Birth-Issues in Perinatal Care最新文献

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Trial registration: ClinicalTrials.gov identifier: NCT05478798.

Introduction: Antepartum fetal surveillance, including nonstress tests, is designed to reduce the incidence of stillbirth. Despite widespread use, there is limited data regarding its efficacy and shared decision-making is advised. Our objective was to evaluate pregnant women's understanding of the rationale for antepartum fetal surveillance and explore its impact.

Methods: Seventeen subjects undergoing scheduled nonstress testing at a large medical center in Portsmouth, Virginia, USA were recruited for this qualitative study. Semi-structured interviews using a standardized guide were conducted and assessed using thematic analysis.

Results: Review of the interview transcripts identified the emergence of five themes and nine subthemes. Several subjects highlighted logistical challenges and costs (both financial and nonfinancial) associated with more frequent visits. Participants referred for antenatal testing appear to have a narrow knowledge of its components, indications, and limitations and are unaware of the implications of abnormal results. Despite a high degree of uncertainty and costs incurred, most women were willing to undergo testing and generally found the process to be a source of comfort.

Conclusion: Our thematic analysis of participants' perceptions suggests that during antepartum fetal surveillance, shared decision-making either does not always occur or that it is not fully optimized. Efforts to improve this process could emphasize more open communication, providing patient-centered, evidence-based information, and actively incorporating individual narratives into the counseling processes.

Background: Understanding future demand for midwifery-led birth centers is critical to increasing utilization of this high-value model of care. This study examines factors associated with interest in birth center care for a future pregnancy.

Methods: We analyzed data from the Listening to Mothers in California survey. The study included 1447 people who had a singleton hospital birth in 2016 and did not have a history of cesarean birth. Multivariate logistic regression models were conducted with variables that were aligned with the Coxon model of birth setting decision-making.

Results: More than half of respondents (n = 789; 54.5%) expressed interest in receiving care at a birth center in the future. Respondents were more likely to express interest in birth center care if they had experienced pressure to have an obstetric intervention (AOR 1.86, 95% CI = 1.83-1.90) or believed that birth is a natural process that should not be interfered with unless medically necessary (AOR 1.74, 95% CI = 1.71-1.78), compared to respondents who did not. They were also more likely to have sought information about hospital cesarean rates (AOR 1.50, 95% CI = 1.47-1.52), had a doula in labor (AOR 1.42, 95% CI = 1.39-1.45), and experienced mistreatment (AOR 1.23, 95% CI = 1.21-1.26).

Conclusions: Broadening access to midwifery-led birth centers to accommodate future demand is needed. Providing pregnant people with comparable quality measures of birth center and hospital care may facilitate informed decision-making. Improving the shared decision-making abilities of healthcare providers could help prevent instances of mistreatment or undue pressure on pregnant individuals to undergo obstetrical interventions.

Introduction: To gain more insight into psychological mechanisms associated with fear of childbirth (FoC), this study examined the relationship between intolerance of uncertainty (IU) and FoC in nulliparous and multiparous pregnant women, as well as the moderating role of maternal parity in this relationship, and the role of inhibitory IU and prospective IU in relation to FoC.

Methods: Validated Dutch versions of the Wijma Delivery Expectations Questionnaire version A (W-DEQ-A) and the Intolerance of Uncertainty scale (IUS-12) were filled out by 410 nulliparous and multiparous pregnant women. Statistical analyses in this cross-sectional study included correlation analyses and (multivariate) linear regression analyses.

Results: A significant, positive correlation was found between IU and FoC (ρ = 0.425, p < 0.001; b = 1.533, p < 0.001). Multivariate linear regression identified multiple variables contributing significantly to the level of FoC, with IU remaining the strongest predictor, both for the total group and for nulliparous and multiparous women separately. Maternal parity was not found to moderate the relationship between IU and FoC. Both inhibitory IU and prospective IU were significantly, positively associated with FoC.

Conclusion: Higher levels of IU are positively associated with higher levels of FoC in both nulliparous and multiparous women. Psychological treatment targeting FoC may benefit from focusing on managing uncertainty and increasing psychological flexibility. Future research is needed to better understand the role of IU in FoC during pregnancy, in order to increase maternal mental health and improve (post-partum) mother-child relationships.