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.
{"title":"Disrespectful Maternity Care During the COVID-19 Pandemic: A Retrospective Cross-Sectional Study in Chandigarh and Kalyani, West Bengal, India.","authors":"Madhu Gupta, Aritrik Das, Paramita Sengupta, Jitendra Majhi, Zawata Afnan, K Safvan, Preetika Banerjee, Nimran Kaur, Tushara Rajeev, Stephanie Pocius, Arita Acharjee, Kayur Mehta, Smisha Agarwal, Anita Shet","doi":"10.1111/birt.70017","DOIUrl":"https://doi.org/10.1111/birt.70017","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Episiotomy is still commonly practiced during childbirth worldwide, despite decades of scientific evidence that indicates no justification for its routine use. Routine episiotomy is associated with increased risk of serious maternal morbidity and no improvements in neonatal outcomes. We sought to analyze this gap between evidence-based knowledge and implementation surrounding reducing episiotomy practice. We systematically reviewed the literature to identify practices that have resulted in a change in episiotomy rates.
Methods
We searched three databases (PubMed/MEDLINE, CINAHL Complete, Embase) using key words and subject headings with no time restriction. Any studies published in English and reporting an original empirical analysis in any global, regional, or country-specific context that examined practice changes that were implemented and reported episiotomy as an outcome were included in our review. Studies were excluded if they only reported on trends or changes in episiotomy rates without examining the specific practices implemented. We sought to identify practices that resulted in a change in episiotomy rates, rather than to evaluate or compare the effectiveness of these practices.
Results
Search results returned 1265 records; 40 papers met the inclusion criteria for a full review. Twenty-five papers were included in our final analysis. All included studies documented a decrease in episiotomy rates, with 21 studies reporting a statistically significant reduction. Most studies were mixed interventions, often a combination of an educational intervention and audit and feedback.
Conclusions
Specific practice changes have been shown to effectively decrease the incidence of episiotomy. The findings from our review provide actionable insights for implementing evidence-based interventions to improve obstetric care. Prioritizing respectful birthing practices and reducing the routine use of episiotomy are critical steps toward addressing obstetric violence and promoting equitable, patient-centered maternity care globally.
{"title":"Interventions and Strategies for Reducing Episiotomy Rates Globally: A Systematic Review","authors":"Angela W. Chen, Maiah J. Hall, Molly R. Altman","doi":"10.1111/birt.70000","DOIUrl":"10.1111/birt.70000","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Episiotomy is still commonly practiced during childbirth worldwide, despite decades of scientific evidence that indicates no justification for its routine use. Routine episiotomy is associated with increased risk of serious maternal morbidity and no improvements in neonatal outcomes. We sought to analyze this gap between evidence-based knowledge and implementation surrounding reducing episiotomy practice. We systematically reviewed the literature to identify practices that have resulted in a change in episiotomy rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched three databases (PubMed/MEDLINE, CINAHL Complete, Embase) using key words and subject headings with no time restriction. Any studies published in English and reporting an original empirical analysis in any global, regional, or country-specific context that examined practice changes that were implemented and reported episiotomy as an outcome were included in our review. Studies were excluded if they only reported on trends or changes in episiotomy rates without examining the specific practices implemented. We sought to identify practices that resulted in a change in episiotomy rates, rather than to evaluate or compare the effectiveness of these practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Search results returned 1265 records; 40 papers met the inclusion criteria for a full review. Twenty-five papers were included in our final analysis. All included studies documented a decrease in episiotomy rates, with 21 studies reporting a statistically significant reduction. Most studies were mixed interventions, often a combination of an educational intervention and audit and feedback.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Specific practice changes have been shown to effectively decrease the incidence of episiotomy. The findings from our review provide actionable insights for implementing evidence-based interventions to improve obstetric care. Prioritizing respectful birthing practices and reducing the routine use of episiotomy are critical steps toward addressing obstetric violence and promoting equitable, patient-centered maternity care globally.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"52 4","pages":"539-552"},"PeriodicalIF":2.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Community births (those in homes or freestanding birth centers) are increasing in the US, although they still represent a small percentage of total births. Research shows that community births can offer positive outcomes for low-risk individuals, such as fewer interventions and greater satisfaction. However, when perinatal complications arise, transfer to hospital can result in negative care outcomes and experiences. Effective integration of care and respectful communication between community and hospital providers during transfers are crucial for improving quality care measures. This study aimed to investigate the experiences and outcomes of individuals transferring from community settings to an urban US hospital with established transfer guidelines.
