Journal of midwifery & women's health最新文献

Introduction: The Guatemalan Ministry of Health has offered traditional midwives (TMs) training programs in Spanish since 1955. Many Guatemalan TMs speak indigenous dialects, with limited reading and writing skills, and may not fully comprehend this information. Additionally, TMs have previously requested instruction on how to measure blood pressure in order to improve outcomes for women developing preeclampsia. Prompt diagnosis of preeclampsia would enable TMs to make more timely decisions for transport to a hospital. The purpose of this quality improvement project therefore was to develop culturally sensitive oral educational activities in the native language of participants to improve their knowledge of preeclampsia and improve their skills in assessing blood pressure.

Process: The project used an action research methodology based on Leininger's cultural care theory. Trainers employed a variety of teaching methods such as repetition, triangulation, role-plays, storytelling, hands-on practice, return demonstrations, and pictorial Preeclampsia Reminder Cards. During a 2-week period in August 2024, 179 TMs attended educational activities about preeclampsia in 11 groups located in the remote Petén. A 26-item written pretest and posttest was used to evaluate changes in knowledge about preeclampsia. An 11-item checklist was used to assess ability to correctly measure blood pressure.

Outcomes: Among 179 TM participants, 49% were found to have limited reading and writing skills. Following the education methods, however, the group demonstrated a significant improvement in knowledge when comparing the 26-item pretest (N = 179, mean [SD], 16.02 [4.04]) with the posttest (mean [SD], 21.5 [4.69]); t₁₇₈ = 12.262; P < .001. Some participants with limited reading and writing skills were provided 1:1 assistance writing down answers they provided to the tests. Additionally, 94% correctly demonstrated all 11 items on a blood pressure assessment checklist. The majority of participants reported the educational activity was useable, feasible, and satisfying.

Discussion: The success of these methods in educating TMs in remote Guatemala has wide-reaching implications for improving maternal and infant health outcomes in low- and middle-income countries.

Introduction: Approximately 161 million women worldwide use intrauterine devices (IUDs), but insertion can cause pain and anxiety. This study examined the effects of virtual reality (nature video and music) and distraction cards on pain, anxiety, and satisfaction during IUD insertion.

Methods: This randomized controlled study included 117 women undergoing IUD insertion, assigned randomly to 1 of 3 groups: virtual reality (nature video and music), distraction cards, or control (n = 39 each). Measures included a demographic form, the State-Trait Anxiety Scale, the Newcastle Satisfaction with Nursing Care Scale, and the Visual Analog Scale. These were administered to all 3 groups at 4 time points: (1) speculum insertion, (2) tenaculum application, (3) IUD insertion, and (4) 15 minutes after IUD insertion. Pulse rate and oxygen saturation were also recorded.

Results: The women's mean (SD) age was 30.2 (6.5) years. A significant effect was observed for group assignment (F_2,114 = 18.754; η² =  .248; P <  .001). A significant group*time interaction was found for anxiety (F_2,114 = 18.270; η² =  .243; P <  .001) and pain scores (F_2,114 = 25.309; η² =  .309; P <  .001). Anxiety scores were significantly higher in the control group than in the virtual reality and distraction card groups (P <  .001). After the procedure, anxiety increased in the control group but decreased significantly in the virtual reality group (P <  .001). Pain scores were also consistently higher in the control group across all time points (P <  .001). Pain peaked during IUD insertion in the distraction card and control groups but was significantly lower 15 minutes postinsertion than after tenaculum application. These pain and anxiety differences were clinically significant.

Discussion: Using virtual reality and distraction cards during IUD insertion reduced pain and anxiety and increased satisfaction. Findings support the use of noninvasive, user-friendly techniques as complementary therapies during IUD insertions.

Clinicaltrials: gov Identifier: NCT05655052.

Introduction: There is very limited information on the rates of trauma exposure and posttraumatic stress disorder (PTSD) symptoms for perinatal individuals who live in rural settings. Increasing understanding of traumatic experiences among rural-dwelling pregnant individuals may be an important avenue through which midwives can help address the care disparities and poor outcomes in this population. This study aimed to implement screening and estimate prevalence rates of trauma exposure and perinatal PTSD symptoms among individuals at a Midwestern rural obstetric clinic.

Methods: Participants completed a brief screening measure that assessed demographics, trauma exposure, mental health knowledge and experience, and PTSD symptoms.

Results: Of the 421 patients screened, the mean age was 26.8 years, and 69.6% identified as White and 11.9% identified as Latina. Over half endorsed trauma exposure (53.0%). The most common types of traumatic events were death of a close family member or friend (36.1%) and childhood sex abuse (14.3%). About 1 in 4 trauma-exposed patients (25.6%) scored above the clinical threshold for probable PTSD (≥3 on the Primary Care PTSD Screen for DSM-5). The most endorsed PTSD symptom type was internal and external avoidance of trauma-related stimuli (32.4%).

