Journal of midwifery & women's health最新文献

{"title":"Development of a Community- and Patient-Engaged Maternal Health Equity Toolkit for Hospitals.","authors":"Kelly M Bower, Lauren A Arrington, Briana E Kramer, Noelene K Jeffers, S Michelle Ogunwole, Tanay Lynn Harris","doi":"10.1111/jmwh.13771","DOIUrl":"https://doi.org/10.1111/jmwh.13771","url":null,"abstract":"<p><p>Inequities in maternal health outcomes are persistent, widespread, and unacceptable. Despite growing awareness that health care organizations play a critical role in addressing the maternal health crisis and eliminating racial inequities in outcomes, hospitals report barriers and limitations in implementing policy changes. We developed a Maternal Health Equity Toolkit and provided hospital maternal care units and departments with a comprehensive systems-level approach to advance health equity. The toolkit offers hospitals access to curated guidance from leading professional, quality and safety, and advocacy organizations. Detailed action steps for operationalizing change ideas are included. This article describes the development process and the final toolkit structure and content.</p>","PeriodicalId":94094,"journal":{"name":"Journal of midwifery & women's health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Social Support on Self-Management of Gestational Diabetes Mellitus: A Qualitative Analysis.","authors":"Tazim Merchant, Julia D DiTosto, Maria Gomez-Roas, Brittney R Williams, Charlotte M Niznik, Joe Feinglass, William A Grobman, Lynn M Yee","doi":"10.1111/jmwh.13782","DOIUrl":"10.1111/jmwh.13782","url":null,"abstract":"<p><strong>Introduction: </strong>Given the rising incidence and importance of treatment adherence for gestational diabetes (GDM), this study aimed to examine patient perspectives on social support's role in gestational diabetes (GDM) management during pregnancy and early postpartum.</p><p><strong>Methods: </strong>This is an analysis of qualitative data collected during a feasibility randomized controlled trial of postpartum patient navigation for individuals with GDM. Participants completed semistructured interviews at 4 to 12 weeks postpartum on their experiences with GDM as well as facilitators and barriers to its management, including social support. Data were analyzed using the constant comparative method.</p><p><strong>Results: </strong>Of 38 participants, 55% reported a family member or friend with a history of GDM, type 1, or type 2 diabetes mellitus. The analysis identified 4 themes: (1) communal support, (2) indirect GDM support (ie, removing logistical barriers to care), (3) direct GDM support, and (4) barriers of social support (eg, stigma), which impeded disease understanding. Participants identified communal support as a catalyst for lifestyle change and a source for advice and emotional support. Indirect support included transportation, childcare, and work accommodations. Direct support included providing healthy food, giving insulin shots, or providing accountability.</p><p><strong>Discussion: </strong>Harnessing social support may be a key strategy to activate and sustain lifestyle and self-management skills in GDM and should be considered in intervention development.</p>","PeriodicalId":94094,"journal":{"name":"Journal of midwifery & women's health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12354251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum Hemorrhage and the Likelihood of Exclusive Breastfeeding Through 6 Months Postpartum: A Case-Control Study.","authors":"Stefanie L Boyles, Sarah R Weinstein, Aleeca F Bell, Elise N Erickson","doi":"10.1111/jmwh.13781","DOIUrl":"https://doi.org/10.1111/jmwh.13781","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this article is to describe the relationship between postpartum hemorrhage (PPH) and exclusive breastfeeding (EBF) duration among participants who planned to breastfeed their infants. We also describe factors that were protective or prohibitive of breastfeeding.</p><p><strong>Methods: </strong>We performed a secondary analysis of data from a case-control study examining genetic variations associated with PPH linked to uterine atony in individuals with singleton vaginal births (n = 60case, n = 40 control participants). Bivariate analyses examined the relationships between breastfeeding exclusivity and various factors, including maternal demographics, birth characteristics, and case-control status. Breastfeeding exclusivity, cessation, challenges, and formula introduction were determined from self-reported infant feeding surveys administered to participants at 6 to 10 weeks, 4 months, and 6 months postpartum. Regression models were used to describe the relationship between breastfeeding exclusivity, breastfeeding duration, and PPH, adjusting for relevant confounding variables.