Journal of midwifery & women's health最新文献

{"title":"The Association Between Unintended Pregnancy and Perinatal Outcomes in Low-Risk Pregnancies: A Retrospective Registry Study in the Netherlands","authors":"Amke M.G. van Tintelen MSc,&nbsp;Danielle E.M.C. Jansen PhD,&nbsp;Sophie H. Bolt PhD,&nbsp;J. Catja Warmelink PhD,&nbsp;Corine J. Verhoeven PhD,&nbsp;Jens Henrichs PhD","doi":"10.1111/jmwh.13634","DOIUrl":"10.1111/jmwh.13634","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>People with unintended pregnancies might be at increased risk of adverse perinatal outcomes due to structural factors, distress, or delayed prenatal care. Existing studies addressing this association yielded inconsistent findings. Using contemporary data from a large Dutch midwifery care registry, we investigated the association between unintended pregnancy ending in birth and neonatal outcomes, parental morbidity, and obstetric interventions. We extend previous research by exploring whether delayed initiation of prenatal care mediates these associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This study used data (N = 9803) from a Dutch nationally representative registry of people with low-risk pregnancies receiving primary midwife-led care in the Netherlands between 2012 and 2020. Using logistic (mediation) regression analyses adjusted for potential confounders we investigated associations between unintended pregnancy and neonatal outcomes (low Apgar score, small for gestational age, and prematurity), parental morbidity (hypertension and gestational diabetes mellitus), and obstetric interventions (induction of labor, pain medication, assisted vaginal birth, and cesarean birth) and whether delayed initiation of prenatal care mediated these associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Unintended pregnancies were associated with increased odds of low Apgar scores (odds ratio [OR], 1.68; 95% CI, 1.09 –2.59), preterm birth (OR, 1.27; 95% CI, 1.02-1.58), small for gestational age (OR, 1.19; 95% CI, 1.00-1.41), and induction of labor (OR, 1.14; 95% CI, 1.01-1.28). Conversely, unintended pregnancy was associated with a decreased odds of cesarean birth (OR, 0.83; 95% CI, 0.71-0.97). The timing of prenatal care initiation did not mediate any of these associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our findings suggest that people in primary midwifery-led care with unintended pregnancies ending in birth are at increased risk for adverse perinatal health outcomes and that structural factors might underlie this link. Health care professionals and policy makers should attend to their own biases and offer nonjudgmental, tailored preventive preconception care and antenatal care strategies for people with higher vulnerabilities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13634","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140660032","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":"Birth Experience Among Black Women in the United States: A Qualitative Meta-Synthesis","authors":"Elizabeth J. Spurlock PhD, RN,&nbsp;Rita H. Pickler PhD, RN","doi":"10.1111/jmwh.13628","DOIUrl":"10.1111/jmwh.13628","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There are striking disparities in perinatal health outcomes for Black women in the United States. Although the causes are multifactorial, research findings have increasingly identified social and structural determinants of health as contributors to perinatal disparities. Maltreatment during perinatal care, which is disproportionately experienced by Black women, may be one such contributor. Qualitative researchers have explored Black women's perinatal care experiences, but childbirth experience data has yet to be analyzed in-depth across studies. The aim of this meta-synthesis was to explore the birthing experience of Black women in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, Embase, PsycINFO, and CINAHL databases were searched. Inclusion criteria were qualitative research studies that included birth experience data shared by self-identified Black or African American women who had given birth in the United States. Exclusion criteria were reports that did not include rich qualitative data or only included experience data that did not specify the race of the participant (eg, data pooled for women of color). The search began February 2022 and ended June 2022. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to appraise the research. Results were synthesized using content analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen studies met inclusion criteria. Main themes included (1) trust: being known and seen; (2) how race influences care; (3) preserving autonomy; and (4) birth as trauma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Fragmented care resulted in reports of poor birth experiences in several studies. Open communication and feeling known by perinatal care providers was influential in improving childbirth experiences among Black women; these themes are consistent with existing research. Further prospective research exploring relationships among these themes and perinatal outcomes is needed. Limitations of this report include the use of content analysis and meta-synthesis which may lose the granularity of the original reports; however, the aggregation of voices may provide valuable, transferable, actionable insight that can inform future supportive care interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140338286","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":"Intrauterine Devices","authors":"","doi":"10.1111/jmwh.13631","DOIUrl":"10.1111/jmwh.13631","url":null,"abstract":"<p>An IUD is a small T-shaped device that is placed through your vagina and cervix into the top of your uterus (womb) by your health care provider. There are 2 kinds of IUDs, nonhormonal or hormonal:</p><p>The copper IUD (Paragard) is effective for up to 10 years. It has no hormones.