Birth-Issues in Perinatal Care最新文献

{"title":"Birth Outcomes After Sexual Violence and the Role of Disclosure to the Maternity Care Provider.","authors":"Hannah de Klerk, Janneke Gitsels, Ank de Jonge, Elsa Montgomery, Janneke Van't Hooft, Marit van der Pijl, Martine Hollander, Corine Verhoeven","doi":"10.1111/birt.70001","DOIUrl":"https://doi.org/10.1111/birt.70001","url":null,"abstract":"<p><strong>Background: </strong>Sexual violence (SV) history is associated with various birth outcomes. Yet, the underlying mechanisms of these associations have not been sufficiently explained. Disclosure of SV history to a maternity care provider may play an important role in maternity care providers' choice for birth interventions and in women's birth experience.</p><p><strong>Methods: </strong>A cross-sectional nationwide survey was conducted among women who had given birth in the 5 years prior to completing the questionnaire. Logistic regression analysis was performed to compare the associations between SV history (total, disclosed, and undisclosed) and birth outcomes.</p><p><strong>Results: </strong>Of 10,867 respondents, 1121 (10.3%) reported SV, of whom 582 (52%) disclosed to their maternity care provider. Respondents who disclosed their SV history had lower adjusted odds of episiotomy than respondents without an SV history (adjusted odds ratio [AOR] 0.71, 95% confidence intervals [95% CI] 0.56-0.90). Primiparous respondents who disclosed their SV history had increased odds of unplanned cesarean birth compared to spontaneous (OR 1.37, 95% CI 1.04-1.81) and assisted vaginal birth (OR 1.75, 95% CI 1.17-2.61). Primiparous respondents with both a disclosed and undisclosed SV history had increased adjusted odds of negative birth (AOR 1.78, 95% CI 1.50-2.12). There were no differences in referral to obstetrician-led care, home birth, preterm labor, and pharmaceutical pain relief between groups.</p><p><strong>Conclusions: </strong>When people disclose their SV history, maternity care providers are less likely to perform an episiotomy, and more likely to choose an unplanned cesarean birth over vaginal birth. However, disclosure of SV history does not ameliorate the birth experience and we therefore recommend better implementation of trauma-informed birth support for women with an SV history.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546266","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":"Interventions and Strategies for Reducing Episiotomy Rates Globally: A Systematic Review.","authors":"Angela W Chen, Maiah J Hall, Molly R Altman","doi":"10.1111/birt.70000","DOIUrl":"https://doi.org/10.1111/birt.70000","url":null,"abstract":"<p><strong>Introduction: </strong>Episiotomy is still commonly practiced during childbirth worldwide, despite decades of scientific evidence that indicates no justification for its routine use. Routine episiotomy is associated with increased risk of serious maternal morbidity and no improvements in neonatal outcomes. We sought to analyze this gap between evidence-based knowledge and implementation surrounding reducing episiotomy practice. We systematically reviewed the literature to identify practices that have resulted in a change in episiotomy rates.</p><p><strong>Methods: </strong>We searched three databases (PubMed/MEDLINE, CINAHL Complete, Embase) using key words and subject headings with no time restriction. Any studies published in English and reporting an original empirical analysis in any global, regional, or country-specific context that examined practice changes that were implemented and reported episiotomy as an outcome were included in our review. Studies were excluded if they only reported on trends or changes in episiotomy rates without examining the specific practices implemented. We sought to identify practices that resulted in a change in episiotomy rates, rather than to evaluate or compare the effectiveness of these practices.</p><p><strong>Results: </strong>Search results returned 1265 records; 40 papers met the inclusion criteria for a full review. Twenty-five papers were included in our final analysis. All included studies documented a decrease in episiotomy rates, with 21 studies reporting a statistically significant reduction. Most studies were mixed interventions, often a combination of an educational intervention and audit and feedback.</p><p><strong>Conclusions: </strong>Specific practice changes have been shown to effectively decrease the incidence of episiotomy. The findings from our review provide actionable insights for implementing evidence-based interventions to improve obstetric care. Prioritizing respectful birthing practices and reducing the routine use of episiotomy are critical steps toward addressing obstetric violence and promoting equitable, patient-centered maternity care globally.