75.8% in the adequacy of ANC. Considering the four dimensions of adequacy, we found that having only one dimension was associated with a relative risk ratio (RRR) of 12.45 (95% CI: 6.40, 24.23), while having two or three dimensions was associated with a RRR of 5.23 (95% CI: 2.83, 9.65) when using adequate ANC as the category of reference.
Conclusions
According to our results, Indigenous women's ANC adequacy was negatively affected by the COVID-19 pandemic. In light of these findings, we emphasize the importance of developing healthcare systems that are prepared to adapt consultation schemes by implementing virtual visits and incorporating community health workers.
{"title":"COVID-19 and the adequacy of antenatal care among Indigenous women: A retrospective crossover analysis","authors":"María Alejandra Aguilar-Rodríguez MD, Lilia V. Castro-Porras DSc","doi":"10.1111/birt.12799","DOIUrl":"10.1111/birt.12799","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Often marginalized and disadvantaged by systems of oppression, Indigenous populations commonly face significant barriers to accessing adequate antenatal care (ANC). The COVID-19 pandemic had an unprecedented impact on healthcare systems worldwide, including on the provision of antenatal care; this was especially so for Indigenous communities in many regions. As such, our study aimed to estimate the association between the COVID-19 pandemic and adequate ANC received by Indigenous women in Chiapas, Mexico.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective crossover analysis with data collected between June and December 2021 from Indigenous women who attended at least one ANC appointment at one of two health centers in San Cristóbal de las Casas, Chiapas. We used a multinomial logistic regression model considering the time frame (before and during the pandemic) as the primary independent variable. Adequate antenatal care comprised four dimensions: attendance by qualified personnel, timely first visit, sufficient frequency of visits, and adequacy of the content provided during the visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the COVID-19 pandemic, there was a significant drop in ANC adequacy, with 12.7% (95% CI: 8.3, 18.9) of Indigenous women receiving ANC, compared with the pre-pandemic rate of 52.5% (95% CI: 44.7, 60.3), among the 158 participants. The pandemic resulted in a reduction of 75.8% in the adequacy of ANC. Considering the four dimensions of adequacy, we found that having only one dimension was associated with a relative risk ratio (RRR) of 12.45 (95% CI: 6.40, 24.23), while having two or three dimensions was associated with a RRR of 5.23 (95% CI: 2.83, 9.65) when using adequate ANC as the category of reference.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>According to our results, Indigenous women's ANC adequacy was negatively affected by the COVID-19 pandemic. In light of these findings, we emphasize the importance of developing healthcare systems that are prepared to adapt consultation schemes by implementing virtual visits and incorporating community health workers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 2","pages":"432-440"},"PeriodicalIF":2.5,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12799","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464510","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}
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}
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