</p><p>IUDs keep sperm from reaching an egg. If sperm can't get to an egg, pregnancy won't happen. The copper IUD changes the lining of the uterus and kills sperm that enter the uterus so they can't reach an egg. The hormonal IUDs prevent ovulation (release of an egg) and make the mucus in your cervix (opening of the uterus) thicker so that sperm can't reach an egg.</p><p>IUDs work very well in protecting you from getting pregnant. Fewer than 1 out of 100 of those using an IUD will get pregnant each year. This is about the same as using the birth control implant, or having a tubal ligation or vasectomy.</p><p>Your health care provider will insert the IUD. It may be inserted right after giving birth, at your postpartum visit, or another time, often during your period. Your provider will help you pick the best time. The IUD is put into your uterus through your vagina and cervix. First, your provider will put a speculum into your vagina to hold it open. Then, your provider may use an instrument to hold your cervix in place while they insert the IUD. A string attached to the IUD comes out of your uterus into the top of your vagina. It is used to pull out the IUD when you want it removed. Your provider will cut the strings on the IUD. You will be able to feel the strings with your fingers when you check for them.</p><p>Inserting an IUD usually only takes a few minutes. You may feel cramping during and after the insertion. You may take ibuprofen (Advil, Motrin) or naproxen (Aleve) an hour before your appointment to have less pain when the IUD is inserted. You can also take these medications if you have cramping right after the IUD is inserted. It helps to be well hydrated and nourished before and after the IUD insertion.</p><p>Your health care provider will let you know the date your IUD should be removed. You can decide to have your IUD removed at any time before this date if you experience undesirable side effects or decide you want to become pregnant. To remove the IUD, your provider will put a speculum into your vagina and then gently pull on the IUD strings. You may feel mild cramping as the IUD is removed.</p><p>You will be protected against pregnancy as soon as a copper IUD is in place. If a hormonal IUD is inserted during the first 7 days of your period, you will be protected against pregnancy as soon as it is in place. If a hormonal IUD is inserted more than 7 days after your period starts, you will need to use another type of birth control, such as condoms, for the first 7 days after the IUD is in place.</p><p>The most common side effect of IUDs is changes in your normal menstrual period. With the copper IUD, periods may be heavier with more cramps. With the hormo","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13631","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140338287","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":"A Qualitative Exploration of Self-Advocacy Experiences of Black Women in the Perinatal Period: Who Is Listening?","authors":"Teresa Hagan Thomas PhD, RN,&nbsp;Savannah Vetterly BA,&nbsp;Elizabeth B. Kaselitz MSW,&nbsp;Willa Doswell PhD, RN, FAAN,&nbsp;Betty Braxter CNM, PhD, RN","doi":"10.1111/jmwh.13630","DOIUrl":"10.1111/jmwh.13630","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Black women face poor maternal health outcomes including being over 3 times more likely to die from pregnancy complications than White women. Yet the lived experience of how these women self-advocate has not been clearly explored. The goal of this cross-sectional qualitative study was to describe the lived experiences of Black women advocating for their needs and priorities during the perinatal period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between January and October of 2022, we recruited Black women from obstetric clinics, research registries, and community advocacy groups who were either in their third trimester of pregnancy or within a year postpartum. Participants completed one-on-one interviews describing their experiences of self-advocacy. These data were analyzed using descriptive content analysis approaches that summarized women's experiences by iteratively creating major themes and subthemes that encapsulate their self-advocacy descriptions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen Black women completed interviews. Major themes and subthemes describing women's experience of self-advocacy were the following: (1) carrying a burden with subthemes of having to be good and easy, not trusting health care information and providers, and being dismissed; (2) building comfort with health care providers with subthemes of trusting I have a good provider, comfort in knowing they understand, and wanting low-touch, high-concern care; and (3) advocating for my child and myself when I need to with subthemes of going with the flow, becoming informed, pushing to ask questions, and balancing being proactive and pushy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Women reported self-advocating mainly due to experiences related to the burdens associated with not trusting providers and health care information. These findings provide clarity to how women carefully balance between ensuring their health is taken seriously while not jeopardizing their health or that of their newborn. This study offers promising directions to support Black women in advocating for their perinatal health care needs and values.