Journal of midwifery & women's health最新文献

Introduction: Despite documented benefits of doula support for patients and newborns, access remains limited. This evaluation examined patient and neonatal outcomes associated with a hospital-based, shift model of doula care.

Methods: This retrospective analysis was conducted on eligible births at a single, safety-net teaching hospital between January 1 and December 31, 2022. Patients who received doula care during labor and/or birth were compared with those who did not. Doulas were volunteers who self-scheduled shifts and provided support when available. Primary outcomes included cesarean birth and neonatal intensive care unit (NICU) admission. Adjusted odds ratios were calculated to assess the association between doula presence and outcomes of interest.

Results: Among 3055 eligible patients, 375 (12.2%) were offered doula support, and 355 (11.6% of total; 94.7% of those offered) accepted. Most patients were 25 to 34 years old (53.6%), were multiparous (67.2%), identified as Hispanic (65.7%), and had public insurance (82.5%). Patients who received doula support were more likely to identify as Black non-Hispanic or multiracial (P = .005). Labor complications, including chorioamnionitis, shoulder dystocia, and arrest of labor, were more frequent among those with doula support (18.9% vs 14.6%; P = .034), as was oxytocin augmentation (54.9% vs 37.0%; P <.001), and induction of labor (55.2% vs 37.1%, P <.001). NICU admissions were lower among doula-supported births, although not statistically significant (2.8% vs. 5.1%, P = .058). Doula-supported patients had lower odds of cesarean birth (11.8% vs 16.5%; P = .024; adjusted odds ratio, 0.69; 95% CI, 0.48-0.97).

Discussion: Doula care provided through a shift-based hospital model was associated with a decreased cesarean birth rate despite increased labor complications, induction of labor, and oxytocin use. These findings suggest that even intermittent doula support may improve outcomes. Additional studies are warranted to further evaluate the impact of shift-based doula care models on perinatal outcomes.

Introduction: Racial disparities in perinatal health continue to drive negative outcomes for Black women in the United States, often due to low-quality perinatal care. Few studies examine patients' perceptions of perinatal care. This study explored Black women's experiences of pregnancy and home birth with race-concordant certified nurse-midwives and their perceptions of care quality.

Methods: This qualitative study used semistructured interviews with Black women who received perinatal and home birth care from Black certified nurse-midwives. Participants were recruited through referrals from midwives in California, Georgia, and New York. Eligible participants self-identified as Black women, received home birth care from a Black nurse-midwife, and provided informed consent. Interviews were conducted between August and November 2022, lasted approximately 60 minutes, and were audio-recorded. Transcripts were analyzed using thematic analysis guided by the Donabedian model. Codes were organized around care structure, process, and outcomes, and then refined into overarching themes.

Results: Ten participants described pregnancy and home birth experiences with race-concordant nurse-midwives. Most had experienced prior hospital births, which informed their decision to seek midwifery care. Analysis produced 3 themes: (1) holistic healing, in which midwives addressed physical, emotional, spiritual, and cultural needs in supportive home environments; (2) liberation through care, in which participants experienced autonomy and empowerment in contrast to prior medicalized births; and (3) race-concordant connections, in which shared racial identity fostered trust, comfort, and personalized relationships that participants perceived as high-quality care.

Discussion: Black women in this study perceived race-concordant home birth midwifery care as high quality, emphasizing holistic support, autonomy, and trust. These findings highlight the importance of culturally responsive, relationship-centered care in addressing persistent perinatal inequities. Increasing racial diversity within the midwifery workforce and expanding access to race-concordant care may improve Black women's perinatal experiences and outcomes.

The Dobbs v Jackson Women's Health Organization US Supreme Court decision significantly limited patients' access to abortion services, and the providers who can legally deliver this care. Currently 22 states license providers other than physicians to provide medication or procedural abortion. However, most midwives and advanced practice clinicians (APCs) do not receive abortion training in their educational programs despite endorsement from professional and health organizations both nationally and abroad. In response to the growing abortion access crisis, 4 accredited midwifery programs incorporated innovative abortion training into their curricula to integrate abortion into the full scope of midwifery practice. This article provides a framework for midwifery and APC programs to implement standardized education and training in abortion services that are trauma informed, culturally sensitive, and patient centered. We outline each program, implementation barriers and facilitators, and conclude with a discussion of mechanisms for overcoming barriers and recommendations for standardization across programs.

This intrapartum escape room learning experience was initially developed as an in-person, summative assessment for midwifery students completing their first intrapartum course prior to beginning their intrapartum clinical rotation. The goal of this experience was to assess the knowledge and skills gained in the course through an innovative, engaging experiential learning activity that consolidates this knowledge in an interactive environment. This learning format leverages constructivist and adult learning theories, requiring students to draw upon prior knowledge to collaboratively solve puzzles related to key midwifery intrapartum concepts, thus reinforcing their learning through active participation and discussion. Course evaluations completed by students indicate a high level of student engagement, community building, and perceived learning value. The escape room format effectively highlighted both individual and group strengths and learning gaps, providing a comprehensive assessment of students' knowledge base for beginning student clinical experiences. The article reviews the use of escape rooms in midwifery education and explains how to develop different types of puzzles to meet the learning objectives of courses and how to connect the puzzles into a full educational escape room experience. The materials needed, logistics, and design for how to achieve this learning modality are discussed.

