Birth-Issues in Perinatal Care最新文献

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.

Introduction: Obstetric anal sphincter injuries (OASIS) are a significant complication of vaginal birth. While most studies focus on patient-related risk factors, the impact of midwife experience and shift timing remains understudied. We examined the association between these factors and OASIS risk in spontaneous vaginal deliveries.

Methods: This retrospective cohort study analyzed term, singleton, cephalic, spontaneous vaginal deliveries at the Galilee Medical Center (March 2020-February 2025), excluding operative vaginal births and cesarean deliveries. Deliveries were categorized by midwife experience: inexperienced (< 2 years), moderately experienced (2-10 years), and highly experienced (> 10 years). Shift timing and delivery patterns within shifts were also examined. The primary outcome was OASIS incidence. Multivariate logistic regression adjusted for confounders such as parity, macrosomia, and second-stage duration.

Results: Among 13,651 term spontaneous vaginal deliveries, OASIS occurred in 0.6%, with the highest rate among early-career midwives (1.9%) compared to mid-career (0.6%) and experienced midwives (0.5%) (p < 0.001). Associations remained significant after multivariate adjustment. Early-career midwives had a higher risk of OASIS (aOR 3.29, 95% CI 1.49-7.26), while mid-career midwives had a comparable risk to experienced midwives (aOR 1.05, 95% CI 0.60-1.85). Evening shift deliveries (aOR 1.73, 95% CI 1.01-2.96) and deliveries during the last 2 h of a shift (aOR 1.82, 95% CI 1.05-3.14) were also independently associated with increased OASIS risk.

Conclusions: Patients delivered by experienced midwives had lower rates of OASIS. This protective effect was especially evident in deliveries without episiotomy. Strengthening midwifery training and optimizing staffing may help improve perineal outcomes.

Introduction: Respectful maternity care promotes dignity, privacy, and informed choices during childbirth, can improve maternal and newborn health outcomes, and broadly contributes to greater gender equality. In India, efforts like the JSY program and the LaQshya initiative are underway, bringing considerable progress in understanding this area. During the COVID-19 pandemic, several health program disruptions resulted in changes in healthcare experiences. This study aimed to estimate the prevalence of disrespectful maternity care and its associated factors before and during the COVID-19 pandemic.

Methods: To understand the experiences of families undergoing maternity care during the pandemic, we surveyed households in Chandigarh, a Union Territory in North India, and Kalyani, a town in West Bengal. This cross-sectional study was conducted among mothers with children less than 2 years old before March 2020 (pre-pandemic period, n = 413) and after March 2020 (pandemic period, n = 407). Disrespectful maternity care was studied across seven domains, which included physical abuse, non-dignified care, non-consented care, non-confidential care, discrimination, abandonment, and detention. Data was managed using REDCap and were analyzed using SPSS (version 25.0). Multivariable logistic regression analysis was used to evaluate differences in the type of maternity care experienced by the two groups.

Results: Of 776 mothers, 227 (29.3%) reported disrespectful maternity care. There were no statistically significant differences in disrespectful maternity care faced pre-pandemic and during the pandemic. Non-dignified care was experienced significantly more commonly during the pandemic as compared to pre-pandemic (aOR = 2.24; 95% CI: 1.23-4.08). During the pandemic, detention (which refers to the demand for bribery or detaining the mother or baby within the healthcare center for failure to pay) was experienced by a significantly higher proportion of women who did not receive financial assistance for delivery care (89.3% vs. 75.4%; aOR = 2.72, 95% CI: 1.13-6.58).

Conclusion: Almost a third of the mothers in our study reported disrespectful maternity care, and the COVID-19 pandemic did not significantly impact this proportion. Our findings highlight the need to reduce non-dignified care and provide financial assistance to mothers during delivery to avoid detention during public health crises such as the COVID-19 pandemic.