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Wadsworth P, Graves L, Pogula M, Duerst A, Southard J, Kothari C, Presberry J. Patients' Perspectives on Informational Support and Education in the Perinatal Period: "The Quicker They Could Be Done With Me, the Better". J Midwifery Womens Health 2024; 69:110-117. [PMID: 37486773 DOI: 10.1111/jmwh.13548] [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] [Revised: 05/24/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION The overall purpose of this study was to elicit perspectives from a diverse group of postpartum individuals about their perinatal outpatient informational support and education. In addition, suggestions from participants are provided. Although informational support is crucial in the peripartum period, it is often inadequate or biased. Qualitative research, which offers a nuanced and patient-centered perspective, is limited. The qualitive research that does exist is limited to the prenatal period only, neglecting perspectives throughout the entire peripartum period. METHODS This qualitative descriptive study was part of a larger observational cross-sectional study of postpartum individuals in Kalamazoo, Michigan in 2017. Two years after the initial study (2019), participants were recruited into 8 focus groups. Trained facilitators guided focus group conversations using semistructured interview questions. The questions centered on overall experiences with perinatal outpatient health care experiences and informational support. Thematic analyses were used in data analysis. Interrater reliability between coders ranged from 92% to 100%. RESULTS Fifty-four individuals (22.1% response rate) participated in a total of 12 focus groups. The overarching theme was the need for recognition of individuality of patients. Three subthemes emerged, including time, multiple modalities of information support, and agency. DISCUSSION This study extended previous qualitative findings across the entire peripartum period and that individualized prenatal care is an important distinction in perceived quality of care. Health care organizations should consider allocating time differently for perinatal office visits, offer flexible visit times based on individualized needs, offer information in multiple modalities, and promote agency of patients. This study was strengthened by the community involvement, women of color only focus groups, and oversampling of Black women. This study was limited by the self-selected, homogenous sample and potential for recall bias.
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Affiliation(s)
- Pamela Wadsworth
- Bronson School of Nursing, Western Michigan University, Kalamazoo, Michigan
| | - Lisa Graves
- Department of Family and Community Medicine, Western Michigan University Medical School, Kalamazoo, Michigan
| | - Mounika Pogula
- Western Michigan University Medical School, Kalamazoo, Michigan
| | - Abby Duerst
- Western Michigan University Medical School, Kalamazoo, Michigan
| | - James Southard
- Western Michigan University Medical School, Kalamazoo, Michigan
| | - Catherine Kothari
- Department of Biomedical Sciences, Western Michigan University Medical School, Kalamazoo, Michigan
| | - Joi Presberry
- Western Michigan University Medical School, Kalamazoo, Michigan
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Miele MJ, Souza RT, Vieira MC, Pacagnella RC, Cecatti JG. A conceptual framework for nutritional evaluation, screening, and monitoring of pregnant women: Evidence from a Brazilian cohort of nulliparous women. Int J Gynaecol Obstet 2023; 161:40-50. [PMID: 36125296 DOI: 10.1002/ijgo.14469] [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: 04/11/2022] [Revised: 08/16/2022] [Accepted: 08/30/2022] [Indexed: 11/07/2022]
Abstract
The present review comes from five previous studies of a multicenter cohort of nulliparous pregnant women from different regions of Brazil. The first study showed a wide difference in consumption of industrialized foods among women from the south and southeast regions compared with northeastern women who chose to eat a healthier diet with fresh natural food. The second investigation intended to understand maternal eating habits, where five dietary patterns were identified: two considered healthy and three with excess protein, ultra-processed foods, fats, and sweets. Considering some barriers to classifying nutrition status during prenatal care, when data on pre-pregnancy weight is unknown, the third study developed a tool to identify three levels of risk for each gestational age range, assessed by measuring arm circumference. Applying those new tools, the associations between maternal nutrition and pregnancy outcomes were investigated: prematurity, pre-eclampsia, gestational diabetes mellitus, and small-for-gestational-age infants. From these analyses, a predictive model was developed indicating that obesity, non-white color, and dietary pattern with excess protein consumption were associated with a greater probability of adverse pregnancy outcomes. Moreover, the potential of the intergenerational influence of head circumference as a proxy for maternal nutrition was analyzed. Using a Path Analysis method, the model was evidenced by different socioeconomic variables. Finally, understanding the complexity of the nutritional assessment, the present conceptual framework was proposed for nutritional assessment, and tracking and monitoring of pregnant women.