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477969","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":"Characteristics and Outcomes Among Asian Birthing People in the American Association of Birth Centers Perinatal Data Registry.","authors":"Amy H Goh, Dia Aurora Kapoor, Anna Nguyen, Devi Soman, Diana R Jolles","doi":"10.1111/birt.12923","DOIUrl":"https://doi.org/10.1111/birt.12923","url":null,"abstract":"<p><strong>Background: </strong>Asian birthing people have the second highest rates of cesarean birth (CB), lowest rates of community (home and birth center), and midwife-attended births compared to other racial and ethnic groups in the United States.</p><p><strong>Methods: </strong>The American Association of Birth Centers Perinatal Data Registry (PDR) was used to abstract socio-demographic and clinical data. Logistic regression analyses identified the drivers of cesarean birth among Asian birthing people in the overall and community birth eligible samples.</p><p><strong>Results: </strong>Between 2007 and 2021, 2983 people self-identified as Asian within the PDR. The Asian sample had a lower percentage of birth center births and a higher percentage of hospital births, CB, gestational diabetes, and postpartum hemorrhage compared to the overall sample. The cesarean rate in the Asian sample was 12.4%. Asian multiparous birthing people were at 1.5 greater odds of CB compared to White multiparous birthing people (OR = 1.54; 95% CI, 1.19-2.03; p < 0.01). Asians in the community birth eligible group had higher odds of CB compared to their White counterparts (OR = 1.54; 95% CI, 1.23-1.93; p < 0.01). Asian and White multiparous birthing people admitted to the hospital from the community birth eligible group had five times higher odds of CB compared to the total sample of Asian and White multiparous birthing people (OR = 5.18; 95% CI, 3.77-7.12; p < 0.01).</p><p><strong>Discussion: </strong>There were lower rates of CB among Asians who birthed in PDR user sites compared to the national average. Future research is needed in community birth outcomes among different Asian ethnicities and Asian birthing people's perspective on community birth.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259432","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 Very Best That It Could Be and a Lot Better Than I Would Have Imagined\": Birthing People's Experiences of Transfer From Community to Hospital.","authors":"Carrie Neerland, Arielle Skalisky, Robyn Schafer","doi":"10.1111/birt.12920","DOIUrl":"https://doi.org/10.1111/birt.12920","url":null,"abstract":"<p><strong>Background: </strong>Community births (those in homes or freestanding birth centers) are increasing in the US, although they still represent a small percentage of total births. Research shows that community births can offer positive outcomes for low-risk individuals, such as fewer interventions and greater satisfaction. However, when perinatal complications arise, transfer to hospital can result in negative care outcomes and experiences. Effective integration of care and respectful communication between community and hospital providers during transfers are crucial for improving quality care measures. This study aimed to investigate the experiences and outcomes of individuals transferring from community settings to an urban US hospital with established transfer guidelines.</p><p><strong>Methods: </strong>This multi-method study, utilizing descriptive statistics and a grounded theory approach, explores the outcomes and experiences of individuals transferring from planned home or birth center births to hospital care for intrapartum management from August 2019 to August 2020. We included participants who were 18 or older, English-speaking, and had experienced a live birth following transfer from home or birth center to hospital. Quantitative outcomes were obtained through chart review. Qualitative interviews were conducted within 6 weeks post-birth, recorded, transcribed, and analyzed using constant comparative analysis.</p><p><strong>Results: </strong>A total of 82 individuals transferred during the study period, with 23 participating in qualitative interviews, we identified 5 major themes: seamless transfer, teamwork, respectful care, changing expectations, and a complex relationship with autonomy and decision-making. Participants valued smooth communication, midwife-to-midwife transfer of care, and the balance between autonomy and reliance on provider recommendations during transfers.</p><p><strong>Discussion: </strong>Understanding the experiences of those who transfer from community settings to hospitals is crucial for improving perinatal care. With established guidelines for transfer in place to facilitate collaboration across care providers and birth settings, transfers can be managed effectively, resulting in respectful experiences of care with positive health outcomes.