Methods
This multi-method study, utilizing descriptive statistics and a grounded theory approach, explores the outcomes and experiences of individuals transferring from planned home or birth center births to hospital care for intrapartum management from August 2019 to August 2020. We included participants who were 18 or older, English-speaking, and had experienced a live birth following transfer from home or birth center to hospital. Quantitative outcomes were obtained through chart review. Qualitative interviews were conducted within 6 weeks post-birth, recorded, transcribed, and analyzed using constant comparative analysis.
Results
A total of 82 individuals transferred during the study period, with 23 participating in qualitative interviews, we identified 5 major themes: seamless transfer, teamwork, respectful care, changing expectations, and a complex relationship with autonomy and decision-making. Participants valued smooth communication, midwife-to-midwife transfer of care, and the balance between autonomy and reliance on provider recommendations during transfers.
Discussion
Understanding the experiences of those who transfer from community settings to hospitals is crucial for improving perinatal care. With established guidelines for transfer in place to facilitate collaboration across care providers and birth settings, transfers can be managed effectively, resulting in respectful experiences of care with positive health outcomes.
{"title":"“The Very Best That It Could Be and a Lot Better Than I Would Have Imagined”: Birthing People's Experiences of Transfer From Community to Hospital","authors":"Carrie Neerland, Arielle Skalisky, Robyn Schafer","doi":"10.1111/birt.12920","DOIUrl":"10.1111/birt.12920","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Community births (those in homes or freestanding birth centers) are increasing in the US, although they still represent a small percentage of total births. Research shows that community births can offer positive outcomes for low-risk individuals, such as fewer interventions and greater satisfaction. However, when perinatal complications arise, transfer to hospital can result in negative care outcomes and experiences. Effective integration of care and respectful communication between community and hospital providers during transfers are crucial for improving quality care measures. This study aimed to investigate the experiences and outcomes of individuals transferring from community settings to an urban US hospital with established transfer guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multi-method study, utilizing descriptive statistics and a grounded theory approach, explores the outcomes and experiences of individuals transferring from planned home or birth center births to hospital care for intrapartum management from August 2019 to August 2020. We included participants who were 18 or older, English-speaking, and had experienced a live birth following transfer from home or birth center to hospital. Quantitative outcomes were obtained through chart review. Qualitative interviews were conducted within 6 weeks post-birth, recorded, transcribed, and analyzed using constant comparative analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 82 individuals transferred during the study period, with 23 participating in qualitative interviews, we identified 5 major themes: seamless transfer, teamwork, respectful care, changing expectations, and a complex relationship with autonomy and decision-making. Participants valued smooth communication, midwife-to-midwife transfer of care, and the balance between autonomy and reliance on provider recommendations during transfers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Understanding the experiences of those who transfer from community settings to hospitals is crucial for improving perinatal care. With established guidelines for transfer in place to facilitate collaboration across care providers and birth settings, transfers can be managed effectively, resulting in respectful experiences of care with positive health outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"52 4","pages":"717-725"},"PeriodicalIF":2.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12920","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To compare participants' perceptions of reasons for admission, labor induction, and rationale for cesarean birth to those documented by clinicians in the electronic health record (EHR) and if these comparisons differed by race and ethnicity.
Methods
We conducted a secondary analysis of data from the Nulliparous Pregnancy Outcomes Study: Monitoring mothers-to-be (2010–2013). We calculated kappa to evaluate agreement between participant postpartum interviews and EHR notes (n = 6085).
Results
Overall, agreement was variable. There was substantial agreement (κ = 0.717, 95% CI 0.704, 0.724) on the reason for obstetric admission, but concordance for the admission reason was lower among preterm births. Only fair agreement was observed (κ = 0.290, 95% CI 0.220, 0.360) for whether labor was electively induced or medically indicated. As a whole, moderate agreement was observed between interview and EHR data on the indication for cesarean birth. EHR documentation on elective labor induction was moderately concurrent with interviews from non-Hispanic White participants; however, it was poor to fair among all other subgroups.
