Journal of midwifery & women's health最新文献

{"title":"Choosing Where to Give Birth","authors":"","doi":"10.1111/jmwh.13751","DOIUrl":"https://doi.org/10.1111/jmwh.13751","url":null,"abstract":"<p>Everyone has the right to give birth in a safe place where they feel comfortable. You can choose to give birth at home, in a birth center, or in a hospital. The decision is an important one based on your health and preferences. Talk to your provider about benefits and risks to you and your baby based on your chosen birth setting.</p><p>If you choose a home birth, you will have regular visits with a midwife during your pregnancy. Sometimes they will come to your home for the visits. Sometimes you may go to an office or clinic. When your labor begins, the midwife will come to your home. You will need to prepare your home for the birth. This includes getting some supplies. The midwife will bring the needed birthing equipment and a few medications to care for you and your baby. The midwife and another person trained in newborn care will be present when you give birth. The midwife will usually stay for several hours after your baby is born to make sure you are both doing well.</p><p>A birth center is a home-like space set up for labor and birth. Birth centers may be freestanding (in a building or house located away from a hospital) or attached to a hospital. Your prenatal visits and birth will occur with a midwife at the birth center. They will provide the supplies, equipment, and medications you might need. You usually stay in the birth center for several hours after you give birth.</p><p>Most people in the United States give birth in a hospital even if they are healthy. Hospitals offer different types of care during pregnancy. Some hospitals have separate areas for labor and postpartum care. Others have special rooms where a person can labor, give birth, and then stay until they go home. A tour of the hospital's labor and delivery area and discussion with the staff will help you find out what services your hospital offers.</p><p>You may want to consider costs of each setting and what services your insurance will cover. The following lists can help you choose the birth setting that is best for you.</p><p><b>Key Differences in the 3 Birth Settings</b>\u0000 \u0000 </p><p>Flesch-Kincaid Reading level 7.2</p><p>Approved February 2025. Replaces “Choosing Where to Give Birth” published in Volume 61, Issue 2, March/April 2016</p><p>This handout may be reproduced for noncommercial use by health care professionals to share with patients, but modifications to the handout are not permitted. The information and recommendations in this handout are not a substitute for health care. Consult your health care provider for information specific to you and your health.</p>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 2","pages":"377-378"},"PeriodicalIF":2.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13751","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143801368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Interventions During Pregnancy to Improve Breastfeeding Self-Efficacy: Systematic Review and Meta-Analysis","authors":"Fatma Koruk PhD, MSN, BSN,&nbsp;Selma Kahraman PhD, MSN, BSN,&nbsp;Zeliha Turan PhD, MSN, BSN,&nbsp;Hatice Nur Özgen MSN, BSN,&nbsp;Burcu Beyazgül MD, PhD","doi":"10.1111/jmwh.13742","DOIUrl":"10.1111/jmwh.13742","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Breastfeeding self-efficacy can be increased through effective interventions to improve breastfeeding rates and promote maternal and infant health. Improving breastfeeding self-efficacy in the prenatal period is important for successful breastfeeding and sustainable breastfeeding practices after birth. Although randomized controlled trials have shown that antenatal and postnatal interventions can boost breastfeeding self-efficacy, evidence is lacking on which interventions are most effective and on the key characteristics of such interventions. The purpose of this review was (1) to examine the effects of various antenatal interventions on breastfeeding self-efficacy and (2) to identify the most effective intervention.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In this meta-analysis, randomized controlled trials and experimental studies were searched using 5 search engines in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocols declaration guidelines. In total, 34 studies were identified, which included 4698 participants. A random effects model, subgroup analysis, and meta-regression analysis were used to pool the results.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;During pregnancy, all types of interventions except model-based counseling provided without prior education and simulation methods have been effective in increasing breastfeeding self-efficacy (&lt;i&gt;P&lt;/i&gt; &lt;.05). Intervention type was the only intervention characteristic that showed statistically significant differences in effect size using the between-group heterogeneity statistic (Q&lt;sub&gt;B&lt;/sub&gt;, 13.888; &lt;i&gt;P&lt;/i&gt; = .016). A meta-regression analysis found a significant effect of differences in intervention types across studies (heterogeneity: τ&lt;sup&gt;2&lt;/sup&gt;, 0.672; Q value = 662.100; &lt;i&gt;df&lt;/i&gt; = 33; &lt;i&gt;P&lt;/i&gt; &lt; .001; &lt;i&gt;I&lt;sup&gt;2&lt;/sup&gt;&lt;/i&gt; = 95.016%; test for overall effect: z, 7.020; &lt;i&gt;P&lt;/i&gt; = .001), and this difference was found to be due to model-based education and counseling, which had the largest effect size in increasing breastfeeding self-efficacy. Intervention type explained 16% of the relationship between interventions to increase breastfeeding self-efficacy during pregnancy and breastfeeding self-efficacy (&lt;i&gt;r&lt;sup&gt;2&lt;/sup&gt;&lt;/i&gt; = 0.16).