The Impact of Extreme Heat Exposure on Pregnant People and Neonates: A State of the Science Review

The relationship between heat exposure and perinatal morbidity and mortality is of increasing concern as global temperatures rise and extreme heat events become more frequent and intense. Heat exposure can lead to a multitude of harmful outcomes for pregnant individuals and neonates, including hospitalization and death. This state of the science review explored the evidence on the associations between heat exposure and negative health outcomes during pregnancy and the neonatal period. Findings suggest that improving health care provider and patient awareness of heat-related risks and implementing specific interventions could mitigate adverse outcomes. Furthermore, public health and other policy interventions are needed to increase thermal comfort and reduce societal exposure to extreme heat and related risks. Early warning systems, medical alerts, provider and patient education, and increased access to health care and thermal comfort may improve pregnancy and early life health outcomes.

Responding to Humanitarian Crises: Midwifery Care in Bangladesh

Sexual and reproductive health and rights (SRHR) is often a neglected topic of intervention in humanitarian crises despite its wide-ranging impact on women and girls' well-being. Increasing frequency of climate-induced natural disasters calls for an urgent need to identify innovative practices for sustainable and effective humanitarian preparedness and response to ensure SRHR of affected populations. One such innovation is the empowerment of midwives in disaster response program planning and implementation. This article describes how midwives deployed to rural primary health centers provided quality SRHR services, particularly for labor and birth assistance and initial management of perinatal emergencies and referral in the aftermath of the 2022 flooding in northern and northeastern Bangladesh. Supportive supervision from physicians, adequate health care logistics and supplies, and administrative support from local health authorities created an enabling environment for the midwives. Community engagement through volunteers helped build rapport with residents and allowed patients to navigate health services. Deploying midwives as a response to climate-induced natural disaster was successful in establishing quality SRHR services. Future recommendations include systematically deploying midwives in health centers closest to the communities in locations vulnerable to climate change as part of routine health service delivery. This innovative approach clearly demonstrated that utilization of midwives during and after natural disasters could build community and health system resilience to climate change.

Experiential Training Workshops for Group Antenatal Care in Malawi

The positive effects of the CenteringPregnancy group antenatal care (ANC) model on perinatal outcomes in the United States has led to its adaptation and implementation in many low- and middle-income countries. Facilitative discussions are a core component of this group ANC model. Facilitator training lays a critical foundation for delivery of this paradigm-shifting model as practitioners learn to adapt their approach to health education from didactive to facilitative. However, there is little rigorous research focused on best practices for training group health care facilitators and none that is guided by a theoretical framework. Kolb's experiential learning theory offers a theoretical framework to guide the development of training workshops that allow trainees to experience, reflect on, and practice the facilitation skills needed to deliver this evidence-based intervention. This article describes an experiential learning-based training workshop that was implemented as part of an ongoing effectiveness-implementation trial of a Centering-based group ANC model in Blantyre District, Malawi. We provide a blueprint for conducting group ANC facilitator trainings that, in addition to imparting knowledge, effectively builds confidence and buy-in to this paradigm-changing approach to ANC delivery. This blueprint can be adapted for use in designing and implementing group health care across settings in the United States and globally.

Building a Global Evidence Base to Guide Policy and Implementation for Group Antenatal Care in Low- and Middle-Income Countries: Key Principles and Research Framework Recommendations from the Global Group Antenatal Care Collaborative

Evidence from high‐income countries suggests that group antenatal care, an alternative service delivery model, may be an effective strategy for improving both the provision and experience of care. Until recently, published research about group antenatal care did not represent findings from low‐ and middle‐income countries, which have health priorities, system challenges, and opportunities that are different than those in high‐income countries. Because high‐quality evidence is limited, the World Health Organization recommends group antenatal care be implemented only in the context of rigorous research. In 2016 the Global Group Antenatal Care Collaborative was formed as a platform for group antenatal care researchers working in low‐ and middle‐income countries to share experiences and shape future research to accelerate development of a robust global evidence base reflecting implementation and outcomes specific to low‐ and middle‐income countries. This article presents a brief history of the Collaborative's work to date, proposes a common definition and key principles for group antenatal care, and recommends an evaluation and reporting framework for group antenatal care research.

Use of a Facilitated Group Process to Design and Implement a Group Antenatal and Postnatal Care Program in Rwanda

INTRODUCTION

The government of Rwanda is exploring strategies that may reduce the incidence of prematurity and low birth weight. Large-scale implementation of group antenatal care (ANC) and postnatal care (PNC) within the context of the Rwanda national health care system is under consideration. To launch a cluster randomized controlled trial of group ANC and PNC in 5 districts in Rwanda, the implementation team needed a customized group care model for this context and trained health care workers to deliver the program.

PROCESS

Adapting the group ANC and group PNC model for the Rwandan context was accomplished through a group process identical to that which is fundamental to group care. A technical working group composed of 10 Rwandan maternal-child health stakeholders met 3 times over the course of 3 months, for 4 to 8 hours each time. Their objectives were to consider the evidence on group ANC, agree on the priorities and constraints of their ANC delivery system, and ultimately define the content and structure of a combined group ANC and PNC model for implementation in Rwanda. The same group process was employed to train health care workers to act as group ANC facilitators.

