Birth-Issues in Perinatal Care最新文献

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.

Background: The consequences of untreated perinatal mental health conditions are well-established, yet fewer than one in five women experiencing perinatal mental health distress receive treatment. Although recommendations for evidence-based treatment are increasingly widespread, patients and providers still face substantial hurdles to accessing needed services. This study sought to update the literature with a report on providers' perceptions of the demand for and accessibility of mental health services for women in the perinatal period with the goal of pinpointing areas where quality improvement should be implemented.

Methods: An eight-item, mixed-methods (i.e., open choice, multiple choice, and open response) questionnaire assessing perceptions of patients' access and barriers to care was sent in a department-wide email at a large academic medical center. Forty-six providers completed the survey (n = 18 physicians, n = 14 nurse midwives, n = 13 advanced practitioner nurses, n = 2 other providers).

Results: Providers reported pervasive barriers to perinatal mental healthcare and that only occasionally are their perinatal patients able to access appropriate mental healthcare.

Discussion: The findings contribute to the growing body of knowledge regarding access to mental healthcare, ultimately aiming to improve the overall well-being of women during the perinatal period. The study emphasizes the ongoing critical need for researchers and the healthcare system to recognize and address the persistent challenges faced by obstetric providers, highlighting the pervasive nature of issues in accessing quality perinatal healthcare and underscoring the importance of acknowledging these challenges for justifying increased clinical access, rigorous intervention studies, and policy change.

Objective: To explore the perinatal and birth experiences of pregnant women infected, or in close contact with SARS-CoV-2 during the first wave of the pandemic in a hospital in northern Spain.

Methods: A qualitative descriptive study was conducted. The Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research were followed. Purposeful and non-probabilistic sampling were used. Recruitment started in December 2022 and continued until February 2023. The inclusion criteria consisted of: (a) Women > 18 years old fluent in Spanish, (b) pregnant women infected with or in close contact with SARS-CoV-2 at the time of delivery, and (c) those who gave birth at HUMV during the first wave of COVID-19 (March-June 2020). In-depth interviews and researcher field notes were used for data collection. A thematic inductive analysis was performed.

Results: Nineteen participants were included. The mean age of participants was 34.94 years (standard deviation, SD: 4.17). Five themes emerged: (a) Uncertainty about COVID-19; (b) Loss of control of the situation; (c) Loss of normality; (d) Impact of restrictions on neonatal care and (e) Unexpected positive experiences.

Conclusions: Participants infected or in isolation due to close contact with SARS-CoV2 who became mothers during the COVID-19 pandemic experienced the perinatal process and particularly childbirth as a traumatic event. Loss of control of the situation and separation from the partner and the baby were experienced with anguish, confusion, and uncertainty. This experience had a lasting emotional impact over time.

Clinical implications: In the future, respecting the woman's decisions in relation to childbirth, humanizing care throughout the process, not separating the mother from the baby except in extreme circumstances, and treating the couple as an inseparable and essential element during pregnancy, childbirth, and postpartum processes could help reduce trauma for people giving birth during pandemics.

Background: The prevalence of substance use disorders (SUDs) among pregnant individuals has risen alongside the opioid epidemic, contributing to increased maternal morbidity and mortality. Many pregnant individuals with SUDs experience significant stigma and bias from the healthcare system, which discourages them from seeking necessary care. This stigma, often exacerbated by fears of child protective services involvement, can prevent patients from engaging in treatment, thereby impacting maternal and fetal health. Reducing stigma among healthcare providers and nurses is critical to improving care and outcomes for this population. This systematic review aims to identify and compile primary literature on interventions designed to decrease stigma in providers and nurses caring for pregnant individuals with SUDs.

