1
|
Louis-Jacques AF, Applequist J, Perkins M, Williams C, Joglekar R, Powis R, Daniel A, Wilson R. Florida Doulas' Perspectives on Their Role in Reducing Maternal Morbidity and Health Disparities. Womens Health Issues 2024; 34:417-428. [PMID: 38503681 DOI: 10.1016/j.whi.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/06/2024] [Accepted: 01/18/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Maternal mortality rates continue to rise in the United States. Considerable racial disparities exist, as Black women face two to three times the risks of dying from pregnancy-related complications compared with white women. Doulas have been associated with improved maternal outcomes. This study aimed to 1) investigate Florida doulas' perspectives and influence on severe maternal morbidity/mortality and related inequities, as well as 2) identify opportunities for actionable change. The social ecological model, which acknowledges how individual, interpersonal, institutional, community, and public policy factors intersect, informed our analysis. METHODS This qualitative study included seven online in-depth interviews and seven focus groups with doulas (N = 31) in Florida. Interview guides investigated how doulas perceive their role in the context of a) maternal morbidity and b) health disparities. RESULTS Doulas associated maternal morbidity and health disparities with Black pregnant people, identifying racism as a major contributor. Doulas identified their role as one that most often intersects with the individual and interpersonal levels of the social ecological model. Doulas report providing positive social surveillance and emotional support, contributing education and resources, and championing for advocacy in health care settings. Actionable steps recommended by doulas to further mitigate health disparities include the integration of implicit bias training into doula certification programs, increasing public health funding to bolster a doula workforce that can serve racial and ethnic communities, establishing doula-hospital partnerships to improve relational communication, providing tailored resources for clients featuring representative messaging, and doulas' continued engagement in positive social surveillance of their clients. CONCLUSIONS Doulas perceived their role as integral to mitigating maternal morbidity and health disparities, particularly in the context of supporting and advocating for birthing persons on all levels of the social ecological model. Equitable access to doulas for low-income and/or minoritized populations may be one key strategy to improve maternal health equity.
Collapse
Affiliation(s)
| | - Janelle Applequist
- Zimmerman School of Advertising & Mass Communications, University of South Florida, Tampa, Florida
| | - Megan Perkins
- College of Medicine, University of Florida, Gainesville, Florida; College of Public Health, University of South Florida, Tampa, Florida
| | | | - Ria Joglekar
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Richard Powis
- College of Public Health, University of South Florida, Tampa, Florida
| | - Angela Daniel
- Family Centered Birth Services, Gainesville, Florida
| | - Roneé Wilson
- College of Public Health, University of South Florida, Tampa, Florida
| |
Collapse
|
2
|
Brand RJ, Gartland CA. Basic psychological needs: A framework for understanding childbirth satisfaction. Birth 2024; 51:395-404. [PMID: 37997653 DOI: 10.1111/birt.12795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023]
Abstract
Women often report being dissatisfied with their childbirth experience, which in turn predicts negative outcomes for themselves and their children. Currently, there is no consensus as to what constitutes a satisfying or positive birth experience. We posit that a useful framework for addressing this question already exists in the form of Basic Psychological Needs Theory, a subtheory of Self-Determination Theory (Deci & Ryan, Can. Psychol., 49, 2008, 182). Specifically, we argue that the degree to which maternity care practitioners support or frustrate women's needs for relatedness, competence, and autonomy predicts their childbirth satisfaction. Using this framework provides a potentially powerful lens to better understand and improve the well-being of new mothers and their infants.
Collapse
|
3
|
Nordin-Remberger C, Wells MB, Woodford J, Lindelöf KS, Johansson M. Preferences of support and barriers and facilitators to help-seeking in pregnant women with severe fear of childbirth in Sweden: a mixed-method study. BMC Pregnancy Childbirth 2024; 24:388. [PMID: 38796427 PMCID: PMC11127315 DOI: 10.1186/s12884-024-06580-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 05/13/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND There are few support interventions for women with fear of childbirth tailored towards type of fears and parity. To inform the future development of an acceptable and relevant intervention for women with severe fear of childbirth, primary objectives were to examine: (1) pregnant women's experiences of and preferences for support and (2) barriers and facilitators to help-seeking. Secondary objectives were to examine if there are any differences based on pregnant women's parity. METHODS Pregnant women with a severe fear of childbirth in Sweden completed an online cross-sectional survey between February and September 2022. Severe fear of childbirth was measured using the fear of childbirth scale. Quantitative data were analysed using descriptive and inferential statistics and free answers were analysed using manifest content analysis. A contiguous approach to integration was adopted with qualitative and quantitative findings reported separately. RESULTS In total, 609 participants, 364 nulliparous and 245 parous women, had severe fear of childbirth. The main category "A twisting road to walk towards receiving support for fear of childbirth" was explored and described by the generic categories: Longing for support, Struggling to ask for support, and Facilitating aspects of seeking support. Over half (63.5%), of pregnant women without planned or ongoing treatment, wanted support for fear of childbirth. Most (60.2%) pregnant women with ongoing or completed fear of childbirth treatment regarded the treatment as less helpful or not at all helpful. If fear of childbirth treatment was not planned, 35.8% of women would have liked to have received treatment. Barriers to help seeking included stigma surrounding fear of childbirth, previous negative experiences with healthcare contacts, fear of not being believed, fear of not being listened to, and discomfort of having to face their fears. Facilitators to help seeking included receiving respectful professional support that was easily available, flexible, and close to home. CONCLUSIONS Most pregnant women with severe fear of childbirth felt unsupported during pregnancy. Findings emphasise the need to develop individual and easily accessible psychological support for women with severe fear of childbirth, delivered by trained professionals with an empathetic and respectful attitude.
Collapse
Affiliation(s)
- Carita Nordin-Remberger
- Obstetric and Reproductive Health Research, Department of Women´s and Children´s Health, Uppsala University, Uppsala, 752 37, Sweden.
- Women's Mental Health during the Reproductive Lifespan - WOMHER, Uppsala University, Uppsala, Sweden.
| | - Michael B Wells
- Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | | | - Margareta Johansson
- Obstetric and Reproductive Health Research, Department of Women´s and Children´s Health, Uppsala University, Uppsala, 752 37, Sweden
| |
Collapse
|
4
|
Afulani PA, Getahun M, Ongeri L, Aborigo R, Kinyua J, Ogolla BA, Okiring J, Moro A, Oluoch I, Dalaba M, Odiase O, Nutor J, Mendes WB, Walker D, Neilands TB. A cluster randomized controlled trial to assess the impact of the 'Caring for Providers to Improve Patient Experience' intervention on person-centered maternity care in Kenya and Ghana: Study Protocol. RESEARCH SQUARE 2024:rs.3.rs-4344678. [PMID: 38766153 PMCID: PMC11100884 DOI: 10.21203/rs.3.rs-4344678/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Poor person-centered maternal care (PCMC) contributes to high maternal mortality and morbidity, directly and indirectly, through lack of, delayed, inadequate, unnecessary, or harmful care. While evidence on poor PCMC prevalence, as well as inequities, expanded in the last decade, there is still a significant gap in evidence-based interventions to address PCMC. We describe the protocol for a trial to test the effectiveness of the "Caring for Providers to Improve Patient Experience" (CPIPE) intervention, which includes five strategies for provider behavior change, targeting provider stress and bias as intermediate factors to improve PCMC and to address inequities. Methods The trial will assess the effect of CPIPE on PCMC, as well as on intermediate and distal outcomes, using a two-arm cluster randomized controlled trial in 40 health facilities in Migori and Homa Bay Counties in Kenya and Upper East and Northeast Regions in Ghana. Twenty facilities in each country will be randomized to 10 intervention and 10 control sites. The primary intervention targets are all healthcare workers who provide maternal health services. The intervention impact will also be assessed first among providers, and then among women who give birth in health facilities. The primary outcome is PCMC measured with the PCMC scale, via multiple cross-sectional surveys of mothers who gave birth in the preceding 12 weeks in study facilities at baseline (prior to the intervention), midline (6 months after intervention start), and endline (12 months post-baseline) (N = 2000 across both countries at each time point). Additionally, 400 providers in the study facilities across both countries will be followed longitudinally at baseline, midline, and endline, to assess intermediate outcomes. The trial incorporates a mixed-methods design; survey data alongside in-depth interviews (IDIs) with healthcare facility leaders, providers, and mothers to qualitatively explore factors influencing the outcomes. Finally, we will collect process and cost data to assess intervention fidelity and cost-effectiveness. Discussion This trial will be the first to rigorously assess an intervention to improve PCMC that addresses both provider stress and bias and will advance the evidence base for interventions to improve PCMC and contribute to equity in maternal and neonatal health.
Collapse
|
5
|
Kaliush PR, Conradt E, Kerig PK, Williams PG, Crowell SE. A multilevel developmental psychopathology model of childbirth and the perinatal transition. Dev Psychopathol 2024; 36:533-544. [PMID: 36700362 PMCID: PMC10368796 DOI: 10.1017/s0954579422001389] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Despite recent applications of a developmental psychopathology perspective to the perinatal period, these conceptualizations have largely ignored the role that childbirth plays in the perinatal transition. Thus, we present a conceptual model of childbirth as a bridge between prenatal and postnatal health. We argue that biopsychosocial factors during pregnancy influence postnatal health trajectories both directly and indirectly through childbirth experiences, and we focus our review on those indirect effects. In order to frame our model within a developmental psychopathology lens, we first describe "typical" biopsychosocial aspects of pregnancy and childbirth. Then, we explore ways in which these processes may deviate from the norm to result in adverse or traumatic childbirth experiences. We briefly describe early postnatal health trajectories that may follow from these birth experiences, including those which are adaptive despite traumatic childbirth, and we conclude with implications for research and clinical practice. We intend for our model to illuminate the importance of including childbirth in multilevel perinatal research. This advancement is critical for reducing perinatal health disparities and promoting health and well-being among birthing parents and their children.
Collapse
Affiliation(s)
- Parisa R. Kaliush
- Department of Psychology, University of Utah, 380 South 1530 East, BEH S 502, Salt Lake City, UT 84112, USA
| | - Elisabeth Conradt
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27701, USA
| | - Patricia K. Kerig
- Department of Psychology, University of Utah, 380 South 1530 East, BEH S 502, Salt Lake City, UT 84112, USA
| | - Paula G. Williams
- Department of Psychology, University of Utah, 380 South 1530 East, BEH S 502, Salt Lake City, UT 84112, USA
| | - Sheila E. Crowell
- Department of Psychology, University of Utah, 380 South 1530 East, BEH S 502, Salt Lake City, UT 84112, USA
- Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA
| |
Collapse
|
6
|
AlKhunaizi AN, Al-Otaibi AG, Alharbi MF, Bahari G. Exploring Healthcare Providers' and Women's Perspectives of Labor Companionship during Childbirth: An Interpretative Phenomenological Analysis Study. Healthcare (Basel) 2024; 12:869. [PMID: 38727426 PMCID: PMC11083292 DOI: 10.3390/healthcare12090869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
A labor companion of choice during childbirth is crucial for improving women's birth experience and confidence to give birth. Labor companions provide various benefits, including enhanced communication, emotional support, non-pharmacological pain relief, and better healthcare. However, little is known about the supportive actions of labor companions with respect to women's needs during labor and birth, as well as healthcare providers' perceptions of labor companions. Therefore, this study was conducted to explore the perceptions of healthcare providers and women regarding labor companions. The study utilized an interpretative phenomenology research design. Data collection involved conducting semi-structured interviews with 14 participants. The sample consisted of mothers, physicians, and nurses, ensuring a diverse range of perspectives. An interpretative phenomenological analysis was conducted for data analysis. Five themes were identified: (a) impact of companionship, (b) benefits for healthcare providers, (c) companion roles, (d) loneliness and alienation of mothers, and (e) challenges of implementation. The findings indicated that the presence of a companion reduces the need for unnecessary medical interventions and eases the workload of healthcare providers. Without a companion, mothers often feel lonely and disconnected during the birthing process. The presence of companions is often hindered by space limitations in delivery rooms, the absence of clear policies, and lack of childbirth education programs for companions. Clear policies, education programs, and adequate space are essential for implementing and promoting labor companionship during childbirth.