Discussion
There were varying degrees of concordance between patient perceptions and what is documented within the EHR. Clinicians should ensure effective communication regarding obstetric procedures and the rationale for interventions, particularly those that are elective. Decision making in later pregnancies should consider all sources of data (EHR and self-reported), particularly where patient and EHR data are discordant around labor dysfunction.
背景：比较参与者对入院原因、引产和剖宫产理由的看法与临床医生在电子健康记录（EHR）中记录的原因，以及这些比较是否因种族和民族而不同。方法：我们对来自“未产妊娠结局研究：监测准妈妈（2010-2013）”的数据进行了二次分析。我们计算kappa来评估参与者产后访谈和EHR记录之间的一致性（n = 6085）。结果：总体而言，同意度是可变的。在产科入院的原因上有实质性的一致性（κ = 0.717, 95% CI 0.704, 0.724），但入院原因的一致性在早产儿中较低。对于引产是选择性引产还是医学指征，仅观察到公平一致（κ = 0.290, 95% CI 0.220, 0.360）。总体而言，访谈和电子病历数据在剖宫产指征方面存在适度一致。选择性引产的电子病历记录与非西班牙裔白人参与者的访谈适度同步；然而，在所有其他亚组中，它都很差。讨论：有不同程度的一致性之间的病人的看法和什么是记录在电子病历。临床医生应确保就产科手术和干预措施，特别是选择性干预措施的理由进行有效沟通。妊娠后期的决策应考虑所有来源的数据（电子病历和自我报告），特别是当患者和电子病历数据在分娩功能障碍方面不一致时。
{"title":"Concordance of Self-Reported Obstetric Outcomes With Electronic Health Record Documentation: A Secondary Analysis of the Nulliparous Pregnancy Outcomes Study Monitoring Mothers-To-Be","authors":"Veronica Barcelona, LinQin Chen, Elise Erickson","doi":"10.1111/birt.12918","DOIUrl":"10.1111/birt.12918","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To compare participants' perceptions of reasons for admission, labor induction, and rationale for cesarean birth to those documented by clinicians in the electronic health record (EHR) and if these comparisons differed by race and ethnicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a secondary analysis of data from the Nulliparous Pregnancy Outcomes Study: Monitoring mothers-to-be (2010–2013). We calculated kappa to evaluate agreement between participant postpartum interviews and EHR notes (<i>n</i> = 6085).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, agreement was variable. There was substantial agreement (<i>κ</i> = 0.717, 95% CI 0.704, 0.724) on the reason for obstetric admission, but concordance for the admission reason was lower among preterm births. Only fair agreement was observed (<i>κ</i> = 0.290, 95% CI 0.220, 0.360) for whether labor was electively induced or medically indicated. As a whole, moderate agreement was observed between interview and EHR data on the indication for cesarean birth. EHR documentation on elective labor induction was moderately concurrent with interviews from non-Hispanic White participants; however, it was poor to fair among all other subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>There were varying degrees of concordance between patient perceptions and what is documented within the EHR. Clinicians should ensure effective communication regarding obstetric procedures and the rationale for interventions, particularly those that are elective. Decision making in later pregnancies should consider all sources of data (EHR and self-reported), particularly where patient and EHR data are discordant around labor dysfunction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"52 4","pages":"708-716"},"PeriodicalIF":2.5,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephanie Batram-Zantvoort, Céline Miani, Ilaria Mariani, Emanuelle Pessa Valente, Mehreen Zaigham, Ingvild Hersoug Nedberg, Magdalena Kurbanović, Elizabete Pumpure, Anja Bohinec, Antigone Sarantaki, Barbara Baranowska, Alessia Abderhalden-Zellweger, Elise de La Rochebrochard, Raquel Costa, Marina Ruxandra Otelea, Alina Liepinaitienė, Jelena Radetic, Amira Ćerimagić, Maryse Arendt, Martina König-Bachmann, Stefano Delle Vedove, Karolina Linden, Sigrun Kongslien, Daniela Drandić, Darta Kreslina, Zalka Drglin, Dimitra Metallinou, Urszula Tataj-Puzyna, Michael Gemperle, Virginie Rozée, Heloísa Dias, Marija Mizgaitienė, Jovana Ruzicic, Imola Simon, Simona Fumagalli, Helen Elden, Eline Skirnisdottir Vik, Barbara Mihevc Ponikvar, Aikaterini Lykeridou, Beata Szlendak, Claire de Labrusse, Tiago Miguel Pinto, Simona Jazdauskienė, Christoph Zenzmaier, Ilana Chertok, Emma Sacks, Marzia Lazzerini, IMAgiNE EURO Study group
Background
Mitigation measures implemented in response to the COVID-19 pandemic led to significant changes in maternity care across Europe, including restrictions on companions during labor and birth. This cross-sectional study explores the association between the presence of a companion of choice and a positive perception of the birth experience. Additionally, it explores the association between health professionals' attention, assistance, and availability during labor and birth and a positive perception of birth.
