RESUMEN
BACKGROUND: Exercise during pregnancy is beneficial to both the pregnant woman and the foetus. Midwifery educators play a crucial role in ensuring that midwifery students receive the knowledge and training needed to demonstrate antenatal exercises. To ensure that their students understand and deliver adequate antenatal care, midwifery educators should be highly knowledgeable in pregnancy-related exercises. OBJECTIVES: The study was conducted to determine the knowledge of midwifery educators about antenatal exercise. METHOD: A descriptive cross-sectional study was conducted of the knowledge about antenatal exercises by midwifery educators. A purposive total population of 54 midwifery educators from three midwifery schools in Cross River State, Nigeria, was included in the study. Questionnaires were used for data collection, and Statistical Package for Social Sciences (SPSS) version 27 was used for data analysis. Ethical issues and rigour were maintained. RESULTS: The study revealed that antenatal exercises are included in the midwifery curriculum and exercise demonstration were mainly done by midwifery educators and clinical instructors. The majority (n = 34, 66.7%) of the respondents were knowledgeable about World Health Organization (WHO) guidelines for exercise during pregnancy and had an average knowledge of the ideal antenatal exercises. CONCLUSION: Midwifery educators have average knowledge of the ideal antenatal exercises, which prompts the development of an exercise programme to guide midwifery training and practice. Midwifery educators should collaborate with exercise specialists to teach and demonstrate antenatal exercises.Contribution: The study highlighted the need for midwifery educators to obtain more information on antenatal exercises to adequately prepare midwifery students for evidence-based exercise care for pregnant women.
Asunto(s)
Partería , Humanos , Nigeria , Estudios Transversales , Femenino , Partería/educación , Partería/estadística & datos numéricos , Partería/normas , Encuestas y Cuestionarios , Embarazo , Adulto , Atención Prenatal/normas , Atención Prenatal/métodos , Atención Prenatal/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Persona de Mediana Edad , Ejercicio Físico/psicologíaRESUMEN
Introduction: male midwifery is a relatively new phenomenon in Ghana and most expectant mothers still do not recognize their contribution to reproductive healthcare. This study aims to assess the acceptability of male midwifery practice among expectant mothers in Savelugu Municipal Hospital. Methods: this was a descriptive cross-sectional study. A total of 391 mothers were recruited using a simple random sampling technique. Data was collected using a structured questionnaire and analyzed using SAS JMP Pro V16.0. Results: approximately 75.7% of mothers would go to a hospital where male midwives examine and attend to them, and 71.9% accepted to be delivered by a younger male midwife. Also, 70.1% agreed to share their obstetric information with a male midwife, and 43.5% agreed that their religious beliefs allowed them to be delivered by a male midwife. Mothers who had no formal education (aOR=2.23, 95% CI: 1.040-4.788, p=0.039) were more likely to go to a hospital where male midwives examine and attend to them than the others, and mothers who were employed (aOR=3.91, 95% CI: 1.770-8.631, p=0.001) were more likely to accept to be delivered by a male midwife who is younger than them than the others. Conclusion: a significant portion of expectant mothers are open to receiving care and examinations from male midwives, even opting to go to hospitals where male midwives are available for maternal care. This suggests that male midwives can contribute to the health of expectant mothers significantly and should be encouraged to practice their profession.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Partería , Madres , Humanos , Ghana , Estudios Transversales , Femenino , Adulto , Partería/estadística & datos numéricos , Embarazo , Masculino , Adulto Joven , Encuestas y Cuestionarios , Madres/psicología , Madres/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Parto Obstétrico/estadística & datos numéricos , Persona de Mediana EdadRESUMEN
BACKGROUND: The objective of this study was to investigate the associations between women's education and access to skilled birth attendant (SBA) services mediated by factors of women's empowerment and sociodemographic characteristics using a path analysis through a structural equation (SEM) modelling approach. METHODS: A sample of 4946 mothers from the most recent Bangladesh Demographic and Health Survey of 2017-18 was used in the SEM analysis. Accessing SBA service at childbirth was operationalized as utilizing SBA during last childbirth. After extracting the relevant variables and cleaning the original survey data, a subsample of 4,946 women were eligible for analysis in the current study. RESULTS: The SEM model revealed strong evidence of direct, indirect, and mediating effects of both education and empowerment of women in accessing SBA services. Educated women have more autonomy in decision making and are less susceptible to family violence and consequently are more likely to access SBA services during childbirth (ß = 0.094, p < 0.001). In addition, age at first marriage, media exposure, husband's education, healthcare accessibility, decision marking, and household wealth index mediated the relationship between education and SBA service use. CONCLUSION: Bangladesh, a country that needs to improve several societal and health indices to achieve the Sustainable Development Goals, need to prioritize women's education to increase accessibility to maternal healthcare services. Health education and mass-media-driven awareness may be potential interventions for LMICs to increase SBA coverage.