Discussion: A history of trauma exposure and perinatal PTSD symptoms were more common than expected when compared with both overall perinatal and rural population PTSD prevalence rates. Specific considerations were identified that facilitated successful screening in our rural population. Future clinical research with rural populations should consider: (1) broad implementation of PTSD symptom screening of perinatal patients and creation of a workflow that establishes follow-up steps for patients who screen positive; (2) development of training and psychoeducational materials for health care providers and patients to facilitate connection with brief trauma interventions; and (3) support of trauma-informed, stepped care models with a range of disciplines and provider types to help manage perinatal PTSD symptoms.

Introduction: More than 80,000 US military servicewomen are stationed in states enforcing abortion bans. US Department of Defense (DOD) policies must adhere to the Hyde Amendment, which restricts abortion coverage. Little research exists regarding active-duty servicewomen's (ADSW) knowledge of these policies or their experiences accessing abortion care. This study examines the reproductive health policy knowledge and lived experiences of ADSW who have accessed abortion care.

Methods: A 24-item questionnaire was designed to measure reproductive health policy knowledge and explore reproductive health experiences among ADSW. Via secondary analysis, a subset of 178 participants self-reported obtaining an abortion while on active duty. A convergent mixed-methods design (quantitative and qualitative) was used.

Results: Most participants (65%; n = 115) did not know TRICARE covered abortion costs in cases of rape or incest; 77% (n = 137) erroneously believed they required leadership permission to get an abortion; and 87% (n = 155) did not know they were entitled to convalescent leave to recover after an elective abortion. More than half (53%; n = 94) took personal leave to access abortion care; 46% (n = 82) traveled more than one hour; 48% experienced financial difficulties; 31% (n = 55) experienced negative professional repercussions; 16% (n = 29) received convalescent leave; 92% (n = 164) were not offered mental health counseling; and 77% (n = 137) felt they would have benefited from mental health counseling postabortion. Qualitative themes included a systemic lack of DOD abortion policy knowledge and lived experiences of accessing abortion care (eg, financial burdens, stigma).

Discussion: Given the systemic lack of policy knowledge reported among study participants, the DOD should develop and implement a standardized abortion policy and access training for military health care professionals, leadership, and service members. Policies ensuring access to abortion should be adopted, codified, and implemented uniformly across all branches of service.

The historically unidirectional movement of global health ideas, practices, and protocols from the Global North (United States, Canada, European countries, Japan, South Korea, Taiwan, Australia, New Zealand, and Israel) to the Global South (Latin American countries, African countries, the Middle East excluding Israel and Asia countries, and Oceania excluding those previously mentioned) has displaced local practice and produced little sustainable change. Actively addressing these unintended consequences, practitioners at Yale School of Nursing in the United States formed a sustainable, mutually beneficial partnership with Makerere University College of Health Sciences and Mother Health International community birth center in Atiak, Uganda, to reduce perinatal mortality in areas with the highest burden. Goals included establishing a collaborative midwifery education and research partnership; developing an interprofessional clinical rotation; and developing a blueprint for teaching the midwifery model of care in the Global South. The partnership has successfully produced outputs including midwifery education support, research, clinical training, interprofessional capacity building, and community integration within local health care systems. Lessons learned from program design, implementation, and evaluation can inform global learning collaborations that are multidirectional and lead to more equitable midwifery collaborations.

Burnout as a public health crisis has gained attention in recent years. Integrating a wellness curriculum into training programs can reduce burnout and cultivate the awareness and skills needed to support a sustainable career in health care. The faculty midwives within the residency program in obstetrics and gynecology at The Warren Alpert Medical School of Brown University have implemented a successful, evidence-based wellness curriculum for residents that focuses on the emotional, physical, and psychological needs of learners. Participants report that this program increases work satisfaction and reduces burnout. The initiative could be modified across many disciplines of clinical training, and with midwife learners, to decrease stress during an academically rigorous and emotionally overwhelming time and provide trainees with tools that will sustain their sense of well-being throughout their careers.

Introduction: Delays to colposcopy increase the risk for cervical cancer development. Our study sought to understand the barriers and facilitators to follow-up after an abnormal cervical cancer screening test result.

Methods: English-speaking adult patients who did not attend at least one of their scheduled appointments at an urban academic colposcopy clinic between June 2021 and June 2023 were eligible. Semistructured interviews were conducted, and thematic analyses using inductive and deductive coding were completed.

Results: Twenty women were interviewed. The mean (SD) age was 34 (10) years, and participants mainly identified as non-Hispanic Black (60%). The mean (SD) time to colposcopy was 12.5 (11.9) months. Seven participants did not have a follow-up colposcopy at the time of the interview. Five categories of themes emerged at the individual, interpersonal, clinic, and system level, including (1) fear of pain and/or pelvic examinations, (2) patient-provider communication (including result communication), (3) clinic interactions (including presence of trainees and lack of continuity), (4) scheduling difficulties, and (5) system-level barriers such as loss of insurance coverage.