Methods
We utilized a structured, validated online questionnaire, available in 25 languages, to assess the quality of maternal care during the COVID-19 pandemic from women's perspectives. We conducted logistic regression to explore associations between variables related to the presence of a companion of choice, health professionals' attention, assistance, and availability, and positive perceptions of birth, when controlled for confounders, including birth mode and medical interventions.
Results
Responses from 48,039 women across 20 countries in the WHO European Region were included. Always having a companion of choice during birth (aOR: 2.11) and always receiving adequate care from health professionals (assistance aOR: 2.12, attention aOR: 36.64, availability aOR: 2.12) were associated with positive birth perception. Instrumental births (aOR: 0.76), episiotomies (aOR: 0.74), fundal pressure (aOR: 0.52), and cesarean births (planned aOR: 0.80, unplanned prelabor aOR: 0.60, unplanned in-labor aOR: 0.52) were associated with less positive birth perceptions.
Discussion
This study highlights the critical role of having a chosen companion and receiving adequate attention, assistance, and availability from health professionals in promoting positive birth perceptions, even in times of crisis such as the COVID-19 pandemic. Ensuring the presence of a companion of choice and comprehensive professional support is crucial for delivering high-quality, respectful maternity care.
{"title":"The Association Between Women's Perception of Birth During the Pandemic, Companion of Choice and Support From Health Professionals: A Cross-Sectional Study in 20 Countries in the WHO European Region","authors":"Stephanie Batram-Zantvoort, Céline Miani, Ilaria Mariani, Emanuelle Pessa Valente, Mehreen Zaigham, Ingvild Hersoug Nedberg, Magdalena Kurbanović, Elizabete Pumpure, Anja Bohinec, Antigone Sarantaki, Barbara Baranowska, Alessia Abderhalden-Zellweger, Elise de La Rochebrochard, Raquel Costa, Marina Ruxandra Otelea, Alina Liepinaitienė, Jelena Radetic, Amira Ćerimagić, Maryse Arendt, Martina König-Bachmann, Stefano Delle Vedove, Karolina Linden, Sigrun Kongslien, Daniela Drandić, Darta Kreslina, Zalka Drglin, Dimitra Metallinou, Urszula Tataj-Puzyna, Michael Gemperle, Virginie Rozée, Heloísa Dias, Marija Mizgaitienė, Jovana Ruzicic, Imola Simon, Simona Fumagalli, Helen Elden, Eline Skirnisdottir Vik, Barbara Mihevc Ponikvar, Aikaterini Lykeridou, Beata Szlendak, Claire de Labrusse, Tiago Miguel Pinto, Simona Jazdauskienė, Christoph Zenzmaier, Ilana Chertok, Emma Sacks, Marzia Lazzerini, IMAgiNE EURO Study group","doi":"10.1111/birt.12915","DOIUrl":"10.1111/birt.12915","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Mitigation measures implemented in response to the COVID-19 pandemic led to significant changes in maternity care across Europe, including restrictions on companions during labor and birth. This cross-sectional study explores the association between the presence of a companion of choice and a positive perception of the birth experience. Additionally, it explores the association between health professionals' attention, assistance, and availability during labor and birth and a positive perception of birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We utilized a structured, validated online questionnaire, available in 25 languages, to assess the quality of maternal care during the COVID-19 pandemic from women's perspectives. We conducted logistic regression to explore associations between variables related to the presence of a companion of choice, health professionals' attention, assistance, and availability, and positive perceptions of birth, when controlled for confounders, including birth mode and medical interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Responses from 48,039 women across 20 countries in the WHO European Region were included. Always having a companion of choice during birth (aOR: 2.11) and always receiving adequate care from health professionals (assistance aOR: 2.12, attention aOR: 36.64, availability aOR: 2.12) were associated with positive birth perception. Instrumental births (aOR: 0.76), episiotomies (aOR: 0.74), fundal pressure (aOR: 0.52), and cesarean births (planned aOR: 0.80, unplanned prelabor aOR: 0.60, unplanned in-labor aOR: 0.52) were associated with less positive birth perceptions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This study highlights the critical role of having a chosen companion and receiving adequate attention, assistance, and availability from health professionals in promoting positive birth perceptions, even in times of crisis such as the COVID-19 pandemic. Ensuring the presence of a companion of choice and comprehensive professional support is crucial for delivering high-quality, respectful maternity care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"52 4","pages":"677-689"},"PeriodicalIF":2.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12915","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the UK, families in temporary accommodation reached record numbers in 2023. Pregnant mothers experiencing homelessness are at risk of poor health outcomes, yet little is known about their experiences. Most biomedical research emphasizes obstetric outcomes rather than maternal experiences. Our study aimed to explore maternal experiences of pregnancy while living in temporary accommodation in the UK.