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Escolaridad , Empoderamiento , Accesibilidad a los Servicios de Salud , Humanos , Femenino , Bangladesh , Adulto , Embarazo , Accesibilidad a los Servicios de Salud/normas , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Análisis de Clases Latentes , Adolescente , Persona de Mediana Edad , Servicios de Salud Materna/estadística & datos numéricos , Servicios de Salud Materna/normas , Partería/educación , Partería/estadística & datos numéricosRESUMEN
BACKGROUND: Domestic, family and sexual violence is a prevalent health and social issue. Nurses may be exposed to higher rates of this violence in their personal lives compared to the community, but little is known about their polyvictimisation experiences or health and well-being impacts. METHODS: An online descriptive, cross-sectional survey of women nurses, midwives and carer members of the Australian Nursing and Midwifery Federation (ANMF) (Victorian Branch) (response rate: 15.2% of nurses sent an invitation email/28.4% opened the email). Violence survey measures included: intimate partner violence (Composite Abuse Scale); child abuse and sexual violence (Australian Bureau of Statistics Personal Safety Survey items). Health measures included: Short Form-12; Fast Alcohol Screening Test; Patient Health Questionnaire-4; Short Screening for DSM-IV Posttraumatic Stress Disorder; well-being measures included: Connor-Davidson Resilience Scale, social support, and financial stress. Proportions were used to describe the prevalence of violence by sociodemographic characteristics and health and well-being issues; logistic regression predicted the odds of experiencing overlapping types of violence and of experiencing health and well-being outcomes. RESULTS: 5,982 participants (from a parent study of 10,674 nurses, midwives and carers) had experienced at least one type of lifetime violence; half (50.1%) had experienced two or three types (polyvictimisation). Survivors of child abuse were three times more likely to experience both intimate partner violence and non-partner adult sexual assault. Any violence was associated with poorer health and well-being, and the proportion of affected participants increased as the types of violence they had experienced increased. Violence in the last 12-months was associated with the poorest health and well-being. CONCLUSIONS: Findings suggest a cumulative, temporal and injurious life course effect of domestic, family and sexual violence. The polyvictimisation experiences and health and well-being associations reported by survivor nurses, midwives and carers underscores the need for more accessible and effective workplace interventions to prevent and mitigate psychosocial ill health, especially in the recent aftermath of violence.
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Cuidadores , Violencia Doméstica , Delitos Sexuales , Humanos , Estudios Transversales , Femenino , Adulto , Delitos Sexuales/psicología , Delitos Sexuales/estadística & datos numéricos , Persona de Mediana Edad , Cuidadores/psicología , Cuidadores/estadística & datos numéricos , Australia , Violencia Doméstica/estadística & datos numéricos , Violencia Doméstica/psicología , Enfermeras y Enfermeros/psicología , Enfermeras y Enfermeros/estadística & datos numéricos , Masculino , Encuestas y Cuestionarios , Adulto Joven , Partería/estadística & datos numéricosRESUMEN
BACKGROUND: Perinatal mortality is a global health problem, especially in Ethiopia, which has the highest perinatal mortality rate. Studies about perinatal mortality were conducted in Ethiopia, but which factors specifically contribute to the change in perinatal mortality across time is unknown. OBJECTIVES: To assess the trend and multivariate decomposition of perinatal mortality in Ethiopia using EDHS 2005-2016. METHODS: A community-based, cross-sectional study design was used. EDHS 2005-2016 data was used, and weighting has been applied to adjust the difference in the probability of selection. Logit-based multivariate decomposition analysis was used using STATA version 14.1. The best model was selected using the lowest AIC value, and variables were selected with a p-value less than 0.05 at 95% CI. RESULT: The trend of perinatal mortality in Ethiopia decreased from 37 per 1000 births in 2005 to 33 per 1000 births in 2016. About 83.3% of the decrease in perinatal mortality in the survey was attributed to the difference in the endowment (composition) of the women. Among the differences in the endowment, the difference in the composition of ANC visits, taking the TT vaccine, urban residence, occupation, secondary education, and birth attendant significantly decreased perinatal mortality in the last 10 years. Among the differences in coefficients, skilled birth attendants significantly decreased perinatal mortality. CONCLUSION AND RECOMMENDATION: The perinatal mortality rate in Ethiopia has declined over time. Variables like ANC visits, taking the TT vaccine, urban residence, occupation, secondary education, and skilled birth attendants reduce perinatal mortality. To reduce perinatal mortality more, scaling up maternal and newborn health services has a critical role.
