Journal of midwifery & women's health最新文献

{"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":"69 4","pages":"567-576"},"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":"69 4","pages":"499-513"},"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}

{"title":"Improving Equitable Postpartum Care in an Urban Private Clinic with Predominantly Black Patients","authors":"Yannique Tello DNP, APRN, CNM, WHNP-BC, RN,&nbsp;Kristin A. Gianelis DNP, APRN, ANP-BC, WHNP-BC","doi":"10.1111/jmwh.13627","DOIUrl":"10.1111/jmwh.13627","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Maternal health disparities based on race, ethnicity, and socioeconomic factors exist in the United States, with Black women experiencing significantly worse outcomes. With much of perinatal morbidity and mortality attributed to the postpartum period, attention to equitable postpartum care is necessary for addressing this disparity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Process</h3>\u0000 \u0000 <p>A rapid-cycle quality improvement initiative was implemented in an urban clinic serving predominantly Black, Medicaid-insured clients. Although baseline data indicated 95% of clients experienced comorbidities, only 65% attended a comprehensive postpartum visit (PPV). The project's goal was to improve equitable postpartum care by increasing PPV attendance and quality of postpartum care to 90% in 8 weeks. The clinical team was engaged throughout to promote organizational change within the clinic. A provider checklist was implemented to improve PPV care metrics, and shared decision-making was initiated surrounding contraception and mood disorders. A care log tracked clinical practice guideline adherence with regular feedback informing the change process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Outcomes</h3>\u0000 \u0000 <p>Postpartum care improved across a variety of factors studied over 8 weeks. The provider checklist prompted a 78% documentation rate of PPV care metrics, and care log tracking reflected an ending PPV attendance rate of 93%. Client satisfaction with postpartum care education was measured using a Likert scale of 1 to 5 (1 = dissatisfied and 5 = satisfied) with a noted improvement from a baseline score of 4.3 to an overall mean of 4.8.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This quality initiative addressed a key factor in health equity for a predominantly Black, Medicaid-insured population in an urban clinic by raising PPV attendance rates above national standards of 90% and improving client satisfaction and the quality of care received during these visits. The project was low cost and created sustainable systems for maintaining evidence-based equitable care. Limitations included the coronavirus disease 19 pandemic, clinic staff turnover, and staff and client biases. Continued innovative research targeted at improving health equity is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 5","pages":"784-789"},"PeriodicalIF":2.1,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140168437","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":"Implicit and Explicit Weight Bias among Midwives: Variations Across Demographic Characteristics","authors":"Heather M. Bradford CNM, PhD,&nbsp;Rebecca M. Puhl PhD,&nbsp;Julia C. Phillippi CNM, PhD,&nbsp;Mary S. Dietrich PhD, MS,&nbsp;Jeremy L. Neal CNM, PhD","doi":"10.1111/jmwh.13616","DOIUrl":"10.1111/jmwh.13616","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Weight bias toward individuals with higher body weights is present in health care settings. However, there has been limited quantitative exploration into weight bias among perinatal care providers and its potential variations based on demographic characteristics. The aim of this study was to examine if the direction and extent of weight bias among midwives certified by the American Midwifery Certification Board (AMCB) varied across age, years since certification, body mass index (BMI), race, ethnicity, and US geographic region.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Through direct email listservs, postcard distribution, social media accounts, and professional networks, midwives were invited to complete an online survey of their implicit weight bias (using the Implicit Association Test) and their explicit weight bias using the Anti-Fat Attitudes Questionnaire (AFA), Fat Phobia Scale (FPS), and Preference for Thin People (PTP) measure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2106 midwives who identified as Black or White and resided in one of 4 US geographic regions participated in the survey. Midwives with a lower BMI expressed higher levels of implicit (<i>P</i> &lt;.01) and explicit (<i>P</i> ≤.01) weight bias across all 4 measures except for the AFA Fear of Fat Subscale. Implicit weight bias levels also varied by age (<i>P</i> &lt;.001) and years since certification (<i>P</i> &lt;.001), with lower levels among younger midwives (vs older) and those with fewer years (vs more) since certification. Only age and BMI remained significant (<i>P</i> &lt;.001) after adjusting for other demographic characteristics. Lower explicit weight bias levels were found among midwives who identified as Black (vs White) on 2 measures (FPS: adjusted β = −0.07, <i>P</i> = .004; PTP: <i>P</i> = .01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This was the first quantitative study of how weight bias varies across demographic characteristics among a national sample of midwives. Further exploration is needed in more diverse samples. In addition, research to determine whether weight bias influences clinical decision-making and quality of care is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 3","pages":"342-352"},"PeriodicalIF":2.7,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13616","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133575","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":"Breastfeeding, Chestfeeding, and Lactating Parents’ Experiences With Online Support Groups: An Integrative Review","authors":"Haley K. Reicher BSN, RN,&nbsp;Diane L. Spatz PhD, RN-BC","doi":"10.1111/jmwh.13618","DOIUrl":"10.1111/jmwh.13618","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The aim of this integrative review is to understand (1) how parents in specific populations engage with online breastfeeding, chestfeeding, or lactation support groups, (2) how these support groups influence extended breastfeeding duration and other outcomes, and (3) whether the use of support groups by these specific populations has changed since the start of the COVID-19 pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Of the articles identified across 4 electronic databases, 10 studies met the inclusion criteria; they were published between 2013 and 2023, written in English, and focused on the use of online peer support groups for breastfeeding, chestfeeding, and lactation support in specific populations. Eight of these studies are qualitative, 1 is a randomized controlled trial, and 1 is mixed methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight themes were identified: (1) overcoming lack of real world support, (2) normalization, (3) practical support, (4) emotional support and shared experiences, (5) building a bridge to in-person relationships, (6) reciprocity and activism, (7) self-efficacy and outcomes, and (8) issues with online support groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Specific subpopulations of breastfeeding, chestfeeding, and lactating parents and their partners found comfort in online support groups because they normalized more unique feeding practices and offered a space to provide and receive encouragement. Additionally, this review includes fathers/partners as a previously ignored subpopulation who benefit from education and support with breastfeeding, chestfeeding, and lactation. This subpopulation is also an area for expanded research on the use of online support groups by partners of lactating parents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 4","pages":"531-542"},"PeriodicalIF":2.1,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121695","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":"Telemedicine for Routine Prenatal Care: Use and Satisfaction During the COVID-19 Pandemic","authors":"Katrina K. Wu CNM, PhD,&nbsp;Julia Phillippi CNM, PhD,&nbsp;Martina Mueller PhD,&nbsp;Cristina Lopez PhD,&nbsp;Michelle Nichols PhD, RN","doi":"10.1111/jmwh.13621","DOIUrl":"10.1111/jmwh.13621","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Telemedicine use in prenatal care has greatly expanded without substantial research. Optimizing user experiences can increase telemedicine's utilization to support care access. The purpose of this study was to explore patient and provider experiences using telemedicine for routine prenatal care during the COVID-19 pandemic, identifying factors affecting its utilization and satisfaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this mixed methods study, online surveys and semi-structured interviews with pregnant and postpartum patients and perinatal providers across the United States were used to explore experiences with telemedicine and prenatal care during the COVID-19 pandemic. Data were collected from July to December 2021. Survey findings were analyzed using descriptive and inferential statistics, and interviews were thematically coded and analyzed, followed by mixed methods analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Results of 946 surveys (750 patients and 196 providers) and 30 interviews (15 patients and 15 providers) met inclusion for analysis. Telemedicine was utilized by 42% of patients and 72% of perinatal provider participants. The primary reason patients did not use telemedicine was because it was not offered. Patients and providers who did not use telemedicine expressed the following main concerns with virtual care: uncertainty about care quality, particularly when blood pressure and the fetal heart rate were not assessed, and potential challenges with developing trusting patient-provider relationships. Patients and providers who used telemedicine rated their experience as mild to moderate satisfaction across the 6 Telehealth Usability Questionnaire domains. Satisfaction scores were not dependent on whether physical examination components were included in virtual visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Providing