Methods
Using an interpretivist paradigm and critical feminist theory, we collected and analyzed semi-structured interview narratives from pregnant and postnatal mothers experiencing homelessness. Interviews with key workers from relevant Third Sector Organisations provided complementary insights. Study planning included Patient and Public Involvement. Data were analyzed using reflexive thematic analysis.
Results
Fourteen mothers and six keyworkers were interviewed. Reflexive thematic analysis generated three themes. Theme one, Pregnant/postnatal bodies in unsafe spaces, described participants' experiences with unsafe accommodations, exposure to environmental hazards, and frequent moves which affected physical and mental health. In Undermining mothers, participants explained how the constant struggle to meet basic needs eroded opportunities to engage with caring roles and destabilized their sense of being “good” mothers. Together these contributed to pregnancy disengagement and feeling unprepared for birth. The third key theme, Feeling unseen in midwifery blind spots, describes barriers to accessing maternity services, as well as interactions with midwives that often reinforced feelings of being invisible.
Discussion
Living in temporary accommodations whilst pregnant negatively impacts physical, mental, and emotional well-being. Improving care for pregnant mothers experiencing homelessness requires systemic change within housing and maternity services to acknowledge housing security as an essential need for pregnant and parenting mothers.
{"title":"Pregnant and Homeless in the UK: A Qualitative Analysis of Maternal Experiences in Temporary Accommodation","authors":"Sara Cumming, Andrew Symon","doi":"10.1111/birt.12919","DOIUrl":"10.1111/birt.12919","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In the UK, families in temporary accommodation reached record numbers in 2023. Pregnant mothers experiencing homelessness are at risk of poor health outcomes, yet little is known about their experiences. Most biomedical research emphasizes obstetric outcomes rather than maternal experiences. Our study aimed to explore maternal experiences of pregnancy while living in temporary accommodation in the UK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using an interpretivist paradigm and critical feminist theory, we collected and analyzed semi-structured interview narratives from pregnant and postnatal mothers experiencing homelessness. Interviews with key workers from relevant Third Sector Organisations provided complementary insights. Study planning included Patient and Public Involvement. Data were analyzed using reflexive thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fourteen mothers and six keyworkers were interviewed. Reflexive thematic analysis generated three themes. Theme one, <i>Pregnant/postnatal bodies in unsafe spaces</i>, described participants' experiences with unsafe accommodations, exposure to environmental hazards, and frequent moves which affected physical and mental health. In <i>Undermining mothers</i>, participants explained how the constant struggle to meet basic needs eroded opportunities to engage with caring roles and destabilized their sense of being “good” mothers. Together these contributed to pregnancy disengagement and feeling unprepared for birth. The third key theme, <i>Feeling unseen in midwifery blind spots</i>, describes barriers to accessing maternity services, as well as interactions with midwives that often reinforced feelings of being invisible.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Living in temporary accommodations whilst pregnant negatively impacts physical, mental, and emotional well-being. Improving care for pregnant mothers experiencing homelessness requires systemic change within housing and maternity services to acknowledge housing security as an essential need for pregnant and parenting mothers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"52 3","pages":"503-510"},"PeriodicalIF":2.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12919","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Charlotte Leroy, Elizaveta Fomenko, Régine Goemaes, Virginie Van Leeuw, Judith Racapé, Sophie Alexander
Objective
To assess the effect of maternity unit characteristics on the cesarean section (CS) rate, using Robson's Ten-Group Classification System (TGCS) and considering the sociodemographic and medical characteristics of the mother.