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Mortalidad Perinatal , Humanos , Etiopía/epidemiología , Femenino , Mortalidad Perinatal/tendencias , Estudios Transversales , Recién Nacido , Adulto , Embarazo , Adulto Joven , Análisis Multivariante , Atención Prenatal/estadística & datos numéricos , Adolescente , Encuestas Epidemiológicas , Partería/estadística & datos numéricosRESUMEN
PROBLEM: Midwives are susceptible to burnout due to the physically and emotionally demanding nature of their job. Burnout is an occupational phenomenon with far-reaching consequences. AIM: This study aimed to assess the magnitude of burnout and predictors among midwives working at public hospitals in northwest Ethiopia. METHODS: An institutional-based cross-sectional study was conducted from February 7 to April 30, 2022. A simple random sampling method was employed to include 640 study participants. Data were collected using a self-administered questionnaire, entered into Epi-data 4.6 software, and exported to SPSS version 25 for analysis. A multivariable linear regression analysis model was fitted to identify factors contributing to midwives' burnout. FINDINGS: The overall prevalence of midwives' burnout was 55.3â¯% (95â¯% CI = 51.7-58.9). The prevalence of personal, work-related, and client-related burnout was 58.3â¯%, 60.3â¯%, and 55.5â¯%, respectively. Factors that were significantly associated with burnout includes workplace violence (ß = 5.02, CI: 2.90, 7.13), not receiving training (ß = 4.32 CI: 1.81, 6.80), being exposed to blood and body fluids or needle stick injuries (ß = 5.13 CI: 3.12, 7.13), low superior support (ß = 5.13 CI: 1.94, 5.30), working in tertiary hospitals (ß = 12.77 CI: 9.48, 16.06), and job rotation of six months or less (ß = 16.75, CI: 13.12, 20.39). CONCLUSION: This study found that the prevalence of burnout among midwives was significantly high. Addressing burnout requires implementing effective burnout prevention measures including enhancing management support, offering professional training, creating a conducive working environment, and adhering to standard precautions.
Asunto(s)
Agotamiento Profesional , Hospitales Públicos , Partería , Enfermeras Obstetrices , Humanos , Agotamiento Profesional/epidemiología , Agotamiento Profesional/psicología , Etiopía/epidemiología , Femenino , Estudios Transversales , Adulto , Encuestas y Cuestionarios , Prevalencia , Partería/estadística & datos numéricos , Enfermeras Obstetrices/psicología , Enfermeras Obstetrices/estadística & datos numéricos , Lugar de Trabajo/psicología , Persona de Mediana Edad , Satisfacción en el Trabajo , EmbarazoRESUMEN
BACKGROUND: Midwives experience elevated levels of work-related stress. However, there is limited understanding of the patterns of this stress, its sociodemographic and work-related determinants, and its association with sub-health. METHOD: This multi-center cross-sectional study, conducted in 21 hospitals in Zhuhai City, Guangdong Province, China, involved 300 midwives. Work-related stress levels in midwives were evaluated using the Chinese version of the Nursing Stress Scale, while social, physical and mental sub-health status was measured with the Sub-Health Measurement Scale. Utilizing latent profile analysis, the study aimed to categorize midwives into homogeneous profiles based on patterns of work-related stress. RESULTS: Among the 300 midwives examined, three distinct profiles were identified: profile 1 (n=57, 19â¯%), characterized by low work-related stress; profile 2 (n=149, 50â¯%), representing the moderate work-related stress class; and profile 3 (n=94, 31â¯%), indicative of high work-related stress. Midwives in the high work-related stress profile tended to be younger, with lower monthly income, lower professional titles, and a higher likelihood of night shift work (all P<0.01). Significant and noteworthy trends were observed in sociodemographic characteristics (age, monthly income, and professional title) and work-related characteristics (night shift status). After controlling for confounders, the work-related stress profile demonstrated a negative association with social, physical and mental sub-health status. CONCLUSION: This study highlights integrating stress domains and adopting a person-centered approach to examine midwives' work-related stress. Identifying predictors of profile membership and their relationship with sub-health can inform tailored interventions to reduce stress and improve midwives' well-being.
Asunto(s)
Partería , Enfermeras Obstetrices , Estrés Laboral , Humanos , Estudios Transversales , Femenino , Adulto , Estrés Laboral/psicología , Partería/estadística & datos numéricos , China/epidemiología , Persona de Mediana Edad , Enfermeras Obstetrices/psicología , Encuestas y Cuestionarios , Estado de Salud , Estrés Psicológico , Lugar de Trabajo/psicologíaRESUMEN
BACKGROUND: Most countries are off-track to achieve global maternal and newborn health goals. Global stakeholders agree that investment in midwifery is an important element of the solution. During a global shortage of health workers, strategic decisions must be made about how to configure services to achieve the best possible outcomes with the available resources. This paper aims to assess the relationship between the strength of low- and middle-income countries' (LMICs') midwifery profession and key maternal and newborn health outcomes, and thus to prompt policy dialogue about service configuration. METHODS: Using the most recent available data from publicly available global databases for the period 2000-2020, we conducted an ecological study to examine the association between the number of midwives per 10,000 population and: (i) maternal mortality, (ii) neonatal mortality, and (iii) caesarean birth rate in LMICs. We developed a composite measure of the strength of the midwifery profession, and examined its relationship with maternal mortality. RESULTS: In LMICs (especially low-income countries), higher availability of midwives is associated with lower maternal and neonatal mortality. In upper-middle-income countries, higher availability of midwives is associated with caesarean birth rates close to 10-15%. However, some countries achieved good outcomes without increasing midwife availability, and some have increased midwife availability and not achieved good outcomes. Similarly, while stronger midwifery service structures are associated with greater reductions in maternal mortality, this is not true in every country. CONCLUSIONS: A complex web of health system factors and social determinants contribute to maternal and newborn health outcomes, but there is enough evidence from this and other studies to indicate that midwives can be a highly cost-effective element of national strategies to improve these outcomes.