Collapse
Affiliation(s)
- Anwar Nader AlKhunaizi
- Maternal and Child Health Nursing Department, College of Nursing, King Saud University, Riyadh 11421, Saudi Arabia; (A.N.A.); (M.F.A.)
| | - Areej Ghalib Al-Otaibi
- Fundamental of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia;
| | - Manal F. Alharbi
- Maternal and Child Health Nursing Department, College of Nursing, King Saud University, Riyadh 11421, Saudi Arabia; (A.N.A.); (M.F.A.)
| | - Ghareeb Bahari
- Nursing Administration and Education Department, College of Nursing, King Saud University, Riyadh 11421, Saudi Arabia
| |
Collapse
|
7
|
Koski P, Raussi-Lehto E, Leskinen P, Klemetti R. Patient perception of labor support behaviors provided by Finnish midwives. Midwifery 2024; 131:103936. [PMID: 38350363 DOI: 10.1016/j.midw.2024.103936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 12/18/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Almost all births in Finland occur in hospitals, but the concept of labor support behavior is not well-known among Finnish midwives. OBJECTIVE The primary aim was to increase perceived labor support as measured by BANSILQ. METHODS This study was tailored to evaluate the impacts of short on-the-job training interventions for midwives (n=70) in labor support given to mothers. The training was conducted at one university hospital and and one regional hospital during 2012. The trainings were carried out twice at both hospitals to reach as many miwdwives as possible to participate. Two university hospitals-one regional and one central-were selected as controls. New mothers were asked to complete the Bryanton Adaptation of the Nursing Support in Labor Questionnaire (BANSILQ) in the postpartum wards at all the selected hospitals before the intervention (n=1500) and after the intervention (n=1500). The data were linked to the Finnish Medical Birth Register (MBR). As this is an in-job training intervention study and not a trial, it has not been registered in a trial registry. RESULTS The response rate was 68% (n=1020) for the pre-intervention survey and 47% (n=704) for the post-intervention survey. At the regional-level intervention hospital, the mean length of the second stage of childbirth decreased significantly. A bonding time of at least three minutes was three times more likely at both intervention hospitals. Support for breastfeeding was twice as likely at the university-level hospital after the intervention. In all the study hospitals, mothers with less education were more likely to receive tangible and informal support than highly educated mothers. CONCLUSIONS This short on-the-job intervention did not increase labor support provided by Finnish midwives in its entirety, and the effect on birth outcomes was minimal. However, support for breastfeeding increased, and some types of support were targeted at those who needed it most. To improve midwifery care, both training and sufficient resources are needed.
Collapse
Affiliation(s)
- Pirjo Koski
- Metropolia University of Applied Sciences, Helsinki, Finland.
| | | | - Päivi Leskinen
- Metropolia University of Applied Sciences, Helsinki, Finland
| | - Reija Klemetti
- Finnish Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
8
|
Dimassi K, Halouani A, Ben Zina F, Khemessi N, Triki A. Regulated Expiratory Methods During Childbirth Process: A Randomized Controlled Trial. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102265. [PMID: 37940044 DOI: 10.1016/j.jogc.2023.102265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To evaluate the impact of a regulated expiratory method (REM) on the childbirth process. METHODS This was a randomized trial. Study population included all first-time mothers with a spontaneous onset of labour, at an early stage, and a fetus in cephalic presentation with a normal weight for gestational age. The evaluated intervention was REM based on the use of a specific device. The primary outcome was the cesarean delivery rate. Secondary outcomes included first and second stages of labour times, rates of spontaneous and instrumental vaginal births, and pain scores. Subjective qualitative outcomes related to childbirth experience were evaluated via 2 interviews conducted with the parturient and the midwife responsible for her delivery. Intention-to-treat analysis was employed to compare the 2 groups. RESULTS The reduction in primary cesarean rates between the 2 groups was not significant (26.7% in control group vs. 18.3% in intervention group; P = 0.274). However, REM allowed for a significant reduction in second stage (P = 0.039) and pushing effort times (P = 0.003). According to midwives, REM had a significant positive impact on parturients' breathing (P < 0.0001) and pushing effort intensity (P = 0.041). It facilitated communication with the parturient (P = 0.002). Moreover, the evaluated method had a significant positive impact on patient's childbirth experience. CONCLUSIONS Although the reduction in immediate cesarean rates was not significant, REM has the potential to shorten labour duration, improve pain management, and ultimately improve maternal childbirth experience.
Collapse
Affiliation(s)
- Kaouther Dimassi
- Department of Obstetrics and Gynecology, University Hospital Mongi Slim La Marsa, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia; Obstetrics and Gynecology Department, Robert Bisson Hospital, Lisieux, France
| | - Ahmed Halouani
- Department of Obstetrics and Gynecology, University Hospital Mongi Slim La Marsa, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
| | - Farah Ben Zina
- Department of Obstetrics and Gynecology, University Hospital Mongi Slim La Marsa, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Najla Khemessi
- Department of Obstetrics and Gynecology, University Hospital Mongi Slim La Marsa, Tunis, Tunisia
| | - Amel Triki
- Department of Obstetrics and Gynecology, University Hospital Mongi Slim La Marsa, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| |
Collapse
|
9
|
Haseli A, Khosravi S, Hajimirzaie SS, Feli R, Rasoal D. Midwifery students' experiences: Violations of dignity during childbirth. Nurs Ethics 2024; 31:296-310. [PMID: 37650382 PMCID: PMC11181724 DOI: 10.1177/09697330231197703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND The principle of human dignity is woven into the ethical principles of the midwifery profession, noted as both an obligation and a human right. RESEARCH OBJECTIVES The aim of this study is to explore the experiences of midwifery students regarding threats to women's dignity during childbirth. RESEARCH DESIGN This is a qualitative study with explorative design. Participants and Research Context: The research was carried out in 2022 at Kermanshah University of Medical Sciences, involving 32 midwifery students in individual interviews that lasted between 30 and 90 minutes. These participants aged 21 to 28 years, with an average age of 23.5 years, provided their perspectives on the matter. RESULTS Four key themes described the threats to women's dignity during childbirth: 1) professional incompetence, 2) abuse of power imbalance, 3) caring only for physical and not mental health, and 4) structural issues within the healthcare system. Professional incompetence was characterized by outdated practices and lack of adherence to evidence-based medicine. Abuse of power imbalance was demonstrated in instances where the authoritative position of healthcare providers was misused, thereby disrupting the respectful care that women are entitled to receive. The disproportionate emphasis on physical health over mental health was evidenced by the disregard for mothers' psychological well-being during childbirth. Lastly, systemic structural issues emerged as significant impediments, revealing the need for system-wide changes. Ethical considerations: This study was approved by the Ethics Committee of the Research Deputy at Kermanshah University. Participation was voluntary and the confidentiality were maintained. CONCLUSION The findings underscore the role that unprofessional behavior, ethical lapses in medical practices, and systemic challenges play in undermining maternal dignity during childbirth. These threats necessitate urgent attention and must be adequately addressed in policy development and program implementation to safeguard the dignity of mothers during childbirth.
Collapse
Affiliation(s)
| | | | | | | | - Dara Rasoal
- School of Health and Welfare, Dalarna University, Sweden
| |
Collapse
|
10
|
Ababneh AMT, Alrida N, Abu-Abbas M, Rayan A, Abu Sumaqa Y, Alhamory S, Al-Zu’bi B. The Lived Experience of Family Support Among Women During and After Childbirth in Jordan: A Phenomenological Study. SAGE Open Nurs 2024; 10:23779608241240137. [PMID: 38515526 PMCID: PMC10956139 DOI: 10.1177/23779608241240137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/04/2024] [Accepted: 02/25/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Many studies highlight the importance of family support in enhancing the experience of childbirth among women. Objective This qualitative study aimed to describe the lived experience of family support from the perspective of women during and after childbirth in the Jordanian context. Methods A qualitative descriptive phenomenological approach was used to explore the experiences of women's family support in the context of their childbirth experiences. A total of 11 Jordanian women participated in the study. Face-to-face semi-structured interviews were conducted to collect data. Results Four major themes emerged from the data describing family support provided to women during and after childbirth. These themes were family support during childbirth, family support in the postpartum period, importance of family support during and after childbirth, and challenges related to receiving family support. Supportive family members primarily included the husband, the woman's family, and the family-in-law, according to the traditions inherited in the Jordanian context and culture. Conclusion The study findings could help maternal health professionals screen pregnant women who are at risk of receiving low family support, contribute to developing effective interventions regarding family-centered care, and enhance the overall childbirth experience for women in Jordanian cultural contexts.
Collapse
Affiliation(s)
| | - Nour Alrida
- School of Nursing, Yarmouk University, Irbid, Jordan
| | | | - Ahmad Rayan
- Dean of the Faculty of Nursing, Zarqa University, Al-Zarqa, Jordan
| | | | | | - Basheer Al-Zu’bi
- Department of Allied Health Professions, Irbid University college/ Al-Balqa Applied University, Al-Salt, Jordan
| |
Collapse
|
11
|
Harte JD, Sheehan A, Stewart S, Foureur M. Application of the Childbirth Supporter Study to Advance the Birth Unit Design Spatial Evaluation Tool. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:148-163. [PMID: 37340757 DOI: 10.1177/19375867231177304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE Translational research to advance design criteria and apply the Childbirth Supporter Study (CSS) findings to practice. BACKGROUND The physical design of birth environments has not undergone substantial improvements in layout or ambiance since the initial move to hospitals. Cooperative, continuously present childbirth supporters are beneficial and are an expectation for most modern birth practices, yet the built environment does not offer support for the supporter. METHODS To advance design criteria, we use a comparative case study approach to create translational findings. Specifically, CSS findings were used as indicators to advance the Birth Unit Design Spatial Evaluation Tool (BUDSET) design characteristics in pursuit of better support for childbirth supporters in the built hospital birth environment. RESULTS This comparative case study provides eight new BUDSET design domain suggestions to benefit the supporter-woman dyad, and subsequently the baby and care providers. CONCLUSIONS Research-informed design imperatives are needed to guide the inclusion of childbirth supporters as both a supporter and as an individual in the birth space. Increased understanding of relationships between specific design features and childbirth supporters' experiences and reactions are provided. Suggestions to enhance the applicability of the BUDSET for birth unit design facility development are made, specifically ones that will better accommodate childbirth supporters.
Collapse
Affiliation(s)
- J Davis Harte
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Boston Architectural College, MA, USA
| | - Athena Sheehan
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- School of Nursing and Midwifery, Western Sydney University, New South Wales, Australia
| | - Susan Stewart
- School of Design, Faculty of Design, Architecture and Building, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Maralyn Foureur
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| |
Collapse
|
12
|
Koranteng YB, Adu-Bonsaffoh K, Oppong-Yeboah B. Physiotherapy practice in women's health: awareness and attitudes of obstetricians and gynecologists in Ghana. BMC Womens Health 2023; 23:666. [PMID: 38082319 PMCID: PMC10714590 DOI: 10.1186/s12905-023-02705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/13/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Physiotherapy is relatively well integrated into women's health in many high-income countries (HICs) as compared to low- and middle- countries (LMICs) like Ghana. Suboptimal integration of physiotherapy in modern obstetrics and gynecology especially in low resource settings is partly due to issues related to the awareness and attitudes of referring physicians. This study assessed the awareness and attitude levels towards physiotherapy in women's health among obstetricians/gynecologists and factors associated with its utilization in Ghana. METHODS A cross-sectional study was conducted among obstetricians/gynecologists working at a tertiary hospital in Ghana using an "Awareness and Attitude Questionnaire" adapted from a standardized questionnaire. Chi-square test or Fisher exact test was performed and logistic regression was used to assess the association between doctors' awareness level of physiotherapy's role in women's health and years of clinical practice. RESULTS Sixty-one (61) respondents comprising 7 consultants, 20 senior residents and 34 junior residents, with age median age of 35 years (range: 29-65 years) were recruited. There were more males than females (82% versus 18%) with a mean (SD) duration of practice of (9.41 ± 4.71) years. The participants reported a considerable awareness of physiotherapists' role in obstetrics (between 72.1% for intrapartum to 91.8% for postnatal) but wide variation in gynecology (from 19.7% in PID to 95. 1% in uterine prolapse). Consultants were more (71.4%) aware of the role of physiotherapy in antenatal care and gynecology while senior residents had more awareness in intrapartum and postnatal care. Junior residents generally showed lowest awareness levels. Duration of clinical practice (≥ 10years) was not significantly associated with doctors' awareness regarding the importance of physiotherapy in childbirth. There were mixed findings concerning doctors' attitudes toward physiotherapy: (1) 41% indicated that physiotherapists have been effective in their inter-professional relationship; (2) none of the doctors strongly agreed that physiotherapy may not contribute significantly to the complete well-being of gynecological patients. The main factors influencing utilization of physiotherapy were the perceived notion of non-availability of physiotherapists to cover various wards and physiotherapists not attending ward rounds with doctors to facilitate more education on the scope of physiotherapy practice. CONCLUSION Although obstetricians/gynecologists showed appreciable awareness and attitudes towards physiotherapy, there remains a considerable gap in provider education to ensure optimal utilization of physiotherapy in contemporary obstetrics and gynecology. Further research is recommended to assess implementation challenges associated with regular utilization of physiotherapy services in women's health in the hospital.