Methods
The study, conducted in Belgium from 2011 to 2019, employed an analytical design utilizing a nationwide register of routine data and focused on hospital births. The CS rate was analyzed by neonatal intensive care unit (NICU) availability and by maternal unit size for TGCS groups 1, 2, and 5, which were the highest contributors to the total CS rate. Multivariable logistic regression models and generalized linear mixed-effects models were utilized to analyze the association between the maternity itself and CS.
Results
The overall CS rate was 20.8%, displaying a twofold variation across maternity units. This variation persisted irrespective of the presence or absence of a NICU and the maternity unit's size. Our findings highlighted a significant association between maternity unit characteristics (size and NICU availability) and the likelihood of performing CS in TGCS groups 1, 2, and 5. This association did not change after adjustment for sociodemographic and medical characteristics. However, the majority of odds ratios for maternity-related variables lost their significance in the multilevel analysis compared to simple logistic regressions.
Conclusions
The CS rate seems to be more influenced by the “philosophy” of the maternity unit than its specific size and NICU characteristics. Future research is needed to explore the underlying mechanisms of this association and to identify potential interventions that could reduce CSs performed without clinical indication in different settings.
{"title":"Effect of Maternity Characteristics on Cesarean Birth Rates in Belgium: A Robson Classification Approach","authors":"Charlotte Leroy, Elizaveta Fomenko, Régine Goemaes, Virginie Van Leeuw, Judith Racapé, Sophie Alexander","doi":"10.1111/birt.12916","DOIUrl":"10.1111/birt.12916","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the effect of maternity unit characteristics on the cesarean section (CS) rate, using Robson's Ten-Group Classification System (TGCS) and considering the sociodemographic and medical characteristics of the mother.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study, conducted in Belgium from 2011 to 2019, employed an analytical design utilizing a nationwide register of routine data and focused on hospital births. The CS rate was analyzed by neonatal intensive care unit (NICU) availability and by maternal unit size for TGCS groups 1, 2, and 5, which were the highest contributors to the total CS rate. Multivariable logistic regression models and generalized linear mixed-effects models were utilized to analyze the association between the maternity itself and CS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall CS rate was 20.8%, displaying a twofold variation across maternity units. This variation persisted irrespective of the presence or absence of a NICU and the maternity unit's size. Our findings highlighted a significant association between maternity unit characteristics (size and NICU availability) and the likelihood of performing CS in TGCS groups 1, 2, and 5. This association did not change after adjustment for sociodemographic and medical characteristics. However, the majority of odds ratios for maternity-related variables lost their significance in the multilevel analysis compared to simple logistic regressions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The CS rate seems to be more influenced by the “philosophy” of the maternity unit than its specific size and NICU characteristics. Future research is needed to explore the underlying mechanisms of this association and to identify potential interventions that could reduce CSs performed without clinical indication in different settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"52 4","pages":"690-698"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carla Meurk, Susan Roberts, Michael Lam, Lisa Wittenhagen, Leonie Callaway, Katherine Moss, Jayne Lucke, Ruth Barker, Elissa Waterson, Natasha Malmstrom, Edward Weaver, Elisabeth Hoehn, Ed Heffernan
Introduction
This article presents an assessment of the mental health profile of women who were the subject of a suicide-related call to police or paramedics around the time of (i) pregnancy or (ii) surgical termination of pregnancy compared to (iii) other women of a similar age.
Methods
Findings are drawn from a population-wide linked dataset of approximately 70,000 individuals who were the subject of a suicide-related call to police or paramedics in Queensland, Australia. Mental health diagnoses were assessed based on the Diagnostic and Statistical Manual (fifth edition). Behavior, impairment, symptoms, and social functioning were assessed using Health of the Nation Outcome Scores (HoNOS).
Results
32.7% of individuals had a record of one or more confirmed mental health diagnoses. The presence of a mental health diagnosis differed significantly across subgroups. Rates of clinically significant problems, as measured by HoNOS, differed significantly across groups for most items.