</p><p><strong>Results: </strong>EBF rates for participants with normal postpartum bleeding versus PPH were 82.5% versus 64.1% (P = .05), 77.5% versus 55% (P = .02), and 70.3% versus 49.1% (P = .04) at 6 to 10 weeks, 4 months, and 6 months, respectively. Early EBF (6-10 weeks) was more strongly associated with psychosocial factors, including higher education, lower depression scores, and higher resilience scores. Median ferritin levels at 6 to 10 weeks postpartum were higher in those who continued to exclusively breastfeed at 4 and 6 months (24.1 ng/mL; interquartile range [IQR], 14.7-46.5) compared with those who did not (17.7 ng/mL; IQR, 10.3-32.0) (P = .03 for both). Higher early breastfeeding self-efficacy emerged as the strongest predictor of EBF across all time points.</p><p><strong>Discussion: </strong>PPH significantly impacts breastfeeding initiation and duration, requiring tailored interventions to support affected individuals. Enhancing maternal self-efficacy may improve EBF outcomes. Future research is needed to elucidate the complex relationship between postpartum ferritin levels and EBF outcomes in those who experience PPH.</p>","PeriodicalId":94094,"journal":{"name":"Journal of midwifery & women's health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conceptualizing the Impacts of Racism on Racialized Midwives in Ontario: An Alert to the Profession.","authors":"Claire Ramlogan-Salanga, Vivienne Lee, Maleeka Munroe, Elizabeth C Cates, R Katie MacKenzie, Karline Wilson-Mitchell, Elizabeth K Darling","doi":"10.1111/jmwh.13773","DOIUrl":"https://doi.org/10.1111/jmwh.13773","url":null,"abstract":"<p><strong>Introduction: </strong>There is a research gap on how racism impacts the mental health of midwives in Ontario. Our aim was to conceptualize the impact of racism on racialized midwives in Ontario.</p><p><strong>Methods: </strong>Informed by constructivist grounded theory, we analyzed data contributed by racialized midwives in Ontario who participated in focus groups and interviews as part of a larger study about mental health. Participants had practiced midwifery within the past 15 months.</p><p><strong>Results: </strong>Seven participants from 2 focus groups and one individual interview were included. Our conceptualization, Hypervigilance: Being Plugged In, describes cause-and-effect relationships between 3 pairs of external exposures and corresponding internal responses. The 3 paired relationships are: (1) microaggressions and social isolation elicit exhaustion, (2) bias checking and systemic exclusion elicit educator fatigue, and (3) Whiteness, the White gaze, and institutional inaction elicit disenfranchisement. Participants identified 2 recommendations to improve the mental health of racialized midwives: (1) identify and fund racially and ethnically concordant mental health practitioners for mental health support and (2) combat racism within the profession by requiring antiracism training as part of annual membership renewal.</p><p><strong>Discussion: </strong>Our research has generated a novel conceptualization explaining how exposure to racism negatively impacts the mental health of midwives. This is further supported by the literature with the concept of allostatic overload, whereby allostasis is no longer possible. When this occurs in the body, it can lead to illness and disability. This signifies an alert to the profession and systems partners to address the impact of racism on the workforce. This study provides insight into racialized midwives' experiences and presents recommendations to counter the impacts of racism.</p>","PeriodicalId":94094,"journal":{"name":"Journal of midwifery & women's health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy Burden: An Integrative Review and Dimensional Analysis of Pregnancy's Hidden Challenges.","authors":"Hannah E Kumarasamy, Felesia Bowen, Becca Billings, Patricia A Patrician","doi":"10.1111/jmwh.13759","DOIUrl":"https://doi.org/10.1111/jmwh.13759","url":null,"abstract":"<p><strong>Introduction: </strong>Outcomes surrounding childbirth have focused on survival, leaving gaps in understanding the comprehensive experience of pregnancy for the pregnant individual. Anecdotally, pregnancy and the opportunity to reproduce is often received with a celebratory response. Yet whether planned or unplanned, a wide array of burdens may exist throughout pregnancy ranging from minor inconveniences to dangerous contributions to morbidity and mortality. The experience of pregnancy is superimposed onto the physical, mental, and social reality that already exists as an individual's life and consistently accentuates aspects of stress that can lead to increased physical, mental, emotional, financial, or other burden that many health and social systems globally lack resources to support. To address this gap, this analysis sought to explore the concept of pregnancy burden.