patients with the choice to use telemedicine as needed or combined with in-person visits for routine prenatal care may increase care utilization. Although not directly linked with satisfaction, interest in using telemedicine would likely increase for patients and providers concerned with care quality if blood pressure and fetal heart rate are assessed during virtual visits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 4","pages":"469-478"},"PeriodicalIF":2.1,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140112504","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 Effects of Transcutaneous Electrical Nerve Stimulation Applied in the Early Postpartum Period After Cesarean Birth on Healing, Pain, and Comfort","authors":"Esra Sabancı Baransel PhD,&nbsp;Sümeyye Barut PhD,&nbsp;Tuba Uçar PhD","doi":"10.1111/jmwh.13625","DOIUrl":"10.1111/jmwh.13625","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This study was conducted to determine the effects of transcutaneous electrical nerve stimulation (TENS) applied in the early postpartum period after cesarean birth on incision site healing, postoperative recovery, pain, and comfort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This randomized, single-blind, placebo-controlled study was conducted with 138 women (TENS group n = 46, placebo group n = 46, control group n = 46) who gave birth by cesarean between January and September 2023. TENS was applied twice at a frequency of 100 Hz with a pulse width of 100 microseconds, at 10 to 12 and 14 to 16 hours after birth, for 30 minutes each. Outcomes were measured with the Postoperative Recovery Index; Redness, Edema, Ecchymosis, Discharge, and Approximation Scale; Visual Analogue Scale; and Postpartum Comfort Questionnaire. Outcomes between groups were compared postintervention, correcting for baseline using analysis of covariance. The study was registered at www.clinicaltrials.gov (NCT05991921).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean scores for postoperative recovery were significantly lower (improved) in the TENS group (113.58) compared with the placebo and control groups (134.67, 136.61; <i>P</i> &lt; .001). The postoperative recovery subscales (psychological symptoms, physical activities, appetite symptoms, bowel symptoms, general symptoms) were also significantly decreased in the TENS group compared with the placebo and control groups. Similarly, mean scores for postpartum comfort, and the corresponding physical comfort, psychospiritual comfort, and sociocultural comfort subscales, were significantly improved in the TENS group (110.26) compared with the placebo and control group (83.80, 81.19; <i>P</i> &lt; .05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>TENS application can be preferred as an alternative method to increase pain control, recovery, and patient comfort after cesarean birth.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 5","pages":"681-688"},"PeriodicalIF":2.1,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13625","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140103084","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":"Organizational Engagement: One State's Experience With Invigorating Affiliate Membership and Building a Sustainable Fundraising Model","authors":"Lauren Narbey CNM, MSN, MSc, WHNP-BC,&nbsp;Rebecca Ingalls CNM, PhD, MSN, WHNP-BC, NCMP,&nbsp;Alice Cline CNM, MSN,&nbsp;Emily C. McGahey CNM, DM, MSN,&nbsp;Amanda Shafton CNM, DNP, MSN,&nbsp;Kim Amsley-Camp CNM, MHA, MSN","doi":"10.1111/jmwh.13623","DOIUrl":"10.1111/jmwh.13623","url":null,"abstract":"<p>Over the last 6 years, the Pennsylvania Affiliate of the American College of Nurse-Midwives has worked to meet the needs of its diverse membership and increase the capacity of the affiliate board by taking a series of strategic steps. This article details the key components of this journey, which has culminated in a successful annual conference with over $118,000 in net revenue to help meet affiliate goals, including pursuing midwifery modernization legislation for Pennsylvania and an increase in our affiliate membership by almost 100 individuals. The annual conference, <i>Midwifery Forward</i>, which completed its fifth year in 2023, has also given our community of midwives a yearly reason to gather and reconnect, celebrate accomplishments, welcome new graduates, and make plans for the year ahead. The goal of this article is to share the specifics of our strategic planning, so that other affiliates and organizations may benefit as they develop strategic plans in the larger effort to increase membership and engagement and generate sustainable income for their midwifery organizations.