Midwifery最新文献

{"title":"Associations of urinary incontinence with postpartum physical activity: A cross-sectional study","authors":"Lisa VanWiel ,&nbsp;Grace V. Conway ,&nbsp;Lucas J. Carr ,&nbsp;Jessica Gorzelitz ,&nbsp;William T. Story ,&nbsp;Kara M. Whitaker","doi":"10.1016/j.midw.2025.104535","DOIUrl":"10.1016/j.midw.2025.104535","url":null,"abstract":"<div><h3>Problem</h3><div>Postpartum women are largely insufficiently active and therefore, at risk for many adverse health outcomes.</div></div><div><h3>Background</h3><div>The 2018 Physical Activity Guidelines recommend postpartum women perform moderate-to-vigorous physical activity (MVPA) and muscle strengthening exercise (MSE) to promote overall health and reduce the risk of chronic diseases. Urinary incontinence (UI) is a barrier to physical activity in the general population, but postpartum women have not been represented in previous studies.</div></div><div><h3>Study Aim</h3><div>To determine the association of UI and its characteristics (presence, severity, type, and bother) with postpartum MVPA and MSE.</div></div><div><h3>Methods</h3><div>This cross-sectional study used electronic self-report questionnaires to assess UI, physical activity, and demographic characteristics. Multiple logistic regression assessed odds of meeting or not meeting postpartum physical activity guidelines. Multiple linear regression assessed associations of UI characteristics with weekly minutes of MVPA and MSE.</div></div><div><h3>Findings</h3><div>Nearly two-thirds (64 %) of 244 postpartum women (32.9 ± 4.4 years) had UI. No UI characteristic was associated with meeting or not meeting physical activity guidelines. Greater UI severity and mixed-type UI were, however, associated with lower weekly minutes of MVPA. Mixed and undefined type UI were associated with lower weekly minutes of MSE.</div></div><div><h3>Discussion</h3><div>Postpartum women with severe, mixed, or undefined UI may be at greater risk for low physical activity and associated health consequences. Additional research using a longitudinal study design and more diverse populations is recommended to confirm this association.</div></div><div><h3>Conclusion</h3><div>Postpartum women should be screened for UI and referred to healthcare professionals with expertise in UI and postpartum exercise prescription.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104535"},"PeriodicalIF":2.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of psychosocial screening tools for identification of postpartum mental health status beyond depressive symptoms","authors":"Kaitlyn K. Stanhope ,&nbsp;Joelle Galatan ,&nbsp;Amal Umerani ,&nbsp;Rehnuma Islam ,&nbsp;Abigail Powers ,&nbsp;Vasiliki Michopoulos ,&nbsp;Megan Lawley ,&nbsp;Sharon L. Leslie ,&nbsp;Shakira F Suglia","doi":"10.1016/j.midw.2025.104530","DOIUrl":"10.1016/j.midw.2025.104530","url":null,"abstract":"<div><h3>Background</h3><div>Mental health is a key driver of maternal health, particularly in the postpartum period. Psychiatric screening may improve linkage to care and outcomes. Limited evidence exists beyond screening for depression.</div></div><div><h3>Objective</h3><div>The goal of this systematic review was to characterize the effects of systematic psychiatric and psychosocial screening on the identification, referral for, and resolution of postpartum mental health symptoms beyond depressive symptoms.</div></div><div><h3>Methods</h3><div>We identified studies that screened for psychiatric or psychosocial symptoms during pregnancy or postpartum and assessed at least one result of the screening in the postpartum year (e.g., diagnosis, linkage to care, resolution of symptoms). We searched six bibliographic databases on October 25, 2022 and again on December 15, 2023. Results were screened using Covidence. Two reviewers assessed each title/abstract and full text. We conducted a quality assessment using a modified version of the EPHPP (Effective Public Health Practice Quality Assessment Tool for Quantitative Studies).</div></div><div><h3>Results</h3><div>Of 5758 initially eligible studies, we selected 47 which fit our criteria. The most common symptom type was anxiety (25), followed by life course trauma (7), general psychosocial screening (4), and posttraumatic stress disorder (6). Studies primarily assessed diagnostic accuracy, followed by referral to care as outcomes. We deemed most studies of low quality (80.8 %), primarily due to a lack of an unscreened control group for assessing screening effectiveness.</div></div><div><h3>Conclusions</h3><div>Postpartum screening is feasible and accurate for many psychiatric symptoms beyond depression. It is unclear whether it is effective in linking to care or improving postpartum outcomes.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104530"},"PeriodicalIF":2.