Collapse
Affiliation(s)
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana.
| | - Bertha Oppong-Yeboah
- Department of Physiotherapy, University of Health and Allied Sciences, Ho, Ghana
| |
Collapse
|
13
|
Obeng CS, Jackson F, Brandenburg D, Byrd KA. Black/African American Women's Woes: Women's Perspectives of Black/African American Maternal Mortality in the USA. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01883-0. [PMID: 38051429 DOI: 10.1007/s40615-023-01883-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Despite advances in perinatal care in the USA, maternal mortality is on the rise, and maternal death is higher than in any other high-income country. Maternal mortality in the USA is a persistent public health concern. This issue disproportionately affects Black/African American women, with their likelihood of pregnancy-related death being three times more likely compared to White women. This study aimed to explore the resources needed for Black/African American women to address the relatively higher maternal mortality rates recorded for them. METHODS An anonymous link with demographic and open-ended questions was sent to US women 18 years and older to participate in the study. A total of 140 participants responded to the survey. We retained a final sample of 118 responses after eliminating responses with missing data. Descriptive statistics are reported for closed-ended items. Open-ended responses were analyzed using content analysis procedures, where we coded and categorized the data into themes. RESULTS Six themes were identified from the study data: (1) Diversity, Equity, and Inclusion (DEI) training for health providers focused on racial bias and discrimination, (2) Advocacy, (3) Provider selection, (4) Researching doctors and delivery hospitals to inform women's birthing decision-making, (5) Women's care-seeking behaviors, and (6) Addressing the Social Determinants of Health. CONCLUSION Based on the study's findings, we recommend DEI training for healthcare professionals providing direct care to pregnant and postpartum women, advocacy and resource-awareness training for pregnant Black/African American women and their spouses/partners, or a family member, to assist them in their pregnancy and birthing journeys.
Collapse
Affiliation(s)
- Cecilia S Obeng
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA.
| | - Frederica Jackson
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA
| | - Dakota Brandenburg
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA
| | - Kourtney A Byrd
- College of Pharmacy, Center for Health Equity and Innovation (CHEqI), Purdue University, Indianapolis, IN, USA
| |
Collapse
|
14
|
Andaya E, Bhatia R. Trading in harms: COVID-19 and sexual and reproductive health disparities during the first surge in New York state. Soc Sci Med 2023; 339:116389. [PMID: 37979493 DOI: 10.1016/j.socscimed.2023.116389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023]
Abstract
In March 2020, New York City was the national epicenter of the novel coronavirus in the United States. This article draws on rapid qualitative research from July to October of 2020 with sexual and reproductive healthcare (SRH) providers who served low-income people from racial and ethnic minority groups in New York State to examine their perceptions of the effects of COVID-related adaptations to care on healthcare access and quality. We found that care delivery protocols during the early months of the pandemic compromised healthcare interactions and clinical experiences by limiting support persons, separating newborns from parents, and restricting care time in hospitals. Additionally, closures of in-person SRH services and prohibitions on prenatal support persons increased obstacles to access and utilization of care. Our intersectional analysis underscores how COVID protocols interacted with other axes of inequality to compound disparities in SRH access and quality of care. Early COVID policies prioritized controlling the risk of viral exposure over the risk of harm from the policies themselves, reflecting zero-sum approaches that we describe as "trading in harms." Our research thus raises crucial questions about how institutions and governing bodies conceive of, and organize, emergency preparedness. We argue that emergency preparedness must center concerns around racial, class, and gender equity, among others, to foreground the risks and benefits of emergency responses for different groups.
Collapse
Affiliation(s)
- Elise Andaya
- Department of Anthropology, University at Albany, 1400 Washington Ave, Arts and Sciences 241, Albany, NY, 12222, USA.
| | - Rajani Bhatia
- Department of Women's, Gender & Sexuality Studies, University at Albany, 1400 Washington Ave, Arts and Sciences 241, Albany, NY, 12222, USA.
| |
Collapse
|
15
|
Kahraman HG, Gökçe İsbir G. The effect of continuous intrapartum supportive care on maternal mental health: a randomized controlled trial. Women Health 2023; 63:774-786. [PMID: 37807722 DOI: 10.1080/03630242.2023.2266009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
Supportive care during labor is the primary role of intrapartum nurses and midwives and provides comfort for women allowing them to have a positive experience. It is argued that supportive care during labor reduces fear and resultant side effects. However, evidence for different parameters of mental health is insufficient. The aim of this study was to evaluate the effect of continuous intrapartum supportive care on the fear of childbirth, perceived control and support at birth, birth trauma and maternal attachment. This is a randomized controlled study with an intervention group and a control group. The intervention group included 40 women receiving continuous intrapartum supportive care and the control group included 40 women receiving routine care. Thirty women in the intervention group and 29 women in the control group completed the study. No significant differences were detected between the two groups at baseline (p > .05). Continuous intrapartum supportive care significantly decreased fear of birth and birth trauma, and significantly increased perceived intrapartum control and support and postpartum maternal attachment (p < .01). Results from this evidence-based study suggest that continuous intrapartum supportive care could protect and maintain perinatal mental health.
Collapse
Affiliation(s)
| | - Gözde Gökçe İsbir
- School of Health, Midwifery Department, Mersin University, Mersin, Türkiye
| |
Collapse
|
16
|
Shahbazi Sighaldeh S, Azadpour A, Vakilian K, Rahimi Foroushani A, Vasegh Rahimparvar SF, Hantoushzadeh S. Comparison of maternal outcomes in caring by Doula, trained lay companion and routine midwifery care. BMC Pregnancy Childbirth 2023; 23:765. [PMID: 37907873 PMCID: PMC10619238 DOI: 10.1186/s12884-023-05987-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/10/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION The aim of this study was to compare maternal and neonatal outcomes in the care provided by Doula, trained lay companion, and routine midwifery care in the labor and obstetric units. In this study, only results related to maternal outcomes were presented. METHOD This is a quasi-experimental study, which was conducted on 150 women with low-risk pregnancies who had been selected for vaginal birth at private clinics and public hospitals of Arak, Iran. Participants were divided into three groups, two intervention groups, doula and trained lay companion, and one control group, midwife's routine care. The intervention groups, in addition to receiving routine care from the labor and maternity units, also received support and training by doula or a trained lay companion, but 50 the control group received only routine midwifery care. In the control group and the trained companion, the samples were taken from 10 clinics of different parts of the city by random sampling method using the SIB center system. Then, among selected numbers, we randomly selected samples for each group. But in Doula group, because of limited number of samples, convenience sampling was used and all women enrolled in doula care were included in the study until the number reached 50. In each group, outcomes such as the duration of active phase and second stage of labor, as well as the severity of pain, anxiety and maternal satisfaction with birth were measured and compared with other groups. Data were collected by a researcher-made checklist, the Spielberger's State-Trait Anxiety Inventory (STAI), the Pain Visual Assessment Scale (VAS), and the Hollins Martin's Birth Satisfaction Scale-Revised (BSS-R). Data were analyzed by SPSS-22 statistical software using Kruskal Wallis, Chi-Square, ANOVA and Fisher's exact tests. FINDINGS Based on the results, the mean duration of active phase between three groups was 234.68 ± 118.74, 256.66 ± 108.75 and 279 ± 94.37 min, respectively (p = 0.022). Also, the mean duration of second stage in three groups was 10 ± 5.61, 10.35 ± 5.1 and 22.30 ± 75.57 min, respectively (p < 0.001). The difference between mean pain scores in the first, second, third, fourth and fifth hours was not statistically significant. The average difference in anxiety score in the two stages of labor was higher in the lay companion group, and this difference was statistically significant (p < 0.001); however, the level of satisfaction in doula group was higher compared to the lay companion and control groups (p < 0.00 1). CONCLUSION According to present study, doula care has a greater effect on reducing the duration of labor than other care models. Based on the study, there was no statistically significant difference between the three groups in terms of variables such as the severity of labor pain. However, the level of anxiety of pregnant mothers in the group supported by lay companion was lower than the other two groups, which indicates the positive effect of mothers' training on increasing maternal comfort and satisfaction. It is suggested that further research investigate the severity of labor pain in groups supported by different care models and also we recommend the use of lay companion' support during childbearing of mothers who could not afford doula. TRAIL REGISTRATION This article has been registered in Iran's Clinical Trial Center with the code: IRCT20230620058548N1. 2023/08/29.
Collapse
Affiliation(s)
- Shirin Shahbazi Sighaldeh
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Breastfeeding Research Center-Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Azadpour
- MSc in Maternal and Child Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Katayoun Vakilian
- Department of Midwifery, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sedigheh Hantoushzadeh
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
17
|
Jewett CG, Sobiech KL, Donahue MC, Alexandrova M, Bucher S. Providing Emotional Support and Physical Comfort During a Time of Social Distancing: A Thematic Analysis of Doulas' Experiences During the Coronavirus Pandemic. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023; 44:89-98. [PMID: 37724030 DOI: 10.1177/0272684x221094172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Doulas are trained, non-clinical professionals that provide a continuum of support for mothers. An interpretive phenomenological approach was used to explore the professional experiences of doulas (n = 17) during the COVID-19 pandemic in the US. Data were collected using brief intake surveys, in-depth semi-structured interviews, and an online discussion group. After a list of significant statements was created and grouped during emergent themes analysis, the reflections were summarized into three themes, (1) Doula Resilience, (2) Experiencing Vulnerability, and (3) Concern for Client Vulnerability that encapsulate the experiences of doulas during the COVID-19 pandemic. We conclude that as part of the COVID-19 recovery process, policy makers should look to non-clinical interventions for improving maternal health, such as promoting and supporting synergy between doulas and other maternal health service providers.
Collapse
Affiliation(s)
- Christian G Jewett
- Eck Institute for Global Health, University of Notre Dame, South Bend, IN, USA
| | - Kathleen L Sobiech
- Eck Institute for Global Health, University of Notre Dame, South Bend, IN, USA
| | - Marie C Donahue
- Eck Institute for Global Health, University of Notre Dame, South Bend, IN, USA
| | - Maria Alexandrova
- Eck Institute for Global Health, University of Notre Dame, South Bend, IN, USA
| | - Sherri Bucher
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
18
|
Soriano-Vidal FJ, Oliver-Roig A, Richart-Martínez M, Cabrero-García J. Predictors of childbirth experience: Prospective observational study in eastern Spain. Midwifery 2023; 124:103748. [PMID: 37285753 DOI: 10.1016/j.midw.2023.103748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/10/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND In recent years, birth experience has been highlighted by national and international organisations as a relevant value in measuring maternal health care quality. According to a standardised tool, we aimed to assess which clinical indicators had the most significant influence on the birth experience. METHODS This prospective observational study was carried out in fourteen hospitals in eastern Spain. 749 women consented to the collection of birth variables at discharge, and subsequently, at 1-4 months, data were collected on the birth experience as measured by the Spanish version of the Childbirth Experience Questionnaire. Next, a linear regression analysis was performed to determine which clinical birth indicators greatly influence the birth experience measure. RESULT The study sample (n = 749) was predominantly Spanish and primipara, with 19.5% vaginal births. The predictors that emerged in the linear regression model were to have a birth companion (B = 0.250, p = 0.028), drink fluids during labour (B = 0.249, p < 0.001), have early skin-to-skin contact (B = 0.213, p < 0.001) and being transferred to a specialised room for the second stage of labour (B = 0.098, p = 0.016). The episiotomy (B = -0.100, p < 0.015) and having an operative birth (B = -0.128, p < 0.008) showed a negative influence. CONCLUSION Our study supports that intrapartum interventions recommended according to clinical practice guidelines positively influence the mother's birth experience. Episiotomy and operative birth should not be used routinely as they negatively influence the birth experience.
Collapse
Affiliation(s)
- F J Soriano-Vidal
- Department of Nursing, University of Alicante. Spain. Cta. San Vicente del Raspeig s/n 03690 San Vicente del Raspeig, Alicante; Department of Nursing Universitat de València. C/Jaume Roig s/n. 46010 Valencia, Spain; Midwife, Hospital Lluis Alcanyis, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Ctra. Xàtiva-Silla, km 2, 46800 Xàtiva, Valencia, Spain
| | - A Oliver-Roig
- Department of Nursing, University of Alicante. Spain. Cta. San Vicente del Raspeig s/n 03690 San Vicente del Raspeig, Alicante.
| | - M Richart-Martínez
- Department of Nursing, University of Alicante. Spain. Cta. San Vicente del Raspeig s/n 03690 San Vicente del Raspeig, Alicante
| | - J Cabrero-García
- Department of Nursing, University of Alicante. Spain. Cta. San Vicente del Raspeig s/n 03690 San Vicente del Raspeig, Alicante
| |
Collapse
|
19
|
Mosley EA, Lindsey A, Turner D, Shah P, Sayyad A, Mack A, Lindberg K. "I want…to serve those communities…[but] my price tag is…not what they can afford": The community-engaged Georgia doula study. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:200-209. [PMID: 37533301 DOI: 10.1363/psrh.12241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
INTRODUCTION In Georgia, maternal mortality is relatively high, and Black women are three times as likely to die from pregnancy-related causes as white women. Doulas can improve perinatal health and reduce disparities, but doula accessibility in Georgia is unclear. METHODS This community-engaged mixed methods study surveyed and interviewed 17 doulas in Georgia. Surveys included structured questions on demographics, businesses, clientele, training, and challenges; we analyzed them using descriptive statistics. In-depth interviews included open-ended questions on doula care benefits, building their businesses, and improving access to doula care. We analyzed the content of transcripts using coding and memoing. RESULTS Our diverse doula participants described providing life-saving services including education, referral to care, and patient advocacy. Yet they described numerous challenges to providing care and building their businesses. Almost all participants reported having fewer than their ideal number of clients and all reported being insufficiently paid for their services. Although training, mentoring, and networking help build their businesses, many doulas want to serve Black women, transgender men, gender non-binary individuals, and families living on lower incomes. Participants suggested Medicaid reimbursement and community health worker models as potential interventions for increasing equitable doula care access. DISCUSSION Doulas can improve perinatal health outcomes and are urgently needed. Yet they face challenges in building businesses and finding clientele, especially from communities and groups at highest risk of negative outcomes during pregnancy, childbirth, and the postpartum period. Identifying avenues for supporting publicly-funded reimbursement, expanding equity-focused doula training, and fostering stronger doula networks with mentorship appears warranted.
