Birth-Issues in Perinatal Care最新文献

Background: Shared decision-making is a woman-centered approach to antenatal decision-making. Few studies have observed maternity clinicians' use of shared decision-making in antenatal clinic consultations.

Aim: The aim of this study was to explore the recorded consultations in antenatal care between pregnant women and maternity clinicians, to ascertain if, when or how shared decision-making is used in antenatal care.

Methods: Twenty-six antenatal clinic consultations were audio-recorded with maternity clinicians and women. Data were analyzed using the Framework Method, within an analytical matrix designed around the 12 items of the validated observer measure of shared decision-making, the OPTION12 scale.

Findings: A total of 12 clinicians and 26 pregnant women were recruited to the study. There were significant limitations to shared decision-making in recorded consultations. Three themes were identified through the use of the Framework Method: Who decides?, Women constrained, and Clinicians omniscient.

Discussion: Reviewing the clinician communication as part of a framework matrix made visible latent themes of relationality and power imbalance between clinicians and pregnant women. Clinicians in this study shared clinical knowledge in a way that highlighted the power imbalance between the clinician and the woman. This study illustrates that shared decision-making is limited in these studied antenatal clinic consultations.

Conclusion: The findings of this study demonstrate how clinician communication can support or sabotage women's involvement in shared decision-making. The results of this study underscore the need for targeted efforts to more effectively integrate shared decision-making into routine antenatal care.

Background: Compassionate care from healthcare professionals is vital for parents following perinatal loss. Changes to maternity care during the COVID-19 pandemic affected perinatal loss care and illuminated the need for new responses. This study reports Australian findings from an international collaboration (PUDDLES) of seven countries investigating parents' experiences of care following perinatal loss during COVID-19.

Methods: Semi-structured interviews were conducted with 15 mothers and 3 fathers who experienced stillbirth, neonatal death, or termination of pregnancy for medical reasons during the COVID-19 pandemic in Australia. Interviews were transcribed and analyzed using template analysis.

Findings: An overarching theme "Compassionate care made up for a lot" described the ways healthcare professionals' actions either mitigated or exacerbated parents' distress beyond the inherent suffering associated with their baby's death. Three themes within this overarching theme were identified: (1) "Encountering a disrupted health system" included parents' experiences of health services and provider responses to COVID-19; (2) "Experiencing the loss-immediate and defining moments" captured how COVID-19-related changes affected crucial moments around the time of the loss and its immediate aftermath; and (3) "Entering a new level of isolation in the community" described lack of aftercare and restricted support opportunities following hospital discharge.

Conclusions: Healthcare professionals' actions matter deeply for families during a time of devastating loss, and perhaps even more so when this coincides with a health system crisis. Embedding conditions and structures for compassionate perinatal loss care is both possible and essential.

Background: Pregnancy can be a difficult time for people who have experienced trauma. Trauma-informed care can address the needs of people who have experienced trauma. In the present study, we describe the creation of a trauma-informed multidisciplinary clinic for pregnant people with a history of trauma or birth trauma.

Methods: We considered the best practices for identifying and training key personnel, developing and implementing trauma-informed interventions, including the development of a trauma-informed birth plan, and designing procedures for patient identification and referral to the clinic.

Results: The implementation of trauma-informed procedures in the clinic and labor and delivery unit is described. All patients agreed to have the trauma-informed birth plan documented in the medical record. Trauma-informed birth plans were well received by staff who reported it was easy to find and clearly documented. Patients reported many of their goals were achieved and that care teams utilized the birth plan. Importantly, the patient experience in the multidisciplinary clinic was positive even if the birth experience and delivery were medically complicated.

Conclusion: The present work demonstrates that a trauma-informed multidisciplinary clinic can address the specific needs of people who have experienced trauma or a traumatic birth. It further demonstrates that trauma-informed interventions can be delivered by a multidisciplinary team across outpatient and inpatient settings and successfully communicated to staff not directly involved in the clinic, but involved in patient care. Hospitals providing care to pregnant people should consider creating a trauma-informed multidisciplinary clinic to support patients with traumatic experiences.

Background: Black birthing people experience disproportionately high rates of adverse maternal and infant health outcomes. Doula support is associated with improved birth outcomes and can help reduce racial disparities, yet culturally congruent doulas face hurdles practicing in the healthcare setting. This quality improvement project aimed to understand the experiences of Black doulas in Nebraska to enhance integration into healthcare systems.

Methods: Three group-based interviews were conducted as part of a quality improvement project in August 2023 with six Black doulas practicing in Nebraska. Participants were recruited through community organizations and snowball sampling. Semi-structured interviews explored doula practices, barriers, motivations, and sources of support. Transcripts were analyzed using thematic analysis.

Results: Three main themes emerged: (1) Barriers inhibiting Black doulas in the healthcare setting, (2) Facilitators of a doula-friendly clinical environment, and (3) Coping strategies. Doulas described facing resistance, stereotypes, and a lack of understanding about their role from some healthcare staff, contrasted with client advocacy. Self-care strategies and peer support networks were critical for sustainable practice.

Conclusion: Despite systemic barriers, Black doulas play a vital role in supporting Black families and addressing inequities. Recommendations include implementing doula-friendly policies, addressing bias, fostering an inclusive environment in healthcare facilities, and enhancing the integration of culturally concordant doula support to improve outcomes for Black birthing people.