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;There is a relationship between the types of interventions for breastfeeding during pregnancy and breastfeeding self-efficacy. To increase breastfeeding self-efficacy during pregnancy, it is recommended that health care ","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 4","pages":"610-623"},"PeriodicalIF":2.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13742","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal Health Care Preferences in a Rural Mennonite Community: A Mixed-Methods Study","authors":"April E. Ward CNM, DM, MSN,&nbsp;Barbara K. Hackley CNM, PhD,&nbsp;Emily C. McGahey CNM, DM, MSN","doi":"10.1111/jmwh.13746","DOIUrl":"10.1111/jmwh.13746","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>A rapidly growing rural community of Old Order Mennonites in upstate New York abruptly lost midwifery services in 2018, causing a crisis in perinatal care access. A mixed-methods study was undertaken to explore health status, perinatal needs, and preferences in this culturally homogenous group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An anonymous survey mailed to 650 Mennonite families assessed demographic characteristics, general health, perinatal optimality, perinatal care characteristics, stress and anxiety related to rural childbearing, and preferences for a perinatal health care system. Voluntary follow-up telephone interviews explored recent perinatal experiences and desires for future care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Surveys were returned by 218 Mennonite women, a 33.5% response rate. Home birth was preferred by 94.6% of participants. The mean (SD) Perinatal Background Index score was 86.7% (11.7), indicating a high level of optimality. Elevated levels of stress and anxiety, as measured by the Rural Pregnancy Experience Scale, were reported by 12 participants (6.6%). Qualitative descriptive analysis of 21 interviews revealed a strong desire to preserve home birth, receive care that was respectful of Mennonite cultural norms, and maintain a personal choice of birth attendants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>According to participants, an ideal perinatal care system would ensure locally available, skilled midwives willing to maintain the community's traditional childbearing practices. Despite rural remoteness, distance from inpatient perinatal services was not associated with increased stress and anxiety. Access to care could be improved by state-level initiatives to expand the licensure of midwives and to remove barriers to birth center development.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 4","pages":"602-609"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Health During Pregnancy","authors":"","doi":"10.1111/jmwh.13752","DOIUrl":"https://doi.org/10.1111/jmwh.13752","url":null,"abstract":"<p>Oral health, the health of your teeth and gums, is important before, during, and after pregnancy. Normal changes that occur during pregnancy can affect the teeth and gums. These include hormone changes, nausea and vomiting, and changes in your diet and lifestyle.</p><p>During pregnancy, the placenta releases the hormones progesterone and estrogen. The increases in these hormones can cause changes in your mouth. This can lead to swelling or bleeding of the gums, loosening of the teeth, and increases in saliva. Progesterone and estrogen increase the risk of infection, cavities, and damage to the structures that support the teeth. Changes to the immune system during pregnancy increase the chance of infections that can affect the health of teeth and gums. Most issues can be prevented if you take good care of your mouth and will go away after the birth of the baby. However, if you have severe problems with your mouth before pregnancy, they may get worse and need more treatment.</p><p>Dental care during pregnancy is safe and recommended to improve oral and general health. Most people don't get the treatment they need. It is also important for your baby's health. Teeth cleaning, dental x-rays, and most dental treatments can be safely done when you are pregnant. Make sure your dentist knows that you are pregnant. If medications for infection or pain are needed, your dentist can prescribe safe choices for you and your baby. Tell your dentist or health care provider about any changes in your mouth, teeth, or gums you have noticed since you became pregnant. Your dentist will determine if x-rays are needed. Your belly should be covered with a lead apron during x-rays to protect you and your baby.</p><p>Flesch-Kincaid Grade Level: 6.6</p><p>Approved February 2025. This handout replaces “Dental Care in Pregnancy” published in Volume 59, Number 1, January/February 2014 and “Oral Health: Keeping Your Mouth Clean and Healthy” published in Volume 56, Number 2, March/April 2011.</p><p>This handout may be reproduced for noncommercial use by health care professionals to share with patients, but modifications to the handout are not permitted. The information and recommendations in this handout are not a substitute for health care. Consult your health care provider for information specific to you and your health.