Birth-Issues in Perinatal Care最新文献

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.

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: Operative vaginal birth (OVB) is a potentially life-saving intervention, but as a procedure with potential risks and benefits, it must first be preceded by an informed consent discussion. Informed consent is one aspect of patient involvement in the decision to deliver with the assistance of instruments, such as forceps or vacuum. However, it is unclear whether patients undergoing operative vaginal delivery consider informed consent to be adequate; and whether the adequacy of consent impacts their birth experience.

Methods: Using open-ended, semi-structured interviews (n = 20), the purpose of this study was to characterize patient perceptions of the informed consent process for OVB and to evaluate the role pre-procedure communication might play in influencing assisted birth experiences. Patients who had undergone an operative vaginal delivery were invited to share their birth experiences and to provide suggestions for improving the consent process when relevant. Using consensus coding, three investigators independently evaluated the transcribed interviews and identified emergent codes. These codes were then compared, and any disparate ideas were discussed until consensus was reached.

Results: Three primary themes emerged from patient narratives: (1) the difficulty of engaging in the consent process during the second stage of labor; (2) no perceived loss of agency; nonetheless, and (3) acceptance of limited consent discussions because OVB is preferred over a cesarean.

Conclusion: The three key themes identified in the study suggest that patients are satisfied with their birth experience following an OVB, despite significant limitations in informed consent. Findings suggest that patients are accepting a substandard consent process, and that renewed attention should be paid to improving information sharing, even during relatively urgent care encounters. Even though patients expressed satisfaction with the consent process, the adequacy of informed consent is not determined by patient satisfaction. Improving information sharing during urgent care encounters could improve the quality of informed consent for patients undergoing operative vaginal delivery.

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.

Background: This article examines the utilization patterns of community birth (CB) and midwife-attended birth (MAB) among Asian/Pacific Islander (API) populations in the United States. It highlights the presence of significant racial-ethnic disparities and discusses cultural variations that influence these birth choices.

Objectives: To describe variation in the probability of CB and MAB in low-risk pregnancies across API communities and to explore contributors to these variations, including traditional birth practices and cultural beliefs.

Methods: The study employs logistic regression analysis of 2010-2020 birth certificate data to examine the probability of CB and MAB across pan-ethnic groups and API subgroups. The data include information on place of birth, birth attendant, maternal demographics, and race-ethnicity, providing a comprehensive view of perinatal care utilization among diverse populations.

Results: The findings reveal that CB and MAB rates are significantly lower among API groups compared to other pan-ethnic groups. Among API subgroups, there is substantial heterogeneity in the uptake of CB and MAB, with lower rates in Asian Indian and Chinese populations and higher rates in Hawaiian, Japanese, and Guamanian populations.

Conclusion: The study underscores the importance of addressing racial-ethnic disparities in perinatal care and promoting culturally sensitive approaches. Factors such as traditional birth customs, cultural beliefs, and conditions of immigration may influence the choice of perinatal care among API communities. Efforts to promote CB and MAB should consider how cultural differences and values across different API subgroups may promote or inhibit the adoption of evidence-based low-intervention perinatal care models.

Introduction: Despite overwhelming evidence of the benefits of breastfeeding (BF) and its potential to decrease infant mortality, BF rates are low in many low- and middle-income countries like Ghana. We sought to assess Ghanaian mothers' BF plans and their rationale for these plans.

Methods: We conducted a mixed method study via face-to-face interviews administered in 2019. We included pregnant or recently delivered maternity ward patients at a tertiary care center in Kumasi, Ghana. Semi-structured interviews were conducted to collect sociodemographic information, BF plans, and reasons for BF preferences. In accordance with World Health Organization recommendations, optimal BF was defined as 6 months of feeding an infant with breastmilk only (exclusive BF) followed by at least 18 months of feeding an infant the combination of breast milk and supplementary liquids and/or solid foods (complementary BF). Demographic characteristics of the cohort were compared by maternal BF plan using Pearson's chi-squared and t-test. Simple thematic analysis was performed to identify reasons for BF preferences.