Methods: We conducted a systematic search of Google Scholar, Web of Science, and Embase using comprehensive terms related to substance use, healthcare providers, stigma, and pregnancy. Only primary research articles were included, with exclusions for review papers, meta-analyses, and commentaries, as well as studies focused on unrelated topics (e.g., prescriptions, schizophrenia, psychosis). Using Covidence software, we screened 2308 articles, with 558 duplicates removed automatically. Double-blind title and abstract screening resulted in the exclusion of 1330 articles, leaving 420 for full-text review. After applying inclusion criteria, 19 studies were included in the final analysis.

Results: The 19 included studies represented a wide range of educational interventions designed to reduce provider stigma toward pregnant individuals with SUDs. Interventions included online learning modules, professional development workshops, clinical immersion experiences, and one arts-based program. While training formats and evaluation tools varied widely, most studies reported improvements in provider knowledge, confidence, and attitudes. However, fewer demonstrated sustained behavior change, and only a minority used validated instruments or long-term follow-up.

Conclusions: Stigma reduction interventions for providers caring for pregnant people with SUDs are becoming more common, particularly in response to rising perinatal substance use rates. Despite the effectiveness of many approaches, intervention and evaluation strategies remain non-standardized. Expanding access to training, especially in high-burden and under-resourced settings, and developing validated, scalable, and emotionally engaging education models will be critical to improving perinatal care quality and equity.

Background: Extensive research highlights the risk of PTSD following traumatic childbirth. However, PTSD during pregnancy-whether preexisting or emerging prenatally-receives far less attention despite its associated harmful effects on maternal and infant well-being. To fill this gap, the current study examines predictors of childbirth-related PTSD symptoms, including maternal ACEs and prenatal PTSD symptoms in 91 mothers from a diverse community sample (47% particpants of c) within the United States.

Methods: Participants completed questionnaires on ACEs and PTSD symptoms during their third trimester of pregnancy and childbirth-related PTSD symptoms at 6-weeks postpartum. The current study used a path analysis model to examine the mediating effects of prenatal PTSD on the relationship between ACEs and childbirth-related PTSD symptoms at 6-weeks postpartum.

Results: Findings indicated that ACEs have implications for childbirth-related PTSD symptoms at 6-weeks postpartum with a significant indirect effect through prenatal PTSD, standardized indirect effect = 0.20, 95% CI = [0.02, 0.36], p = 0.03.

Conclusion: Screening for childhood adversity during pregnancy may have dual benefits for prenatal and postpartum health, such that screening can help identify women at risk for prenatal PTSD as well as those at risk for later childbirth-related trauma symptoms who may benefit from trauma-informed targeted prevention and intervention efforts.

Background: Individuals experiencing perinatal loss are entitled to respectful maternity care, but a paucity of research examines respectful care at the time of pregnancy loss.

Method: We used data from an online cross-sectional survey (July 2020-February 2022), where 172 individuals reported on early (miscarriage) and late (late second trimester, stillbirth, neonatal death) losses since 2009. We aimed to explore inequities in respectful care experiences among individuals experiencing a late versus early perinatal loss in Canada. We assessed their experiences using the Mothers' Autonomy in Decision Making (MADM) scale and the Mothers on Respect Index (MORi). We created the Compassionate Disclosure of (perinatal) Loss (CDL) index to measure respectful care at the time of a loss. A single separate item, provider not listening to the individual's expression of concerns during pregnancy, was also analyzed.

Results: The early and late loss groups differed in education levels. Individuals who self-identified as Indigenous/Black/People of Color (IBPOC) had lower odds of scoring in the top quartile on MADM and MORi scales (AOR = 0.31, 95% CI 0.13, 0.75; AOR = 0.34, 95% CI 0.13, 0.86); and higher odds of reporting that providers did not listen to their concerns prior to the loss (AOR = 2.61, 95% CI 1.24, 5.48). Psychometric analysis supported the CDL index. Participants experiencing late loss had higher odds of reporting top quartile CDL scores than those experiencing early loss (AOR = 3.08, CI 1.22, 7.77).

Conclusion: Canadian individuals with perinatal loss report disproportionately poorer care when they are experiencing a miscarriage and when they identify as IBPOC.