Birth-Issues in Perinatal Care最新文献

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: 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: Postpartum pain, a common symptom after a cesarean birth, is influenced by psychosocial factors. This exploratory qualitative study examined patient perspectives on social support and healthcare communication behaviors in the postpartum setting in relation to the pain experience.

Methods: In-depth, semi-structured, qualitative interviews about postpartum pain experiences were conducted 2-3 days and 2-6 weeks postpartum with individuals who underwent a cesarean birth (2020-2021). Data were analyzed using the constant comparative method.

Results: Among 49 postpartum individuals, themes related to social support and healthcare communication were identified in relation to postpartum pain. Participants discussed the impact of non-healthcare social support (e.g., partners, extended family, other children) on postpartum pain, highlighting emotional and practical assistance. Most commonly mentioned were the positive impacts of emotional and logistical support with household activities and childcare on postpartum pain recovery. The second theme covered individuals' views on how healthcare support and communication affected postpartum pain, with themes of both positive and negative experiences. Some participants discussed positive experiences of shared decision-making and responsiveness of the healthcare team, whereas others recounted negative experiences of lack of counseling and poor outpatient communication.

Discussion: Social support and healthcare communication are integral influences on pain recovery after a cesarean birth. These findings highlight the need for interventions to address psychosocial support and healthcare team communication in the immediate postpartum period.

Background: Triplet pregnancies are increasingly leaning toward planned cesarean deliveries (CD), yet data on determining factors and outcomes remain limited.

Objective: To assess the success of vaginal delivery (VD) in triplet pregnancies and compare neonatal and maternal outcomes with those of CD.

Methods: A retrospective cohort study included triplet pregnancies from 26 weeks' gestation onward in a tertiary center between 2000 and 2020. The primary outcome was the actual mode of delivery (successful VD, planned CD, or unplanned CD). Secondary outcomes included indications for CD, as well as neonatal and maternal outcomes.

Results: Seventy-one women were included. Of these, 41% attempted VD, with 90% successfully delivering vaginally. Planned CD was chosen by 59%, mainly for fetal (64%) or maternal (19%) indications, or patient preference (17%). Neonatal mortality did not differ significantly between planned VD and CD (aOR: 0.29; 95% CI: 0.06-1.50; p = 0.14). However, neonates born via VD compared to CD had lower risks for sepsis (aOR: 0.19; 95% CI: 0.04-0.94; p = 0.04) and retinopathy of prematurity (aOR: 0.17; 95% CI: 0.03-0.93; p = 0.04). Neonates born after VD had higher risks of infant respiratory distress syndrome (OR: 2.70; 95% CI: 1.03-7.08; p = 0.04) and interventricular hemorrhage (OR: 4.00; 95% CI: 1.20-13.35; p = 0.02), though these associations were not significant after adjusting for gestational age (p = 0.92 and p = 0.32, respectively).

Conclusions: Women opting for VD in triplet pregnancies had a 90% success rate. VD can be safe after careful case selection and access to highly trained personnel at a tertiary center. Centralization might enhance safety and outcomes, offering essential insights for clinicians.