Asunto(s)
Países en Desarrollo , Mortalidad Infantil , Servicios de Salud Materna , Mortalidad Materna , Partería , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Cesárea/estadística & datos numéricos , Salud Global , Accesibilidad a los Servicios de Salud , Mortalidad Infantil/tendencias , Mortalidad Materna/tendencias , Partería/estadística & datos numéricos , Condiciones de TrabajoRESUMEN
BACKGROUND: The debate on the safety and outcomes of home versus hospital births highlights the need for evidence-based evaluations of these birthing settings, particularly in Catalonia where both options are available. AIM: To compare sociodemographic characteristics and maternal and neonatal outcomes between low-risk women opting for home versus hospital births in Catalonia, Spain. METHODS: This observational cross-sectional study analysed 3,463 low-risk births between 2016 and 2018, including 2,713 hospital and 750 home births. Researchers collected sociodemographic data, birthing processes, and outcomes, using statistical analysis to explore differences between the settings. FINDINGS: Notable differences emerged: Women choosing home births typically had higher education levels and were predominantly Spanish. They were 3.43 times more likely to have a spontaneous birth and significantly less likely to undergo instrumental births than those in hospitals. Home births were associated with higher utilization of non-pharmacological analgesia and a more pronounced tendency to iniciate breastfeeding within the first hour post birth and stronger inclination towards breastfeeding. Hospital births, conversely, showed higher use of the lithotomy position and epidural analgesia. There were no significant differences in neonatal outcomes between the two groups. CONCLUSIONS AND IMPLICATION FOR PRACTICE: Home births managed by midwives offered better obstetric and neonatal outcomes for low-risk women than hospital births. These results suggest home birth as a safe, viable option that promotes natural birthing processes and reduces medical interventions. The study supports the integration of midwife-led home birth into public health policies, affirming its benefits for maternal and neonatal health.
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Parto Domiciliario , Partería , Resultado del Embarazo , Humanos , Parto Domiciliario/estadística & datos numéricos , Parto Domiciliario/normas , Parto Domiciliario/tendencias , Femenino , España , Embarazo , Adulto , Estudios Transversales , Partería/estadística & datos numéricos , Resultado del Embarazo/epidemiología , Recién NacidoRESUMEN
OBJECTIVES: The COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy-related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March-June 2020) on provision of maternity care and maternal pregnancy-related outcomes in the Netherlands. STUDY DESIGN: National quasi-experimental study. METHODS: Multiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010-2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020. RESULTS: A total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, -3% [-5%,-0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [-1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, -1% [-2%, +0%]), obstetric anal sphincter injury (2%, +0% [-0%, +1%]), episiotomy (21%, -0% [-2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, -0% [-1%, +1%]). CONCLUSIONS: During the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions.
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COVID-19 , Servicios de Salud Materna , Resultado del Embarazo , Humanos , COVID-19/epidemiología , COVID-19/prevención & control , Países Bajos/epidemiología , Embarazo , Femenino , Servicios de Salud Materna/estadística & datos numéricos , Adulto , Resultado del Embarazo/epidemiología , Partería/estadística & datos numéricos , Control de Enfermedades Transmisibles/métodos , SARS-CoV-2RESUMEN
Background: One of the main characteristics of the mental health condition known as burnout syndrome is an overwhelming feeling of physical and emotional tiredness, particularly with regard to one's work. Midwives are the group most prone to burnout because they work in emergency situations to save two lives at a time, share the stress of laboring women, and put in extra hours without enough payment. Besides this, there is little information on burnout among Ethiopian midwives. Objectives: To assess burnout and associated factors among midwives working in public health facilities in West Arsi Zone, Ethiopia. Methods and materials: A census method cross-sectional study was conducted among all 467 midwives working in public health facilities found in the West Arsi Zone, Ethiopia, from September 1 and 30, 2023. A pretested, validated face-to-face interviewer-administered structured questionnaire was used to collect data. Then, binary logistic regression was used for analysis. Bi-variable and multivariable logistic regression analyses were employed to identify factors associated with burnout. The level of statistical significance was declared at p < 0.05 with a 95% CI. Results: Overall, the prevalence of burnout among midwives was 47.10% (95% CI: 42.55, 51.75%). Marital status not in union 2.03 (95% CI: 1.32-3.13), working more than 40 h per week 2.00 (95% CI: 1.29-3.08), conflict with their metron 2.33 (95% CI: 1.54-3.54), not satisfied with their current job 2.39 (95% CI: 1.56-3.66) and having depression symptoms 1.71 (95% CI: 1.06-2.74) were factors significantly associated with burnout. Conclusion: This study found that in the study area, almost half of the midwives experienced burnout. Thus, it is recommended that midwives should develop respectful interactions with both their mentors and colleagues. Secondly, we suggest that zonal health offices set up systems that by shortening working hours and boost job satisfaction by creating conducive working environment, provide opportunities for career advancement and increase employee engagement.