Background: Previous trial-based or modeling studies of cost differences between births following induction of labor (IOL) and expectant management (EM) showed mixed findings and did not account for the full range of costs at a population level.

Methods: We included singleton, cephalic, and term live births between 01/07/2016 and 30/06/2018 in public hospitals of one Australian state (Queensland). We excluded individuals with a previous cesarean birth, no labor, and specific maternal conditions. The mean costs per pregnancy (AUD 2021/22), capturing all health service events and prescription medications accessed during the month of labor and birth, were compared. Generalized linear models were used to calculate cost ratios (CR) and their 95% confidence intervals (CI) after adjusting for potential confounders.

Results: The analysis included 30,924 births. The mean costs per pregnancy (combined women and neonates) were higher for IOL at each week of gestation (37-40), compared with EM, both before and after adjustment, regardless of parity. The largest ($7684, CR = 1.31; 95% CI: 1.23-1.40) and smallest ($1502, CR = 1.06; 95% CI: 1.03-1.09) cost differences were found among nulliparous women at 37 and 39 weeks, respectively. Maternal inpatient admissions largely drove these cost differences.

Discussion: These findings suggest that higher costs associated with IOL in low-risk women are likely due to the intervention itself-such as increased intrapartum procedures or complications-rather than underlying maternal risk. This supports previous evidence of higher cesarean rates after IOL and highlights the need for further evaluation of its cost-effectiveness in the Australian context.

Introduction: Primary tokophobia is a potent and pathological fear of pregnancy and childbirth. This condition can affect both nulliparous women and childless men and compel them to entirely refrain from parenthood, thus leading to a childless life. However, the dearth of validated Arabic scales assessing this construct hinders research in Arabic-speaking populations. Therefore, this study aims to assess the psychometric properties of the Childbirth Fear-Prior to Pregnancy scale (CFPP) within the Lebanese population.

Methods: We recruited 1269 participants (651 nulliparous women and 618 childless men) in a cross-sectional study via social media snowball sampling. The questionnaire included the CFPP scale and other Arabic-validated measures of primary tokophobia and psychological distress.

Results: The confirmatory factor analysis of the CFPP scale confirmed its unidimensional nature, and the scale's reliability was excellent. In addition, the CFPP scale demonstrated gender invariance. Convergent validity was established by strong correlations between the CFPP scale and the Tokophobia Severity Scale (TSS) in women as well as the Fathers' Fear of Childbirth Scale (FFCS) in men. Modest, but significant correlations between the CFPP scores and anxiety/depression measures also suggested that the scale specifically captures childbirth fear rather than psychological distress, supporting its divergent validity.

Conclusion: Validating the Arabic CFPP scale for both women and men in an understudied Arabic population, our study offers a valuable tool for identifying childbirth fear prior to pregnancy. This validated scale can improve detection, inform support services, and ultimately benefit both men and women experiencing primary tokophobia. Furthermore, our study paves the way for cross-cultural research tackling cultural influences on primary tokophobia, particularly in non-Western countries.

Background: The Quality Maternal and Newborn Care Framework index (QMNCFi) is a 44-item tool that assesses service users' perspectives of the quality of maternal and newborn care. Transforming a survey tool for use in another language requires both linguistic and cultural adaptation. This study aimed to translate and cross-culturally adapt the QMNCFi into standard Chinese.

Methods: A standard translation and adaptation model was used, including independent translation, back translation, checking of the items' wording, applicability, and relevance by a senior panel. This was followed by purposive sampling of 30 mothers to participate in cognitive interviews and then verification of back translations by the original lead authors of QMNCFi. Finally, a further 16 mothers were purposively selected to participate in two rounds of cognitive interviews. Data were analyzed using content analysis to assess item, semantic, operational, conceptual, and measurement equivalence, ultimately resulting in a culturally adapted Chinese version.

Results: Adaptations were made to the QMNCFi covering item, semantic, operational, and conceptual equivalence. The item-level content validity index from the panel consultations ranged from 0.813 to 1.000 (first round) to 0.933 to 1.000 (second round). The average scale-level content validity index was 0.990 and 0.998, respectively, indicating strong content validity, so no revisions were made for measurement equivalence.

Conclusion: This study achieved cultural equivalence through cross-cultural translation and adaptation of QMNCFi. The adapted Chinese version of QMNCFi will now be formally validated.

Introduction: Late preterm and early term birth are associated with increased risks of adverse health outcomes throughout life. Where such births have been decided upon in advance, many parents are dissatisfied with the input they are able to have in the decision-making process. This paper reports a qualitative investigation exploring the input parents want and expect in decision-making about possible planned LPET birth; how their experiences compare with these; and how they feel about the input they are able to have.

Method: Semi-structured interviews were conducted with parents of babies up to 6 months old, who had been involved in discussions with doctors about the possibility of planned late preterm or early term birth. Data were analyzed using Reflexive Thematic Analysis.

Results: Twelve parents of nine singleton babies took part. Analysis generated three themes: (1) What matters most to us in this decision? (2) We are in a new and strange place, and (3) Can we work together to reach a decision? Each theme encompassed two or more sub-themes.

Conclusion: Parents want to feel able to voice their questions and concerns; to understand why early birth is being considered, their options and the reason behind specific recommendations; and to work with healthcare professionals to reach a plan that is agreed by all as best for the baby, inclusive of other issues they consider important, and carried out as planned. Suggestions are made for what parents need if these wishes and expectations are to be met.