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152904","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":"Characteristics of Women, Intrapartum Interventions, and Maternal and Neonatal Outcomes Among Users of Intrapartum Water Immersion: The UK POOL Cohort Study.","authors":"Julia Sanders, Christy Barlow, Peter Brocklehurst, Rebecca Cannings-John, Susan Channon, Judith Cutter, Billie Hunter, Mervi Jokinen, Fiona Lugg-Widger, Sarah Milosevic, Chris Gale, Rebecca Milton, Leah Morantz, Shantini Paranjothy, Rachel Plachcinski, Michael Robling","doi":"10.1111/birt.12921","DOIUrl":"https://doi.org/10.1111/birt.12921","url":null,"abstract":"<p><strong>Background: </strong>The POOL study explored intrapartum water immersion and associated maternal and neonatal outcomes at 26 UK sites 2015-2022.</p><p><strong>Methods: </strong>Retrospective and prospective data captured in electronic maternity and neonatal UK National Health Service (NHS) information systems. Analysis-(a) proportions of women using and factors associated with water immersion during labour or birth; (b) outcomes among \"low-risk\" women who used water immersion during labour or birth; (c) management and outcomes of the third stage of labour following waterbirth.</p><p><strong>Results: </strong>Among 869,744 included births, 10% (n = 87,040) used water immersion during labour or birth and 4.6% (n = 39,627) gave birth in water, with rates falling over time. Being of white or multi-ethnicity, fluent in English, non-smokers or ex-smokers, from more affluent areas, and nulliparous were associated with higher rates of water use. Overall, 39.6% of nulliparous and 9.9% of parous women at low risk at labour onset, and who used water immersion during labour, received obstetric or anesthetic care during the intrapartum period. Physiological third stage management was used following 27.1% (n = 10,737) of waterbirths and following 8.6% (n = 2260) of waterbirths the placenta was delivered into water. The rate of recorded blood loss ≥ 1000 mL was not significantly different when the placenta was delivered in water compared to placental delivery out of water.</p><p><strong>Conclusion: </strong>This large UK study of water immersion during labour and birth provides important information for policymakers, maternity health professionals, and for women and families considering the option of intrapartum water immersion. Care providers need to ensure equal access to intrapartum water immersion across demographic groups and provide women with evidence-based rates of obstetric interventions that take into account their risk status and birth choices.</p><p><strong>Trial registration: </strong>ISRCTN13315580.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053235","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":"Cultural Brokering in Pregnancy Care: A Qualitative Study.","authors":"Lauren Spigel, Maria Bazan, Ami Karlage, Karen Schoenherr, Amanda DiMeo, Saugata Chakraborty, Rose L Molina","doi":"10.1111/birt.12922","DOIUrl":"https://doi.org/10.1111/birt.12922","url":null,"abstract":"<p><strong>Introduction: </strong>Cultural brokers bridge cultural and linguistic differences between patients and healthcare teams, but their role in pregnancy care is not well understood. We aimed to identify and describe the roles cultural brokers fulfill throughout pregnancy care, moments of impact when they enhance care for patients with limited English proficiency (LEP), and how to integrate cultural brokering into pregnancy care teams.</p><p><strong>Methods: </strong>We conducted a descriptive qualitative study nested within a human centered design process. We conducted 21 semi-structured, qualitative interviews among Spanish-speaking pregnancy care patients with LEP, cultural brokers, and pregnancy care clinicians in the Boston metropolitan area between December 2022 and May 2023. Data were coded and analyzed using qualitative content analysis to summarize themes about cultural brokering within pregnancy care. Data were used to create a journey map of an illustrative pregnancy experience.</p><p><strong>Results: </strong>Cultural brokers played five key roles in pregnancy care for Spanish-speaking patients with LEP: cultural bridging, language support, social support, health system navigation, and advocacy. The journey map highlighted moments of impact when cultural brokers enhanced patient care: connecting patients to care, meeting the care team, making informed decisions, connecting to resources, childbirth, and transitioning to parenthood. Most participants wanted cultural brokers to be integrated into pregnancy care teams to diversify teaming and enable shared decision-making; however, additional training, clarifying cultural broker roles, and adequate compensation for cultural brokers would be needed to achieve integration.</p><p><strong>Conclusion: </strong>Cultural brokers fulfill a critical role during pregnancy care for patients with LEP. However, more work is needed to recognize, value, and integrate cultural brokering into pregnancy care.