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144665430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When postnatal debriefing silences women: A critique through the lens of set and setting","authors":"Orli Dahan ,&nbsp;Sapir Bar","doi":"10.1016/j.midw.2025.104522","DOIUrl":"10.1016/j.midw.2025.104522","url":null,"abstract":"<div><div>Postnatal debriefing is often framed as a therapeutic conversation that helps women make sense of their birth experience and prevent psychological distress. However, emerging research reveals that debriefing can have highly variable effects, particularly for women who experienced trauma. This commentary offers a theoretical critique of postnatal debriefing through the lens of \"set and setting,\" a framework adapted from consciousness studies. Drawing on a personal encounter and recent empirical studies, we argue that when debriefing focuses solely on women’s expectations (set) while ignoring the institutional and relational context of the birth (setting), it can become a form of subtle coercion. In some cases, it risks shifting responsibility for trauma away from systemic failures and onto the individual woman, thereby reinforcing dynamics of gaslighting and epistemic injustice. We propose that debriefing should not be viewed as a neutral or purely technical task, but as an ethically charged relational act. A set and setting-informed approach to postnatal debriefing may foster deeper validation, accountability, and healing. This critique invites a rethinking of who conducts debriefing, how it is done, and in what context—especially when the institution providing care is also the site of potential harm.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104522"},"PeriodicalIF":2.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traditional birth attendant training programs in low resource countries: an integrative literature review","authors":"Sara David ,&nbsp;Zoe Bradfield ,&nbsp;Yvonne Hauck ,&nbsp;Michelle A Kelly","doi":"10.1016/j.midw.2025.104532","DOIUrl":"10.1016/j.midw.2025.104532","url":null,"abstract":"<div><h3>Background</h3><div><strong>:</strong> Pregnant women continue to die from preventable causes, the greatest number in low-resource countries, where neglect of Traditional Birth Attendant [TBA] training is adversely affecting women with the least access to family planning or a Skilled Birth Attendant. Consideration for TBAs role to strengthen maternity care in low resource settings is recommended. The scope of the TBA role, appropriate training and supervision remains a challenge.</div></div><div><h3>Aim</h3><div><strong>:</strong> This integrative literature review analysed publications about TBA training programs in low-resource countries.</div></div><div><h3>Methods</h3><div><strong>:</strong> A search strategy was implemented incorporating a five-step framework utilising electronic databases. Twenty- five publications were reviewed. Four themes and eleven sub-themes were identified about “TBA training programs in low-resource countries”: (1) Variance in role of TBAs affecting training including subthemes of variance in role, scope and title of TBAs, appointment and remuneration, and articulation of TBA work; (2) Training influenced by where TBAs provide services including areas of high Maternal and Neonatal Mortality, and with low access to health; (3) Educational needs of TBAs, including lack of consensus around specific knowledge and skills, need for culturally appropriate educational needs assessment and importance of education about role of health facilities and referral process; (4) Training and teaching TBAs, including methods, cultural contexts and resources.</div></div><div><h3>Discussion</h3><div><strong>:</strong> There is global confusion about TBA’s role within maternity services in low-resource countries, including their title, scope of practice, remuneration, specific training needs and required clinical skills. Community engagement to ensure a culturally applicable role for TBAs, appropriate training information and materials is imperative to ensure sustainability and effectiveness. A gap in knowledge exists around measurable outcomes related to training programs. Recommendations are offered to incorporate TBAs into the maternity healthcare system for low resource settings.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104532"},"PeriodicalIF":2.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The process of implementation of OMGP: staff experiences of service change","authors":"Shelley A. Wilkinson ,&nbsp;Katie Day ,&nbsp;Naomi Homel ,&nbsp;Josephine Laurie","doi":"10.1016/j.midw.2025.104528","DOIUrl":"10.1016/j.midw.2025.104528","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;In 2023 our service introduced “OMGP”, the obstetric-medicine midwifery group practice model of care for women with complex medical care needs. OMGP is a collaborative, woman-centred model incorporating obstetrics, obstetric medicine, credentialled diabetes educators, and midwifery group practice.