Conclusion
Findings present a complex picture of the relationship between mental health diagnosis, pregnancy or termination of pregnancy, and other stressors experienced around the time of a suicide-related contact with police or paramedics.
{"title":"Mental Health Profile Relating to Suicide Crises Among Women in and Around Pregnancy and Surgical Termination of Pregnancy: A Data Linkage Study","authors":"Carla Meurk, Susan Roberts, Michael Lam, Lisa Wittenhagen, Leonie Callaway, Katherine Moss, Jayne Lucke, Ruth Barker, Elissa Waterson, Natasha Malmstrom, Edward Weaver, Elisabeth Hoehn, Ed Heffernan","doi":"10.1111/birt.12917","DOIUrl":"10.1111/birt.12917","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This article presents an assessment of the mental health profile of women who were the subject of a suicide-related call to police or paramedics around the time of (i) pregnancy or (ii) surgical termination of pregnancy compared to (iii) other women of a similar age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Findings are drawn from a population-wide linked dataset of approximately 70,000 individuals who were the subject of a suicide-related call to police or paramedics in Queensland, Australia. Mental health diagnoses were assessed based on the Diagnostic and Statistical Manual (fifth edition). Behavior, impairment, symptoms, and social functioning were assessed using Health of the Nation Outcome Scores (HoNOS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>32.7% of individuals had a record of one or more confirmed mental health diagnoses. The presence of a mental health diagnosis differed significantly across subgroups. Rates of clinically significant problems, as measured by HoNOS, differed significantly across groups for most items.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Findings present a complex picture of the relationship between mental health diagnosis, pregnancy or termination of pregnancy, and other stressors experienced around the time of a suicide-related contact with police or paramedics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"52 4","pages":"699-707"},"PeriodicalIF":2.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12917","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fiona Weeks, Rebecca Myerson, Ronald Gangnon, Jennifer Dykema, Candi Cornelius, Tiffany Green
Introduction
The postpartum visit is an important opportunity to prevent pregnancy-related morbidity and mortality; however, about 1 in 10 birthing people do not attend this visit. Intrapartum care experiences are an understudied factor that may contribute to postpartum healthcare engagement.
Materials and Methods
We analyze data from a novel survey supplement on intrapartum care experiences administered to a probability-based population sample of people who have recently given birth through the Wisconsin Pregnancy Risk Assessment Monitoring System.
Results
In regression models adjusting for a robust set of individual characteristics and birth hospital clustering, we find that lower provider responsiveness during intrapartum care is associated with increased odds of forgoing the postpartum visit (aOR 1.4, 95% CI 1.0–2.0).
Discussion
The quality of care received during the birth hospitalization may shape how birthing people feel about health care providers and their willingness to attend future visits. Experiences of care during the intrapartum period may contribute to future health care utilization. Improving these experiences is an opportunity to promote long-term health.
产后随访是预防妊娠相关发病和死亡的重要机会；然而，大约十分之一的产妇没有参加这次访问。产时护理经验是一个未充分研究的因素，可能有助于产后保健参与。材料和方法：我们分析了一项关于分娩时护理经验的新调查补充数据，该调查是通过威斯康星州妊娠风险评估监测系统对最近分娩的基于概率的人群样本进行的。结果：在校正了一组稳健的个体特征和出生医院聚类的回归模型中，我们发现产中护理时较低的提供者反应性与放弃产后就诊的几率增加有关（aOR 1.4, 95% CI 1.0-2.0）。讨论：分娩住院期间接受的护理质量可能会影响分娩患者对卫生保健提供者的感觉以及他们未来就诊的意愿。分娩期间的护理经验可能有助于未来的卫生保健利用。改善这些经历是促进长期健康的一个机会。
{"title":"Intrapartum Care Experiences Associated With Postpartum Visit Attendance","authors":"Fiona Weeks, Rebecca Myerson, Ronald Gangnon, Jennifer Dykema, Candi Cornelius, Tiffany Green","doi":"10.1111/birt.12910","DOIUrl":"10.1111/birt.12910","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The postpartum visit is an important opportunity to prevent pregnancy-related morbidity and mortality; however, about 1 in 10 birthing people do not attend this visit. Intrapartum care experiences are an understudied factor that may contribute to postpartum healthcare engagement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We analyze data from a novel survey supplement on intrapartum care experiences administered to a probability-based population sample of people who have recently given birth through the Wisconsin Pregnancy Risk Assessment Monitoring System.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In regression models adjusting for a robust set of individual characteristics and birth hospital clustering, we find that lower provider responsiveness during intrapartum care is associated with increased odds of forgoing the postpartum visit (aOR 1.4, 95% CI 1.0–2.0).