Asunto(s)
Agotamiento Profesional , Partería , Humanos , Estudios Transversales , Etiopía/epidemiología , Agotamiento Profesional/epidemiología , Agotamiento Profesional/psicología , Femenino , Prevalencia , Adulto , Encuestas y Cuestionarios , Partería/estadística & datos numéricos , Persona de Mediana Edad , Satisfacción en el Trabajo , Factores de RiesgoRESUMEN
INTRODUCTION: In Italy, the primary place of birth is typically a hospital, with only a small number of women opting for an out-of-hospital setting. This study details the characteristics of midwifery care and perinatal and maternal outcomes of women who gave birth in an out-of-hospital setting in the Lazio Region, Italy, from 2019 to 2021. METHODS: A cross-sectional study was carried out. The study population included 542 healthy low-risk women who completed the process of planning an out-of-hospital birth, and excluding transfers, this resulted in a total sample of 478 women who gave birth out-of-hospital. Descriptive and inferential analyses and also a logistic regression model were performed. RESULTS: The main outcomes of the out-of-hospital deliveries were: intact perineum in 38.9% of cases, two cases of 3rd degree laceration (0.4%) and in one case (0.2%) episiotomy. Intrapartum emergencies occurred in 85 out of 478 women (17.8%) but only 10 women required a transfer to hospital after delivery. The one minute Apgar score was equal to or greater than 7 in 99.2% of cases. Exclusive breastfeeding of 96% one week after birth and 94.6% one month. Furthermore, having a previous vaginal hospital birth (adjOR 9.7; CI 95% 4.33-21.68 P<0.001) and a previous out-of-hospital birth (adjOR 24.2; CI 95% 3.23-181.48 P=0.002) was associated with the continuation of out-of-hospital birth. CONCLUSIONS: For low-risk pregnant women who have planned an out-of-hospital birth, it has been shown to be a safe, adequate, appropriate, and effective alternative.
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Resultado del Embarazo , Humanos , Estudios Transversales , Italia/epidemiología , Femenino , Embarazo , Adulto , Resultado del Embarazo/epidemiología , Parto Domiciliario/estadística & datos numéricos , Parto Obstétrico/estadística & datos numéricos , Recién Nacido , Adulto Joven , Partería/estadística & datos numéricosRESUMEN
INTRODUCTION: Maternal obesity and excessive gestational weight gain are associated with adverse maternal and neonatal outcomes. There is uncertainty over the most effective antenatal healthy lifestyle service, with little research determining the impact of different lifestyle intervention intensities on pregnancy outcomes. METHOD: This retrospective cohort study compared pregnancy and birth outcomes in women with a body mass index of 40 or above who were offered a low intensity midwife-led antenatal healthy lifestyle service (one visit) with women who were offered an enhanced service (three visits). The primary outcome was gestational weight gain. RESULTS: There were no differences between the two healthy lifestyle service intensities (N = 682) in the primary outcome of mean gestational weight gain [adjusted mean difference (aMD) -1.1 kg (95 % CI -2.3 to 0.1)]. Women offered the enhanced service had lower odds of gaining weight in excess of Institute of Medicine recommendations [adjusted odds ratio (aOR) 0.63 (95 % CI 0.40-0.98)] with this reduction mainly evident in multiparous women. Multiparous women also gained less weight per week [aMD -0.06 kg/week (95 % CI -0.11 to -0.01)]. No overall beneficial effects were seen in maternal or neonatal outcomes measured such as birth weight [aMD 25 g (95 % CI -71 to 121)], vaginal birth [aOR 0.87 (95 % CI 0.64-1.19)] or gestational diabetes mellitus [aOR 1.42 (95 % CI 0.93-2.17)]. However, multiparous women receiving the enhanced service had reduced odds of small for gestational age [aOR 0.52 (95 % CI 0.31-0.87)]. This study was however underpowered to detect differences in some outcomes with low incidences. DISCUSSION: Uncertainty remains over the best management of women with severe obesity regarding effective interventions in terms of intensity. It is suggested that further research needs to consider the different classes of obesity separately and have a particular focus on the needs of nulliparous women given the lack of effectiveness of this service among these women.
