Journal of midwifery & women's health最新文献

Introduction: Black midwives today and in the past have indicated their motivation to provide physically and emotionally safe perinatal care that includes building meaningful relationships, equitably sharing information, spending more time with clients, and providing racially concordant care. An unexplored element within the literature the consideration of a patient's environment. This work seeks to understand the importance of this element in a patient's care and reproductive experience.

Methods: Semistructured interviews (60-75 minutes) of 5 Black midwives across the continental United States were conducted to answer the research question How do considerations of the environment shape Black midwives' care praxis? Participants held a variety of licensing designations; 3 were certified nurse-midwives, 1 was a certified midwife, and 1 was originally unlicensed but later became a certified professional midwife. Abductive analysis was used, and multiple rounds of coding were conducted to produce themes.

Results: Three general categorizations of environment emerged: (1) natural or climatic environment, (2) social environment, and (3) caregiving environment. Environmental consideration informs anticipatory guidance, or experiences witnessed and participated in that inform how midwives will advise a future patient. This anticipatory guidance demonstrates how Black midwives draw on their embodied knowledge of past experiences to inform and personalize their care for current and future patients.

Discussion: Black midwives consider the environment in a multiplicity of ways to inform their care and how it may impact a pregnancy. Awareness of both the natural and social environment of a patient informs the midwives on relevant aspects of the patient's history and steers the Black midwives' anticipatory guidance, which can go beyond just one patient. Overall, the consideration of the environment for Black midwives does not necessarily change the quality or type of care they administer, but instead informs how to approach care so that they can provide a more personalized experience for patients.

During labor and birth, inadvertent negative suggestions from care givers and support people are common and may lead to negative experiences known as nocebo effects. Counteracting nocebo effects with the use of effective communication techniques can reduce distress, enhance birth experiences, and improve health outcomes. There are very few examples in the literature describing how effective communication techniques can be used by midwives and other birth attendants when providing care to individuals in labor and birth. This article provides a practical structured communication approach to facilitate effective communication during childbirth using greeting; rapport; expectation; addressing concerns; tacit agreement (GREAT) and listening; acceptance; utilization; reframing and suggestion (LAURS) frameworks. GREAT represents a communication structure for any interaction, whereas LAURS represents an approach that builds rapport and reshapes perceptions and behaviors by providing a learnable structure to facilitate the practice and teaching of intuitive (subconscious) communication. These techniques can thus enable midwives to optimize the birth experience and avoid inadvertent nocebo effects. With unprecedented rates of birth trauma, more attention to conscious and subconscious forms of communication is needed to facilitate positive and humanizing birth experiences.

Introduction: Inadequate postpartum care coordination may contribute to preventable maternal morbidity and mortality and misses a crucial opportunity to engage patients in their care after giving birth. More than half of pregnancy-related deaths occur between one week and one year postpartum, and health disparities are consistently observed for marginalized populations. The optimization of providing postpartum care must prioritize a person-centered approach and support the transition back to primary care in order to improve maternal health outcomes.

Process: A rapid-cycle quality improvement initiative was implemented over 8 weeks in a federally qualified health center serving a population with predominantly low risk medical needs. At baseline, only 53% of clinic patients attended a postpartum visit within 3 weeks of birth, and none had a care plan in place to facilitate the transition back into primary care. This initiative aimed to improve the patient experience of fourth trimester care planning and engagement to a mean score of 5 (from a baseline of 4.3 on a 6-point scale) on the modified 9-item Shared Decision Making Questionnaire (SDM-Q-9) in 8 weeks. Care coordination using a pregnancy care passport and a fourth trimester registry were implemented to support patient-centered engagement, evidence-based care, and to track outcomes related to care coordination progress.

Outcomes: Engagement in postpartum care planning as a shared decision-making experience improved to a mean score of 5.8 on the SDM-Q-9 in eight weeks. The registry demonstrated a statistically significant improvement in fourth trimester visit scheduling and attendance (P <.05), with the largest gains noted in the use of lactation services.

Discussion: This initiative employed patient-centered postpartum care planning and coordination to improve patient satisfaction, engagement, and access to health care services in the postpartum period, using tools that can be adapted for other settings. Future projects should explore the use of these interventions in higher-risk populations.