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The quality of care received during the birth hospitalization may shape how birthing people feel about health care providers and their willingness to attend future visits. Experiences of care during the intrapartum period may contribute to future health care utilization. Improving these experiences is an opportunity to promote long-term health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"52 4","pages":"652-658"},"PeriodicalIF":2.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12910","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Molly R. Altman, Teresa van Winkle, Brittany Ferrell, A. J. Lowik, Kodiak R. S. Soled, Lesley A. Tarasoff, Jeanette McCulloch, Kathrin Stoll, Juno Obedin-Maliver, Saraswathi Vedam, Birth Includes US Community Steering Council
Introduction
Despite increased recognition of and support for family building among lesbian, gay, bisexual, transgender, queer, Two-Spirit, and other sexual and gender minoritized (LGBTQ2S+) populations, there is still little evidence describing the experiences of pregnancy care within these populations in quantifiable ways. This paper describes our pilot study process and the feasibility of implementing a community-developed survey measuring respectful pregnancy care within LGBTQ2S+ communities.
Methods
Using a participatory action research approach, a Community Steering Council developed and piloted the Birth Includes Us survey. To assess the feasibility of the survey, recruitment was assessed through how participants heard about the study, and enrollment and survey completion were tracked in the REDCap survey platform. We used descriptive statistics to report the demographics of the pilot sample.
Results
Recruitment through social media, predominantly Facebook, was an effective route to reach the target population, accounting for over 60% of the sample. Of the 404 eligible participants who opened the survey, 91% completed the survey. The pilot study sample represented 41/50 states in the USA and 5/13 provinces and territories across Canada. While only 17% of the sample were members of racially minoritized communities, there was wide representation across genders and sexualities.
Conclusion
The findings of this feasibility pilot study will inform the implementation of the Birth Includes Us survey to ensure the recruitment, enrollment, and retention of diverse participants. Lessons learned from this process will also support researchers in developing mitigating strategies to minimize the harm incurred during the process of LGBTQ2S+ family building.
{"title":"Feasibility of a Community-Developed Survey Measuring Experiences of Pregnancy Care for LGBTQ2S+ Families","authors":"Molly R. Altman, Teresa van Winkle, Brittany Ferrell, A. J. Lowik, Kodiak R. S. Soled, Lesley A. Tarasoff, Jeanette McCulloch, Kathrin Stoll, Juno Obedin-Maliver, Saraswathi Vedam, Birth Includes US Community Steering Council","doi":"10.1111/birt.12911","DOIUrl":"10.1111/birt.12911","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite increased recognition of and support for family building among lesbian, gay, bisexual, transgender, queer, Two-Spirit, and other sexual and gender minoritized (LGBTQ2S+) populations, there is still little evidence describing the experiences of pregnancy care within these populations in quantifiable ways. This paper describes our pilot study process and the feasibility of implementing a community-developed survey measuring respectful pregnancy care within LGBTQ2S+ communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a participatory action research approach, a Community Steering Council developed and piloted the Birth Includes Us survey. To assess the feasibility of the survey, recruitment was assessed through how participants heard about the study, and enrollment and survey completion were tracked in the REDCap survey platform. We used descriptive statistics to report the demographics of the pilot sample.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Recruitment through social media, predominantly Facebook, was an effective route to reach the target population, accounting for over 60% of the sample. Of the 404 eligible participants who opened the survey, 91% completed the survey. The pilot study sample represented 41/50 states in the USA and 5/13 provinces and territories across Canada. While only 17% of the sample were members of racially minoritized communities, there was wide representation across genders and sexualities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings of this feasibility pilot study will inform the implementation of the Birth Includes Us survey to ensure the recruitment, enrollment, and retention of diverse participants. Lessons learned from this process will also support researchers in developing mitigating strategies to minimize the harm incurred during the process of LGBTQ2S+ family building.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"52 3","pages":"517-526"},"PeriodicalIF":2.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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