Collapse
Affiliation(s)
- Elizabeth A Mosley
- Center for Reproductive Health Research in the Southeast (RISE), Emory University, Atlanta, Georgia, USA
| | - Alyssa Lindsey
- Center for Reproductive Health Research in the Southeast (RISE), Emory University, Atlanta, Georgia, USA
| | - Daria Turner
- Center for Reproductive Health Research in the Southeast (RISE), Emory University, Atlanta, Georgia, USA
| | - Priya Shah
- Center for Reproductive Health Research in the Southeast (RISE), Emory University, Atlanta, Georgia, USA
| | - Ayeesha Sayyad
- Center for Reproductive Health Research in the Southeast (RISE), Emory University, Atlanta, Georgia, USA
| | - Amber Mack
- Healthy Mothers Healthy Babies Coalition of Georgia, Atlanta, Georgia, USA
| | - Ky Lindberg
- Healthy Mothers Healthy Babies Coalition of Georgia, Atlanta, Georgia, USA
| |
Collapse
|
20
|
Dubey K, Sharma N, Chawla D, Khatuja R, Jain S. Impact of Birth Companionship on Maternal and Fetal Outcomes in Primigravida Women in a Government Tertiary Care Center. Cureus 2023; 15:e38497. [PMID: 37273329 PMCID: PMC10237517 DOI: 10.7759/cureus.38497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Studies have shown that the support provided by birth companions during labour and childbirth improves maternal and neonatal outcomes and helps women in having a positive childbirth experience. OBJECTIVE To study the role of birth companionship on maternal and foetal outcomes along with their satisfaction rates in primigravidas supported by birth companions compared to those receiving routine care in the labour room. DESIGN The study was a prospective comparative observational study. One hundred fifty primigravida women were randomly divided into two groups, one group (n = 75) who were allowed a female companion of their choice (A) and the other group (n = 75) who did not have a birth companion receiving routine standard care as routinely practised in our hospital. The data was entered in MS Excel Sheet and analysis was done using the statistical package for social sciences (SPSS) version 21.0 (IBM Corp., Armonk, NY). A p-value of <0.05 was considered statistically significant. RESULTS Spontaneous vaginal births were significantly higher in group A (Group A: mean = 67; SD = 89.3%, Group B: mean = 57; SD = 76 %; p = 0.03) along with a favourable trend in a shorter duration of the first stage of labour (9.96±1.09 vs 11.95±3.11 hours) and decreased need of augmentation (Group A; mean = 10; SD = 13.3, Group B: mean = 23; SD = 30.7; p = 0.01). Maternal satisfaction was significantly higher in group A (Group A: mean = 60; SD = 80, Group B: mean = 44; SD = 58.7; p <0.01) and in the early initiation of breastfeeding (Group A: mean = 70; SD = 93.3, Group B: mean = 55; SD = 73.3; p <0.01). No statistical difference was observed between the mean duration of labour, mode of delivery, and NICU stay of the baby. CONCLUSIONS Companionship during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter labour duration, a low five-minute Apgar score, and higher satisfaction rates with childbirth experiences.
Collapse
Affiliation(s)
- Kanak Dubey
- Obstetrics and Gynecology, Dr. Babasaheb Ambedkar Medical College and Hospital, New Delhi, IND
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Neeraj Sharma
- Obstetrics and Gynecology, Dr. Babasaheb Ambedkar Medical College and Hospital, New Delhi, IND
| | - Dolly Chawla
- Obstetrics and Gynecology, Dr. Babasaheb Ambedkar Medical College and Hospital, New Delhi, IND
| | - Ritu Khatuja
- Obstetrics and Gynecology, Dr. Babasaheb Ambedkar Medical College and Hospital, New Delhi, IND
| | - Sandhya Jain
- Obstetrics and Gynecology, Dr. Babasaheb Ambedkar Medical College and Hospital, New Delhi, IND
| |
Collapse
|
21
|
Afulani PA, Okiring J, Aborigo RA, Nutor JJ, Kuwolamo I, Dorzie JBK, Semko S, Okonofua JA, Mendes WB. Provider implicit and explicit bias in person-centered maternity care: a cross-sectional study with maternity providers in Northern Ghana. BMC Health Serv Res 2023; 23:254. [PMID: 36918860 PMCID: PMC10015736 DOI: 10.1186/s12913-023-09261-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Person-centered maternity care (PCMC) has become a priority in the global health discourse on quality of care due to the high prevalence of disrespectful and lack of responsive care during facility-based childbirth. Although PCMC is generally sub-optimal, there are significant disparities. On average, women of low socioeconomic status (SES) tend to receive poorer PCMC than women of higher SES. Yet few studies have explored factors underlying these inequities. In this study, we examined provider implicit and explicit biases that could lead to inequitable PCMC based on SES. METHODS Data are from a cross-sectional survey with 150 providers recruited from 19 health facilities in the Upper East region of Ghana from October 2020 to January 2021. Explicit SES bias was assessed using situationally-specific vignettes (low SES and high SES characteristics) on providers' perceptions of women's expectations, attitudes, and behaviors. Implicit SES bias was assessed using an Implicit Association Test (IAT) that measures associations between women's SES characteristics and providers' perceptions of women as 'difficult' or 'good'. Analysis included descriptive statistics, mixed-model ANOVA, and bivariate and multivariate linear regression. RESULTS The average explicit bias score was 18.1 out of 28 (SD = 3.60) for the low SES woman vignette and 16.9 out of 28 (SD = 3.15) for the high SES woman vignette (p < 0.001), suggesting stronger negative explicit bias towards the lower SES woman. These biases manifested in higher agreement to statements such as the low SES woman in the vignette is not likely to expect providers to introduce themselves and is not likely to understand explanations. The average IAT score was 0.71 (SD = 0.43), indicating a significant bias in associating positive characteristics with high SES women and negative characteristics with low SES women. Providers with higher education had significantly lower explicit bias scores on the low SES vignette than those with less education. Providers in private facilities had higher IAT scores than those in government hospitals. CONCLUSIONS The findings provide evidence of both implicit and explicit SES bias among maternity providers. These biases need to be addressed in interventions to achieve equity in PCMC and to improve PCMC for all women.
Collapse
Affiliation(s)
- Patience A Afulani
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th St, San Francisco, CA, 94158, USA.
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Jerry John Nutor
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, USA
| | | | | | - Sierra Semko
- Department of Psychology, University of California, Berkeley, Berkeley, USA
| | - Jason A Okonofua
- Department of Psychology, University of California, Berkeley, Berkeley, USA
| | - Wendy Berry Mendes
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, USA
| |
Collapse
|
22
|
Lindsey A, Narasimhan S, Sayyad A, Turner D, Mosley EA. " I can be pro-abortion and pro-birth": Opportunities and challenges for full spectrum care among doulas in Georgia. Front Glob Womens Health 2023; 4:966208. [PMID: 36937040 PMCID: PMC10014539 DOI: 10.3389/fgwh.2023.966208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 01/02/2023] [Indexed: 03/05/2023] Open
Abstract
Background The work of full spectrum doulas (i.e., non-medically trained care workers offering support before, during, and after pregnancy including abortion)-is increasingly important as abortion access decreases across the U.S. Few studies have examined the work of community-based doulas in restrictive abortion settings or how they might further incorporate full spectrum care. As part of the community-engaged mixed methods Georgia Doula Study, this analysis examines the scope of work of community-based doulas regarding full spectrum and abortion services, doula opinions on full spectrum and abortion work, and potential barriers and facilitators for full spectrum doula care in metro-Atlanta, Georgia. Methods From October 2020 to February 2022, the team recruited 20 community-based doulas with 8 who provide full spectrum services including abortion. Surveys covered demographics, doula scope of work, family planning attitudes, and abortion stigma. Survey data were analyzed using descriptive and bivariate statistics. In-depth interviews further explored those topics. They were de-identified and thematically analyzed using a semi-deductive approach. Results The findings are organized around five themes: (1) doulas of all kinds center reproductive autonomy; (2) abortion doulas play important roles in reproductive autonomy; (3) doulas have mixed feelings about contraceptive counseling; (4) abortion doulas provide diverse services carrying numerous benefits in a stigmatized environment; and (5) abortion doulas experience challenges including stigma but they offer solutions. All but two doulas in this study were interested in learning how to incorporate contraception and abortion services in their current scope of work, and most participants supported the role of full spectrum doulas. Conclusion This analysis highlights the experiences of abortion and full spectrum doulas, reactions of the larger doula community to those services, and facilitators and barriers to full spectrum doula care in a restrictive abortion setting. There are urgent needs and opportunities for full spectrum doulas to offer life-protecting services to pregnant people across the U.S. and globally. Coordination efforts for U.S. abortion care post-Roe v. Wade must include community-based doulas, who are largely open to aiding abortion clients through education, connection to care, and emotional support.
Collapse
Affiliation(s)
- Alyssa Lindsey
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
- The Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, United States
| | - Subasri Narasimhan
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
- The Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, United States
| | - Ayeesha Sayyad
- The Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, United States
- Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta, GA, United States
| | - Daria Turner
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Elizabeth A. Mosley
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
- The Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, United States
- Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta, GA, United States
- Division of General Internal Medicine, Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| |
Collapse
|
23
|
Asim M, Hameed W, Khan B, Saleem S, Avan BI. Applying the COM-B Model to Understand the Drivers of Mistreatment During Childbirth: A Qualitative Enquiry Among Maternity Care Staff. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00267. [PMID: 36853644 PMCID: PMC9972373 DOI: 10.9745/ghsp-d-22-00267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/28/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Respectful maternity care (RMC) during childbirth is an integral component of quality of care. However, women's experiences of mistreatment are prevalent in many low- and middle-income countries. This is a complex phenomenon that has not been well explored from a behavioral science perspective. We aimed to understand the behavioral drivers of mistreatment during childbirth among maternity care staff at public health facilities in the Sindh province of Pakistan. METHODS Applying the COM-B (capability-opportunity-motivation that leads to behavior change) model, we conducted semistructured in-depth interviews among clinical and nonclinical staff in public health facilities in Thatta and Sujawal, Sindh, Pakistan. Data were analyzed using thematic deductive analysis, and findings were synthesized using the COM-B model. RESULTS We identified several behavioral drivers of mistreatment during childbirth: (1) institutional guidelines on RMC and training opportunities were absent, resulting in a lack of providers' knowledge and skills; (2) facilities lacked the infrastructure to maintain patient privacy and confidentiality and did not permit males as birth companions; (3) lack of provider performance monitoring system and patient feedback mechanism contributed to providers not feeling appreciated or recognized. Staff bias against patients from lower castes contributed to patient abuse and mistreatment. The perspectives of clinical and nonclinical staff overlapped regarding potential drivers of mistreatment during childbirth. CONCLUSIONS Addressing mistreatment during childbirth requires improving the knowledge and capacity of maternity staff on RMC and psychosocial support to enhance their understanding of RMC. At the health facility level, governance and accountability mechanisms in routine supervision and monitoring of staff need to be improved. Patients' feedback should be incorporated for continuous improvement in providing maternity care services that meet patients' preferences and needs.