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056254","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":"Concordance of Self-Reported Obstetric Outcomes With Electronic Health Record Documentation: A Secondary Analysis of the Nulliparous Pregnancy Outcomes Study Monitoring Mothers-To-Be.","authors":"Veronica Barcelona, LinQin Chen, Elise Erickson","doi":"10.1111/birt.12918","DOIUrl":"https://doi.org/10.1111/birt.12918","url":null,"abstract":"<p><strong>Background: </strong>To compare participants' perceptions of reasons for admission, labor induction, and rationale for cesarean birth to those documented by clinicians in the electronic health record (EHR) and if these comparisons differed by race and ethnicity.</p><p><strong>Methods: </strong>We conducted a secondary analysis of data from the Nulliparous Pregnancy Outcomes Study: Monitoring mothers-to-be (2010-2013). We calculated kappa to evaluate agreement between participant postpartum interviews and EHR notes (n = 6085).</p><p><strong>Results: </strong>Overall, agreement was variable. There was substantial agreement (κ = 0.717, 95% CI 0.704, 0.724) on the reason for obstetric admission, but concordance for the admission reason was lower among preterm births. Only fair agreement was observed (κ = 0.290, 95% CI 0.220, 0.360) for whether labor was electively induced or medically indicated. As a whole, moderate agreement was observed between interview and EHR data on the indication for cesarean birth. EHR documentation on elective labor induction was moderately concurrent with interviews from non-Hispanic White participants; however, it was poor to fair among all other subgroups.</p><p><strong>Discussion: </strong>There were varying degrees of concordance between patient perceptions and what is documented within the EHR. Clinicians should ensure effective communication regarding obstetric procedures and the rationale for interventions, particularly those that are elective. Decision making in later pregnancies should consider all sources of data (EHR and self-reported), particularly where patient and EHR data are discordant around labor dysfunction.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063283","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 Association Between Women's Perception of Birth During the Pandemic, Companion of Choice and Support From Health Professionals: A Cross-Sectional Study in 20 Countries in the WHO European Region.","authors":"Stephanie Batram-Zantvoort, Céline Miani, Ilaria Mariani, Emanuelle Pessa Valente, Mehreen Zaigham, Ingvild Hersoug Nedberg, Magdalena Kurbanović, Elizabete Pumpure, Anja Bohinec, Antigone Sarantaki, Barbara Baranowska, Alessia Abderhalden-Zellweger, Elise de La Rochebrochard, Raquel Costa, Marina Ruxandra Otelea, Alina Liepinaitienė, Jelena Radetic, Amira Ćerimagić, Maryse Arendt, Martina König-Bachmann, Stefano Delle Vedove, Karolina Linden, Sigrun Kongslien, Daniela Drandić, Darta Kreslina, Zalka Drglin, Dimitra Metallinou, Urszula Tataj-Puzyna, Michael Gemperle, Virginie Rozée, Heloísa Dias, Marija Mizgaitienė, Jovana Ruzicic, Imola Simon, Simona Fumagalli, Helen Elden, Eline Skirnisdottir Vik, Barbara Mihevc Ponikvar, Aikaterini Lykeridou, Beata Szlendak, Claire de Labrusse, Tiago Miguel Pinto, Simona Jazdauskienė, Christoph Zenzmaier, Ilana Chertok, Emma Sacks, Marzia Lazzerini","doi":"10.1111/birt.12915","DOIUrl":"https://doi.org/10.1111/birt.12915","url":null,"abstract":"<p><strong>Background: </strong>Mitigation measures implemented in response to the COVID-19 pandemic led to significant changes in maternity care across Europe, including restrictions on companions during labor and birth. This cross-sectional study explores the association between the presence of a companion of choice and a positive perception of the birth experience. Additionally, it explores the association between health professionals' attention, assistance, and availability during labor and birth and a positive perception of birth.</p><p><strong>Methods: </strong>We utilized a structured, validated online questionnaire, available in 25 languages, to assess the quality of maternal care during the COVID-19 pandemic from women's perspectives. We conducted logistic regression to explore associations between variables related to the presence of a companion of choice, health professionals' attention, assistance, and availability, and positive perceptions of birth, when controlled for confounders, including birth mode and medical interventions.</p><p><strong>Results: </strong>Responses from 48,039 women across 20 countries in the WHO European Region were included. Always having a companion of choice during birth (aOR: 2.11) and always receiving adequate care from health professionals (assistance aOR: 2.12, attention aOR: 36.64, availability aOR: 2.12) were associated with positive birth perception. Instrumental births (aOR: 0.76), episiotomies (aOR: 0.74), fundal pressure (aOR: 0.52), and cesarean births (planned aOR: 0.80, unplanned prelabor aOR: 0.60, unplanned in-labor aOR: 0.52) were associated with less positive birth perceptions.