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Affiliation(s)
- Maria J Miele
- Department of Obstetrics and Gynaecology, School of Medicine, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Renato T Souza
- Division of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Matias C Vieira
- Department of Obstetrics and Gynaecology, School of Medicine, University of Campinas (UNICAMP), Campinas, SP, Brazil
- Division of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynaecology, School of Medicine, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - José G Cecatti
- Department of Obstetrics and Gynaecology, School of Medicine, University of Campinas (UNICAMP), Campinas, SP, Brazil
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Johnsen M, Braaten T, Skeie G, Laholt H, Hansen S. Midwives and public health nurses' knowledge and clinical practice in securing sufficient iodine status in relation to pregnancy. A cross-sectional study. Nurs Open 2023. [PMID: 36840923 DOI: 10.1002/nop2.1675] [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: 10/20/2022] [Revised: 12/21/2022] [Accepted: 02/08/2023] [Indexed: 02/26/2023] Open
Abstract
AIM To investigate midwives' (MWs) and public health nurses' (PHNs) clinical practice and knowledge related to nutrition, with a particular focus on iodine in northern parts of Norway. Maternal iodine status prior to and during pregnancy, and the lactating period, is crucial for brain development and growth of the foetus and infant, from conception up until the first two years of life. In Norway, studies have documented mild to moderate iodine deficiency in this group. DESIGN/METHODS MWs (n = 128) and PHNs (n = 154) responded to a survey regarding nutrition and iodine. Descriptive data and non-parametric tests were used to analyse data. RESULTS Around half of the participants provided dietary guidance to a great extent. Practice of iodine-specific recommendations was lower, particularly regarding lactating women. Compared to other nutrients, iodine was not a priority. CONCLUSION The study indicates a lack of knowledge and poor clinical practice about iodine among MWs and PHNs.
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Affiliation(s)
- Maren Johnsen
- Department of Health Care and Sciences. Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Tonje Braaten
- Department of Community Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Hilde Laholt
- Department of Health Care and Sciences. Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Solrunn Hansen
- Department of Health Care and Sciences. Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
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Super S, Wagemakers A. Understanding empowerment for a healthy dietary intake during pregnancy. Int J Qual Stud Health Well-being 2021; 16:1857550. [PMID: 33317432 PMCID: PMC7738301 DOI: 10.1080/17482631.2020.1857550] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/23/2020] [Accepted: 11/23/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose: In order for health professionals to encourage pregnant women with a low socioeconomic status (SES) to move towards empowerment for a healthy dietary intake, crucial steps are to understand the perspectives of pregnant women of food and eating and to identify opportunities for empowerment. This study aimed to examine the perspectives of pregnant women on food and eating and to identify the opportunities for empowerment towards a healthy dietary intake. Methods: This was a qualitative participatory study. Thirteen semi-structured interviews were conducted with low SES pregnant women in the Netherlands and analysed using an inductive approach. Results: Five perspectives on food and eating emerged: 1) health-promoting foods and products, 2) challenges in healthy eating, 3) risky products, 4) strategies for healthy eating, and 5) motivational aspects. Opportunities for empowerment were: searching balanced and personalized information, developing strategies to implement healthy diets, navigating the social environment, and dealing with different motivations. Conclusion: Pregnant women hold diverse perspectives regarding food and eating, signalling the need to adjust dietary support from health-care professionals. Professionals in antenatal care could optimize their interactions by engaging in pregnant women's empowerment processes to make healthy modifications to their dietary intake.