</p>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 4","pages":"593-599"},"PeriodicalIF":2.1,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140103083","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":"Weight Bias Among Certified Nurse-Midwives and Certified Midwives: Findings From a National Sample","authors":"Heather M. Bradford CNM, PhD,&nbsp;Rebecca M. Puhl PhD,&nbsp;Julia C. Phillippi CNM, PhD,&nbsp;Mary S. Dietrich PhD, MS,&nbsp;Jeremy L. Neal CNM, PhD","doi":"10.1111/jmwh.13608","DOIUrl":"10.1111/jmwh.13608","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Weight bias toward individuals with higher body weights permeates health care settings in the United States and has been associated with poor weight-related communication and quality of care as well as adverse health outcomes. However, there has been limited quantitative investigation into weight bias among perinatal care providers. Certified nurse-midwives (CNMs)/certified midwives (CMs) attend approximately 11% of all births in the United States. The aims of this study were to measure the direction and extent of weight bias among CNMs/CMs and compare their levels of weight bias to the US public and other health professionals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Through direct postcard distribution, social media accounts, professional networks, and email listservs, American Midwifery Certification Board (AMCB)-certified midwives were solicited to complete an online survey of their implicit weight bias using the Implicit Association Test and their explicit weight bias using the Antifat Attitudes Questionnaire, Fat Phobia Scale, and Preference for Thin People measure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2257 midwives participated in the survey, yielding a completion rate of 17.7%. Participants were mostly White and female, with a median age of 46 years and 11 years since AMCB certification. More than 70% of midwives have some level of implicit weight bias, although to a lesser extent compared with previously published findings among the US public (<i>P</i> &lt; .01) and other health professionals (<i>P</i> &lt; .01). In a subsample comparison of female midwives to female physicians, implicit weight bias levels were similar (<i>P</i> &gt; .05). Midwives also express explicit weight bias, but at lower levels than the US public and other health professionals (<i>P</i> &lt; .05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This study provides the first quantitative research documenting weight bias among a national US sample of perinatal care providers. Findings can inform educational efforts to mitigate weight bias in the perinatal care setting and decrease harm.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 3","pages":"333-341"},"PeriodicalIF":2.7,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13608","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140066352","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 Impact of Military Trauma Exposures on Servicewomen's Pregnancy Outcomes: A Scoping Review","authors":"MAJ Laura L. Manzo MSN, MBA, BSN, CCRN,&nbsp;MAJ Rebeccah A. Dindinger DNP, RNC-OB, IBCLC,&nbsp;Janene Batten EdD, MLS,&nbsp;Joan L. Combellick CNM, PhD, MPH, MSN,&nbsp;Bridget Basile-Ibrahim PhD, MA, RN, FNP-BC","doi":"10.1111/jmwh.13620","DOIUrl":"10.1111/jmwh.13620","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Active-duty servicewomen and veterans make up nearly 20% of the United States military and may experience trauma specific to military service. Military-specific trauma includes combat deployment and military sexual trauma, exposure to which may result in posttraumatic stress disorder (PTSD). The purpose of this scoping review is to examine the extent to which military trauma exposures impact the pregnancy outcomes of active-duty servicewomen and women veterans.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of OVID MEDLINE, OVID Embase, and OVID PsycINFO from inception to September 25, 2023, identified studies examining associations between military trauma exposures and perinatal outcomes. Of the 614 studies identified, 464 were reviewed for relevance, with 16 meeting inclusion criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 16 included studies, 14 found associations between military trauma exposure and adverse pregnancy outcomes including preterm birth, gestational diabetes, hypertensive disorders of pregnancy, low birth weight, and perinatal mood and anxiety disorders. The risks of adverse pregnancy outcomes increased with the severity of PTSD, the recency of combat deployment, and repetitive deployment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This scoping review strengthens the link between trauma exposures and adverse pregnancy outcomes for current and former military servicewomen. A gap in the literature persists regarding trauma exposure among active-duty servicewomen, which differs significantly from women veterans. As mental health conditions are the leading underlying cause of maternal mortality, standardized screening during the perinatal period for military-specific trauma exposures and PTSD is recommended for this population. Black servicewomen of junior enlisted rank carry disproportionate burdens of PTSD diagnosis and adverse pregnancy outcomes. Comprehensive prenatal and postpartum management may improve perinatal and neonatal outcomes for military servicewomen and provide an innovative approach to reducing existing racial disparities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 5","pages":"634-646"},"PeriodicalIF":2.1,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934910","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}