</p>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 2","pages":"375-376"},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13752","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143801433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing Type 2 Diabetes in Women With Gestational Diabetes: Three Theoretical Perspectives on Behavior Change","authors":"Lotte Elton MBBS, MSc, MPhil,&nbsp;Ann-Kristin Porth MD,&nbsp;Julie L. O'Sullivan PhD,&nbsp;Jan C. Zoellick PhD,&nbsp;Paul Gellert PhD,&nbsp;Andy Guise PhD,&nbsp;Alexandra Kautzky-Willer MD, PhD","doi":"10.1111/jmwh.13747","DOIUrl":"10.1111/jmwh.13747","url":null,"abstract":"&lt;p&gt;Gestational diabetes (GDM) affects 1 in 6 pregnancies worldwide&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; and around a third of those diagnosed with GDM will develop Type 2 diabetes mellitus (T2DM) within 15 years.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Follow-up care for people with GDM therefore offers an opportunity to detect blood glucose abnormalities early and reduce the risk of T2DM complications.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Recommendations for postpartum GDM care focus on glucose testing and health education for lifestyle changes.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Guidelines recommend that people with GDM should undergo glucose testing with an oral glucose tolerance test or with hemoglobin A1c (HbA1c) at 6 to 12 weeks postpartum to exclude T2DM. HbA1c or fasting glucose testing at regular 1 to 3 year intervals is advised to identify progression to T2DM.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; People diagnosed with GDM should be offered lifestyle advice on weight control, diet, and exercise, which may be delivered via structured education programs.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Although guidelines emphasize the importance of providing follow-up care to people with prior GDM,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; this care is often lacking. A recent editorial in &lt;i&gt;The Lancet&lt;/i&gt; highlights the slow progress made in implementing GDM follow-up care, despite its potential to improve long-term cardiometabolic health.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Uptake of glucose screening is poor globally, with only a third of people with prior GDM receiving regular screening as recommended.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Barriers to screening include a lack of clear guidance about T2DM risk, competing responsibilities such as work or childcare, and poor continuity between pregnancy and primary care services.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Behavioral interventions for T2DM prevention have also had mixed success.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Only 2 of 13 controlled trials regarding lifestyle interventions for people with prior GDM showed significant reduction in T2DM, and there is evidence of publication bias.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; All this suggests that postpartum glucose screening and education interventions have not had the desired effect.&lt;/p&gt;&lt;p&gt;Public health interventions are complex, involving multiple stakeholders and unpredictable outcomes. One way to understand and improve these interventions is by using theory: frameworks of ideas or concepts to explain how something works or why something happens. Theoretical frameworks can help policymakers and health care professionals understand the behavior of key stakeholders, identify appropriate strategies for change, and predict possible outcomes. By incorporating social, psychological, and behavioral factors, theory provides useful insight when developing new interventions or assessing why existing ones have not been successful. However, interventions for T2DM prevention in people with GDM often lack theoretical grounding, and few studies specify a theoretical framework for their interventi","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 4","pages":"545-548"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13747","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation in the Use of Guideline-Based Care by Prenatal Site: Decomposing the Disparity in Preterm Birth for Non-Hispanic Black Women","authors":"Patricia McGaughey CNM, MSN, PhD,&nbsp;Renata E. Howland PhD, MPH","doi":"10.1111/jmwh.13745","DOIUrl":"10.1111/jmwh.13745","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite longstanding status as a public health priority, preterm birth rates continue to be higher among non-Hispanic Black women compared with other racial and ethnic groups. A growing body of literature highlights the site of care as a key factor in pregnancy outcomes. Although research shows that many individuals do not receive guideline-based prenatal care, little is known about site-level variation in the use of recommended prenatal services and its potential relationship with Black-White preterm birth disparities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this cross-sectional cohort study, we analyzed variation in site-level use of 4 key prenatal services: tetanus, diphtheria, and pertussis (Tdap) vaccination, [per the CDC website] and screening for bacteriuria, diabetes, and group Beta streptococcus, using administrative data from New York State Medicaid and the American Community Survey. We used multivariable logistic regressions to estimate the odds of attending a low-use site (mean &lt;2 services per patient) by race and ethnicity, controlling for age, high-poverty residential address, and low prenatal care attendance. We performed Fairlie decomposition