Asunto(s)
Resultado del Embarazo , Atención Prenatal , Humanos , Femenino , Embarazo , Estudios Retrospectivos , Adulto , Estudios de Cohortes , Resultado del Embarazo/epidemiología , Atención Prenatal/métodos , Atención Prenatal/estadística & datos numéricos , Estilo de Vida Saludable , Índice de Masa Corporal , Partería/métodos , Partería/estadística & datos numéricos , Recién Nacido , Ganancia de Peso GestacionalRESUMEN
BACKGROUND: In South Africa, screening for tuberculosis during pregnancy is a serious challenge. Tuberculosis is one of the leading indirect causes of mortality in pregnant women. OBJECTIVES: The objective of the study was to explore the challenges experienced by midwives regarding tuberculosis in pregnant women. METHOD: A qualitative exploratory research method was used to conduct the study. The study population comprised midwives who worked at primary healthcare clinics in the selected local area, Capricorn District, Limpopo province. Purposive non-probability sampling was used to select 10 participants. Data from participants were acquired using in-depth individual semi-structured interviews. Data analysis was carried out using manual thematic analysis following Tesch's technique. RESULTS: The outcomes of this study included midwives knowing their roles regarding tuberculosis screening among pregnant women. They further highlighted their challenges while screening tuberculosis in pregnant women, such as shortage of screening tools, withholding of tuberculosis information, and language barrier. CONCLUSION: Midwives should have the necessary equipment and be trained in various languages used in the province to improve tuberculosis screening among all pregnant women.Contribution: Infected pregnant women and their unborn children's health can be improved by tuberculosis screening.
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Tamizaje Masivo , Partería , Investigación Cualitativa , Tuberculosis , Humanos , Sudáfrica/epidemiología , Femenino , Embarazo , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Tamizaje Masivo/estadística & datos numéricos , Partería/normas , Partería/estadística & datos numéricos , Partería/métodos , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Adulto , Entrevistas como Asunto/métodosRESUMEN
OBJECTIVES: In many countries, the healthcare sector is dealing with important challenges such as increased demand for healthcare services, capacity problems in hospitals and rising healthcare costs. Therefore, one of the aims of the Dutch government is to move care from in-hospital to out-of-hospital care settings. An example of an innovation where care is moved from a more specialised setting to a less specialised setting is the performance of an antenatal cardiotocography (aCTG) in primary midwife-led care. The aim of this study was to assess the budget impact of implementing aCTG for healthy pregnant women in midwife-led care compared with usual obstetrician-led care in the Netherlands. METHODS: A budget impact analysis was conducted to estimate the actual costs and reimbursement of aCTG performed in midwife-led care and obstetrician-led care (ie, base-case analysis) from the Dutch healthcare perspective. Epidemiological and healthcare utilisation data describing both care pathways were obtained from a prospective cohort, survey and national databases. Different implementation rates of aCTG in midwife-led care were explored. A probabilistic sensitivity analysis was conducted to estimate the uncertainty surrounding the budget impact estimates. RESULTS: Shifting aCTG from obstetrician-led care to midwife-led-care would increase actual costs with 311 763 (97.5% CI 188 574 to 426 072) and 1 247 052 (97.5% CI 754 296 to 1 704 290) for implementation rates of 25% and 100%, respectively, while it would decrease reimbursement with -7 538 335 (97.5% CI -10 302 306 to -4 559 661) and -30 153 342 (97.5% CI -41 209 225 to -18 238 645) for implementation rates of 25% and 100%, respectively. The sensitivity analysis results were consistent with those of the main analysis. CONCLUSIONS: From the Dutch healthcare perspective, we estimated that implementing aCTG in midwife-led care may increase the associated actual costs. At the same time, it might lower the healthcare reimbursement.