OUTCOMES

A customized group ANC and PNC model and guidelines for its introduction were developed in the context of a cluster randomized controlled trial in 36 health centers. Descriptions of this model and the implementation plan are included in this article.

DISCUSSION

Our experience suggests that the group process fundamental to successful group ANC and PNC is an effective method to customize and implement this innovative health services delivery model in a new context and is instrumental in achieving local ownership.

A Meta-Synthesis of the Birth Experiences of African Immigrant Women Affected by Female Genital Cutting

INTRODUCTION

The purpose of this qualitative meta-synthesis was to understand the labor and birth experiences of immigrant women in countries of resettlement who have a history of female genital cutting (FGC), also known as female genital mutilation or female circumcision.

METHODS

We used a meta-ethnography approach to synthesize the literature on this topic. We searched PubMed, Embase, Web of Science, CINAHL, PsycINFO, and Sociological Abstracts databases from inception to May 2016 using the search terms female genital cutting, female circumcision, clitorectomy, clitoridectomy, pharaonic circumcision, genital circumcision, female genital mutilation, infibulation, and deinfibulation. Our inclusion criteria were 1) peer-reviewed, original qualitative research; 2) focused on populations affected by FGC or their health care providers; 3) conducted in a country where FGC is not documented as an indigenous practice; 4) English language; and 5) included a description of postmigratory labor and birth experiences of women affected by FGC. Fourteen articles were included.

RESULTS

Two new syntheses emerged from our sample of studies including African immigrant women primarily resettled in Europe and the United States. First, birth after FGC in the context of resettlement included pain and anxiety, and has the potential to retraumatize. Second, while women experienced nostalgia for familiar traditions and perceived disrespect in their new setting, they questioned traditions, including the role of FGC, in their and their daughters' lives.

DISCUSSION

The negative birth experiences of women affected by FGC highlight the need to improve care for this population. Health care professionals can serve as a source of support for women affected by FGC by acknowledging and addressing FGC in their care and actively listening to their perspectives and concerns.

Patient Satisfaction With Maternity Waiting Homes in Liberia: A Case Study During the Ebola Outbreak

INTRODUCTION

Liberia in West Africa has one of the highest maternal mortality ratios in the world (990/100,000 live births). Many women in Liberia live in rural, remote villages with little access to safe maternity services. The World Health Organization has identified maternity waiting homes (MWHs) as one strategy to minimize the barrier of distance in accessing a skilled birth attendant. However, limited data exist on satisfaction with MWHs or maternal health care in Liberia.

METHODS

This mixed-methods case study examines women's satisfaction with their stay at a MWH and compares utilization rates before and during the Ebola outbreak. From 2012 to 2014, 650 women who stayed at one of 6 MWHs in rural Liberia during the perinatal or postnatal period were surveyed. Additionally, 60 semi-structured interviews were conducted with traditional providers, skilled birth attendants, and women utilizing the MWHs. Quantitative analyses assessed satisfaction rates before and during the Ebola outbreak. Content analysis of semi-structured interviews supplemented the quantitative data and provided a lens into the elements of satisfaction with the MWHs.

RESULTS

The majority of women who utilized the MWHs stated they would suggest the MWH to a friend or relative who was pregnant (99.5%), and nearly all would utilize the home again (98.8%). Although satisfaction with the MWHs significantly decreased during the Ebola outbreak (P < .001), participants were satisfied overall with the MWHs. Content analysis identified areas of satisfaction that encompassed the themes of restful and supportive environment as well as areas for improvement such as lacking necessary resources and loneliness.

DISCUSSION

This case study demonstrated that women using MWHs in Bong County, Liberia are generally satisfied with their experience and plan to use an MWH again during future pregnancies to access a skilled birth attendant for birth. Women are also willing to encourage family and friends to use MWHs.

Task Analysis as a Resource for Strengthening Health Systems

Task analysis is a descriptive study methodology that has wide application in the health professions. Task analysis is particularly useful in assessment and definition of the knowledge, skills, and behaviors that define the scope of practice of a health profession or occupation. Jhpiego, a US-based nongovernmental organization, has adapted traditional task analysis methods in several countries in assessment of workforce education and practice issues. Four case studies are presented to describe the utility and adaptability of the task analysis approach. Traditional task analysis field survey methods were used in assessment of the general and maternal-child health nursing workforce in Mozambique that led to curriculum redesign, reducing the number of education pathways from 4 to 2. The process of health system strengthening in Liberia, following a long history of civil war conflict, included a traditional task analysis study conducted among 119 registered nurses and 46 certified midwives who had graduated in the last 6 months to 2 years to determine gaps in education and preparation. An innovative approach for data collection that involves "playing cards" to document participant opinions (Task Master, Mining for Data) was developed by Jhpiego for application in other countries. Results of a task analysis involving 54 nurses and 100 nurse-midwives conducted in Lesotho were used to verify the newly drafted scope and standards of practice for nurses and to inform planning for a competency-based preservice curriculum for nursing. The Nursing and Midwifery Council developed a 100-question licensing examination for new graduates following a task analysis in Botswana. The task analysis process in each country resulted in recommendations that were action oriented and were implemented by the country governments. For maximal utility and ongoing impact, a task analysis study should be repeated on a periodic basis and more frequently in countries undergoing rapid change in development of workforce policy.