Collapse
Affiliation(s)
- Muhammad Asim
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Bushra Khan
- Department of Psychology, University of Karachi, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Bilal Iqbal Avan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| |
Collapse
|
24
|
Chinkam S, Ibrahim BB, Diaz B, Steer-Massaro C, Kennedy HP, Shorten A. Learning from women: Improving experiences of respectful maternity care during unplanned caesarean birth for women with diverse ethnicity and racial backgrounds. Women Birth 2023; 36:e125-e133. [PMID: 35610171 DOI: 10.1016/j.wombi.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 05/01/2022] [Accepted: 05/08/2022] [Indexed: 01/25/2023]
Abstract
PROBLEM Women from diverse ethnicity and racial backgrounds have few opportunities to share birth experiences to inform improvements in care. BACKGROUND Respectful maternity care is recognised as a global women's health priority. Integrating that framework into diverse care systems and models may help bridge care gaps for women who had unexpected birth experiences, including unplanned caesarean birth. AIM To describe the experiences of women who had unplanned caesarean births and use knowledge gained to inform best practice recommendations that embody respectful maternity care. METHODS Qualitative data were analysed from focus groups involving a convenience sample of 11 English speaking women, from diverse ethnic and racial backgrounds, with prior unplanned caesarean experience. Respectful maternity care was used as the lens for interpreting women's narratives using Thorne's interpretive description. The study site was an outpatient prenatal clinic within an urban academic, tertiary-care medical centre in the United States. FINDINGS Two predominant, contrasting themes emerged: "not feeling well cared for" and "feeling well supported". Positive experiences included sources of support and strength from the midwifery practice, group prenatal care, and a doula program. Eight domains of respectful maternity care were applied to findings, highlighting current positive institutional practices and proposing areas for future quality improvement. CONCLUSION Key practices promoting respectful maternity care include adequate communication and information sharing between pregnancy care providers and women, and a more robust informed consent process. Further emphasis on respectful maternity care is needed to support women to make shared decisions that best fit their circumstances and preferences.
Collapse
Affiliation(s)
- Somphit Chinkam
- Department of OBGYN, Boston University School of Medicine, 771 Albany Street, Dowling 4, Boston, MA 02118, United States.
| | - Bridget Basile Ibrahim
- Rural Health Equity Postdoctoral Program, University of Minnesota Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, 2221 University Ave. SE #350, Minneapolis, MN 55414-3078, United States.
| | - Brittany Diaz
- Department of OBGYN, Boston University School of Medicine, 771 Albany Street, Dowling 4, Boston, MA 02118, United States.
| | - Courtney Steer-Massaro
- Department of OBGYN, Boston University School of Medicine, 771 Albany Street, Dowling 4, Boston, MA 02118, United States.
| | - Holly Powell Kennedy
- Helen Varney Professor of Midwifery, Yale School of Nursing, 400 West Campus Drive, Room 22302, West Haven, CT 06516, United States.
| | - Allison Shorten
- UAB School of Nursing, University of Alabama at Birmingham, 1701 University Blvde, Birmingham, AL 35294, United States.
| |
Collapse
|
25
|
Bašková M, Urbanová E, Ďuríčeková B, Škodová Z, Bánovčinová Ľ. Selected Factors of Experiencing Pregnancy and Birth in Association with Postpartum Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2624. [PMID: 36767994 PMCID: PMC9916054 DOI: 10.3390/ijerph20032624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The aim of the study is to analyse the risk of postpartum depression using dimensions of perceived support (information, emotional, and physical), antenatal education (satisfaction and attitude), and attitude toward pregnancy (wanted or unwanted). METHODS A cross-sectional study was carried out among 584 postpartum women in two university birth centres in Slovakia. The Edinburgh Postnatal Depression Scale (EPDS) score was used. Descriptive statistics and analysis of variance, as well as logistic regression, were employed in the study. Found associations were adjusted for education level, type of birth, psychiatric history, and age. RESULTS As many as 95.1% of women reported their pregnancy as being wanted. Antenatal education, particularly satisfaction with it, showed a negative association with the EPDS score level. No significant differences in depression levels were found considering attitude toward pregnancy and perceived support. CONCLUSIONS The study pointed out the significance of antenatal education to lower the risk of the postpartum depression. One of the important criteria of effective education is a woman's subjective satisfaction with it.
Collapse
|
26
|
Abstract
This JAMA Forum discusses community models of perinatal care, workforce challenges, and policies to reduce maternity deserts.
Collapse
Affiliation(s)
- Andrea Sonenberg
- College of Health Professions, Lienhard School of Nursing, Pace University, New York, New York
| | - Diana J Mason
- Center for Health Policy and Media Engagement, School of Nursing, George Washington University, Washington, DC
| |
Collapse
|
27
|
Doba YS, Bulto GA, Tefera EG, Wakgari N, Daksisa T, Muda T, Daba Dina G, Moti BE. Birth attendants' attitudes and practice of companionship during facility-based childbirth and associated factors in the West Shoa Zone, central Ethiopia: A mixed method design. SAGE Open Med 2023; 11:20503121231168284. [PMID: 37123384 PMCID: PMC10134150 DOI: 10.1177/20503121231168284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/21/2023] [Indexed: 05/02/2023] Open
Abstract
Objectives The World Health Organization strongly recommends companion of choice for all women during health facility delivery. However, in the developing countries, it is low and not well studied in Ethiopia. Thus, the study aimed to assess the birth attendants' attitude and practice of companionship during health facility-based childbirth and associated factors in the West Shoa Zone, Ethiopia. Methods A cross-sectional study design with a concurrent mixed method approach was employed from 17 August to 23 September 2021. A simple random sampling was used to collect data from 422 birth attendants using a pretested structured self-administered questionnaire. The data was entered into Epi-data 3.1 and exported to the Statistical Package for Social Sciences for analysis. Bivariate and multivariate logistic regressions were done. The qualitative data was analyzed manually using thematic analysis, and the result was triangulated with the quantitative data. Results About, 208 (51.2%) of birth attendants had favorable attitude, and only 79 (19.5%) of them reported that they practice companion presence during childbirth. Reported job satisfaction (adjusted odds ratio = 5.29, 95% confidence interval: 3.08, 9.1), presence of a screen (adjusted odds ratio (AOR) = 3.4, 95% confidence interval: 1.94, 5.99), and wideness of the delivery room (adjusted odds ratio = 4.74, 95% confidence interval: 2.48, 9.04) were factors associated with the attitude of birth attendants. The number of deliveries per month (adjusted odds ratio = 3.34, 95% confidence interval: 1.37, 8.13), having had training (adjusted odds ratio = 3.286, 95% confidence interval: 1.52, 7.08), and presence of a screen (adjusted odds ratio = 2.88, 95% confidence interval: 1.42, 5.85) were statistically associated with practice of companion presence during childbirth. The main themes that emerged as the key barriers to the practice of companion presence during childbirth include structural factors, societal norms and culture, lack of interest, birth attendant-related barriers, unsupportive administration protocol, and companions' awareness. Conclusion The magnitude of favorable attitudes and reported practice of birth attendants regarding companion presence during childbirth is low. Structural related factors were the main barriers. Training of birth attendants and structural interventions are needed to ensure that delivery rooms are designed in ways that facilitate the presence of companions during childbirth.
Collapse
Affiliation(s)
- Yonas Sagni Doba
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Gizachew Abdissa Bulto
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
- Gizachew Abdissa Bulto, Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Oromia, Ethiopia.
| | - Eden Girmaye Tefera
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Negash Wakgari
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Temesgen Daksisa
- Department of Midwifery, College of Medicine and Health Sciences, Mada Walabu University, Shashemane, Ethiopia
| | - Tura Muda
- Elwaye District Health Office, Borena Zone, Yabello, Ethiopia
| | - Gurmessa Daba Dina
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Berhanu Ejara Moti
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| |
Collapse
|
28
|
Turner D, Lindsey A, Shah P, Sayyad A, Mack A, Rice WS, Mosley EA. "Doulas shouldn't be considered visitors, we should be considered a part of [the] team": doula care in Georgia, USA during the COVID-19 pandemic. Sex Reprod Health Matters 2022; 30:2133351. [PMID: 36448944 PMCID: PMC9718548 DOI: 10.1080/26410397.2022.2133351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Doula support improves maternal-child health outcomes. However, during the COVID-19 pandemic, hospitals restricted the number of support people allowed during childbirth. An academic-community research team conducted 17 in-depth interviews and structured surveys with doulas in metro-Atlanta, Georgia, USA from November 2020 to January 2021. Surveys were analysed for descriptive statistics in Stata v. 14, and interviews were analysed in Dedoose using a codebook and memo-ing for thematic analysis. All 17 doulas reported COVID-19 changed their practices: most were unable to accompany clients to delivery (14), started using personal protective equipment (13), used virtual services (12), and had to limit the number of in-person prenatal/postpartum visits (11). Several attended more home births (6) because birthing people were afraid to have their babies in the hospital. Some stopped seeing clients altogether due to safety concerns (2). Many lost clientele who could no longer afford doula services, and some offered pro bono services. Most doulas pointed to restrictive hospital policies that excluded doulas and disallowed virtual support as they felt doulas should be considered a part of the team and clients should not be forced to decide between having their doula or their partner in the room. COVID-19 has severely impacted access to and provision of doula care, mostly due to economic hardship for clients and restrictive hospital policies. At the same time, doulas and their clients have been resourceful - using virtual technology, innovative payment models, and home births.
Collapse
Affiliation(s)
- Daria Turner
- Master of Public Health Student, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Alyssa Lindsey
- Master of Public Health Student and Graduate Research Assistant, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Priya Shah
- Master of Public Health Student, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Ayeesha Sayyad
- Master of Public Health Student, Georgia State University School of Public Health, Atlanta, GA, USA,Graduate Research Assistant, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Amber Mack
- Research and Policy Analyst, Healthy Mothers, Healthy Babies Coalition of Georgia, Atlanta, GA, USA
| | - Whitney S. Rice
- Assistant Professor, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Elizabeth A. Mosley
- Affiliate Faculty Member, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA,Assistant Professor, Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, USA.,Correspondence:,
| |
Collapse
|
29
|
Kamath P, Pai M, Shenoy R, Karkada S, D’souza S, Noronha J. Effectiveness of a peanut ball device during labour on maternal and neonatal outcomes: protocol for a randomised controlled trial. F1000Res 2022; 11:717. [PMID: 36531256 PMCID: PMC9727314 DOI: 10.12688/f1000research.109537.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 11/23/2022] Open
Abstract
Frequent positional changes and movements during labour is one of the recommendations by the World Health Organization (WHO) to prevent prolonged labour, thereby avoiding cesarean sections. However, labour induction, continuous fetal monitoring in supine position and immobilising the women during labour are standard practices in most private hospitals. To combat these problems and to implement WHO recommendations, the peanut ball is an effective device through which frequent positional changes will be achieved without disrupting the labour procedures. The current study aims to evaluate the effectiveness of the peanut ball device during labour on maternal and neonatal outcomes and assess the stress response induced by labour in terms of maternal and neonatal cortisol in low-risk primigravid women. The study is a prospective, block randomised controlled trial with parallel arms. A total of 768 study participants will be randomised to the peanut-ball group (intervention) and standard care group (control). The intervention group will receive different peanut ball positions during labour at or after 4 cm of cervical dilatation. The primary outcomes of the study are maternal outcome that includes measurement of duration of the active and the second stage of labour, stress level as measured by serum cortisol level at 3-4 cm and at 10 cm of cervical dilatation, mode of delivery, perception of pain, behavioural response during the active stage of labour and neonatal outcomes, which includes the pattern of fetal heart rate, APGAR score, birth injuries, and umbilical serum and salivary cortisol level. The collected data will be compared between the intervention and control groups. Trial Registration: This research is registered under the CTRI (Clinical Trials Registry of India) ( CTRI/2019/08/020802) (21/8/2019).
Collapse
Affiliation(s)
- Pratibha Kamath
- Department of Obstetrics and Gynecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Muralidhar Pai
- Sikkim Manipal Institute of Medical Sciences(SMIMS),, Sikkim Manipal University(SMU),, Gangtok, Sikkim, India,
| | - Revathi Shenoy
- Department of Biochemistry,, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal,, Karnataka, 576104, India
| | - Sushmitha Karkada
- Department of Obstetrics and Gynecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Sonia D’souza
- Department of Obstetrics and Gynecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Judith Noronha
- Department of Obstetrics and Gynecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| |
Collapse
|
30
|
Premkumar A, You WB. The (After)life of a Trial: Biocommunicability of an At-Risk Pregnancy. Med Anthropol 2022; 41:794-809. [PMID: 35914240 DOI: 10.1080/01459740.2022.2106862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The publication of A Randomized Trial of Induction Versus Expectant Management (ARRIVE), conducted in the United States in 2018, heralded a paradigm shift within the obstetrical management of term pregnancy among people who have not previously given birth. ARRIVE finds its home among other canonical - and controversial - randomized controlled trials (RCTs) within obstetrics. We argue that RCTs have their own (after)life, both creating new subjects for biomedical intervention and recalibrating who reproductive health practitioners consider to be at risk of adverse health outcomes. These data have important consequences for medical social scientific engagement with RCTs to further interrogate the questions of risk and intervention within reproductive health.