</p><p><strong>Discussion: </strong>This study highlights the critical role of having a chosen companion and receiving adequate attention, assistance, and availability from health professionals in promoting positive birth perceptions, even in times of crisis such as the COVID-19 pandemic. Ensuring the presence of a companion of choice and comprehensive professional support is crucial for delivering high-quality, respectful maternity care.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782033","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":"Pregnant and Homeless in the UK: A Qualitative Analysis of Maternal Experiences in Temporary Accommodation.","authors":"Sara Cumming, Andrew Symon","doi":"10.1111/birt.12919","DOIUrl":"https://doi.org/10.1111/birt.12919","url":null,"abstract":"<p><strong>Background: </strong>In the UK, families in temporary accommodation reached record numbers in 2023. Pregnant mothers experiencing homelessness are at risk of poor health outcomes, yet little is known about their experiences. Most biomedical research emphasizes obstetric outcomes rather than maternal experiences. Our study aimed to explore maternal experiences of pregnancy while living in temporary accommodation in the UK.</p><p><strong>Methods: </strong>Using an interpretivist paradigm and critical feminist theory, we collected and analyzed semi-structured interview narratives from pregnant and postnatal mothers experiencing homelessness. Interviews with key workers from relevant Third Sector Organisations provided complementary insights. Study planning included Patient and Public Involvement. Data were analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>Fourteen mothers and six keyworkers were interviewed. Reflexive thematic analysis generated three themes. Theme one, Pregnant/postnatal bodies in unsafe spaces, described participants' experiences with unsafe accommodations, exposure to environmental hazards, and frequent moves which affected physical and mental health. In Undermining mothers, participants explained how the constant struggle to meet basic needs eroded opportunities to engage with caring roles and destabilized their sense of being \"good\" mothers. Together these contributed to pregnancy disengagement and feeling unprepared for birth. The third key theme, Feeling unseen in midwifery blind spots, describes barriers to accessing maternity services, as well as interactions with midwives that often reinforced feelings of being invisible.</p><p><strong>Discussion: </strong>Living in temporary accommodations whilst pregnant negatively impacts physical, mental, and emotional well-being. Improving care for pregnant mothers experiencing homelessness requires systemic change within housing and maternity services to acknowledge housing security as an essential need for pregnant and parenting mothers.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782078","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":"Effect of Maternity Characteristics on Cesarean Section Rates in Belgium: A Robson Classification Approach.","authors":"Charlotte Leroy, Elizaveta Fomenko, Régine Goemaes, Virginie Van Leeuw, Judith Racapé, Sophie Alexander","doi":"10.1111/birt.12916","DOIUrl":"https://doi.org/10.1111/birt.12916","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effect of maternity unit characteristics on the cesarean section (CS) rate, using Robson's Ten-Group Classification System (TGCS) and considering the sociodemographic and medical characteristics of the mother.</p><p><strong>Methods: </strong>The study, conducted in Belgium from 2011 to 2019, employed an analytical design utilizing a nationwide register of routine data and focused on hospital births. The CS rate was analyzed by neonatal intensive care unit (NICU) availability and by maternal unit size for TGCS groups 1, 2, and 5, which were the highest contributors to the total CS rate. Multivariable logistic regression models and generalized linear mixed-effects models were utilized to analyze the association between the maternity itself and CS.</p><p><strong>Results: </strong>The overall CS rate was 20.8%, displaying a twofold variation across maternity units. This variation persisted irrespective of the presence or absence of a NICU and the maternity unit's size. Our findings highlighted a significant association between maternity unit characteristics (size and NICU availability) and the likelihood of performing CS in TGCS groups 1, 2, and 5. This association did not change after adjustment for sociodemographic and medical characteristics. However, the majority of odds ratios for maternity-related variables lost their significance in the multilevel analysis compared to simple logistic regressions.</p><p><strong>Conclusions: </strong>The CS rate seems to be more influenced by the \"philosophy\" of the maternity unit than its specific size and NICU characteristics. Future research is needed to explore the underlying mechanisms of this association and to identify potential interventions that could reduce CSs performed without clinical indication in different settings.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755696","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}