Development of innovative education programs in a time of demographic and economic pressures in higher education requires strategy and collaboration. This article explores the development, theory, and implementation of the first postgraduate certificate in abortion care in the United States, as well as implications for other innovative programs. Requirements for such programs include (1) needs assessments, (2) allyship and relationship-building with key stakeholders, (3) intentional use of theoretical foundation, (4) community relationships, and (5) expectation of the unexpected. Strategies used included leveraging professional relationships, identifying mutual interests, cultivating key allies in the relevant systems, and focusing on the role of nursing and midwifery in effectively addressing structural issues. Although this program relates to abortion care, the lessons learned are relevant to any innovative education program.

The success of midwifery education relies heavily on the time and expertise shared by experienced midwifery preceptors. Although there are several known and documented barriers to preceptor availability and willingness to participate in the education of future midwives, clinical education opportunities are crucial to midwifery education. Mentorship and training from preceptors not only benefit the students but also contributes to the development of a well-prepared, compassionate midwifery workforce. Advocates for growing the US midwifery workforce point to the alarming rate of maternity health care deserts, in which families lack access to maternity health care providers and maternity care services. Midwives are the logical solution to fill this health care gap, but this requires the growth of midwifery education programs and clinical preceptors. Recognizing the importance of precepting and easing the role of the preceptor with recommended teaching methods can lighten the burden and make the precepting experience more beneficial. Health profession education has used various preceptor models to guide learning interactions, but there is not a specific model for midwifery clinical education. Midwives need standardized, reliable, and consistent methods that engage students, promote critical thinking skills, and create positive learning experiences. In this article, we propose and discuss the use of 2 evidence-based models: the One-Minute Preceptor method and the Summarize, Narrow, Analyze, Probe, Plan, Select method to facilitate and support the role of the preceptor. Investing in preceptors is an investment in the future of quality midwifery care.

Introduction: This systematic review compared the effects of physiologic care or expectant management during the third stage of labor with oxytocin prophylaxis in preventing postpartum hemorrhage following physiologic birth.

Methods: We searched MEDLINE, Embase, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials (to December 15, 2023), ClinicalTrials.gov (to July 8, 2024), and reference lists of eligible studies. We included randomized and nonrandomized studies of individuals who experienced physiologic birth or received minimal obstetric interventions. Two reviewers independently assessed eligibility and risk of bias. Random-effects meta-analyses were performed, and evidence certainty was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.

Results: Three randomized controlled trials and 4 nonrandomized studies (N = 7; 7091 participants) were included, with 3 studies contributing data to the quantitative analyses. For individuals with physiologic birth, low-certainty evidence from one nonrandomized study (3436 participants) suggests that physiologic third-stage care results in a large reduction in the risk of blood loss greater than 1000 mL compared with oxytocin (relative risk [RR], 0.29; 95% CI, 0.09-0.92; 18 fewer per 1000; 95% CI, 22 fewer to 2 fewer). In contrast, evidence from one randomized controlled trial (1686 participants) indicates that expectant management likely results in a large increase in the risk of excessive blood loss greater than 1000 mL (RR, 1.87; 95% CI, 1.36-2.57; 21 more per 1000; 95% CI, 9 more to 39 more; moderate certainty) compared with oxytocin but may not increase the risk of transfusion (low certainty) and results in little to no difference in well-being or breastfeeding (high certainty).

Discussion: Compared with oxytocin, physiologic third-stage care may result in a large reduction in the risk of excessive blood loss, whereas expectant management likely results in a large increase. Further research is needed to improve evidence certainty, focus on patient-important outcomes, and enhance generalizability.

Introduction: Exercise during pregnancy benefits maternal and fetal health, yet many pregnant individuals struggle to maintain regular physical activity. Biological, psychological, and social factors, along with structural determinants of health, shape engagement, particularly among populations historically underrepresented in prenatal exercise research.

Methods: This secondary analysis of the Prenatal Heart Smart trial examined motivational interviews from 108 pregnant individuals participating in a low-intensity exercise intervention involving walking or stretching 5 days a week during the last 10 weeks of pregnancy. Weekly motivational interviews evaluating importance and confidence ratings for exercise were collected on a 0 to 10 scale. Qualitative data were analyzed using content analysis, and quantitative data were analyzed descriptively.