Collapse
Affiliation(s)
- Ashish Premkumar
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA.,Department of Anthropology, The Graduate School, Northwestern University, Chicago, Illinois, USA
| | - Whitney B You
- Department of Obstetrics and Gynecology, NorthShore University Healthcare System, Evanston, Illinois, USA
| |
Collapse
|
31
|
Fernandes LMM, Mishkin KE, Lansky S. Doula support among brazilian women who attended the senses of birth health education intervention - a cross sectional analysis. BMC Pregnancy Childbirth 2022; 22:765. [PMID: 36224541 PMCID: PMC9558943 DOI: 10.1186/s12884-022-05069-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While maternal health is a priority in international goals, maternal health outcomes remain poor in many regions of the world. In Brazil, maternal mortality has decreased over the past decades, but the country's maternal mortality ratio is higher than over half of all countries at 59 deaths per 100,000 live births. The Brazilian maternal health care model facilitates high rates of medical interventions during labor and childbirth; 56% of births are by cesarean birth. Doula support is considered a potential strategy to reduce medically unnecessary interventions during childbirth that contribute to maternal mortality. METHODS The cross-sectional study analyses associations with use of doula support and normal birth among Brazilian women who participated in a health education intervention named the Senses of Birth (SoB). The SoB intervention, implemented in five cities from 2015 to 2017, was developed to educate about normal birth and to evidence-based practices (EBP) reduce medically in childbirth. Chi-Square tests were performed to identify the relationship between doula support during childbirth and sociodemographic characteristics, childbirth information, perceived knowledge, and use of EBPs during labor. Logistic regression was performed to identify associations in adjusted analysis. RESULTS Controlling for covariates, doula support was associated with vaginal delivery (OR 2.47, 95% CI: 1.37-4.45.) Findings also suggest that women who had doula support were more likely to use non-pharmacological pain relief methods during labor (OR 9.68, 95% CI: 2.67-34.61), deliver in a public hospital (OR 2.02, 95% CI: 1.09-3.72), and be low and mid-level income compared to women with high income. CONCLUSION This study's findings suggest that doula support is significantly associated with vaginal birth. The results may be useful for advocating for changes to the childbirth care model in Brazil. Incorporating EBPs, such as doula support, for all women who desire may improve maternal and child outcomes.
Collapse
Affiliation(s)
- Luísa M M Fernandes
- Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Minas Gerais, Brazil
| | | | - Sônia Lansky
- Department of Health, City Hall, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
32
|
Schmitt N, Striebich S, Meyer G, Berg A, Ayerle GM. The partner's experiences of childbirth in countries with a highly developed clinical setting: a scoping review. BMC Pregnancy Childbirth 2022; 22:742. [PMID: 36192684 PMCID: PMC9528111 DOI: 10.1186/s12884-022-05014-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/24/2022] [Indexed: 12/03/2022] Open
Abstract
Background In Western countries, it is common practice for a woman to be supported by a trusted person during childbirth, usually the other parent. Numerous studies have shown that this has a positive effect both on the woman’s satisfaction with the birth process and on physical outcomes. However, there is little research on the birth experience of partners and their wellbeing. The aim of this review is to summarise the existing literature on partner experience, consider its quality and identify the underlying themes. Methods Both a systematic literature search in three databases and a manual search were conducted, for qualitative, quantitative, and mixed-methods studies from Western countries examining the experiences of partners present at a birth. Results A total of 35 studies were included. Only one study included same-sex partners (the other studies addressed fathers’ experiences only) and only one validated questionnaire examining partners’ birth experiences was identified. Four major themes were found to influence partners’ birth experiences: (1) intense feelings, (2) role of support, (3) staff support, and (4) becoming a father. Conclusions Partners may feel very vulnerable and stressed in this unfamiliar situation. They need emotional and informal support from staff, want to be actively involved, and play an important role for the birthing woman. To promote good attachment for parents, systematic exploration of the needs of partners is essential for a positive birth experience. Because of the diversity of family constellations, all partners should be included in further studies, especially same-sex partners. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05014-1.
Collapse
Affiliation(s)
- Nadine Schmitt
- Medical Faculty, Institute for Health and Nursing Science, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
| | - Sabine Striebich
- Department of Nursing and Management, Hamburg University of Applied Sciences, Berliner Tor 5, 20099, Hamburg, Germany
| | - Gabriele Meyer
- Medical Faculty, Institute for Health and Nursing Science, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Almuth Berg
- Medical Faculty, Institute for Health and Nursing Science, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Gertrud M Ayerle
- Medical Faculty, Institute for Health and Nursing Science, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| |
Collapse
|
33
|
Amiri-Farahani L, Gharacheh M, Sadeghzadeh N, Peyravi H, Pezaro S. Iranian midwives' lived experiences of providing continuous midwife-led intrapartum care: a qualitative study. BMC Pregnancy Childbirth 2022; 22:724. [PMID: 36151533 PMCID: PMC9502875 DOI: 10.1186/s12884-022-05040-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background & Objective Continuity of midwifery-led care during labour and birth is considered optimal. To ensure its sustainability in practice where limited evidence is available, the aim of the present study was to explore midwives’ lived experiences of delivering continuous midwife-led intrapartum care. Methods This study took a qualitative approach in meeting its aim. Participants were midwives working in the labour wards of private and public hospitals in Iran. The data were purposefully collected in 2019 through in-depth, semi-structured, and face-to-face interviews with midwives (n = 10) aged between 26 and 55 years. A thematic analysis based on descriptive phenomenology was undertaken to make sense of the data collected. Results “Wanting to lead continuous woman-centered care but being unable to” was identified as an overarching theme. Three other themes “emphasis on the non-interventional care”, “midwifery-specific focus” and “barriers and challenges of midwifery care” were also identified. Ultimately, midwives described knowing how to and wanting to lead continuous ‘woman’-centered care but being unable to. Perceived barriers included lack of familiarity with and knowledge in relation to childbirth, the insignificant role of midwives in decision making, obstetrician utilitarianism, high workloads along with work-related stress argument-driven communication between midwives and obstetricians and an absence of a ‘triangle of trust’ in care. Conclusion Future research strategies could usefully include obstetricians and focus on the upscaling of midwifery in Iran using continuity of care models, highlight the value of midwives, identify why uptake of antenatal education in Iran is poor and develop user friendly, evidence based, midwife-led programs. Initiatives aiming to promote mutual professional respect, trust and collegiality and increased remuneration for midwifery work would be also welcomed in pursuit of reducing maternal and infant mortality in Iran.
Collapse
Affiliation(s)
- Leila Amiri-Farahani
- Nursing and Midwifery Care Research Center, Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, 1996713883, Iran.
| | - Maryam Gharacheh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Narges Sadeghzadeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Peyravi
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Sally Pezaro
- The Centre for Healthcare research, Coventry University, Coventry, UK
| |
Collapse
|
34
|
Guðmundsdóttir EÝ, Nieuwenhuijze M, Einarsdóttir K, Hálfdánsdóttir B, Gottfreðsdóttir H. Use of pain management in childbirth among migrant women in Iceland: A population-based cohort study. Birth 2022; 49:486-496. [PMID: 35187714 PMCID: PMC9545143 DOI: 10.1111/birt.12619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Immigration is rapidly increasing in Iceland with 13.6% of the population holding foreign citizenship in 2020. Earlier findings identified inequities in childbirth care for some women in Iceland. To gain insight into the quality of intrapartum midwifery care, migrant women's use of pain management methods during birth in Iceland was explored. METHODS A population-based cohort study including all women with a singleton birth in Iceland between 2007 and 2018, in total 48 173 births. Logistic regression analyses with odds ratios (ORs) and 95% confidence intervals (CIs) were used to investigate the relationship between migrant backgrounds defined as holding foreign citizenship and the use of pain management during birth. The main outcome measures were use of nonpharmacological and pharmacological pain management methods. RESULTS Data from 6097 migrant women were included. Migrant women had higher adjusted OR (aORs) for no use of pain management (aOR = 1.23 95% CI [1.12, 1.34]), when compared to Icelandic women. Migrant women also had lower aORs for the use of acupuncture (0.73 [0.64, 0.83]), transcutaneous electrical nerve stimulation (TENS) (0.92 [0.01, 0.67]), shower/bath (0.73 [0.66, 0.82]), aromatherapy (0.59 [0.44, 0.78]), and nitrous oxide inhalation (0.89 [0.83, 0.96]). Human Development Index (HDI) scores of countries of citizenship <0.900 were associated with lower aORs for the use of various pain management methods. CONCLUSIONS Our results suggest that being a migrant in Iceland is an important factor that limits the use of nonpharmacological pain management, especially for migrant women with citizenship from countries with HDI score <0.900.
Collapse
Affiliation(s)
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery ScienceAcademie Verloskunde MaastrichtZuydThe Netherlands,CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtThe Netherlands
| | - Kristjana Einarsdóttir
- Faculty of MedicineCentre of Public Health SciencesUniversity of IcelandReykjavíkIceland
| | | | - Helga Gottfreðsdóttir
- Department of MidwiferyFaculty of NursingUniversity of IcelandReykjavíkIceland,Department of Obstetrics and GynecologyWomen's ClinicLandspítali University HospitalReykjavíkIceland
| |
Collapse
|
35
|
Shamoradifar Z, Asghari-Jafarabadi M, Nourizadeh R, Mehrabi E, Areshtanab HN, Shaigan H. The impact of effective communication-based care on the childbirth experience and satisfaction among primiparous women: an experimental study. J Egypt Public Health Assoc 2022; 97:12. [PMID: 35941334 PMCID: PMC9360278 DOI: 10.1186/s42506-022-00108-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/04/2022] [Indexed: 12/04/2022]
Abstract
Background There is insufficient scientific evidence on the effect of communication skills of childbirth care providers on maternal childbirth experience and satisfaction. The present study aimed to determine the effect of communication-based care on the childbirth experience and satisfaction among primiparous women. Methods A total of 80 primiparous women participated in this experimental study who were randomly assigned into the intervention and control groups. According to the World Health Organization (WHO) care model, the intervention group received effective communication-based care, and the control group received the routine care. Data were collected using demographic and obstetric questionnaires, Labor Agentry Scale (LAS) and Birth Satisfaction Scale-Revised (BSS-R), and Support and Control in Birth (SCIB) scale applied 12 to 24 h after the intervention. Results After controlling the effect of confounding variables, the mean scores of childbirth experience (51.23(1.54) and satisfaction (26.03(0.81) in the intervention group were significantly higher than that in the control group (45.33 (1.54) and 22.66 (0.81) respectively; [adjusted mean difference (AMD) = 5.90, CI = 95%: 1.17 to 10.62, P = 0.01] versus AMD =3.37, CI: 95%: 0.87 to 5.87, P = 0.001]. Conclusion Eeffective communication-based care improved childbirth experience and satisfaction of primiparous women. Therefore, it is recommended that health-care providers should be trained on the communication skills in the delivery room especially during a vital threatened crises such as the Covid pandemic.
Collapse
Affiliation(s)
- Zahra Shamoradifar
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari-Jafarabadi
- Department of Statistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.,Center for the Development of Interdisciplinary Research in Islamic Sciences and Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roghaiyeh Nourizadeh
- Department of Nursing and Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Esmat Mehrabi
- Department of Nursing and Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Hossein Namdar Areshtanab
- Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hoorieh Shaigan
- Department of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
36
|
Chautems C. "Restoring the Sacred Part of Birth": Doula Care and Cesarean Birth in Switzerland. Med Anthropol 2022; 41:560-573. [PMID: 35819827 DOI: 10.1080/01459740.2022.2098492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
At 32.3%, Switzerland ranks among countries with the highest rates of cesarean deliveries in Europe. Because cesareans generally negatively influence the birth experience, parents turn to holistic therapists to heal somatic and emotional disorders not addressed by standard biomedical follow-ups. Doula care is still emerging in Switzerland. Although doulas are not allowed in the operation rooms, they support parents before birth and during the postpartum period. They aim at improving the birth experience by restoring intimate, "sacred" elements of birth through symbolic and spiritual practices. Based on interviews with doulas, I explore their experiences and practices regarding surgical birth.
Collapse
Affiliation(s)
- Caroline Chautems
- Institute of Social Sciences, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
37
|
Disrespect and abuse during labour and birth amongst 12,239 women in the Netherlands: a national survey. Reprod Health 2022; 19:160. [PMID: 35804419 PMCID: PMC9266084 DOI: 10.1186/s12978-022-01460-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/20/2022] [Indexed: 11/20/2022] Open
Abstract
Background Women experience disrespect and abuse during labour and birth all over the world. While the gravity of many forms of disrespect and abuse is evident, some of its more subtle forms may not always be experienced as upsetting by women. This study examines (1) how often women experience disrespect and abuse during labour and birth in the Netherlands and (2) how frequently they consider such experiences upsetting. We also examine (3) which respondent characteristics (age, ethnicity, educational level and parity) are associated with those experiences of disrespect and abuse that are upsetting, and (4) the associations between upsetting experiences of disrespect and abuse, and women’s labour and birth experiences. Methods Women who gave birth up to five years ago were recruited through social media platforms to participate in an online survey. The survey consisted of 37 questions about experiences of disrespect and abuse divided into seven categories, dichotomised in (1) not experienced, or experienced but not considered upsetting (2) experienced and considered upsetting. A multivariable logistic regression analysis was performed to examine associated characteristics with upsetting experiences of disrespect and abuse. A Chi-square test was used to investigate the association between upsetting experiences of disrespect and abuse and overall birth experience.