Results: During the study period, 126 participants were enrolled. Forty-two (33.3%) participants planned to practice optimal BF. Participants who were married were more likely to have optimal BF plans than unmarried participants (OR 0.17; 95% CI 0.04, 0.53). There was no association between optimal BF plans and age, education, religion, and pre- or post-delivery status. Reasons for not practicing optimal BF included concern about the nutritional sufficiency and infants' enjoyment of breastmilk, logistical challenges of optimal BF, milk underproduction, and medical concerns for mother or baby.

Conclusions: Only one-third of our cohort planned to practice optimal BF. Strengthening family support systems and improving patient education may increase optimal BF rates in Ghana.

Background: In perinatal care, obstetric violence and birth trauma are two distinct yet often conflated concepts. This confusion can obscure the specific harms of obstetric violence, as its impact is frequently subsumed under the broader idea of birth trauma, leading to underreporting of obstetric violence. Simultaneous concept analysis is used to clarify two related concepts by comparing their unique elements and identifying overlaps.

Aim: To compare the antecedents, attributes, and consequences of both the concepts and to identify their intersections.

Methods: A comprehensive search across PubMed, Google Scholar, CINAHL, and ProQuest yielded 98 articles on obstetric violence and 62 on birth trauma. Thematic analysis of antecedents, attributes, and outcomes informed a comparative validity matrix.

Results: Obstetric violence and birth trauma have different causes and characteristics but lead to similar outcomes. Birth trauma arises from experiences like fear or unmet expectations, while obstetric violence involves abuse by providers and systemic failures. Both result in emotional distress, anxiety, and fear of future childbirth.

Conclusion: Existing literature uses the term "birth trauma" as a euphemism for what is essentially obstetric violence. Considering the conceptual confusion between the subjective trauma arising from childbirth experiences and the trauma specifically resulting from abuse by healthcare providers, we are suggesting a new term, "Obstetric Trauma" This would specifically indicate the structural and institutional consequences of obstetric violence on women. It would also help guide targeted interventions, policy changes, and support systems aimed at preventing obstetric violence and promoting respectful maternity care.

Background: Studies suggest that midwifery care can decrease the rate of unplanned cesarean birth. In this study, we compared unplanned cesarean rates, labor interventions, and birth outcomes for mixed-risk patients receiving intrapartum care from obstetricians or midwives.

Methods: We conducted a retrospective cohort study using perinatal data from a single academic tertiary center from 2013 to 2018. The sample included nulliparous and multiparous patients with a term, singleton, vertex fetus. We included induced and spontaneous labor as well as trial of labor after cesarean. We excluded patients with planned cesarean delivery or any high-risk diagnosis requiring obstetrician care.

Results: Our cohort included 7694 patients. Of those, 3543 (46.0%) received intrapartum care from an obstetrician and 4151 (54.0%) from a midwife. The overall cesarean rate was 11.8%. Patients receiving midwifery care had significantly lower cesarean rates (8.9% vs. 15.2%; p < 0.01) overall and by adjusted analysis [aOR 0.49 (0.40-0.60) 95% CI]. Patients receiving obstetrician care more frequently experienced induction/augmentation, neuraxial anesthesia, and operative vaginal delivery. Obstetrician-led care was associated with increased lacerations, intra-amniotic infection, and severe maternal morbidity, while midwifery-led care was associated with increased rates of postpartum hemorrhage, blood transfusion, and shoulder dystocia.

Discussion: Midwifery intrapartum care was associated with lower rates of unplanned cesarean birth in this mixed-risk cohort of laboring and induced patients. Wider integration of midwives for intrapartum care could increase vaginal delivery rates. Additional studies are needed to explore underlying mechanisms and implications for systems- and practice-based changes in the United States.