analyses to quantify the contribution of individual and site-level factors to the observed difference in preterm birth rates among Black and White non-Hispanic women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Site-level use of recommended prenatal services ranged from an average of 1 to 3.6 services per patient. Non-Hispanic Black women had more than twice the odds (adjusted odds ratio, 2.42; 95% CI, 2.32-2.52) of attending a low-use site compared with non-Hispanic White women. Among factors in the decomposition analysis, site-level screening for bacteriuria and diabetes accounted for the highest proportion of the explained variance in the observed preterm birth rates for non-Hispanic Black (10.7%) and non-Hispanic White (6.7%) women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Results from this research support immediate improvement in guideline-based prenatal care to narrow the gap in preterm birth for non-Hispanic Black women. Research is needed to identify and correct site-level barriers to recommended prenatal services.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 4","pages":"560-568"},"PeriodicalIF":2.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Remote Intensive Monitoring: A Novel Approach to Reduce Black Postpartum Maternal Cardiovascular Complications","authors":"Michelle Villegas-Downs PhD, RN,&nbsp;Tara A. Peters BS, CCRP,&nbsp;Jared Matthews MS,&nbsp;Anne M. Fink PhD,&nbsp;Alicia K. Matthews PhD,&nbsp;Judith Schlaeger CNM, PhD, LAc,&nbsp;Aiguo Han PhD,&nbsp;William D. O'Brien Jr PhD,&nbsp;Joan E. Briller MD,&nbsp;Woon-Hong Yeo PhD,&nbsp;Barbara L. McFarlin CNM, PhD, RDMS","doi":"10.1111/jmwh.13743","DOIUrl":"10.1111/jmwh.13743","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Approximately 53% of maternal mortality occurs in the postpartum period, a time with little monitoring and health surveillance. The objective of this study was to test the feasibility, usability, appropriateness, and acceptability of remote low-burden physiologic monitoring of Black postpartum women, using a novel soft wearable patch and home vital sign monitoring for the first 4 weeks postpartum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective longitudinal cohort feasibility study of 20 Black postpartum women was conducted using home monitoring equipment and a wearable patch with physiologic sensors measuring temperature, pulse oximetry, blood pressure, electrocardiogram (ECG), heart rate, and respiration twice daily during the first 4 weeks postpartum. Feasibility, acceptability, appropriateness, and usability were measured at the end of the study with the Feasibility of Intervention Measure, Acceptability of Intervention Measure, Intervention Appropriateness Measure, and System Usability Scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty Black women were recruited and consented to participate in the study. Remote physiologic monitoring using a wearable patch and home monitoring equipment was rated as feasible (93%), acceptable (93%), appropriate (92%), and useable (80%). During the first 2 weeks postpartum, remote home monitoring detected that 60% of the women had blood pressures exceeding 140/90 mm Hg. The wearable patch provided useable data on ECG, heart rate, heart rate variability, pulse oximetry, and temperature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our research suggests that remote monitoring in the first 4 weeks postpartum has the potential to identify Black women at risk for postpartum complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 4","pages":"549-559"},"PeriodicalIF":2.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13743","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing Bias in the Care of Pregnant and Parenting People with Substance Use Disorder","authors":"Briana E. Kramer CNM, MS, MPH,&nbsp;Nicole Warren CNM, PhD, MSN,&nbsp;Mishka Terplan MD, MPH,&nbsp;Andreea A. Creanga PhD, MD,&nbsp;Kelly M. Bower PhD, MSN, MPH, RN","doi":"10.1111/jmwh.13744","DOIUrl":"10.1111/jmwh.13744","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Unintentional overdose is the leading cause of pregnancy-associated death in Maryland and is preventable. Stigma contributes to birthing peoples’ disengagement with the health care system, and health care professionals may participate in stigmatizing processes. We aimed to develop and evaluate a training on stigma and bias related to substance use disorder (SUD) for maternal health care professionals in Maryland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used a community-engaged process to develop a training on stigma and bias related to SUD in pregnancy and implemented it with Maryland maternal health care professionals employed in birth hospital settings. We conducted a multimethod pre-post training evaluation, using a quantitative analysis of implementation reach, a pre-post knowledge test, a satisfaction survey, and a qualitative analysis of hospital facilitation meeting logs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The training was completed by 1145 health care professionals. Knowledge test scores increased significantly after training, with the greatest change noted in the safety of medications for opioid use disorder during pregnancy. Over 90% of participants found the training relevant and planned to actively use what they learned. Qualitative feedback indicated the training may increase empathy with the patient population and contribute to practice changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our evaluation suggests that this