Journal of midwifery & women's health最新文献

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.

The CHOICES Black Midwifery Fellowship Program is an exemplar of a transformative postgraduate model in midwifery education that extends beyond traditional training frameworks. The program is designed around 5 core pillars: full-scope reproductive health services education and training, Black feminist thought, leadership and mentorship, neonatal and postnatal care, and community and patient-centered care. By embedding these frameworks into the curriculum, the fellowship challenges the prevailing medicalized approach to birth that often neglects the unique needs of marginalized communities. This perspective equips fellows with a critical understanding of the social, political, and economic factors that influence health outcomes, enabling them to advocate effectively for their patients and communities. In addition to improving clinical outcomes, the fellowship has also played a crucial role in restoring trust between Black birthing people and the health care system. Historical injustices and ongoing systemic racism have led to deep-seated mistrust of mainstream health care institutions among many Black communities. By training Black midwives who understand and share the cultural and lived experiences of their patients, the CHOICES fellowship helps to bridge this trust gap. Fellows are taught to adopt a patient-centered approach that prioritizes informed consent, shared-decision-making, and respect for cultural practices. In this article we outline the structure, curriculum, and training activities of the CHOICES Black Midwifery Fellowship. Additionally, we review the challenges encountered and lessons learned during the implementation process.

Introduction: Maternal morbidity and mortality rates in the United States and Georgia remain alarmingly high, exceeding those of many low-resource regions despite extensive interventions. Research highlights the role of competent midwifery care in addressing key contributing factors, such as limited health care access, insufficient prenatal care, and adverse social determinants of health. To expand the pool of qualified certified midwives and certified nurse-midwives, there is a pressing need for robust midwifery education programs, reliable and valid evaluation tools for student assessment, and documentation of skill development and confidence improvement among trainees.

Process: To evaluate preparedness and competency, a quality improvement project was initiated to assess the effectiveness and efficiency of the intrapartum simulation laboratory. A modified version of the National League for Nursing Student Satisfaction and Self-Confidence in Learning tool was used. Third-semester midwifery students at Emory University School of Nursing in Atlanta, Georgia, completed pre- and postlaboratory surveys, which included a Likert scale to measure confidence in the simulation laboratory's ability to meet their educational needs. Qualitative questions were incorporated to identify suggestions for laboratory improvements.

Outcomes: Statistically significant improvements were observed in midwifery students' pre- and postlaboratory assessments, particularly in their confidence regarding the skills reviewed, the alignment of simulation and laboratory time with their learning styles, and their trust in faculty members' ability to effectively teach essential midwifery practices.

Discussion: The findings validate the effectiveness of intentional teaching strategies and innovative simulation technologies in enhancing midwifery education. Increasing the number of competent midwives in practice represents a critical step in addressing the persistently high maternal morbidity and mortality rates in the United States. These teaching approaches and technologies can also be applied to other midwifery simulation laboratories and adapted for use in other advanced practice registered nursing specialties.

Introduction: Given the rising number of studies on synthetic osmotic dilators, there is a lack of comprehensive reviews for their use compared with other commonly used cervical ripening methods. This study aimed to examine the maternal and neonatal safety and efficacy in cervical ripening and labor induction using synthetic osmotic dilators compared with pharmacologic agents (prostaglandin E₁, prostaglandin E₂, oxytocin) for labor induction.

Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) and cohort studies was conducted, using MEDLINE, Embase, CINAHL, and Cochrane Library databases search. Two reviewers independently screened studies and assessed the risk of bias with Risk of Bias 2 and Risk Of Bias In Nonrandomized Studies - of Interventions tools. Relative risks (RRs) and mean differences (MDs) were calculated with 95% CIs.

Results: Eleven studies (8 RCTs, 3 cohort; 2355 participants) showed no statistically significant differences in safety outcomes between synthetic osmotic dilators and pharmacologic agents, including maternal infection (RR, 1.27), postpartum bleeding (RR, 0.87), neonatal infection (RR, 1.19), low Apgar scores (RR, 0.74), and admission to neonatal intensive care unit (RR, 1.06) (all P > .05). Efficacy outcomes were comparable for vaginal birth rates (RR, 0.98) and Bishop score changes (MD, 0.0) (both P > .05). Synthetic osmotic dilators reduced uterine hyperstimulation (RR, 0.45) and digestive symptoms (RR, 0.15) but required more artificial rupture of membrane (RR, 1.57) (all P < .05).

Discussion: Synthetic osmotic dilators are a safe, effective, and viable option for labor induction, reducing maternal risks of uterine hyperstimulation. These findings have implications for incorporating the clinical use of synthetic osmotic dilators for cervical ripening into international guidelines. As evidence supports their efficacy and safety, educating nurses and midwives in the use of synthetic osmotic dilators for labor induction is required.

Introduction: Several anatomical and endocrine factors have been linked to breastfeeding difficulties, yet there is limited evidence for their prevalence and associated postpartum breastfeeding outcomes. Knowledge of the prevalence and impact of nonmodifiable lactation risk factors can inform clinical care. We examined the prevalence of antenatally identifiable lactation risk factors and associated breastfeeding outcomes at 6 to 8 weeks postpartum.

Methods: A retrospective study examined matched antenatal lactation risk screening data and infant feeding method at 6 to 8 weeks postpartum in a cohort of Australian women who gave birth at term gestation. The prevalence of lactation risk factors, associated full breastfeeding rates, and risk ratios for not fully breastfeeding at 6 to 8 weeks postpartum were calculated.

Results: Screening data were obtained for 519 women; 408 were complete, and 296 had matched lactation outcome data. One lactation risk factor was identified in 65.4% (267 of 408) of women. Of those with no risk factors, 77.1% (81 of 105) were fully breastfeeding compared with 60.2% (115 of 191) with one risk factor, with a relative risk of not fully breastfeeding at 6 to 8 weeks of 1.69 (95% CI, 1.14-2.50). Other significant risk factors included gestational diabetes (GDM) (relative risk, 1.70; 95% CI, 1.24-2.34) and prepregnancy body mass index greater than or equal to 25 (relative risk, 1.74; 95% CI, 1.30-2.34); coexistence of these factors more than doubled the risk of not fully breastfeeding at 6 to 8 weeks postpartum (relative risk, 2.18; 95% CI, 1.58-3.01).

Discussion: Nonmodifiable lactation risk factors may be identified in half of pregnant women. Previously identified risks of GDM and increased body mass index are compounded when they coexist, posing significant risks to early full breastfeeding outcomes. Antenatal identification of lactation risk factors offers opportunities to proactively educate and support women at risk to optimize breastfeeding and subsequent maternal and child health outcomes.