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140338285","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":"Influence of Food Security Status and Diet Quality on Maternal Gestational Weight Gain","authors":"Joshua R. Sparks PhD,&nbsp;Candice A. Myers PhD,&nbsp;Suzanne Phelan PhD,&nbsp;Robert L. Newton Jr PhD,&nbsp;Shengping Yang PhD,&nbsp;Leanne M. Redman PhD","doi":"10.1111/jmwh.13622","DOIUrl":"10.1111/jmwh.13622","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recommended gestational weight gain (GWG) is crucial for health of women and their offspring. Food security status is hypothesized to influence diet quality and GWG. Therefore, we examined the relationship between diet quality and GWG by food security status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants (n = 679) were enrolled in the Initial Vanguard Study of the National Children's Study. GWG was calculated as third trimester weight minus prepregnancy weight. Food security status and diet quality (Healthy Eating Index [HEI]-2015) were assessed using the Household Food Security Survey and a Diet History Questionnaire, respectively. General linear models evaluated the relationship between GWG and HEI-2015 by food security status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A greater proportion of women experienced food security (81.3%) compared with food insecurity (18.7%). In women with food security, GWG was negatively associated with HEI-2015 in women having overweight (<i>r</i> = −0.421, <i>P</i> = .003) and positively associated with HEI-2015 in women with inadequate GWG (<i>r</i> = 0.224, <i>P</i> = .019). Conversely, no significant relationships were found between GWG and HEI-2015 in women with food insecurity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Improved diet quality potentially lowers GWG in women with food security. However, in vulnerable populations, including women with food insecurity, improvements in diet quality may not effectively enhance GWG.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140327558","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":"Research and Professional Literature to Inform Practice, March/April 2024","authors":"Amy Alspaugh CNM, PhD, MSN","doi":"10.1111/jmwh.13629","DOIUrl":"https://doi.org/10.1111/jmwh.13629","url":null,"abstract":"","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13629","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140351580","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":"Systematic Reviews to Inform Practice, March/April 2024","authors":"Nena R. Harris CNM, PhD, FNP-BC, CNE","doi":"10.1111/jmwh.13632","DOIUrl":"10.1111/jmwh.13632","url":null,"abstract":"","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140327559","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":"Celebrating Midwifery Globally: Intangible Cultural Heritage","authors":"Melissa D. Avery CNM, PhD","doi":"10.1111/jmwh.13633","DOIUrl":"10.1111/jmwh.13633","url":null,"abstract":"<p>In October 2023, and formally presented at their 18th meeting in December 2023, the Intergovernmental Committee for the Safeguarding of Intangible Cultural Heritage announced that <i>Midwifery: Knowledge, Skills and Practices</i> was selected to be included in the United Nations Educational, Scientific and Cultural Organization (UNESCO) <i>List of the Intangible Cultural Heritage of Humanity</i>. Selection of the practice and profession of midwifery is a profound honor and an important recognition of our profession.</p><p>UNESCO grew out of the First and Second World Wars, which occurred between 1917 and 1948.<span>¹</span> European countries gathered and began looking for a way to promote peace globally following wars related to racism and anti-Semitism. They were later joined by the United States and many other countries.<span>¹</span> UNESCO is an organization of the United Nations that aims to promote peace and understanding through education and culture by sharing knowledge and ideas around the world. Much more information about the history and ongoing activities of UNESCO can be found on their website. Readers may be more familiar with other UNESCO designations such as World Heritage sites, biosphere reserves, and Global Geoparks.</p><p>Cultural heritage is viewed as much more than monuments and items that can be placed on a museum shelf. It includes cultural traditions that have a history and context and are passed from previous to current and future generations. Cultural heritage may include art, oral traditions, social traditions, knowledge about creating traditional crafts, among other categories. These traditions are based in community.<span>³</span> Midwifery is deeply based in community-based cultural traditions that differ country to country yet share a common language. Likewise, midwifery has been expressed in written and oral formats, visual arts, media, formal media programming (think <i>Call the Midwife</i>), music, poetry, and so much more. Midwifery is also based on a deep tradition of knowledge and skills, as well as the best scientific evidence.</p><p>The nomination of midwifery as intangible cultural heritage was developed by 8 countries: Colombia, Cyprus, Germany, Kyrgyzstan, Luxembourg, Nigeria, Slovenia, and Togo. The nomination process included providing descriptive information about midwifery, evidence of consent from the concerned communities, a description of the inventory of the specific intangible cultural heritage, in this case, the midwifery profession, as well as photographs and a video. Interested readers may review item 8.b.26, titled <i>Midwifery: Knowledge, Skills and Practices</i>, from the December 2023 meeting agenda.