Journal of midwifery & women's health最新文献

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.

Introduction: Although awareness of respectful maternity care is increasing, international maternal and newborn care standards often overlook culture as a key component of respectful care. Indigenous communities may have unique pregnancy care needs due to cultural and lived experience differences from the broader US population, yet little is known about Indigenous preferences for pregnancy care. We must articulate a vision for positive pregnancy care among Indigenous people in the United States.

Methods: In partnership with Indigenous academic researchers, a Tribal Health Department, and a Native-serving health center, the research team conducted a qualitative descriptive study informed by Indigenous research methodologies to explore the care preferences of Indigenous persons throughout pregnancy. We recruited participants from all 12 Indian Health Service regions, including Hawai'i. The senior author conducted semi-structured interviews with 27 Indigenous women to gather insights on their aspirations related to place, people, and the provision of pregnancy care.

Results: We identified 3 overarching themes that describe Indigenous women's preferences for pregnancy care: rights and validity; safety, dignity, and humanity; and pregnancy care options. Although we identified common themes that Indigenous women share with the broader population, there are specific and unique preferences for comprehensive wraparound services, for the ability to incorporate Indigenous birthing practices, and for health systems to reposition themselves to be emotionally, spiritually, and physically safe institutions for Indigenous women.

Discussion: Our findings highlight the need for a culturally centered approach to maternity care, urging health systems to adopt policies and practices that better support Indigenous women.

Introduction: Although community-based interventions, including Participatory Learning and Action (PLA) groups, have demonstrated significant success in improving maternal and newborn health outcomes and promoting equity in low to middle-income countries, the evidence in high-income settings remains limited. This systematic review, carried out in collaboration with Women and Children First (a UK-based charity focusing on improving the lives of women and children globally), explores community-based initiatives that are currently used in high-income countries (HICs) to enhance maternal and newborn health, as well as the effectiveness of these initiatives in improving maternal and newborn health outcomes. Additionally, the review aims to examine the relationship between community-based initiatives and PLA methodology.

Methods: This is a mixed-method systematic review with a narrative synthesis of results. MEDLINE, Embase, CINAHL, and MIDIRS databases were searched for community-based initiatives for any maternal and neonatal health outcome between 2000 and 2023. Both quantitative and qualitative studies were included and assessed for methodological quality using the Mixed-Methods Appraisal Tool. A convergent results-based synthesis approach was used.

Results: A total of18 studies were included for review. Three main types of community-based interventions were identified: peer support, social support, and health education. Most interventions had beneficial effects on their maternal and neonatal health outcomes of interest. Qualitative analysis revealed 4 main aspects of peer support-connectedness, emotional validation, self-efficacy, and information sharing-which helps to explain the positive effects of peer support, particularly for breastfeeding and maternal mental health. The community-based initiatives linked to PLA methodology in some ways but were lacking in promoting community mobilization since the majority were aimed at the individual or group level, as opposed to engaging whole communities.

Discussion: Community-based initiatives can be effective in HICs for improving aspects of maternal and neonatal health, particularly maternal mental health and breastfeeding. There is very limited research on more participatory community-based initiatives, such as PLA, in HICs that promote community-wide engagement and mobilization. Further research is needed in this area.

Introduction: The midwifery continuity of care model is well-established internationally, but it is rarely offered in Sweden. Pregnant women's interest in midwifery continuity of care has not been investigated in recent years. This study aimed to investigate the interest of pregnant women and new mothers in Sweden regarding midwifery continuity of care and to identify factors associated with this interest.

Methods: A national longitudinal digital questionnaire was conducted to collect background information, pregnancy-related variables, and childbirth-related variables, as well as to measure interest in midwifery continuity of care among women in Sweden. Odds ratios with 95% CIs and logistic regression analyses were used.

Results: Of 1697 women who responded, 68.1% expressed a strong interest in midwifery continuity of care during pregnancy, and 74.2% during postpartum. Fear of childbirth was associated with a higher interest in midwifery continuity of care during pregnancy (adjusted odds ratio [aOR] 1.75; 95% CI, 1.34-2.27). Women who had mixed or negative experiences with the care they received were also more likely to be interested in the model (aOR, 2.33; 95% CI, 1.43-3.97).

Discussion: Pregnant women and new mothers in Sweden show a high level of interest in midwifery continuity of care. However, current maternity services do not adequately meet these preferences, indicating a need to scale up continuity of care models, particularly for women who experience fear of childbirth and dissatisfaction with their care. Therefore, antenatal, intrapartum, and postpartum care in Sweden should be enhanced to better align with the needs and preferences of pregnant women and new mothers.