Journal of midwifery & women's health最新文献

{"title":"Respectful Maternity Care in the United States: A Scoping Review of the Research and Birthing People's Experiences","authors":"Morgan Richardson Cayama MPH,&nbsp;Cheryl A. Vamos PhD, MPH,&nbsp;Nicole L. Harris MA,&nbsp;Rachel G. Logan PhD, MPH,&nbsp;Allison Howard MLIS,&nbsp;Ellen M. Daley PhD, MPH","doi":"10.1111/jmwh.13729","DOIUrl":"10.1111/jmwh.13729","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Birthing people around the world experience mistreatment during labor and birth, contributing to adverse maternal health outcomes. The adoption of respectful maternity care (RMC) has been recommended to address this mistreatment and improve care quality. Most RMC and mistreatment research has been conducted internationally. The purpose of this scoping review was to (1) explore the extent of RMC research and (2) describe labor and birth experiences in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Embase, Scopus, and CINAHL databases were searched for concepts relating to RMC and mistreatment. A total of 66 studies met review inclusion criteria. Two reviewers screened titles, abstracts, and full-text articles. Data were extracted and categorized using the Bohren et al typology of mistreatment. Summary statistics and narrative summaries were used to describe study characteristics and birthing people's experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most studies represented national or urban samples and Western or Northeastern US regions. Few were from the South, and only one represented rural participants specifically. Few studies represented the unique experiences of justice-involved birthing people, and none represented sexual and gender minorities or Indigenous people. Qualitative methods were predominant. The most common forms of mistreatment included (1) poor rapport between women and health care providers (88% of studies), (2) stigma and discrimination (79%), and (3) a failure to meet professional standards of care (73%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The extent of mistreatment in the United States highlights the need for robust programs and policies targeting provision of RMC. Additional research is needed to better understand the experiences of additional minority communities and those living rural areas and in the Southern United States.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 2","pages":"212-222"},"PeriodicalIF":2.1,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13729","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985844","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":"Financial Barriers to Expanded Birth Center Access in New Jersey: A Qualitative Thematic Analysis","authors":"Rebecca H. Ofrane DrPH,&nbsp;Slawa Rokicki PhD,&nbsp;Leslie Kantor PhD,&nbsp;Julie Blumenfeld CNM, DNP","doi":"10.1111/jmwh.13732","DOIUrl":"10.1111/jmwh.13732","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Birth centers are an underused care setting with potential to improve birth experience and satisfaction. Both hospital-based and freestanding birth centers operate with the midwifery model of care that focuses on safe, low-intervention physiologic birth experiences for healthy, low-risk pregnant people. However, financial barriers limit freestanding birth center sustainability and accessibility in New Jersey, especially for traditionally marginalized populations. This qualitative study explores the financial barriers faced by freestanding birth centers in order to expand access and choice for pregnant people in New Jersey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Semistructured interviews were conducted with participants from 4 sectors: (1) birth center or health system, (2) policy-adjacent philanthropy or research, (3) state departments, and (4) health insurance. Coding and analysis followed a reflexive thematic analysis process, resulting in the identification of 4 financial barriers to birth center access.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Facility Medicaid reimbursement rates are a primary barrier for birth centers, along with startup and operating costs and, more indirectly, low supply of midwives and low patient demand for birth center care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>New Jersey is well-positioned to enact critical policies and programs that can improve out-of-hospital birth center access, based on the findings and recommendations from this research. Other states can follow suit in pursuit of solutions to improve maternal health access and equitable birth center sustainability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 3","pages":"494-501"},"PeriodicalIF":2.1,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13732","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960778","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":"Proactive Management of Lactation in the Birth Hospital to Ensure Long-Term Milk Production and Sustainable Breastfeeding","authors":"Diane L. Spatz PhD, RN-BC, FAWHONN,&nbsp;Salomé Álvarez Rodríguez RM, BSc, MSc,&nbsp;Sarah Benjilany RM, IBCLC, MSc,&nbsp;Barbara Finderle RM, MSc, IBCLC,&nbsp;Aleyd von Gartzen RM, BSc, IBCLC,&nbsp;Ann Yates RN, RM,&nbsp;Jessica Brumley CNM, PhD","doi":"10.1111/jmwh.13726","DOIUrl":"10.1111/jmwh.13726","url":null,"abstract":"<p>Individuals who are at risk of not achieving a full milk supply are often overlooked in scientific literature. There is available guidance to help establish an adequate milk supply for healthy individuals experiencing a physiologic labor and birth, and there are robust recommendations for the lactating parents of small, sick, and preterm newborns to ensure that these newborns can receive human milk. Missing from the literature are clinical practice guidelines that address the preexisting health, pregnancy, birth, or newborn-related risk factors for suboptimal lactation. This can include risk factors that impact secretory activation or newborns who may not attach and suckle effectively to provide the stimulation and removal necessary to reach full milk