</p><p><strong>Methods: </strong>A formal search of 5 databases was conducted using integrative review methodology, with a total of 37 articles meeting inclusion criteria. To better conceptualize pregnancy burden, a dimensional analysis was then undertaken posing the research question, \"What is pregnancy burden?\"</p><p><strong>Results: </strong>The current social construction of pregnancy burden revealed multidimensional contributors to burden that were identified as both intrinsic and extrinsic, with no current definition available. Five dimensions of pregnancy burden were discovered: health, education, financial or cost, inequity, and social support. Three distinct perspectives were identified that included the pregnant person; their partners, family, or friends; and health systems or care providers. To best answer the research question and focus on the personal experience, the scope of this analysis was limited to the perspective of the pregnant individual.</p><p><strong>Discussion: </strong>The term burden is discussed and well-developed in chronic disease literature but has not been inclusive of pregnancy. This review revealed that pregnancy burden exists but remains unclassified and understudied, supporting the need for further exploration. Better understanding and valuing of the total experience of pregnancy, inclusive of burden, has the potential to improve the pregnancy experience.</p>","PeriodicalId":94094,"journal":{"name":"Journal of midwifery & women's health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy, Birth, and Mental Health Outcomes Associated With Recent Reproductive Coercion and Intimate Partner Violence in a Crowd-Sourced National Sample.","authors":"Karen Trister Grace, Jhumka Gupta, Kathryn Fay, Tara Altay, Samantha Kanselaar, Elizabeth Miller","doi":"10.1111/jmwh.13758","DOIUrl":"10.1111/jmwh.13758","url":null,"abstract":"<p><strong>Introduction: </strong>Reproductive coercion (RC) is a type of intimate partner violence (IPV) in which partners control reproductive health decision-making. More evidence is needed on peripartum health outcomes related to RC, with and without IPV, to inform interventions and health care response. The purpose of this study was to determine the impact of RC, with and without other forms of IPV, on pregnancy, birth, and mental health outcomes in a sample of people who were currently or recently pregnant.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey with people who had been pregnant in the past 2 years (N = 1941). Logistic regression models examined predicted outcomes with RC as a primary exposure and explored combinations of RC and IPV.</p><p><strong>Results: </strong>A total of 23.8% of the sample reported any past-2-years RC. RC was significantly associated with most pregnancy, birth, neonatal, and mental health outcomes. People who experienced RC alone had 2.44 higher odds of having a low birth weight newborn (95% CI, 1.04-5.71) and 1.78 higher odds of postpartum depression (95% CI, 1.03-3.08) compared with people who did not experience RC or IPV. RC with other forms of IPV had a significant impact on suicidality even controlling for depression and anxiety (odds ratio, 2.85; 95% CI, 1.94-4.18), compared with those who did not experience either.</p><p><strong>Discussion: </strong>Our findings underscore the importance of studying RC as its own construct due to its clear, independent impact on maternal health outcomes. RC, with and without physical violence, is common and detrimental to the health of pregnant and postpartum people. Greater attention to mechanisms for these associations (and the disproportionate burden on populations experiencing marginalization) is needed to interrupt and prevent harmful downstream effects.</p>","PeriodicalId":94094,"journal":{"name":"Journal of midwifery & women's health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}