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Affiliation(s)
- Sabina Super
- Health and Society, Social Sciences Group, Wageningen University, Wageningen, The Netherlands
| | - Annemarie Wagemakers
- Health and Society, Social Sciences Group, Wageningen University, Wageningen, The Netherlands
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Eating Behaviors and Dietary Patterns of Women during Pregnancy: Optimizing the Universal 'Teachable Moment'. Nutrients 2021; 13:nu13093298. [PMID: 34579175 PMCID: PMC8471126 DOI: 10.3390/nu13093298] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 01/13/2023] Open
Abstract
Understanding women’s perceptions of eating behaviors and dietary patterns can inform the ‘teachable moment’ model of pregnancy. Our objectives were to describe eating behaviors and dietary patterns in pregnancy. This was a cross-sectional, national electronic survey. Women were ≥18 years of age, living in the United States, currently pregnant or less than two years postpartum, and had internet access. Age, education, race, and marriage were included as covariates in ordinal and binary logistic regressions (significance p < 0.05). Women (n = 587 eligible) made positive or negative changes to their diets, while others maintained pre-existing eating behaviors. The majority of women did not try (84.9 to 95.1% across diets) and were unwilling to try (66.6 to 81%) specific dietary patterns during pregnancy. Concerns included not eating a balanced diet (60.1 to 65.9%), difficulty in implementation without family (63.2 to 64.8%), and expense (58.7 to 60.1%). Helpful strategies included being provided all meals and snacks (88.1 to 90.6%) and periodic consultations with a dietitian or nutritionist (85 to 86.7%). Responses differed across subgroups of parity, body mass index, and trimester, notably in women with obesity who reported healthier changes to their diet (p < 0.05). Our study underscores the importance of tailoring care early to individual needs, characteristics, and circumstances.
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Bidwell P, Sevdalis N, Silverton L, Harris J, Gurol-Urganci I, Hellyer A, Freeman R, van der Meulen J, Thakar R. Women's experiences of the OASI Care Bundle; a package of care to reduce severe perineal trauma. Int Urogynecol J 2021; 32:1807-1816. [PMID: 33475817 PMCID: PMC8295065 DOI: 10.1007/s00192-020-04653-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/10/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Obstetric anal sphincter injury (OASI) is a severe form of perineal trauma that can occur during vaginal birth. Long-term morbidities include anal incontinence and psychosocial disorders. To reduce these injuries within England, Scotland and Wales, the OASI Care Bundle was introduced to 16 maternity units (January 2017-March 2018). The OASI Care Bundle comprises four elements: (1) antenatal information, (2) manual perineal protection, (3) medio-lateral episiotomy (when indicated) and 4) recognition and diagnosis of tears. As part of the project evaluation, a qualitative study was conducted to explore women's experiences of the OASI Care Bundle. METHODS Semi-structured interviews were conducted with women (n = 19) who received the OASI Care Bundle as part of their maternity care. This was to explore their experience of each element. A thematic analysis of the interview data was performed. RESULTS Three themes were identified: (1) memories of touch, whereby women reported that a 'hands-on' approach to perineal protection was a positive experience; (2) midwife as a supportive guide, where women reported that good communication facilitated a calm birth and post-birth diagnosis; (3) education: women need more information about perineal trauma. CONCLUSION This study contributes to the literature through its exploration of women's experiences of perineal protection techniques and diagnosis of perineal trauma. Interviewed women indicated that they did not experience any of the care bundle elements as an intrusion of their physical integrity. Additionally, an urgent need was identified for more information about perineal trauma in terms of risk, prevention and recovery.
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Affiliation(s)
- Posy Bidwell
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK.
| | - Nick Sevdalis
- Health Service and Population Research Department, King's College London, De Crespingy Park, London, SE5 8AF, UK
| | - Louise Silverton
- Royal College of Midwives, 10-18 Union Street, London, SE1 1SZ, UK
| | - James Harris
- Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Ipek Gurol-Urganci
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Alexandra Hellyer
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK
| | - Robert Freeman
- University Hospitals Plymouth NHS Trust, Derriford Road, Devon, PL6 8DH, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Ranee Thakar
- Croydon Health Services NHS Trust, 530 London Road, Croydon, CR7 7YE, UK
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