volume. Secretory activation can only occur after the birth of the newborn and the placenta, with milk volume being established during the first weeks of breastfeeding. Recognizing this gap, over the past 2 years, an international group of midwives led by a doctoral nurse scientist in lactation conducted an extensive literature review to identify the most significant risk factors that can disrupt normal physiologic lactation. Our group sought to establish proactive lactation management strategies to ensure long-term milk production. We developed an evidence-based perinatal operational breastfeeding plan alongside clinical pathways to guide health care professionals in assessment, care, and necessary education for families who present with risk. Our goal is for midwives and other health care professionals to integrate the perinatal operational breastfeeding plan into practice and use these pathways to ensure (1) timely and effective secretory activation, (2) building a milk supply as robust as feasible for personal situations and conditions, (3) more newborns receiving more human milk and (4) more families achieving their personal breastfeeding goals.</p>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 2","pages":"343-349"},"PeriodicalIF":2.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13726","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899924","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":"Defining Midwifery-Led Care in the United States Using Concept Analysis","authors":"Katie Page CNM, MSN,&nbsp;Julia Phillippi CNM, PhD,&nbsp;Cathy L. Emeis CNM, PhD,&nbsp;Allison Cummins RM, PhD,&nbsp;Brie Thumm CNM, PhD, MBA","doi":"10.1111/jmwh.13727","DOIUrl":"10.1111/jmwh.13727","url":null,"abstract":"<p>National health policy initiatives recommend increased integration of midwifery care in the United States to improve care quality and reduce maternal health disparities. However, the service models through which midwives provide midwifery care and produce quality outcomes are poorly understood. Midwifery-led care is a service model frequently associated with improved outcomes compared with other models. The service model has been infrequently or inconsistently studied in the Unites States and has been narrowly defined and applied to perinatal care. The purpose of this concept analysis was to evaluate the concept of midwifery-led care and expand the definition to guide midwifery practice, research, and health policy. The analysis followed Walker and Avant's methodology. Three attributes of midwifery-led care were identified: (1) midwife as the lead clinician; (2) person-midwife partnership; and (3) care embodies midwifery philosophy. Antecedents were (1) license to practice as a midwife; (2) a person needing or desiring sexual, reproductive, perinatal, or newborn care; (3) a person with low- or moderate-risk health status; (4) regulations and guidelines that support provision of midwifery care; and (5) reimbursement for services. Consequences of midwifery-led care included (1) improved maternal and neonatal outcomes, (2) patient satisfaction, and (3) reduced health care costs. The presented expanded definition of midwifery-led care is the first to use a systems level approach and explicitly center the person receiving care and the philosophical approach of midwifery care. Application of this definition is needed in theoretical and pragmatic research to classify midwifery-led care and other service models and compare patient- and organization-level outcomes.</p>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 2","pages":"223-234"},"PeriodicalIF":2.1,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13727","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901476","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":"Perceptions of Coping With Breastfeeding Pain: A Secondary Analysis","authors":"Megan Russell BSN, RN,&nbsp;Ruth Lucas PhD, RNC, CLS,&nbsp;Katherine Bernier Carney PhD, RN","doi":"10.1111/jmwh.13723","DOIUrl":"10.1111/jmwh.13723","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although there are many known benefits of providing human milk to infants, breastfeeding-related pain is a significant reason for breastfeeding cessation. Breastfeeding-related pain is a unique experience due to breastfeeding's goal-directed purpose, repetitive nature, and socio-emotional reflections of successful parenting. Understanding how lactating parents cope with breastfeeding-related pain will inform clinical practice to encourage individuals to meet their lactation goals. The aim of this study was to evaluate how lactating parents view coping with breastfeeding-related pain to be different from coping with other types of pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a secondary analysis of a pilot randomized control study of a breastfeeding pain self-management intervention. Data from 57 participants who breastfed and completed self-report surveys at 1, 2, and 6 weeks postpartum were included. We employed Boyatzis’ thematic analysis method to evaluate affirmative responses to “Is coping with breastfeeding pain different than coping with other pain?” We evaluated correlations between responses to coping with breastfeeding pain and pain severity scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 3 main themes: (1) uncharted waters, (2) light at the end of the tunnel, and (3) parental role and responsibility. No significant differences were detected between the pain scores of individuals who viewed coping with breastfeeding to be different and those who did not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Lactating parents reported an array of psychological coping strategies in response to breastfeeding-related pain. Coping processes were influenced by personal goals, parental role evaluations, and a desire to meet their infant's needs. Interventions during prenatal and postpartum care that incorporate individualized coping strategies could support breastfeeding goal attainment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 