training is valuable, effective at increasing knowledge, and a potential catalyst for practice change among health care professionals working with pregnant and postpartum patients with SUD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 4","pages":"651-657"},"PeriodicalIF":2.3,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Midwives’ Experiences Within Canada's First Alongside Midwifery Unit: Impacts and Implications for Midwifery Practice","authors":"Beth Murray-Davis RM, PhD,&nbsp;Lindsay N. Grenier MA,&nbsp;Anne M. Malott RM, PhD,&nbsp;Cristina A. Mattison PhD,&nbsp;Carol Cameron RM, MA,&nbsp;Eileen K. Hutton PhD,&nbsp;Elizabeth K. Darling RM, PhD","doi":"10.1111/jmwh.13740","DOIUrl":"10.1111/jmwh.13740","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although midwifery-led units in hospitals are associated with positive outcomes, little is known about the experiences of the midwives who work within this model. Despite the increase in midwifery-led units globally, the first unit of this kind opened its doors in Canada in 2018. The Alongside Midwifery Unit (AMU) is staffed by a hospitalist midwife (a novel role in this country) and community midwives, working in a caseload model, who attend their clients’ labor and birth on the unit. The AMU is a low-risk birthing unit located adjacent to the obstetric unit, offering midwifery-led care, in a homelike setting. Our aim was to explore and describe the experiences of midwives working in this model of care on the AMU.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Qualitative semistructured interviews and one focus group with community and hospitalist midwives working at the AMU were conducted and analyzed using a grounded theory approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified that midwives were able to maintain the midwifery philosophy of care, strengthen relationships, amplify hospital integration, and grow midwifery leadership in this model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Implementation of an AMU supports best practice, intra- and interprofessional relationships, and integration of midwives. Our findings demonstrate a positive impact of this model along with the absence of detrimental impact on midwifery values and philosophy. An improved understanding of the impact of the AMU on midwives and their practice is useful for refining the model of care and informing implementation in other settings. This research contributes to the growing evidence demonstrating the benefits of midwifery-led units.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 3","pages":"486-493"},"PeriodicalIF":2.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13740","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The OptiBreech Trial Feasibility Study: A Qualitative Inventory of the Roles and Responsibilities of Breech Specialist Midwives","authors":"Siân M. Davies MSc,&nbsp;Alice Hodder BSc,&nbsp;Shawn Walker PhD,&nbsp;Natasha Bale MSc,&nbsp;Honor Vincent MA,&nbsp;Tisha Dasgupta MSc,&nbsp;Alexandra Birch MSc,&nbsp;Keelie Piper,&nbsp;Sergio A. Silverio MSc","doi":"10.1111/jmwh.13728","DOIUrl":"10.1111/jmwh.13728","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The safety of vaginal breech birth is associated with the skill and experience of professionals in attendance, but minimal training opportunities exist. OptiBreech collaborative care is an evidence-based care bundle, based on previous research. This care pathway is designed to improve access to care and the safety of vaginal breech births, when they occur, through dedicated breech clinics and intrapartum support. This improved process also enhances professional training. Care coordination is accomplished in most cases by a key breech specialist midwife on the team. The goal of this qualitative inventory was to describe the roles and tasks undertaken by specialist midwives in the OptiBreech care implementation feasibility study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Semistructured interviews were conducted with OptiBreech team members (17 midwives and 4 obstetricians; N = 21), via video conferencing software. Template analysis was used to code, analyze, and interpret data relating to the roles of the midwives delivering breech services. Tasks identified through initial coding were organized into 5 key themes in a template, following reflective discussion at weekly staff meetings and stakeholder events. This template was then applied to all interviews to structure the analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Breech specialist midwives functioned as change agents. In each setting, they fulfilled similar roles to support their teams, whether this role was formally recognized or not. We report an inventory of tasks performed by breech specialist midwives, organized into 5 themes: care coordination and planning, service development, clinical care delivery, education and training, and research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Breech specialist midwives perform a consistent set of roles and responsibilities to co-ordinate care throughout the OptiBreech pathway. The inventory has been formally incorporated into the OptiBreech collaborative care logic model. This detailed description can be used by employers and professional organizations who wish to formalize similar roles to meet consistent standards and improve care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 2","pages":"270-278"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13728","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}