Journal of midwifery & women's health最新文献

Introduction: Although there are many known benefits of providing human milk to infants, breastfeeding-related pain is a significant reason for breastfeeding cessation. Breastfeeding-related pain is a unique experience due to breastfeeding's goal-directed purpose, repetitive nature, and socio-emotional reflections of successful parenting. Understanding how lactating parents cope with breastfeeding-related pain will inform clinical practice to encourage individuals to meet their lactation goals. The aim of this study was to evaluate how lactating parents view coping with breastfeeding-related pain to be different from coping with other types of pain.

Methods: We conducted a secondary analysis of a pilot randomized control study of a breastfeeding pain self-management intervention. Data from 57 participants who breastfed and completed self-report surveys at 1, 2, and 6 weeks postpartum were included. We employed Boyatzis' thematic analysis method to evaluate affirmative responses to "Is coping with breastfeeding pain different than coping with other pain?" We evaluated correlations between responses to coping with breastfeeding pain and pain severity scores.

Results: We identified 3 main themes: (1) uncharted waters, (2) light at the end of the tunnel, and (3) parental role and responsibility. No significant differences were detected between the pain scores of individuals who viewed coping with breastfeeding to be different and those who did not.

Discussion: Lactating parents reported an array of psychological coping strategies in response to breastfeeding-related pain. Coping processes were influenced by personal goals, parental role evaluations, and a desire to meet their infant's needs. Interventions during prenatal and postpartum care that incorporate individualized coping strategies could support breastfeeding goal attainment.

Introduction: The US maternity care system achieves worse outcomes for birthing people identifying as Black versus White. Assessment of fetal well-being in labor is an area of perinatal care subject to significant interobserver variability and therefore may be at particular risk of medical racism influencing care.

Methods: Statewide collaborative quality initiative data, focused on decreasing the nulliparous, term, singleton, vertex (NTSV) cesarean birth rate, were used to conduct a retrospective cohort study to assess differences in cesarean birth for nonreassuring fetal status between birthing people identifying as Black compared with White. Generalized linear mixed modeling with hospital as a random intercept was used for multivariate analyses accounting for birthing people clustering within hospitals.

Results: Between March 1, 2020, and December 31, 2022, 69,622 births were identified, 8291 (11.9%) of which were an unplanned cesarean with a primary indication of nonreassuring fetal heart tracing (cesarean for FHT). Race and ethnicity were significantly associated with a higher risk, after controlling for covariates: compared with White birthing people, birthing people of unknown race or ethnicity had 1.23 (95% CI 1.13-1.35) and Asian Pacific Islander birthing people had 1.55 times the odds (95% CI 1.37-1.76), whereas Black birthing people had 1.71 times the odds (95% CI 1.59-1.83) of birthing via unplanned cesarean for FHT. In adjusted analysis, prepregnancy diabetes, positive COVID-19 status at admission, elevated body mass index, and birthing in the Detroit Metro area were associated with cesarean for FHT. In an unplanned subgroup analysis of births within the Detroit Metro region, Black individuals remained significantly more likely to have an unplanned cesarean for FHT (aOR 1.63, 95% CI 1.48-1.79).

Discussion: After controlling for individual and hospital-level factors, cesarean for FHT was more common among non-Hispanic Black vs non-Hispanic White birthing people in this statewide cohort of NTSV births.

Introduction: First-trimester prenatal care is an important component of quality care during pregnancy and is associated with improved perinatal outcomes. Despite its importance, many pregnant people delay prenatal care initiation or receive no prenatal care. This scoping review assessed multilevel factors associated with first-trimester prenatal care initiation in the United States among studies that included a measure of prenatal care timing, using the socioecological model as an organizing framework.

Methods: A scoping review was conducted according to the Joanna Briggs Institute methodology for scoping reviews and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines for reporting. PubMed, Cochrane, Embase, CINAHL, and Social Sciences Abstracts were searched for peer-reviewed papers that focused on facilitators and barriers associated with first-trimester prenatal care initiation, were written in English, included a measure of prenatal care timing, and used data gathered after 2014.

Results: Of the 1469 articles identified in the search, 19 met inclusion criteria and were included in the final review. Articles described intrapersonal, interpersonal, and environmental-level barriers and facilitators of first-trimester prenatal care initiation including Medicaid expansion, immigration status, and the COVID-19 pandemic. Significant heterogeneity in the measurement of prenatal care timing existed across studies.

Discussion: Our findings suggest that, although environmental domain factors have been impactful toward increasing population-level rates of first-trimester prenatal care initiation, benefits have not been equitable across sociodemographic factors. Increasing the proportion of pregnant people who initiate first-trimester prenatal care will require comprehensive efforts that address sociodemographic and contextual factors, including persistent structural and systemic barriers that cause and widen health disparities.