Results 13,359 respondents started the questionnaire, of whom 12,239 met the inclusion and exclusion criteria. Disrespect and abuse in terms of ‘lack of choices’ (39.8%) was reported most, followed by ‘lack of communication’ (29.9%), ‘lack of support’ (21.3%) and ‘harsh or rough treatment/physical violence’ (21.1%). Large variation was found in how frequently certain types of disrespect and abuse were considered upsetting, with 36.3% of women experiencing at least one situation of disrespect and abuse as upsetting. Primiparity and a migrant background were risk factors for experiencing upsetting disrespect and abuse in all categories. Experiencing more categories of upsetting disrespect and abuse was found to be associated with a more negative birth experience. Conclusions Disrespectful and abusive experiences during labour and birth are reported regularly in the Netherlands, and are often (but not always) experienced as upsetting. This emphasizes an urgent need to implement respectful maternity care, even in high income countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01460-4. Disrespect and abuse during labour and birth is a globally recognized phenomenon and has been linked to traumatic birth experiences and PTSD. In our study, we investigated how often women experience disrespect and abuse during labour and birth in the Netherlands and what proportion of these experiences was found to be upsetting. We also looked at risk factors for experiencing upsetting disrespect and abuse and to what extent upsetting disrespect and abuse influences the overall labour and birth experience. We conducted an online survey, with 12,239 respondents included in the analysis. We found a large variation in how frequently certain types of disrespect and abuse were considered upsetting, with 36.3% of women experiencing at least one situation of disrespect and abuse as upsetting. More subtle forms of disrespect and abuse, such as lack of choice, communication or support, were most prevalent and often considered upsetting. Giving birth for the first time and having a migrant background were risk factors for experiencing upsetting disrespect and abuse. Upsetting disrespect and abuse was found to have a strong impact on the overall labour and birth experience; with every additional experienced category of upsetting disrespect and abuse, the number of (very) positive labour and birth experiences decreases and the number of very negative ones increases. Although disrespect and abuse is a complex issue and its measurement subjective, this study shows that there is still a long way to go before achieving optimal respectful maternity care for all women, even in high income countries.
Collapse
|
38
|
Tomori C, Penta B, Richman R. Centering the Right to Health of Childbearing People in the US During the COVID-19 Pandemic. Front Public Health 2022; 10:862454. [PMID: 35719640 PMCID: PMC9201686 DOI: 10.3389/fpubh.2022.862454] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Childbearing people in the US have experienced the double burden of increased risks from infection and significant disruptions to access and quality of essential health care services during the COVID pandemic. A single person could face multiple impacts across the course of their reproductive trajectory. We highlight how failure to prioritize this population in the COVID-19 policy response have led to profound disruptions from contraception services to vaccination access, which violate foundational principles of public health, human rights and perpetuate inequities. These disruptions continued through the omicron surge, during which many health systems became overwhelmed and re-imposed earlier restrictions. We argue that an integrated pandemic response that prioritizes the healthcare needs and rights of childbearing people must be implemented to avoid deepening inequities in this and future pandemics.
Collapse
Affiliation(s)
- Cecília Tomori
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, MD, United States.,Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Bhavana Penta
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Rebecca Richman
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, MD, United States.,Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| |
Collapse
|
39
|
Akbaş P, Özkan Şat S, Yaman Sözbir Ş. The Effect of Holistic Birth Support Strategies on Coping With Labor Pain, Birth Satisfaction, and Fear of Childbirth: A Randomized, Triple-Blind, Controlled Trial. Clin Nurs Res 2022; 31:1352-1361. [PMID: 35698748 DOI: 10.1177/10547738221103329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current study was aimed to evaluate the effects of interventions conducted in line with the coping with labor pain algorithm (holistic birth support strategies) on women's coping with labor pain, birth satisfaction, and fear of childbirth. The study is a single-center, parallel-group randomized, three-blind, controlled trial. The study was completed with 33 women in the experimental group and 31 in the control group. The mean score of the women in the experimental group from the Birth Satisfaction Scale (128.57 ± 5.83) was statistically significantly higher than that of the women in the control group (81.80 ± 7.73). The mean score of the women in the experimental group (61.96 ± 9.78) from the Wijma Birth Expectation/Experience Scale, Version B scale was statistically significantly lower than that of the women in the control group (148.64 ± 14.62). It was found that the women in the experimental group were able to better cope with labor pain, had higher birth satisfaction, and had less fear of childbirth.
Collapse
Affiliation(s)
- Pınar Akbaş
- Karabük Yenice State Hospital, Karabük, Turkey
| | - Sultan Özkan Şat
- Bitlis Eren University, Faculty of Health Sciences, Nursing Department, Bitlis, Turkey
| | - Şengül Yaman Sözbir
- Gazi University, Faculty of Health Sciences, Nursing Department, Ankara, Turkey
| |
Collapse
|
40
|
Turan Z, Suveren Y, Vural G. A qualitative study on the expectations and experiences of mothers during the childbirth process in Western Anatolia, Turkey. Women Health 2022; 62:444-453. [DOI: 10.1080/03630242.2022.2084211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Zekiye Turan
- Department of Nursing, Faculty of Health Sciences, Sakarya University, Sakarya, Turkey
| | - Yaşar Suveren
- Department of Sociology, Faculty of Science and Literature, Sakarya University, Sakarya, Turkey
| | - Gülşen Vural
- Department of Obstetrics and Genecology Nursing, Faculty of Nursing, Near East University, Lefkosa, Cyprus
| |
Collapse
|
41
|
Mamo A, Abera M, Abebe L, Bergen N, Asfaw S, Bulcha G, Asefa Y, Erko E, Bedru KH, Lakew M, Kurji J, Kulkarni MA, Labonté R, Birhanu Z, Morankar S. Maternal social support and health facility delivery in Southwest Ethiopia. Arch Public Health 2022; 80:135. [PMID: 35546410 PMCID: PMC9092803 DOI: 10.1186/s13690-022-00890-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality continues to decrease in the world but remain the most important health problems in low-income countries. Although evidence indicates that social support is an important factor influencing health facility delivery, it has not been extensively studied in Ethiopia. Therefore, this study aimed to assess the effect of maternal social support and related factors on health facility delivery in southwest Ethiopia. METHODS A cross-sectional survey data on 3304 women aged 15-47 years in three districts of Ethiopia, were analyzed. Using multivariable logistic regression, we assessed the association between health facility birth, social support, and socio-demography variables. Adjusted odds ratios with 95% confidence intervals were used to identify statistically significant associations at 5% alpha level. RESULT Overall, 46.9% of women delivered at health facility in their last pregnancy. Average travel time from closest health facility (AOR: 1.51, 95% CI 1.21 to 2.90), mean perception score of health facility use (AOR: 1.83, 95% CI 1.44 to 2.33), involvement in final decision to identify their place of childbirth (AOR: 2.12, 95% CI 1.73 to 2.58) had significantly higher odds of health facility childbirth. From social support variables, women who perceived there were family members and husband to help them during childbirth (AOR: 3.62, 95% CI 2.74 to 4.79), women who received continuous support (AOR: 1.97, 95% CI 1.20 to 3.23), women with companions for facility visits (AOR: 1.63, 95% CI 1.34 to 2.00) and women who received support from friends (AOR: 1.62, 95% CI 1.16 to 3.23) had significantly higher odds of health facility childbirth. CONCLUSIONS Social support was critical to enhance health facility delivery, especially if women's close ties help facility delivery. An intervention to increase facility delivery uptake should target not only the women's general social supports, but also continuous support during childbirth from close ties including family members and close friends as these are influential in place of childbirth. Also actions that increase women's healthcare decision could be effective in improving health facility delivery.
Collapse
Affiliation(s)
- Abebe Mamo
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, PO Box 378, Jimma, Ethiopia.
| | - Muluemebet Abera
- Department of population and family health, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Lakew Abebe
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, PO Box 378, Jimma, Ethiopia
| | - Nicole Bergen
- School of Epidemiology and Public Health, University of Ottawa, Ontario, K1G 5Z3, Canada
| | - Shifera Asfaw
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, PO Box 378, Jimma, Ethiopia
| | | | - Yisalemush Asefa
- Department of Health Policy & Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Endale Erko
- Maternal and Child Health Directorate, Addis Ababa City Administration Health Bureau, Maternal Health, Family Planning and AYH Advisor, Addis Ababa, Ethiopia
| | | | | | - Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, Ontario, K1G 5Z3, Canada
| | - Manisha A Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, Ontario, K1G 5Z3, Canada
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ontario, K1G 5Z3, Canada
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, PO Box 378, Jimma, Ethiopia
| | - Sudhakar Morankar
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, PO Box 378, Jimma, Ethiopia
| |
Collapse
|
42
|
Guo H, Que M, Shen J, Nie Q, Chen Y, Huang Q, Jin A. Effect of Music Therapy Combined with Free Position Delivery on Labor Pain and Birth Outcomes. Appl Bionics Biomech 2022; 2022:8963656. [PMID: 35600844 PMCID: PMC9117077 DOI: 10.1155/2022/8963656] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/18/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
Objective At present, the clinical effect of music therapy combined with free position to assist delivery is rarely reported. Based on evidence-based nursing, this study is aimed at exploring the effect of the combination of music therapy and free position delivery on labor pain and maternal and fetal outcomes. Methods A total of 440 primiparas with vaginal delivery in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Soochow University between July 2018 and July 2019 were selected. They were divided into music therapy, free position delivery group (n = 201) and traditional delivery group (n = 239). Subsequently, the two groups were compared in terms of the Chinese Perception of Labor Pain Questionnaire (PLPQ) score, bleeding amount at 2 hours after birth, perineal injury, labor stage duration, and 1 minute Apgar score. Results The combination group had better results of the Chinese PLPQ score, postpartum hemorrhage, and perineum condition. However, compared with traditional delivery, a longer duration of the first stage and total stage of labor was found in the combination group. Music therapy combined with free position delivery required less medical intervention during delivery, and there was no significant difference in 1 minute Apgar score between the two groups. Conclusions Music therapy combined with free position delivery, an intervention based on evidence-based nursing, can effectively reduce maternal labor pain, postpartum hemorrhage, soft birth canal injury, and medical intervention during labor. It is, therefore, a safe intervention to assist delivery.
Collapse
Affiliation(s)
- Huimin Guo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, Jiangsu, China
| | - Mochun Que
- Department of Physiology and Neurobiology, Medical College of Soochow University, China
| | - Jie Shen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, Jiangsu, China
| | - Qiaole Nie
- Beijing Yuedi Music Analgesia Labor Institute, Beijing, China
| | - Youguo Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, Jiangsu, China
| | - Qin Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, Jiangsu, China
| | - Aiying Jin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, Jiangsu, China
| |
Collapse
|
43
|
Gélinas É, Mallé Samb O. [The impact of a humanized childbirth intervention on women's experience of care in Senegal]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2022; Vol. 33:695-704. [PMID: 35485126 DOI: 10.3917/spub.215.0695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Violence against women during institutional childbirth is recognized as a major barrier to the quality of care. In recent years, several countries have implemented interventions aimed at improving the childbirth experience of women through humanized care. However, the literature on the effectiveness of these interventions remains weak. PURPOSE OF RESEARCH The aim of this study is therefore to analyze the experience of care of women regarding the intervention of humanized childbirth in Senegal. Qualitative research based on a multiple case study was done. Three collection methods were used: observation, individual interview, and document analysis. Individual interview were carried out with 20 women. RESULTS In general, women who gave birth following the intervention appreciated their experience due to changes such as the opportunity to eat and drink, to be accompanied by a trusted person and to choose their position during childbirth. However, it was the way in which women were received at the health facility and the attitude of health professionals that were decisive in their level of satisfaction with care. Few women benefited from all the components of the intervention. The difficulties encountered in the implementation such as non-functional delivery rooms, the lack of qualified human resources and the lack of awareness of the intervention explain this. CONCLUSIONS Our results therefore suggest that improving the quality of care at birth, for a “humanized” (or natural, respectful) birth, is only possible when certain materials and medical conditions are met and prepared in advance, during the prenatal period.