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Aim&lt;/h3&gt;&lt;div&gt;To qualitatively explore knowledge and expectation of staff prior to its adoption and at a year post-implementation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This study utilised profession-specific focus groups with OMGP staff (obstetricians, obstetric medicine physicians, credentialled diabetes educators, and midwifery group practice midwives) at baseline and 12 months post-implementation. Questions focused on understanding of and thoughts about the OMGP model of care, as well as important considerations for managing diabetes in pregnancy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;At baseline, the main theme relating to OMGP related to continuity of care. The main theme relating to how OMGP differs from usual models focused on enhanced benefits from interprofessional collaboration. Three themes existed around diabetes in pregnancy, including clinical knowledge, procedural concerns and professional boundaries. Initial expectations were broadly positive, acknowledging potential for scalability, but with caution regarding role clarity and adaption to change. A year following the model’s implementation, three themes were identified. These were: the benefits of a coordinated care delivery model, reflections and realisations, and embedding and strengthening, focusing on administrative/ procedural and systemic aspects of care delivery, highlighting areas for improvement and monitoring.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The insights of each professional group informed preparation for the launch of the model of care. Over time the model was successfully embedded, enhancing care coordination and delivery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Statement of significance&lt;/h3&gt;&lt;div&gt;&lt;strong&gt;Issue:&lt;/strong&gt; Women with complex medical needs during pregnancy often experience fragmented and medicalised care, potentially leading to worse outcomes and less satisfaction with care.&lt;/div&gt;&lt;div&gt;&lt;strong&gt;What is already known&lt;/strong&gt;: Continuity of midwifery care has been shown to improve birth outcomes and satisfaction with care for women. However, most evidence of the benefits of continuity of care exists for low to medium-risk cohorts, presenting a barrier to implementation of this model of care for higher medical risk women.&lt;/div&gt;&lt;div&gt;&lt;strong&gt;What this paper adds:&lt;/strong&gt; This qualitative exploration of staff’s expectations and experience prior to and following the introduction of a collaborative, women focussed model of care for women at high medical risk. It revealed how, despite concerns regarding roles, processes, and clinical considerations, a shared goal of continuity of care and respect for interprofessional collaboration, str","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104528"},"PeriodicalIF":2.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144656824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of low birth weight among newborns of women from a Middle Eastern Country: a retrospective case - control study","authors":"Eman Al Mamari ,&nbsp;Iman Al Hashmi ,&nbsp;Omar Al Omari","doi":"10.1016/j.midw.2025.104531","DOIUrl":"10.1016/j.midw.2025.104531","url":null,"abstract":"<div><h3>Background</h3><div>Low birth weight (LBW) is the leading cause of inpatient morbidity for newborns under seven days of age and it is a major determinants of neonate’s long-term health.</div></div><div><h3>Purpose</h3><div>To examine determinants of low birth weight among newborns born to women from a Middle Eastern Country.</div></div><div><h3>Methods</h3><div>In this retrospective matched (1:1) case-control study, 414 participants were included from five major tertiary hospitals in Oman. A standardized report form was developed by the study principal investigator on the basis of a literature review on determinants of low birth weight. A Chi square test and a binary logistic regression were used to analyze the outcome of LBW (case versus control) and its determinants.</div></div><div><h3>Results</h3><div>Between January to June 2023, descriptive statistics showed that 8.3 % of newborns were born with LWB. Logistic regression results showed that total weight gain (β = -0.004, <em>p</em> &lt; 0.05), baby gender (β = 0.685, <em>p</em> &lt; 0.05), presence of IUGR (β = 1.82, <em>p</em> &lt; 0.05), and hemoglobin level at delivery (β = -0.010, <em>p</em> &lt; 0.05) were the only significant determinants of low birth weight.</div></div><div><h3>Conclusion</h3><div>According to our study, LBW is significantly determined by maternal weight gain, maternal hemoglobin level at delivery, baby’s gender and IUGR. Midwives and antenatal healthcare providers are recommended to closely monitor hemoglobin levels and total weight gain throughout pregnancy. Furthermore, midwives are encouraged to adopt enhanced prenatal screening protocols that incorporate gender-specific risk assessments and more rigorous monitoring of signs of IUGR to mitigate the adverse outcomes associated with LBW, thus improving neonatal health outcomes and reducing LBW burden on health systems.