2","pages":"315-324"},"PeriodicalIF":2.1,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13723","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848705","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":"Unplanned Cesarean for Abnormal or Indeterminate Fetal Heart Tracing Varies Significantly by Race and Ethnicity","authors":"Elizabeth Langen MD,&nbsp;Althea Bourdeau MPH,&nbsp;Jessi Ems RN, BSN,&nbsp;Eliza Wilson-Powers MA,&nbsp;Lisa Kane Low CNM, PhD","doi":"10.1111/jmwh.13720","DOIUrl":"10.1111/jmwh.13720","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The US maternity care system achieves worse outcomes for birthing people identifying as Black versus White. Assessment of fetal well-being in labor is an area of perinatal care subject to significant interobserver variability and therefore may be at particular risk of medical racism influencing care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Statewide collaborative quality initiative data, focused on decreasing the nulliparous, term, singleton, vertex (NTSV) cesarean birth rate, were used to conduct a retrospective cohort study to assess differences in cesarean birth for nonreassuring fetal status between birthing people identifying as Black compared with White. Generalized linear mixed modeling with hospital as a random intercept was used for multivariate analyses accounting for birthing people clustering within hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between March 1, 2020, and December 31, 2022, 69,622 births were identified, 8291 (11.9%) of which were an unplanned cesarean with a primary indication of nonreassuring fetal heart tracing (cesarean for FHT). Race and ethnicity were significantly associated with a higher risk, after controlling for covariates: compared with White birthing people, birthing people of unknown race or ethnicity had 1.23 (95% CI 1.13-1.35) and Asian Pacific Islander birthing people had 1.55 times the odds (95% CI 1.37-1.76), whereas Black birthing people had 1.71 times the odds (95% CI 1.59-1.83) of birthing via unplanned cesarean for FHT. In adjusted analysis, prepregnancy diabetes, positive COVID-19 status at admission, elevated body mass index, and birthing in the Detroit Metro area were associated with cesarean for FHT. In an unplanned subgroup analysis of births within the Detroit Metro region, Black individuals remained significantly more likely to have an unplanned cesarean for FHT (aOR 1.63, 95% CI 1.48-1.79).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>After controlling for individual and hospital-level factors, cesarean for FHT was more common among non-Hispanic Black vs non-Hispanic White birthing people in this statewide cohort of NTSV births.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 2","pages":"279-291"},"PeriodicalIF":2.1,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13720","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848706","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":"Factors Associated With First-Trimester Prenatal Care Initiation In The United States: A Scoping Review","authors":"Melissa B. Eggen PhD, MPH,&nbsp;Dani LaPreze MLS, MS,&nbsp;Seyed Karimi PhD,&nbsp;Liza Creel PhD, MPH,&nbsp;Bertis Little PhD,&nbsp;Bridget Basile Ibrahim PhD, MA, RN, FNP-BC","doi":"10.1111/jmwh.13724","DOIUrl":"10.1111/jmwh.13724","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>First-trimester prenatal care is an important component of quality care during pregnancy and is associated with improved perinatal outcomes. Despite its importance, many pregnant people delay prenatal care initiation or receive no prenatal care. This scoping review assessed multilevel factors associated with first-trimester prenatal care initiation in the United States among studies that included a measure of prenatal care timing, using the socioecological model as an organizing framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A scoping review was conducted according to the Joanna Briggs Institute methodology for scoping reviews and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines for reporting. PubMed, Cochrane, Embase, CINAHL, and Social Sciences Abstracts were searched for peer-reviewed papers that focused on facilitators and barriers associated with first-trimester prenatal care initiation, were written in English, included a measure of prenatal care timing, and used data gathered after 2014.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1469 articles identified in the search, 19 met inclusion criteria and were included in the final review. Articles described intrapersonal, interpersonal, and environmental-level barriers and facilitators of first-trimester prenatal care initiation including Medicaid expansion, immigration status, and the COVID-19 pandemic. Significant heterogeneity in the measurement of prenatal care timing existed across studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our findings suggest that, although environmental domain factors have been impactful toward increasing population-level rates of first-trimester prenatal care initiation, benefits have not been equitable across sociodemographic factors. Increasing the proportion of pregnant people who initiate first-trimester prenatal care will require comprehensive efforts that address sociodemographic and contextual factors, including persistent structural and systemic barriers that cause and widen health disparities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 2","pages":"259-269"},"PeriodicalIF":2.1,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13724","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831528","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":"Supporting Labor After 2 Cesarean Births","authors":"Bridget Forte RN, BSN,&nbsp;Stephanie Welsh CNM, DNP, MSN,&nbsp;Jenna A. LoGiudice CNM, PhD, RN","doi":"10.1111/jmwh.13721","DOIUrl":"10.1111/jmwh.13721","url":null,"abstract":"<p>Labor after cesarean (LAC) is a safe alternative for pregnant persons who have had 1 or 2 previous cesarean births (CBs) and have no contraindication to vaginal birth. When compared with repeat CB, vaginal birth after cesarean (VBAC) reduces short- and long-term health complications and morbidity and should therefore be presented as an option. Despite recommendations from the American College of Nurse-Midwives and the American College of Obstetricians and Gynecologists in support of LAC, not all pregnant persons who are candidates have access to this option. In some areas, provider hesitancy and institutional guidelines limit the availability of LAC, especially after more than one CB. Midwives are uniquely positioned to advocate for this birthing option through the use of shared decision-making. In the antepartum period, birth decision aids, VBAC calculators, and continued dialogue allows for pregnant persons to make informed choices meeting their unique health needs and goals. This clinical rounds article highlights the safety of labor in a pregnant person with a history of 2 prior CBs. As presented in this case, when LAC includes the need for induction of labor, the use of a transcervical balloon catheter for cervical ripening and judicious use of oxytocin are safe, evidence-based options. Ultimately, LAC can offer pregnant persons an increased sense of autonomy and control over their labor and birth, which improve both satisfaction and outcomes, consistent with the family- and person-centered hallmarks of midwifery care.</p>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 2","pages":"350-355"},"PeriodicalIF":2.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13721","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815405","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":"Mandala as a New Intervention for Reducing Fear of Childbirth: A Randomized Controlled Trial","authors":"Tuğba Topcu MSc,&nbsp;Fadime Bayri Bingöl PhD","doi":"10.1111/jmwh.13722","DOIUrl":"10.1111/jmwh.13722","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Fear of childbirth is common in nulliparous women. More accessible and less costly interventions such as mandala are needed to reduce fear of childbirth. The purpose of this study was to test the efficacy of mandala coloring added to antenatal education to reduce fear of childbirth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An open, randomized controlled trial with a parallel group design was conducted at a tertiary care hospital in Turkey (ClinicalTrials.gov registration NCT05217368). Nulliparous pregnant women without pregnancy complications, between 24 and 32 weeks’ gestation, and with increased fear of childbirth were included in the study. A total of 140 pregnant women were allocated to the intervention (mandala coloring plus antenatal education) and control (antenatal education alone) groups, and 100 participants completed the study. Fear before childbirth was measured with the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A at baseline and after completion of antenatal education with or without mandala coloring. Fear during childbirth was measured with the W-DEQ version B retrospectively within one week of giving birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, the intervention and control groups experienced similar fear of childbirth (57.1 vs 57.0; <i>P</i> = .978). After completing antenatal education, the mean fear of childbirth decreased more in the intervention group than in the control group (42.6 vs 50.1; <i>P</i> = .018). In the postpartum period, the intervention group reported less fear during childbirth than the intervention group (68.5 vs 58.0; <i>P</i> = .030). Perinatal outcomes were statistically similar between the 2 groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Adding mandala coloring to antenatal education significantly reduced fear of childbirth before and during birth. More studies examining the effects of mandala coloring on perinatal mental health should be conducted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 3","pages":"414-421"},"PeriodicalIF":2.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13722","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815402","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":"Preserving the Midwifery Model of Care on a High Acuity Labor and Delivery Unit: Midwives’ Perspectives Working in a US Tribal Health System","authors":"Anjali Madeira CNM, DNP, MPH,&nbsp;Kimberly Fleming CNM, MA/MSN, MPH,&nbsp;Megan Webb CNM,&nbsp;Heather Wheelock CNM, WHNP-BC","doi":"10.1111/jmwh.13716","DOIUrl":"10.1111/jmwh.13716","url":null,"abstract":"<p>Today nearly 9 out of 10 certified nurse-midwives/certified midwives (CNMs/CMs) attend births in hospitals. As the demand for hospital midwifery care has increased over the last quarter century, CNM/CMs' scope of practice has expanded to include care for high-risk patients. Hospital CNMs/CMs are faced with the challenge of balancing support for physiologic birth with an increasingly complex pregnant population cared for in a medicalized ecosystem. Varied perceptions of patient risk and unique philosophies of care can lead to complex discussions between midwives and physicians on the most appropriate care plan for patients. This article shares the experiences and successes of a hospital midwifery practice in the Alaska Native Tribal Health System and explores strategies for promoting the midwifery model of care (MMOC). Midwives in this Tribal Health System experience robust interprofessional collaboration and an organizational focus on patient-centered relationship-based care. Interprofessional collaboration is noted to be among the most critical elements for protecting a MMOC in a hospital setting. Although distinct from one another, the medical and midwifery models can be complementary in the care of high-risk patients, and the Indigenous concept of Two-Eyed Seeing is offered as an approach to integrating the 2 models of care to achieve optimal care for birthing people and their families.</p>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 2","pages":"336-342"},"PeriodicalIF":2.1,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13716","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796646","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}