Labor after cesarean (LAC) is a safe alternative for pregnant persons who have had 1 or 2 previous cesarean births (CBs) and have no contraindication to vaginal birth. When compared with repeat CB, vaginal birth after cesarean (VBAC) reduces short- and long-term health complications and morbidity and should therefore be presented as an option. Despite recommendations from the American College of Nurse-Midwives and the American College of Obstetricians and Gynecologists in support of LAC, not all pregnant persons who are candidates have access to this option. In some areas, provider hesitancy and institutional guidelines limit the availability of LAC, especially after more than one CB. Midwives are uniquely positioned to advocate for this birthing option through the use of shared decision-making. In the antepartum period, birth decision aids, VBAC calculators, and continued dialogue allows for pregnant persons to make informed choices meeting their unique health needs and goals. This clinical rounds article highlights the safety of labor in a pregnant person with a history of 2 prior CBs. As presented in this case, when LAC includes the need for induction of labor, the use of a transcervical balloon catheter for cervical ripening and judicious use of oxytocin are safe, evidence-based options. Ultimately, LAC can offer pregnant persons an increased sense of autonomy and control over their labor and birth, which improve both satisfaction and outcomes, consistent with the family- and person-centered hallmarks of midwifery care.

Introduction: Fear of childbirth is common in nulliparous women. More accessible and less costly interventions such as mandala are needed to reduce fear of childbirth. The purpose of this study was to test the efficacy of mandala coloring added to antenatal education to reduce fear of childbirth.

Methods: An open, randomized controlled trial with a parallel group design was conducted at a tertiary care hospital in Turkey (ClinicalTrials.gov registration NCT05217368). Nulliparous pregnant women without pregnancy complications, between 24 and 32 weeks' gestation, and with increased fear of childbirth were included in the study. A total of 140 pregnant women were allocated to the intervention (mandala coloring plus antenatal education) and control (antenatal education alone) groups, and 100 participants completed the study. Fear before childbirth was measured with the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A at baseline and after completion of antenatal education with or without mandala coloring. Fear during childbirth was measured with the W-DEQ version B retrospectively within one week of giving birth.

Results: At baseline, the intervention and control groups experienced similar fear of childbirth (57.1 vs 57.0; P = .978). After completing antenatal education, the mean fear of childbirth decreased more in the intervention group than in the control group (42.6 vs 50.1; P = .018). In the postpartum period, the intervention group reported less fear during childbirth than the intervention group (68.5 vs 58.0; P = .030). Perinatal outcomes were statistically similar between the 2 groups.

Discussion: Adding mandala coloring to antenatal education significantly reduced fear of childbirth before and during birth. More studies examining the effects of mandala coloring on perinatal mental health should be conducted.

Today nearly 9 out of 10 certified nurse-midwives/certified midwives (CNMs/CMs) attend births in hospitals. As the demand for hospital midwifery care has increased over the last quarter century, CNM/CMs' scope of practice has expanded to include care for high-risk patients. Hospital CNMs/CMs are faced with the challenge of balancing support for physiologic birth with an increasingly complex pregnant population cared for in a medicalized ecosystem. Varied perceptions of patient risk and unique philosophies of care can lead to complex discussions between midwives and physicians on the most appropriate care plan for patients. This article shares the experiences and successes of a hospital midwifery practice in the Alaska Native Tribal Health System and explores strategies for promoting the midwifery model of care (MMOC). Midwives in this Tribal Health System experience robust interprofessional collaboration and an organizational focus on patient-centered relationship-based care. Interprofessional collaboration is noted to be among the most critical elements for protecting a MMOC in a hospital setting. Although distinct from one another, the medical and midwifery models can be complementary in the care of high-risk patients, and the Indigenous concept of Two-Eyed Seeing is offered as an approach to integrating the 2 models of care to achieve optimal care for birthing people and their families.

Introduction: According to the Centers for Disease Control and Prevention, the state of Florida became the epicenter of the COVID-19 delta variant during the summer of 2021. There is limited knowledge on how the pandemic impacted postpartum women's lived experiences in the United States. The purpose of the study was to explore the lived experiences of postpartum women living in South Florida during the COVID-19 pandemic and their responses.

Methods: A descriptive qualitative study design was used. Study participants included 26 postpartum women living in South Florida who had given birth to a live newborn from March 2020 to May 2022. We used purposeful sampling and social media recruitment methods. Sociodemographic information was collected using REDCap, and live face-to-face in-depth interviews were conducted on Webex using a semistructured questionnaire. Content analysis was used to analyze the research data and develop themes and subthemes.

Results: The first central theme, raising an infant during a pandemic, included 3 subthemes: (1) protecting the infant, (2) feeling isolated, and (3) food for thought. The second central theme, maternal needs during a pandemic, included 3 subthemes: (1) mental health needs, (2) support needs, and (3) health care needs.