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104531"},"PeriodicalIF":2.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of mindfulness-based interventions on mental health among women with fetal loss: A systematic review and meta-analysis","authors":"Xin Wang ,&nbsp;Ying Luo ,&nbsp;Ying Gao ,&nbsp;Jun-yan Li ,&nbsp;Yan-Qiong Ouyang ,&nbsp;Rong Wang","doi":"10.1016/j.midw.2025.104520","DOIUrl":"10.1016/j.midw.2025.104520","url":null,"abstract":"<div><h3>Background</h3><div>Mindfulness-based interventions (MBIs) have shown potential in reducing maternal negative emotions, but their effectiveness for women with fetal loss requires further investigation. This study aimed to evaluate the effects of MBIs on mental health outcomes among these women.</div></div><div><h3>Methods</h3><div>Randomized controlled trials (RCTs) on MBIs for women with fetal loss were retrieved from eight databases, covering literature from inception to ^{January 21, 2025}. Outcomes included depression, anxiety, and post-traumatic growth. Risk of bias was assessed using Cochrane RoB 1.0, and meta-analyses were performed using Review Manager 5.4.</div></div><div><h3>Results</h3><div>Ten RCTs were included. MBIs significantly improve depression (SMD=1.01, 95 %<em>CI</em> (0.60,1.41), <em>p</em> &lt; 0.01), anxiety (SMD=1.24, 95 %<em>CI</em> (0.57, 1.91), <em>p</em> &lt; 0.01), stress (SMD=0.99, 95 %<em>CI</em> (0.11, 1.86), <em>p</em> = 0.03) and post-traumatic growth (MD=19.67, 95 %<em>CI</em> (10.96, 28.38), <em>p</em> &lt; 0.01) in women with fetal loss. Subgroup analyses were feasible only for depression and anxiety. MBIs significantly reduced depressive symptoms in both women with pre-existing psychological symptoms (SMD=0.85, <em>p</em> &lt; 0.01) and those without (SMD=1.07, <em>p</em> &lt; 0.01), with no significant difference by intervention duration (<em>p</em> &gt; 0.05). For anxiety symptoms, MBIs were effective only in women without symptoms (SMD=1.57, <em>p</em> &lt; 0.01). Short-duration MBIs (≤4 weeks, SMD=2.59, <em>p</em> &lt; 0.01) showed greater effects than long-duration MBIs (&gt;4 weeks, SMD=0.74, <em>p</em> &lt; 0.01).</div></div><div><h3>Limitations</h3><div>There are few high-quality RCTs, small sample sizes, and a lack of long-term follow-up.</div></div><div><h3>Conclusions</h3><div>MBIs effectively improve mental health in women with fetal loss, with short-duration effects exceeding long-duration ones. These findings support the integration of MBIs into psychosocial care, particularly for women with pre-existing psychological symptoms, and highlight the need to refine intervention strategies.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104520"},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifactorial determinants of postpartum care uptake in low- and middle-income countries: A systematic review and meta-analysis","authors":"Asmaa Habib ,&nbsp;Hafiz. T.A. Khan ,&nbsp;Caroline Lafarge ,&nbsp;Amalia Tsiami","doi":"10.1016/j.midw.2025.104524","DOIUrl":"10.1016/j.midw.2025.104524","url":null,"abstract":"<div><h3>Background</h3><div>Postpartum care (PPC) uptake within six weeks after delivery is essential to prevent maternal morbidity and mortality.</div></div><div><h3>Aim</h3><div>to understand the determinants contributing to PPC uptake in low-and-middle income countries (LMIC).</div></div><div><h3>Method</h3><div>PubMed, Embase, CINAHL, Cochrane, Web of Science databases were searched on PPC uptake for childbearing women in LMIC. Studies published in English in peer-reviewed journals since 2013 were eligible. A meta-analysis using a random-effect model was undertaken to measure the pooled effect of five key determinants of PPC uptake.</div></div><div><h3>Findings</h3><div>Among 1602 generated records, 24 cross-sectional studies were selected for the review. Nine of them were included in the meta-analysis (n=198 402 women). Overall, 55.4 % of women used PPC. The pooled findings of PPC uptake were associated with urban locations (OR=1.88, 95 % confidence interval (CI):0.76-1.91), and women’s primary (OR=1.45,95 %CI:1.31-1.61) and secondary (OR=1.67,95 %CI:1.45-1.92) education levels. Moreover, women from poor (OR=1.38,95 %CI:1.23-1.56), middle (OR=1.56,95 %CI:1.35-1.80), richer (OR=2.01,95 %CI:1.71-2.35) and the richest (OR=3.31,95 %CI:2.82-3.88) households were more likely to use PPC. Other facilitators included: PPC awareness, knowledge of postpartum morbidities, antenatal care, skilled birth attendant, health facility-based delivery, caesarean, women’s autonomy in decision-making, wanted pregnancy, primiparity, mass media exposure, women’s partner education and employment. Barriers to PPC uptake included: distance from health facilities, single marital status, unwanted pregnancy, cultural belief.