Results: Participants rated exercise as highly important (mean [SD], 8.46 [1.71]) and expressed moderate-to-high confidence in engaging in it (mean [SD], 7.70 [1.98]). Fatigue, pain, and discomfort were common barriers, whereas accessible, home-based activities supported engagement. Psychological barriers included fear of overexertion, uncertainty about safety, and fluctuating motivation, whereas intrinsic motivation, stress relief, and routine formation facilitated consistency. Social support from partners, family, and health care providers encouraged participation, although many cited limited provider guidance and competing responsibilities as challenges. Structural determinants such as work demands and neighborhood safety further shaped engagement.

Discussion: Exercise during pregnancy is influenced by intersecting biological, psychological, social, and structural factors. Pregnant individuals may value exercise but lack the confidence, resources, and systemic support necessary to sustain it. Interventions should extend beyond education to include culturally responsive, accessible, and community-based approaches that strengthen confidence, social support, and structural equity to promote sustainable prenatal physical activity.

Introduction: Clinical education is a cornerstone of midwifery training. Although international studies highlight the importance of preceptor support, predictability, and a positive learning environment, little is known about which aspects of clinical education in the United States best support or hinder student learning.

Methods: We conducted a national, cross-sectional survey of certified nurse-midwives and certified midwives certified between 2019 and 2024. Eligible participants were recruited via email through the American Midwifery Certification Board. The survey included 46 items, including 23 items about their clinical education experiences and 23 items about their current practice and demographic characteristics. In this article, we have analyzed 3 open-ended questions that asked participants to describe the best and worst parts of their clinical education using reflexive thematic analysis.

Results: We received 640 completed surveys resulting in a response rate of 16%. From our analysis, we identified 3 themes. The first was the centrality of the preceptor as a make-or-break component of clinical education. Participants overwhelmingly emphasized the central role of preceptors in influencing the quality of their experiences, describing supportive mentors as crucial to building confidence, independence, and professional growth. Conversely, negative preceptor behaviors, including bullying and discrimination, hindered learning. The second theme, the need for diversity in setting and care to produce a full-scope midwife, highlighted the various clinical experiences needed to create a full-scope midwife. The third theme described participants' desire for clinical education that fits within their lives.

Discussion: Findings demonstrate that the quality of clinical education hinges on supportive preceptors and diverse learning environments; yet students frequently encounter mistreatment and systemic barriers. Midwifery programs and professional organizations must enhance oversight of clinical placements, invest in accessible preceptor training, and provide structured support for students navigating challenging sites. Strengthening clinical education is essential to sustaining a well-prepared, resilient midwifery workforce that can provide equitable, evidence-based care.

Introduction: In the aftermath of perinatal loss, the physiologic onset of lactation presents a complex array of emotional responses for women, including grief and despair. Effective lactation management is essential for maternal health, yet it is often inadequately addressed by health care professionals, potentially compromising the physical and psychological recovery of the bereaved mother. The aim of this study was to investigate how Italian health care providers support women in managing lactation after a perinatal loss.

Methods: This study employed a web-based, cross-sectional design. Participants involved in perinatal bereavement care were asked to answer a survey consisting of 3 areas: sociodemographic information, knowledge and experience of perinatal loss, and lactation after perinatal loss.

Results: A total of 1227 health care professionals participated in this study. A significant majority (60.2%) had received formal training on perinatal loss care, expressing high satisfaction with an average score of 4.7 out of 5. However, less than half (42.5%) reported having a guideline for bereavement care in their workplace. Despite the opportunity, 25% of the respondents did not provide lactation information. Discussions predominantly centered on pharmacologic suppression of lactation in cases of stillbirth (89.5%) and neonatal death (83.8%), as well as complications associated with these events. Postdischarge follow-up was reported as lacking by 78.2% of the sample.

Conclusions: The discrepancy between the training of health care professionals and their practice highlights a critical need to enhance the implementation of bereavement care guidelines and follow-up support, underscoring the importance of integrating lactation management into the perinatal loss care continuum.