<span>⁴</span></p><p>The beautiful film produced by the midwives in the 8 countries making the nomination, <i>The Midwife</i>, is available to midwives and others around the world on Vimeo (https://vimeo.com/432611607). It is a beautiful and time","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13633","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140308411","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":"Maintaining A Long-Term Practice of Daily Pelvic Floor Muscle Exercises: What Do Childbearing Women Think?","authors":"Susan M. Yount-Tavener CNM(Ret), PhD, WHNP,&nbsp;Rebecca A. Fay CNM, DNP, WHNP-BC, CNE","doi":"10.1111/jmwh.13626","DOIUrl":"10.1111/jmwh.13626","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>To be effective, pelvic floor muscle therapy (PFMT) exercises should be intense, be practiced consistently, and include clinical support. Many women do not adhere to a consistent PFMT program, compromising the resolution or prevention of urinary incontinence (UI). This study aimed to answer 2 key questions: What prevents women from performing PFMT long term, and what can health care providers do to support women to perform them?</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Postpartum women from 4 sites in the United States completed a questionnaire about experiences with PFMT or Kegel exercises during and after pregnancy. This study focused on one of the 7 open-ended questions: What would prevent you from performing Kegels lifelong? Thematic analysis was implemented via an inductive approach using Braun and Clarke's 6-phase process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three salient themes emerged that help explain factors that prevent women from adhering to a daily PFMT routine: (1) life gets in the way, (2) inadequate PFMT education and instruction, and (3) disconnect exists about long-term consequences. The sample included 368 participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The themes were congruent with the limited body of qualitative literature on experience with PFMT exercises. This study was able to identify areas of need in the US maternal health care system to help childbearing people adopt daily PFMT, such as (1) inadequate parental leave and childcare support, (2) no formalized education related to UI and PFMT and a lack of pelvic health promotion, (3) lacking prioritization of long-term PFMT, and (4) the need to dispel the acceptance that UI postbirth is normal. Health care providers should prioritize interactive education, emphasizing how to correctly perform PFMT and the importance and effectiveness of integrating clinical support. To adequately encompass pelvic floor health care and education up to one year postbirth, changes are needed to the US perinatal health care system, providing sufficient insurance reimbursement and parental social support programs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140195378","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":"The Role of Passive Descent and Epidural Analgesia in Outcomes Associated With Prolonged Pushing Among Nulliparous Individuals in Midwifery Care","authors":"Elise N. Erickson CNM, PhD,&nbsp;Sally R. Hersh CNM, DNP,&nbsp;Mariah R. Wharton CNM, DNP,&nbsp;Marit L. Bovbjerg PhD,&nbsp;Ellen L. Tilden CNM, PhD","doi":"10.1111/jmwh.13624","DOIUrl":"10.1111/jmwh.13624","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Efforts to reduce primary cesarean birth may include supporting longer second stages of labor. Although midwifery-led care is associated with lower cesarean use, little has been published on associated outcomes of prolonged second stage (≥3 hours of pushing) for nulliparous individuals in US hospital-based midwifery care. Epidural analgesia and the role of passive descent in midwifery-led care are also underexplored in relation to the second stage. In this study, we report the incidence of prolonged second stage stratified by epidural analgesia and/or passive descent. Secondary aims included calculating the odds of cesarean birth, obstetric anal sphincter injury (OASI), postpartum hemorrhage (PPH), and neonatal complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were collected prospectively from a single academic center in the United States from 2012 through 2019. Our cohort analysis of labors attended by midwives for nulliparous, term, singleton, and vertex pregnancies included both descriptive and inferential statistics comparing outcomes between prolonged versus nonprolonged pushing groups. We stratified the sample and quantified second stage outcomes by epidural analgesia and by use of passive descent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1465 births, 17% (n = 247) included prolonged pushing. Cesarean ranged from 2.2% without prolonged pushing to 26.7% with prolonged pushing. Fetal malposition, epidural analgesia, and longer passive descent were more common among those with prolonged active pushing. Despite these factors, neither odds for PPH nor poor neonatal outcomes were associated with prolonged pushing. Those with more than one hour of passive descent in the second stage who also had prolonged active pushing had lower odds for cesarean but higher odds for OASI relative to those who had little passive descent before pushing for more than 3 hours.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Prolonged pushing occurred in nearly 2 of 10 nulliparous labors. Fetal malposition, epidural analgesia, and prolonged pushing were commonly observed with longer passive descent, cesarean, and OASI. Passive descent in these data likely reflects individualized midwifery care strategies when pushing was complicated by fetal malposition or other complexities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140178371","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}