Journal of midwifery & women's health最新文献

Background: The safety of vaginal breech birth is associated with the skill and experience of professionals in attendance, but minimal training opportunities exist. OptiBreech collaborative care is an evidence-based care bundle, based on previous research. This care pathway is designed to improve access to care and the safety of vaginal breech births, when they occur, through dedicated breech clinics and intrapartum support. This improved process also enhances professional training. Care coordination is accomplished in most cases by a key breech specialist midwife on the team. The goal of this qualitative inventory was to describe the roles and tasks undertaken by specialist midwives in the OptiBreech care implementation feasibility study.

Methods: Semistructured interviews were conducted with OptiBreech team members (17 midwives and 4 obstetricians; N = 21), via video conferencing software. Template analysis was used to code, analyze, and interpret data relating to the roles of the midwives delivering breech services. Tasks identified through initial coding were organized into 5 key themes in a template, following reflective discussion at weekly staff meetings and stakeholder events. This template was then applied to all interviews to structure the analysis.

Results: Breech specialist midwives functioned as change agents. In each setting, they fulfilled similar roles to support their teams, whether this role was formally recognized or not. We report an inventory of tasks performed by breech specialist midwives, organized into 5 themes: care coordination and planning, service development, clinical care delivery, education and training, and research.

Discussion: Breech specialist midwives perform a consistent set of roles and responsibilities to co-ordinate care throughout the OptiBreech pathway. The inventory has been formally incorporated into the OptiBreech collaborative care logic model. This detailed description can be used by employers and professional organizations who wish to formalize similar roles to meet consistent standards and improve care.

Introduction: The purpose of this descriptive study was to explore the relationship between the experience of institutional betrayal (IB) during childbirth and postpartum mental health.

Methods: Women who had given birth within the last 3 years in the United States as of June 2021 were recruited via Qualtrics to complete an online survey. Participants (N = 588) answered questions about their birth experiences, including adverse medical events and experiences of IB. Multiple logistic regressions examined whether experiencing one or more types of IB was associated with receiving a diagnosis of a postpartum mental health condition, controlling for other theoretically relevant covariates.

Results: More than one-third (39%) of respondents experienced one or more types of IB during childbirth, with a mean (SD) of 1.7 (0.47) and maximum of 2. Experiencing IB increased the odds of a postpartum mental health condition diagnosis by 2.86 (95% CI, 1.63-5.05; P < .001).

Discussion: The findings suggest that experiencing IB may be one mechanism driving negative postpartum mental health outcomes. Health care providers and policymakers should be aware of the role that IB can play in women's birth experiences and consider how strategies to decrease instances of IB during childbirth may improve postpartum mental health.

As access to doula services expands through state Medicaid coverage and specific initiatives aimed at improving maternal health equity, there is a need to build and improve upon relationships between the doula community, hospital leaders, and clinical staff. Previous research and reports suggest rapport-building, provider education, and forming partnerships between community-based organizations and hospitals can improve such relationships. However, few interventions or programs incorporating such approaches are described in the literature. This article describes the development and 5 core components of the Champion Dyad Initiative (CDI), a novel program that uses bidirectional feedback between SisterWeb, a community-based doula organization, and 5 clinical sites (4 hospitals and one birthing center) to ensure pregnant and birthing people receive fair and equitable treatment. We also describe implementation challenges related to documentation, funding, and institutional support. The CDI is a promising model for community-based doula organizations and health care institutions to develop collaborative partnerships, build respectful doula-provider relationships, and work toward improving the pregnancy-related care that Black, Indigenous, and people of color receive in hospital and birth center settings. It is our hope that this innovative initiative can serve as a model that can be adapted for other locales, organizations, and hospitals.

Introduction: Midwives report high rates of exposure to traumatic births that can negatively affect their psychosocial well-being. Self-compassion can be considered as a tool to promote psychosocial well-being. The aim of this study was to assess the prevalence of midwives' exposure to traumatic births and explore midwives' self-compassion and its correlation to their psychosocial well-being in relation to experiences of traumatic births.

Methods: In a cross-sectional correlational study, data were collected using an electronic questionnaire by way of social networks and the website of the Israel Midwives Association. Inclusion criteria were certified Israeli midwives working in a hospital delivery room and able to read and write Hebrew. The questionnaire was composed of 4 parts: a demographic section, a traumatic events in perinatal care list, a self-compassion scale-short form, and a psychosocial health and well-being tool (short form of Copenhagen Psychosocial Questionnaire).

Results: The most common traumatic event reported was death. Self-compassion and psychosocial health and well-being were found to be at a medium-high level (mean [SD], 40.66 [6.5]; 38.33 [13.03]), and correlated significantly (r = 0.339; P < .001). There was a significant interaction effect between low self-compassion (mean, ≤3.17) and exposure to traumatic birth in the last year on psychosocial well-being compared with those who were not exposed to traumatic birth in the last year (F_2,103 = 3.25; P = .043). No significant effect was found in those women with medium (mean, 3.18-3.67) or high (mean, ≥3.68) self-compassion.

Discussion: Self-compassion is related to the psychosocial health and well-being of midwives exposed to traumatic birth. Self-compassion can be learned and should be considered for inclusion in midwives' basic and continuing education.