Certified midwives, certified nurse-midwives, and women's health nurse practitioners (WHNPs) play a vital role in triaging pregnant patients in the ambulatory and inpatient settings. Demonstrating proficiency with this skill set requires time and experience. In an effort to provide students the opportunity to develop their triage skills, a triage activity was designed and implemented at a large, distance-based hybrid nurse-midwifery and WHNP program. The aim of this simulation was to help students integrate knowledge attained from their second specialty ambulatory care course with an online simulation activity designed to provide practical hands-on application. The 14-week ambulatory care course work focused on complex pregnancy care with weekly meetings in a live virtual classroom and included a clinical companion course. On the last day of the term, students were assigned to work in small groups with different rotating roles. Faculty assumed the role of the patient while using an interactive PowerPoint to bring the simulation to life. Students had the opportunity to rotate through different roles-nurse, provider, and consultant, and simulated triaging pregnant patients via telehealth, in the office, and hospital setting. After each scenario, faculty debriefed with the students about the approach and content. The intention was to offer a safe space to hone challenging skills, practice delegation of tasks, and sort through complex triage content. This article describes the implementation of this virtual triage simulation activity as a blueprint for other programs to adopt similar innovative educational experiences.

Introduction: The first year after childbirth can be affected by persistent or new-onset maternal health problems related to pregnancy and childbirth, leading to a reduction in quality of life, maternal well-being, and mother-child bonding. Evidence on determinants of health care utilization among postpartum women is limited by generalizability or the focus on 6 weeks postpartum. This study aimed to examine the prevalence of maternal health problems and health care utilization and to identify the determinants of health care utilization among postpartum women in the Netherlands within the first year after childbirth.

Methods: A cross-sectional design was used. Data were collected using a questionnaire from women 12 to 30 months postpartum in the Netherlands between March and May 2024. Health care utilization was measured as a proxy for health services. Nineteen potential determinants were derived from Andersen's behavioral model of health care utilization, of which 7 aligned with Levesque's complementary model of access to care and were analyzed using forward logistic regression.

Results: In the sample of 1268 responses, 89.6% reported health problems, and 94.2% utilized health care in the first year after childbirth. The most frequently reported health problem was (extreme) fatigue (51.4%). The most common health care provider consulted was a general practitioner (73.2%). The odds of health care utilization were lower when postpartum women were unaware of health care services (odds ratio, 0.40; 95% CI, 0.25-0.67).

Discussion: The study demonstrated a high prevalence of health problems and health care use among Dutch postpartum women. Lack of awareness about the availability of health care was a key finding. Improving the dissemination of information about postpartum health care options may increase awareness of health problems beyond the immediate postpartum period. Additionally, findings emphasize the importance of long-term counseling in addressing potential health problems.

The Safe Babies Safe Moms Women's and Infants' Services Perinatal Mental Health and Wellness Program offers screening, assessment, prevention, and treatment options, as well as referrals, for complex care needs using an integrated collaborative care framework. Group and individual therapy options are available, leveraging both office-based and telehealth options. The article details the program's framework for services, describes the care team and program workflow, and summarizes program activities. In calendar year 2024, 3383 screenings using the Edinburgh Postnatal Depression Scale were completed for 1914 unique patients. Perinatal social workers conducted 1328 care coordination visits and completed 148 perinatal mental health assessments for elevated screenings. Integrated therapeutic services reached 220 people, and 53 were referred to psychiatry for complex care needs. The strengths of this program stem from early initiation of screening, multiple screenings throughout the perinatal period, care coordination for social services interventions, and a shared-decision-making process centered around the patients' needs and goals for perinatal mental health care. This integrated mental health model establishes a distinct, well-defined, yet dynamic pathway to provide screening, care coordination, and interventions for both prevention and treatment to optimize perinatal mental health outcomes. Evaluation of program outcomes is ongoing.

Introduction: Psychological birth trauma affects a significant proportion of birthing individuals globally, with estimates ranging from 18% to 45% perceiving their birth as traumatic and 4% being diagnosed with posttraumatic stress disorder. Despite growing recognition of birth trauma, the lived experience of healing from it remains understudied.

Methods: This qualitative study employed interpretive phenomenological analysis (IPA) to explore how 11 participants, purposively sampled for diverse birth trauma experiences, understood healing from birth trauma. Semistructured interviews were conducted, transcribed, and analyzed using IPA methodology.

Results: Three main themes emerged: (1) healing as a process, not a destination; (2) healing as being at peace with the experience; and (3) healing as holding multiple truths. Participants described healing as an active, nonlinear process involving milestones, integration of the experience into daily life without being overwhelmed, and acceptance of changed priorities and emotions.

Discussion: The findings highlight the importance of understanding trauma recovery as a gradual process, creating safer spaces for storytelling while respecting boundaries, and acknowledging the capacity to hold both challenging and positive emotions. The study calls for more research on birth trauma recovery centering the individual as an expert in their experience, involving diverse birthing individuals and researchers. Integrating lived experiences of healing is crucial for developing client-centered initiatives and programming to support those affected by birth trauma.

Introduction: Mental health conditions are the leading cause of pregnancy-related death in the United States. The purpose of this study was to explore the use of interprofessional simulation for postpartum depression management.

Methods: Midwifery, women's health gender-related nurse practitioner, and psychiatric mental health nurse practitioner students participated in an interprofessional postpartum depression simulation. Full-time students enrolled at the university in 2024 and 2025 were eligible to participate in a study using a pre-posttest design. Attitudes toward and confidence in management of postpartum depression were assessed before and after the simulation using a modified version of the Revised Depression Attitude Questionnaire (R-DAQ).

Results: There was a significant increase in modified R-DAQ scores following the intervention. Students' comments showed that they found the experience positive and that it helped improve their interprofessional communication and confidence in the management of postpartum depression.

Discussion: This is the first known study assessing the efficacy of an interprofessional postpartum depression simulation. Limitations include a lack of longitudinal data, a single site, and the use of a modified rating scale. Interprofessional simulation can be an effective educational intervention to prepare advanced practice nursing students to manage postpartum depression.