Asunto(s)
Presupuestos , Cardiotocografía , Partería , Humanos , Femenino , Países Bajos , Embarazo , Partería/estadística & datos numéricos , Partería/economía , Partería/métodos , Cardiotocografía/métodos , Cardiotocografía/estadística & datos numéricos , Cardiotocografía/economía , Cardiotocografía/normas , Presupuestos/estadística & datos numéricos , Presupuestos/métodos , Adulto , Estudios Prospectivos , Atención Prenatal/estadística & datos numéricos , Atención Prenatal/economía , Atención Prenatal/métodosRESUMEN
BACKGROUND: Progress on skilled birth attendance (SBA) has been very uneven across low-income and middle-income countries (LMICs). There is scant empirical evidence on the role of fundamental development processes in explaining differences in SBA outcomes across world regions over time in these settings. We therefore aimed to estimate how these processes have contributed to observed changes in SBA across Latin America and the Caribbean, South Asia, Southeast Asia, and sub-Saharan Africa. METHODS: We pooled all available Demographic and Health Survey (DHS) rounds that contained detailed birth attendance information. The compiled data covers about 1·1 million births (1·1 million female individuals) from 103 DHS rounds in 37 countries. We estimated the determinants of SBA using multivariable regression techniques and Oaxaca-Blinder decompositions for different world regions and time periods (1990s, 2000s, and 2010s). FINDINGS: We show that progress in SBA is associated with improvements in terms of household-level wealth, mothers' education, urbanisation, contraceptive knowledge, and proxies of female empowerment. Furthermore, we show that changes in the underlying relationship between SBA and specific development indicators (wealth, education, and rural residence status) have further contributed to the observed rise in SBA across LMICs. Our findings further suggest that certain determinants of improvements in SBA are region-specific (eg, importance of rural residence status in sub-Saharan Africa), whereas some of the studied processes (eg, poverty, maternal education, and urbanisation) have become less predictive for the uptake of SBA over time. INTERPRETATION: Although substantial progress has been made in increasing SBA rates over the past three decades across LMICs, further efforts for continued progress are still needed to achieve international targets on SBA as part of the Sustainable Development Goals, the Every Newborn Action Plan, and the Ending Preventable Maternal Mortality initiative. According to our findings, these efforts can include general policies (eg, female empowerment) and region-specific policies (eg, poverty reduction programmes in Southeast Asia). FUNDING: Bernhard Nocht Institute for Tropical Medicine. TRANSLATIONS: For the French and Indonesian translations of the abstract see Supplementary Materials section.
Asunto(s)
Países en Desarrollo , Humanos , Femenino , Embarazo , Adulto , Servicios de Salud Materna/estadística & datos numéricos , Adulto Joven , Parto Obstétrico/estadística & datos numéricos , Región del Caribe , Pobreza , África del Sur del Sahara , Adolescente , Factores Socioeconómicos , Partería/estadística & datos numéricos , América LatinaRESUMEN
Pregnant women in rural Uganda largely rely on medicinal plants for inducing labor, treating postpartum hemorrhage (PPH), and inducing abortion. 90% of the women in both rural and urban Uganda use plants to manage pregnancy symptoms like constipation, heartburn, morning sickness, body aches, nausea, and vomiting. After delivery women continue using plants to manage postpartum complications and for infant care especially herbal baths. This study documented how ethnomedical folklore has been used to aid childbirth, manage postpartum hemorrhage, and induce abortion. METHODS: A cross-sectional ethnobotanical survey was conducted from May - December 2023 in Najjemebe sub-county, Buikwe district. 206 respondents from 12 villages were selected using snowball sampling. Key informants included Traditional Birth Attendants (TBAs) and herbalists. Data was collected using semi-structured questionnaires and focus group discussions. Voucher specimens of the plants were identified and authenticated at Makerere University Herbarium. Data were analyzed using descriptive statistics, Informant Consensus factor (ICF), Use Reports (URs), paired comparisons, and GraphPad Prism® version 9.0.0 software. RESULTS: All respondents (N = 206, 100%), used plants to induce labour, treat PPH, and induce abortion. One hundred four plant species were documented: most cited or preferred were: Hoslundia opposita (N = 109, 53%), Phytolacca dodecandra (N = 72, 35%), and Commelina erecta (N = 47, 23%). The plants belonged to 49 families, Lamiaceae (16.3%) and Fabaceae (14.3%) having the majority of the species. Herbs were 42 (40%) and trees 23 (22%). Oral administration 95(72%) was the commonest, then topical 19 (14.4%) and vaginal 14(10.6%). CONCLUSION: Health surveys revealed that about 27% of deliveries in Uganda take place outside a health facility. Due to the oxytocic effects of plant species reported in this study, they play a triple role of being uterotonics, abortifacients, and treating postpartum haemmorhage. The dilemma lies in the unknown dosages and toxicity levels that could endanger both the mother's and the unborn child's lives. Due to Uganda's high rates of population growth, overall fertility, maternal mortality, and morbidity, policies, and programmes on gendered health provision need to be reevaluated. Integrating herbal medicine into health care systems appears to be a feasible solution.