Discussion: Barriers to follow-up care exist across multiple levels. A one-size-fits-all approach may be ineffective for facilitating follow-up; rather, a multipronged approach may be needed to improve adherence and reduce delays to follow-up care after an abnormal cervical cancer screening test result.

Introduction: Given the prevalence and consequences of unmet social needs in perinatal populations, there is a critical demand for perinatal care that addresses social needs. To better support health systems in providing comprehensive social and perinatal care services, this quality improvement initiative uses the Donabedian model for care quality to describe the structure, process, and outcomes of embedding an innovative perinatal care program with integrated social care into an established primary care center.

Process: The Improving Maternal Outcomes Now! (IMON) program was designed to address the clinical and health-related social needs of patients at highest risk of maternal health disparities. The IMON program offers holistic prenatal and postpartum care through the provision of midwifery services, obstetrician support, intensive social needs support, and around-the-clock virtual care. Program implementation began in June 2023 at a federally qualified health center.

Outcomes: During the first 18 months of implementation, 102 pregnant patients received prenatal care. Forty-four percent of patients identified as Hispanic, with more than half (54%) reporting Spanish as their preferred language. Patients were highly engaged with program services. Nearly two-thirds of IMON patients (65%) initiated prenatal care in their first trimester, and most (91%) were assisted with social needs during or after pregnancy. A majority (88%) enrolled to receive adjunctive virtual care services. Among the 61 patients who gave birth, 77% did so vaginally, whereas the remaining 23% did so via cesarean birth. On average, patients gave birth at 39 weeks' gestation, with only 5% giving birth preterm and 3% having a newborn that was small for gestational age.

Discussion: Preliminary findings suggest that IMON can be implemented within a safety-net setting, with high patient engagement and social needs support. Early outcomes show promising maternal and neonatal health indicators.

Substance use disorder (SUD) is the most common cause of pregnancy-associated deaths for women in Illinois. In this article, we describe how to provide multimodality education and teaching opportunities in SUD and medication for opioid use disorder, incorporate community outreach to offer new experiential clinical learning opportunities, and enhance preceptor relationships to bolster educational partnerships as an innovative approach to incorporating SUD education into midwifery programs. Our teaching efforts identify the most vulnerable communities and create an innovative, midwifery-led solution to provide much-needed culturally aligned care addressing health disparities of those in rural and underserved communities. We highlight our utilization of an online education and training platform that students enroll in to obtain foundational knowledge in medication management for opioid use disorder, describe how we expanded clinical partnerships with providers actively providing medication management for opioid use disorders, and discuss how we evaluated those experiences and provided teaching/learning opportunities for students to present material across multiple cohorts of students. This innovative approach to integrating education for medication management of SUD through the above teaching modalities highlights our ability to meet the needs of our patients and prepare the future midwifery workforce with the clinical skills necessary for the work needed in clinical settings across the United States.

Introduction: Community-based birth supported by midwives and nurses is increasing in the United States amid stark racial disparities in maternal outcomes and worsening access to pregnancy care. Although studies examining prenatal confidence have shown that persons with higher confidence are more likely to give birth vaginally, reporting less pain, anxiety, and dissatisfaction, existing measurement tools have focused on hospital births. Accordingly, we adapted the previously validated Preparation for Labor and Birth (P-LAB) instrument, which measures third-trimester confidence for physiologic birth, for community-based births, centering the perspectives of Black populations.

Methods: Expert stakeholders (N = 5) including practicing midwives and maternal health researchers assessed the relevance and completeness of the P-LAB. Following individual reviews, stakeholders adapted the tool during a group review session. Virtual cognitive interviews were then conducted with community stakeholders (N = 10), prenatal and newly postpartum persons, to test comprehensibility, informing further adaptation of P-LAB items. Findings were summarized and analyzed using an abbreviated framework method. A subset of community stakeholders (N = 5) pretested the final instrument for redundancy and appropriateness.

Results: The iterative adaptation process informed removal of irrelevant items (N = 6), further clarification of existing items (N = 12), and the generation of additional items (N = 7). The final instrument, the Preparation for Community-Based Labor and Birth (P-CLAB), is a 23-item, Likert-response survey. Expert stakeholder engagement resulted in replacing medication-focused measures with items related to safety, dignity, and racial concordance while incorporating language aligning with the midwifery model of care. Community stakeholder engagement highlighted unclear items and opportunities to improve relevance.

Discussion: In addition to promising utility for research, measuring prenatal confidence may equip midwives and nurses to further engage in person-centered care by addressing maternal fears and empowering patients according to their specific needs. The participatory P-CLAB adaptation enhances the instrument's utility and applicability to community-based care settings.