Collapse
|
44
|
Power C, Williams C, Brown A. Physical and Psychological Childbirth Experiences and Early Infant Temperament. Front Psychol 2022; 13:792392. [PMID: 35350728 PMCID: PMC8958029 DOI: 10.3389/fpsyg.2022.792392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To examine how physical and psychological childbirth experiences affect maternal perceptions and experiences of early infant behavioural style (temperament). Background Unnecessary interventions may disturb the normal progression of physiological childbirth and instinctive neonatal behaviours that facilitate mother-infant bonding and breastfeeding. While little is known about how a medicalised birth may influence developing infant temperament, high impact interventions which affect neonatal crying and cortisol levels could have longer term consequences for infant behaviour and functioning. Methods A retrospective Internet survey was designed to fully explore maternal experiences of childbirth and her postnatal perceptions of infant behaviour. Data collected from 999 mother-infant dyads were analysed using Pearson's correlations and multiple analyses of covariance, employing the Bonferroni method of correction to establish initially significant variables. Multiple linear regressions were conducted to determine major perinatal contributors to perceived early infant temperament. Results Multiple regression analyses on each of the eight Mother and Baby Scales outcome variables indicated that early infant behavioural style (0-6 months) was largely predicted by subjective maternal states during and post-childbirth, postnatal depression scores, maternal personality traits and infant age. For example, infant age (Beta = 0.440, p = 0.000) was the most significant predictor of Alert-Responsive infant behaviour, followed by maternal Postnatal Positive experience (Beta = 0.181, p = 0.000). In contrast, depression (EPDS) scores (Beta = 0.370, p = 0.000) were the most significant predictor of Unsettled-Irregular infant behaviour, followed by Anxious-Afraid Birth Emotions (Beta = 0.171, p = 0.000) and infant age (Beta = -0.196, p = 0.000). Mothers also perceived their infants as more Alert-Responsive (Beta = 0.080, p = 0.010) and Easier overall (Beta = 0.085, p = 0.008) after a Supported birth experience. Conclusion Maternal and infant outcomes were influenced by multiple physical and psychological perinatal variables. The mother's subjective experience appeared to be of equal significance to more objective factors (e.g. birthplace/mode). Social support enhanced the mother's childbirth experience, benefitting her perceptions of her baby's early temperament. These findings provide further support for current World Health Organisation intrapartum guidelines (2018) on the importance of making childbirth a 'positive experience' for women.
Collapse
Affiliation(s)
- Carmen Power
- School of Health and Social Care, Faculty of Medicine, Health and Life Science, University of Swansea, Swansea, United Kingdom
| | - Claire Williams
- School of Psychology, Faculty of Medicine, Health and Life Science, University of Swansea, Swansea, United Kingdom
- Elysium Neurological Services, Elysium Healthcare, The Avalon Centre, Swindon, United Kingdom
| | - Amy Brown
- School of Health and Social Care, Faculty of Medicine, Health and Life Science, University of Swansea, Swansea, United Kingdom
| |
Collapse
|
45
|
Adams C. Pregnancy and birth in the United States during the COVID-19 pandemic: The views of doulas. Birth 2022; 49:116-122. [PMID: 34296466 PMCID: PMC8444816 DOI: 10.1111/birt.12580] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/12/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Much of the emerging research on the effects of SARS-CoV-2 disease (COVID-19) on pregnant people and their infants has been clinical, devoting little attention to how the pandemic has affected families navigating pregnancy and birth. This study examined the perspectives of doulas, or nonclinical labor support professionals, on how pregnancy and birth experiences and maternal health care delivery systems changed in the early weeks of the COVID-19 pandemic. METHODS Semi-structured interviews using open-ended questions were conducted over the phone with 15 birth doulas. Doulas were invited to participate because of their close relationships with pregnant and birthing people and the comprehensive support they offer. The interview transcripts were analyzed inductively. RESULTS Doulas' clients faced three predominant COVID-19-related pregnancy and birth challenges: (a) fear of exposure; (b) limited access to their expected support systems; and (c) uncertainties surrounding hospital restrictions on labor and birth. Doulas responded creatively to help their clients confront these challenges. Participants expressed various criticisms of how maternal health care systems handled the emerging crisis, argued that COVID-19 exposed preexisting weaknesses in US maternity care, and called for a coordinated care model involving doulas. DISCUSSION Doulas' close relationships with pregnant people enabled them to be an important source of support during the COVID-19 pandemic. Added to the larger body of work on the impacts of doula care, this study supports widespread calls for universally integrating doulas into maternity care systems as a targeted strategy to better support pregnant and birthing people in both crisis and noncrisis situations.
Collapse
Affiliation(s)
- Crystal Adams
- Department of SociologySiena CollegeLoudonvilleNYUSA
| |
Collapse
|
46
|
Dado M, Smith V, Barry P. Women's experiences of water immersion during labour and childbirth in a hospital setting in Ireland: A qualitative study. Midwifery 2022; 108:103278. [DOI: 10.1016/j.midw.2022.103278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/24/2022] [Accepted: 02/06/2022] [Indexed: 10/19/2022]
|
47
|
Beyable AA, Bayable SD, Ashebir YG. Pharmacologic and non-pharmacologic labor pain management techniques in a resource-limited setting: A systematic review. Ann Med Surg (Lond) 2022; 74:103312. [PMID: 35145676 PMCID: PMC8818540 DOI: 10.1016/j.amsu.2022.103312] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background Despite improvement in pain management programs, labor pain is mostly ignored especially in low and middle-income countries. Methods The aim of this study is to establish a clear clinical working guideline for labor pain management in resource limited settings. This systematic review is conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline 2020. After formulating clear criteria for the evidences to be included an appropriate method of searching was conducted by using the Pub Med, Google scholar and Cochrane library using the following MeSH terms: (‘Parenteral opioids’ AND′ Labor pain’, ‘Labor’ AND ‘Pain management, ‘Non-pharmacologic methods ‘AND ‘Labor pain’, ‘Labor pain management AND massage therapy). The study quality of literatures was categorized based on WHO 2011 level of evidence and degree of recommendation. Final conclusions and recommendations are done with the analysis of risk and benefits of alternative management strategies for non-regional techniques of labor pain management. The study is registered with research registry unique identifying number (UIN) of 1267 “https://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/.” and the study is moderate based on AMSTAR 2 quality assessment criteria/https://amstar.ca/Amstar_Checklist.php. Discussion Combined forms of Non-pharmacologic and selected low dose pharmacologic approaches of labor pain management, provides significant benefits to women and their infants. During provision of labor analgesia complications may happen and the service provider should involve in the management of those complications. Conclusion This study has a paramount importance to practice the most reliable, available and cost effective method of labor analgesia. Appropriate history and physical examinations are crucial to avoid contraindicated medications in labor pain managment. Combined non-pharmacologic methods with a lower dose of indicated drugs provides significant advantages for both mothers and their infants. Using available and cost effective labor pain managment with minimal complications has paramount importance in resource limited setting. During provision of labor analgesia service provider should aware of complications to intervene at theright time.
Collapse
|
48
|
Buran G, Aksu H. Effect of Hypnobirthing Training on Fear, Pain, Satisfaction Related to Birth, and Birth Outcomes: A Randomized Controlled Trial. Clin Nurs Res 2022; 31:918-930. [PMID: 35083920 DOI: 10.1177/10547738211073394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to determine the effect of Hypnobirthing training on fear of childbirth (FOC), birth pain, birth satisfaction and birth outcomes. This randomized controlled trial study was conducted with 80 nulliparous pregnant who were divided into two groups (experimental group n = 40 and control n = 40) in a maternity hospital. The couples received the training in groups(4 weeks, once a week, 3-hour, group session). The mean score of hypnobirthing group for the whole Wijma Birth Expectancy/Experience Scale was significantly lower than that of the routine care group (p < .001).In the latent, active, and transitional phases of labor, the Visual Analog Scale (VAS)scores of the experimental groups were found to be significantly lower than those of the control group (p < .001).The experimental group's rates of birth intervention were significantly lower and their deliveries period were shorter, than those that of the routine control group (p < .001).In addition, the vaginal delivery rates (p = .037)and the scores for the Birth Satisfaction Scale-Revised (BSS-R) were also found to be higher than those of the control group (p < .001).
Collapse
|
49
|
Perrotta C, Romero M, Sguassero Y, Straw C, Gialdini C, Righetti N, Betran AP, Ramos S. Caesarean birth in public maternities in Argentina: a formative research study on the views of obstetricians, midwives and trainees. BMJ Open 2022; 12:e053419. [PMID: 35078842 PMCID: PMC8796244 DOI: 10.1136/bmjopen-2021-053419] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To explore obstetricians', midwives' and trainees' perceptions of caesarean section (CS) determinants in the context of public obstetric care services provision in Argentina. Our hypothesis is that known determinants of CS use may differ in settings with limited access to essential obstetric services. SETTING We conducted a formative research study in 19 public maternity hospitals in Argentina. An institutional survey assessed the availability of essential obstetric services. Subsequently, we conducted online surveys and semistructured interviews to assess the opinions of providers on known CS determinants. RESULTS Obstetric services showed an adequate provision of emergency obstetric care but limited services to support women during birth. Midwives, with some exceptions, are not involved during labour. We received 680 surveys from obstetricians, residents and midwives (response rate of 63%) and interviewed 26 key informants. Six out of 10 providers (411, 61%) indicated that the use of CS is associated with the complexities of our caseload. Limited pain management access was deemed a potential contributing factor for CS in adolescents and first-time mothers. Providers have conflicting views on the adequacy of training to deal with complex or prolonged labour. Obstetricians with more than 10 years of clinical experience indicated that fear of litigation was also associated with CS. Overall, there is consensus on the need to implement interventions to reduce unnecessary CS. CONCLUSIONS Public maternity hospitals in Argentina have made significant improvements in the provision of emergency services. The environment of service provision does not seem to facilitate the physiological process of vaginal birth. Providers acknowledged some of these challenges.
Collapse
Affiliation(s)
- Carla Perrotta
- School of Public Health, Physiotherapy and Sport Sciences, University College Dublin, Dublin, Ireland
| | - Mariana Romero
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
- Health, Economy and Society Department, CEDES, Buenos Aires, Argentina
| | | | - Cecilia Straw
- School of Social Sciences, University of Buenos Aires, CEDES, Buenos Aires, Argentina
| | | | - Natalia Righetti
- Health, Economy and Society Department, CEDES, Buenos Aires, Argentina
| | - Ana Pilar Betran
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Silvina Ramos
- Health, Economy and Society Department, CEDES, Buenos Aires, Argentina
| |
Collapse
|
50
|
Doenmez CFT, Cidro J, Sinclair S, Hayward A, Wodtke L, Nychuk A. Heart work: Indigenous doulas responding to challenges of western systems and revitalizing Indigenous birthing care in Canada. BMC Pregnancy Childbirth 2022; 22:41. [PMID: 35034612 PMCID: PMC8761381 DOI: 10.1186/s12884-021-04333-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Canada, there has been a significant increase in the training of Indigenous doulas, who provide continuous, culturally appropriate support to Indigenous birthing people during pregnancy, birth, and the postpartum period. The purpose of our project was to interview Indigenous doulas across Canada in order to document how they worked through the logistics of providing doula care and to discern their main challenges and innovations. POPULATION/SETTING Our paper analyzes interviews conducted with members of five Indigenous doula collectives across Canada, from the provinces of British Columbia, Manitoba, Ontario, Quebec and Nova Scotia. METHODS Semi-structured interviews were conducted with members of the five Indigenous doula collectives across Canada in 2020 as part of the project, "She Walks With Me: Supporting Urban Indigenous Expectant Mothers Through Culturally Based Doulas." Interview transcripts were approved by participants and subsequently coded by the entire research team to identify key themes. RESULTS Our paper examines two themes that emerged in interviews: the main challenges Indigenous doulas describe confronting when working within western systems, and how they navigate and overcome these obstacles. Specifically, interview participants described tensions with the biomedical approach to maternal healthcare and conflicts with the practice of Indigenous infant apprehension. In response to these challenges, Indigenous doulas are working to develop Indigenous-specific doula training curricula, engaging in collective problem-solving, and advocating for the reformation of a grant program in order to fund more Indigenous doulas. CONCLUSIONS Both the biomedical model of maternal healthcare and the crisis of Indigenous infant apprehension renders Canadian hospitals unsafe and uncomfortable spaces for many Indigenous birthing people and their families. Indigenous doulas are continually navigating these challenges and creatively and concertedly working towards the revitalization of Indigenous birthing care. Indigenous doula care is critical to counter systemic, colonial barriers and issues that disproportionately impact Indigenous families, as well as recentering birth as the foundation of Indigenous sovereignty and community health.
Collapse
Affiliation(s)
- Caroline Fidan Tyler Doenmez
- University of Minnesota, Minneapolis, USA.,University of Winnipeg, 515 Portage Avenue, Winnipeg, Manitoba, R3B 2E9, Canada
| | - Jaime Cidro
- University of Winnipeg, 515 Portage Avenue, Winnipeg, Manitoba, R3B 2E9, Canada.
| | - Stephanie Sinclair
- University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada
| | - Ashley Hayward
- University of Winnipeg, 515 Portage Avenue, Winnipeg, Manitoba, R3B 2E9, Canada.,Kishaadigeh Collaborative Research Centre, University of Manitoba, Winnipeg, Canada
| | - Larissa Wodtke
- Kishaadigeh Collaborative Research Centre, University of Winnipeg, 515 Portage Avenue, Winnipeg, Manitoba, R3B 2E9, Canada
| | - Alexandra Nychuk
- University of Winnipeg, 515 Portage Avenue, Winnipeg, Manitoba, R3B 2E9, Canada
| |
Collapse
|