Conclusion: Findings suggest women experienced significant challenges in caring for themselves and their infants during the COVID-19 pandemic. Findings highlight the need for policy reform that secures comprehensive and quality postpartum health care for women that includes mental health screenings.

Introduction: A growing number of families are using exclusive breastmilk expression to feed their newborns. They need accurate information and support from their providers.

Methods: The purpose of this integrative review was to explore the prevalence, characteristics, practices, and outcomes of families who fed exclusively expressed breastmilk to their infants. The electronic databases of CINAHL, Scopus, PubMed, Web of Science, and article reference lists for articles on expressing human milk for infants were searched. Results were filtered to glean published studies between 2012 and 2022, academic journals, human studies, and English language journals while excluding secondary reviews and expert opinions. Both authors screened records within Covidence systematic review management software. Selected studies were evaluated for quality of evidence using the Johns Hopkins Research Evidence Appraisal Tool.

Results: Twenty-seven studies were included in this review. Most families who exclusively expressed originally planned to directly breastfeed their newborns and only began pumping after encountering problems. The most frequently recurring theme was that advice from health care personnel was inconsistent. Women described a knowledge deficit and received more help with exclusive expression from informal social media groups than their providers. Prevalence of exclusive breastmilk expression is highest in Asian countries and in the neonatal intensive care unit environment. These women had a shorter duration of human milk feeding and higher likelihood of cessation compared with women who both fed expressed milk and directly breastfed.

Discussion: Only recently have breastfeeding researchers begun distinguishing the type of milk (human milk or artificial formula) from the feeding method in their publications. This approach allows clinicians to provide better guidance on the outcomes of each feeding method. As clinicians, we can help families by encouraging them and providing consistently accurate information. Solely feeding expressed human milk is a valid option when the lactating person is unable or unwilling to directly breastfeed.

Introduction: Among Black birthing people, high-quality, respectful care throughout pregnancy and postpartum is hindered by distrust, racial discrimination, and unsatisfactory care. The purpose of this integrative review was to examine prenatal and postpartum care experiences among Black birthing people in the United States.

Methods: A literature search, spanning from inception through October 6, 2022, across 4 research databases, used a combination of keywords to capture reports on care experiences among Black birthing people. We included quantitative and qualitative studies in the United States with people who self-identified as Black or African American and reported prenatal or postpartum health care experiences. Intrapartum experiences were excluded. All studies were evaluated with the Mixed-Methods Appraisal Tool, National Institutes of Health Study Quality Assessment tool, or Joanna Briggs Institute critical appraisal checklist. Data were analyzed and synthesized using the Joanna Briggs Institute convergent integrated approach to incorporate quantitative and qualitative research.

Results: A total of 16 studies published over 27 years met the inclusion criteria. All studies examined the health care experiences of Black birthing people during prenatal or postpartum care. None of the studies focused solely on postpartum care experiences. The 2 most prominent themes were models of care and patient-provider interactions, encompassing both positive and negative experiences. Positive care experiences included collaborative patient-provider interactions, continuity of care, and culturally centered care. Adverse experiences were more frequently noted and involved discriminatory treatment during patient-provider interactions, fragmented care models, and a lack of cultural awareness.

Discussion: Black birthing people in the United States report some positive but more negative health care experiences during pregnancy and postpartum care, which may play an important role in health inequities. Promoting prenatal and postpartum care models that provide continuity and are high-quality, collaborative, and culturally centered were identified as high-priority targets to foster patient safety and improve clinical outcomes.

Introduction: This study explored perinatal health care providers' perspectives on the recruitment of pregnant participants and integrating clinical research into their practice, with a particular emphasis on the complexities introduced by the COVID-19 pandemic.

Methods: From May to September 2021, semistructured interviews were conducted with 10 perinatal health care providers from an urban US health center. The interview transcripts were analyzed using Braun and Clarke's thematic analysis framework, a rigorous method for analyzing qualitative data by identifying, coding, and reporting themes. This approach allowed us to systematically code the data and identify key themes related to recruitment strategies and integration of clinical trials during prenatal care.

Results: Barriers to integrating clinical trials into the perinatal infrastructure included pandemic-related restrictions, heavy workloads, time constraints, ineffective communication and coordination, and maintaining the relevance of the research among providers. Facilitators included the use of communication tools, collaboration with multidisciplinary teams and stakeholders, creation of detailed study information for clinic staff, and fostering commitment to supporting research among providers.

Discussion: The perspectives of perinatal health care providers uncover barriers and facilitators regarding the recruitment of pregnant individuals for clinical trials and shed light on the unprecedented challenges of research in this population during the COVID-19 pandemic and lessons learned postpandemic. This information can support the development of evidence-based solutions and strategies to improve the recruitment of pregnant individuals, as well as enhance clinical research integration into infrastructure in perinatal health clinics.