</div></div><div><h3>Conclusion</h3><div>The differences in PPC uptake in LMIC reflect social inequities. These findings can inform equitable maternal health policies and programs in LMICs. Strengthening community outreach and addressing structural barriers by improving PPC quality and access may enhance uptake and reduce preventable complications.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104524"},"PeriodicalIF":2.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of a digital application intervention supporting recommended weight gain among pregnant women with BMI ≥27 in Denmark – a qualitative study","authors":"Sofia Sif Overby Fjorback ,&nbsp;Amalie Wienmann Hugin ,&nbsp;Michaela Louise Schiøtz ,&nbsp;Mette Kabell Hansen ,&nbsp;Sakura Goto Bokul Brethvad ,&nbsp;Ellen Christine Leth Løkkegaard ,&nbsp;Jane Marie Bendix ,&nbsp;Lotte Broberg","doi":"10.1016/j.midw.2025.104519","DOIUrl":"10.1016/j.midw.2025.104519","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the experiences of a digital application supporting recommended gestational weight gain among pregnant women with BMI ≥27 participating in the HealthyPregnancy Pilot-study.</div></div><div><h3>Methods</h3><div>A qualitative study using semi-structured interviews (<em>n</em> = 17) analyzed through reflexive thematic analysis.</div></div><div><h3>Findings</h3><div>Four themes were identified: 1) Mixed experiences and feelings towards a BMI-based intervention; 2) A holistic approach to health beyond BMI; 3) When daily life and individual circumstances interfere; 4) A reliable lifeline providing feelings of security. Most women viewed the intervention positively, while some experienced initial feelings of stigma, though this feeling was temporary and limited to recruitment. The pregnant women highlighted the importance of a dual focus on physical and mental health in the intervention and valued the application’s reliable information and access to healthcare professionals.</div></div><div><h3>Conclusion</h3><div>A holistic approach that integrates mental health support with physical activity and nutrition was emphasized as essential. Practical barriers like family demands limited participation. Accessibility to reliable support was valued, even when the intervention features were not frequently used. The results emphasize the need for accessible support addressing the diverse circumstances of pregnant women, and interventions must carefully consider framing and recruitment to minimize stigma.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104519"},"PeriodicalIF":2.6,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144656825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators to the implementation of a midwifery-led care model: a qualitative systematic review","authors":"Andreia Soares Goncalves ,&nbsp;Márcia Pestana-Santos ,&nbsp;Christine McCourt ,&nbsp;Ana Paula Prata","doi":"10.1016/j.midw.2025.104514","DOIUrl":"10.1016/j.midw.2025.104514","url":null,"abstract":"<div><h3>Problem</h3><div>Despite the overwhelming benefits of midwifery-led care models, in many countries, for several reasons, there is a resistance to their implementation.</div></div><div><h3>Background</h3><div>These care models provide both short-term and long-term advantages for mothers and newborn, demonstrate sustainability, and offer economic benefits.</div></div><div><h3>Aim</h3><div>This qualitative systematic review explores and synthesises evidence on stakeholders’ perceptions of the barriers and facilitators to implementing a shift from doctor-led or shared-care models to midwifery-led models of care.</div></div><div><h3>Methods</h3><div>The review followed Joanna Briggs Institute guidance for qualitative systematic reviews, including a comprehensive database search, study selection, quality appraisal by two independent reviewers, data extraction using a tool for qualitative findings, and thematic synthesis. The Consolidated Framework for Implementation Research guided the organisation and presentation of results, and the credibility and dependability of findings were assessed using ConQual.</div></div><div><h3>Results and Discussion</h3><div>Seven studies met the inclusion criteria. Fourteen findings, five facilitators and nine barriers, were identified by stakeholders including women, midwives, doctors and educators. These relate to four implementation domains: innovation, outer setting, inner setting, and individuals. Key themes included cost, local attitudes, local attitudes and conditions, laws and policies, tension for change, relationships, infrastructure, compatibility, access to knowledge, client-centeredness and capability. The review underscores the need for evidence-based strategies to overcome barriers and enhance facilitators.</div></div><div><h3>Conclusion</h3><div>Context-specific strategies informed by implementation science must be developed to support the sustainable integration of midwifery-led care models, with a particular emphasis on policy development and stakeholder engagement.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104514"},"PeriodicalIF":2.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}