Introduction: Birthing people around the world experience mistreatment during labor and birth, contributing to adverse maternal health outcomes. The adoption of respectful maternity care (RMC) has been recommended to address this mistreatment and improve care quality. Most RMC and mistreatment research has been conducted internationally. The purpose of this scoping review was to (1) explore the extent of RMC research and (2) describe labor and birth experiences in the United States.

Methods: Embase, Scopus, and CINAHL databases were searched for concepts relating to RMC and mistreatment. A total of 66 studies met review inclusion criteria. Two reviewers screened titles, abstracts, and full-text articles. Data were extracted and categorized using the Bohren et al typology of mistreatment. Summary statistics and narrative summaries were used to describe study characteristics and birthing people's experiences.

Results: Most studies represented national or urban samples and Western or Northeastern US regions. Few were from the South, and only one represented rural participants specifically. Few studies represented the unique experiences of justice-involved birthing people, and none represented sexual and gender minorities or Indigenous people. Qualitative methods were predominant. The most common forms of mistreatment included (1) poor rapport between women and health care providers (88% of studies), (2) stigma and discrimination (79%), and (3) a failure to meet professional standards of care (73%).

Discussion: The extent of mistreatment in the United States highlights the need for robust programs and policies targeting provision of RMC. Additional research is needed to better understand the experiences of additional minority communities and those living rural areas and in the Southern United States.

Introduction: Birth centers are an underused care setting with potential to improve birth experience and satisfaction. Both hospital-based and freestanding birth centers operate with the midwifery model of care that focuses on safe, low-intervention physiologic birth experiences for healthy, low-risk pregnant people. However, financial barriers limit freestanding birth center sustainability and accessibility in New Jersey, especially for traditionally marginalized populations. This qualitative study explores the financial barriers faced by freestanding birth centers in order to expand access and choice for pregnant people in New Jersey.

Methods: Semistructured interviews were conducted with participants from 4 sectors: (1) birth center or health system, (2) policy-adjacent philanthropy or research, (3) state departments, and (4) health insurance. Coding and analysis followed a reflexive thematic analysis process, resulting in the identification of 4 financial barriers to birth center access.

Results: Facility Medicaid reimbursement rates are a primary barrier for birth centers, along with startup and operating costs and, more indirectly, low supply of midwives and low patient demand for birth center care.

Discussion: New Jersey is well-positioned to enact critical policies and programs that can improve out-of-hospital birth center access, based on the findings and recommendations from this research. Other states can follow suit in pursuit of solutions to improve maternal health access and equitable birth center sustainability.

Individuals who are at risk of not achieving a full milk supply are often overlooked in scientific literature. There is available guidance to help establish an adequate milk supply for healthy individuals experiencing a physiologic labor and birth, and there are robust recommendations for the lactating parents of small, sick, and preterm newborns to ensure that these newborns can receive human milk. Missing from the literature are clinical practice guidelines that address the preexisting health, pregnancy, birth, or newborn-related risk factors for suboptimal lactation. This can include risk factors that impact secretory activation or newborns who may not attach and suckle effectively to provide the stimulation and removal necessary to reach full milk volume. Secretory activation can only occur after the birth of the newborn and the placenta, with milk volume being established during the first weeks of breastfeeding. Recognizing this gap, over the past 2 years, an international group of midwives led by a doctoral nurse scientist in lactation conducted an extensive literature review to identify the most significant risk factors that can disrupt normal physiologic lactation. Our group sought to establish proactive lactation management strategies to ensure long-term milk production. We developed an evidence-based perinatal operational breastfeeding plan alongside clinical pathways to guide health care professionals in assessment, care, and necessary education for families who present with risk. Our goal is for midwives and other health care professionals to integrate the perinatal operational breastfeeding plan into practice and use these pathways to ensure (1) timely and effective secretory activation, (2) building a milk supply as robust as feasible for personal situations and conditions, (3) more newborns receiving more human milk and (4) more families achieving their personal breastfeeding goals.

National health policy initiatives recommend increased integration of midwifery care in the United States to improve care quality and reduce maternal health disparities. However, the service models through which midwives provide midwifery care and produce quality outcomes are poorly understood. Midwifery-led care is a service model frequently associated with improved outcomes compared with other models. The service model has been infrequently or inconsistently studied in the Unites States and has been narrowly defined and applied to perinatal care. The purpose of this concept analysis was to evaluate the concept of midwifery-led care and expand the definition to guide midwifery practice, research, and health policy. The analysis followed Walker and Avant's methodology. Three attributes of midwifery-led care were identified: (1) midwife as the lead clinician; (2) person-midwife partnership; and (3) care embodies midwifery philosophy. Antecedents were (1) license to practice as a midwife; (2) a person needing or desiring sexual, reproductive, perinatal, or newborn care; (3) a person with low- or moderate-risk health status; (4) regulations and guidelines that support provision of midwifery care; and (5) reimbursement for services. Consequences of midwifery-led care included (1) improved maternal and neonatal outcomes, (2) patient satisfaction, and (3) reduced health care costs. The presented expanded definition of midwifery-led care is the first to use a systems level approach and explicitly center the person receiving care and the philosophical approach of midwifery care. Application of this definition is needed in theoretical and pragmatic research to classify midwifery-led care and other service models and compare patient- and organization-level outcomes.