Asunto(s)
Medicinas Tradicionales Africanas , Hemorragia Posparto , Humanos , Femenino , Uganda , Estudios Transversales , Adulto , Embarazo , Hemorragia Posparto/tratamiento farmacológico , Medicinas Tradicionales Africanas/métodos , Medicinas Tradicionales Africanas/estadística & datos numéricos , Aborto Inducido/métodos , Aborto Inducido/estadística & datos numéricos , Fitoterapia/métodos , Fitoterapia/estadística & datos numéricos , Plantas Medicinales , Persona de Mediana Edad , Adulto Joven , Etnobotánica , Encuestas y Cuestionarios , Preparaciones de Plantas/uso terapéutico , Partería/estadística & datos numéricos , MasculinoRESUMEN
AIM: To examine the association between Midwifery Continuity of Care (MCoC) and exclusive breastfeeding at hospital discharge and neonatal hyperbilirubinemia. METHODS: A matched cohort design was employed using data from the Swedish Pregnancy Register. The study included 12,096 women who gave birth at a university hospital in Stockholm, Sweden from January 2019 to August 2021. Women and newborns cared for in a MCoC model were compared with a propensity-score matched set receiving standard care. Risk ratios (RR) were determined with 95 % confidence intervals (CI) based on the matched cohort through modified Poisson regressions with robust standard error. A mediation analysis assessed the direct and indirect effects of MCoC on exclusive breastfeeding at hospital discharge and neonatal hyperbilirubinemia and to what extent the association was mediated by preterm birth. FINDING: Findings showed that MCoC was associated with a higher chance of exclusive breastfeeding rate (RR: 1.06, 95 % CI: 1.01-1.12) and lower risk of neonatal hyperbilirubinemia (RR: 0.51, 95 % CI: 0.32-0.82) compared with standard care. Mediation analysis demonstrated that lower preterm birth accounted for approximately 28 % of total effect on the reduced risk of neonatal hyperbilirubinemia. DISCUSSION/CONCLUSION: This matched cohort study provided preliminary evidence that MCoC models could be an intervention for improving exclusive breastfeeding rates at hospital discharge and reducing the risk of neonatal hyperbilirubinemia.
Asunto(s)
Lactancia Materna , Continuidad de la Atención al Paciente , Hiperbilirrubinemia Neonatal , Humanos , Hiperbilirrubinemia Neonatal/terapia , Hiperbilirrubinemia Neonatal/epidemiología , Hiperbilirrubinemia Neonatal/prevención & control , Lactancia Materna/estadística & datos numéricos , Lactancia Materna/métodos , Femenino , Suecia , Estudios Retrospectivos , Recién Nacido , Adulto , Estudios de Cohortes , Continuidad de la Atención al Paciente/normas , Continuidad de la Atención al Paciente/estadística & datos numéricos , Embarazo , Partería/estadística & datos numéricos , Partería/métodosRESUMEN
Although the quality of care during childbirth is a maternity service's goal, less is known about the impact of the birth setting dimension on provision of care, defined as evidence-based intrapartum midwifery practices. This study's aim was to investigate the impact of hospital birth volume (≥1000 vs. <1000 births/year) on intrapartum midwifery care and perinatal outcomes. We conducted a population-based cohort study on healthy pregnant women who gave birth between 2018 and 2022 in Lombardy, Italy. A total of 145,224 (41.14%) women were selected from nationally linked databases. To achieve the primary aim, log-binomial regression models were constructed. More than 70% of healthy pregnant women gave birth in hospitals (≥1000 births/year) where there was lower use of nonpharmacological coping strategies, higher likelihood of epidural analgesia, episiotomy, birth companion's presence at birth, skin-to-skin contact, and first breastfeeding within 1 h (p-value < 0.001). Midwives attended almost all the births regardless of birth volume (98.80%), while gynecologists and pediatricians were more frequently present in smaller hospitals. There were no significant differences in perinatal outcomes. Our findings highlighted the impact of the birth setting dimension on the provision of care to healthy pregnant women.
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Calidad de la Atención de Salud , Humanos , Italia , Femenino , Embarazo , Adulto , Estudios de Cohortes , Partería/estadística & datos numéricos , Adulto Joven , Parto Obstétrico/estadística & datos numéricos , PartoRESUMEN
OBJECTIVE: To investigate the status of the midwifery workforce and childbirth services in China and to identify the association between midwife staffing and childbirth outcomes. DESIGN: A descriptive, multicentre cross-sectional survey. SETTING: Maternity hospitals from the eastern, central and western regions of China. PARTICIPANTS: Stratified sampling of maternity hospitals between 1 July and 31 December 2021.The sample hospitals received a package of questionnaires, and the head midwives from the participating hospitals were invited to fill in the questionnaires. RESULTS: A total of 180 hospitals were selected and investigated, staffed with 4159 midwives, 412 obstetric nurses and 1007 obstetricians at the labour and delivery units. The average efficiency index of annual midwifery services was 272 deliveries per midwife. In the sample hospitals, 44.9% of women had a caesarean delivery and 21.4% had an episiotomy. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery (adjusted ß -0.032, 95% CI -0.115 to -0.012, p<0.05) and episiotomy (adjusted ß -0.171, 95% CI -0.190 to -0.056, p<0.001). CONCLUSION: The rates of childbirth interventions including the overall caesarean section in China and the episiotomy rate, especially in the central region, remain relatively high. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery and episiotomy, indicating that further investments in the midwifery workforce could produce better childbirth outcomes.