Birth (Berkeley, Calif.)[JOURNAL]
Sun
200 papers
Exploring the Passive Second Stage of Labour and Related Perinatal Outcomes in a Physiological Cohort.
Zagra L, Panzeri M, Fumagalli S … +4 more , Gramegna T, Nespoli A, Ornaghi S, Locatelli A
Birth · 2026 May · PMID 42068157 · Publisher ↗
BACKGROUND: The passive second stage of labor has been increasingly recognized as a normal phase of labor. However, it remains poorly studied, especially in healthy women. This study aims to assess the passive phase in h...
BACKGROUND: The passive second stage of labor has been increasingly recognized as a normal phase of labor. However, it remains poorly studied, especially in healthy women. This study aims to assess the passive phase in healthy laboring women and maternal and neonatal outcomes. METHODS: A retrospective cross-sectional study on women who gave birth in an Italian University maternity center between 2019 and 2023. Only healthy laboring women without epidural analgesia or intrapartum interventions were included. Data were extracted from electronic records and analyzed overall and by parity. RESULTS: A passive second stage was identified in 466 out of 2810 eligible women (16.6%), with a median duration of 30 min. The passive phase occurred more frequently in nulliparous women (63.9%; p < 0.001) and was associated with more advanced cervical dilatation at partograph initiation (p < 0.001) and longer second-stage duration (p < 0.001), even when stratified by parity. Analysis stratified by parity showed higher rates of episiotomy (p = 0.02) and lithotomy position (p = 0.013) among nulliparas, and of neonatal macrosomia (p = 0.001) and NICU admissions (p = 0.009) among multiparas with a passive second stage. Mode of birth did not differ in either group. DISCUSSION: The passive second stage occurred in a minority of healthy laboring women and may be underdiagnosed due to inconsistent definitions and reliance solely on vaginal examinations. Recognizing and accurately documenting this phase may contribute to a more precise description of physiological labor progression, without implying causal effects on maternal or neonatal outcomes.
Effect of Group Prenatal Care Attendance on Gestational Diabetes Mellitus and Preterm Birth.
Nianogo RA, Hsieh CT, Chen Y … +4 more , Britt JL, Zhang L, Crockett AH, Chen L
Birth · 2026 Apr · PMID 41947416 · Publisher ↗
INTRODUCTION: Adequate prenatal care is an important tool for achieving optimal health outcomes for both mothers and their babies. A low group prenatal care (GPNC) attendance rate may influence clinical outcomes. We aime...
INTRODUCTION: Adequate prenatal care is an important tool for achieving optimal health outcomes for both mothers and their babies. A low group prenatal care (GPNC) attendance rate may influence clinical outcomes. We aimed to estimate the effect of GPNC attendance on the risk of gestational diabetes (GDM) and preterm birth (PTB). METHODS: This is a prospective study that included pregnant individuals (N = 1089) enrolled in the GPNC arm of the Cradle RCT from February 2016 to March 2020. We performed multivariable logistic regressions to estimate the effect of GPNC sessions on PTB or GDM adjusting for potential confounders. RESULTS: Each additional GPNC session attended was associated with a 9% reduction in the risk of PTB (95% CI, 4%-14%) and 1 fewer (95% CI, 0-2) PTB cases per 100 pregnant individuals. Similarly, each additional GPNC session attended was associated with an 11% reduction in the risk of GDM (95% CI, 4%-17%) or 1 fewer (95% CI, 0-2) GDM cases per 100 pregnant individuals. The risk reduction was even higher when attending ≥ 5 GPNC versus < GPNC: adjusted risk ratio [aRR] 0.54: 95% CI (0.36, 0.82) for PTB; aRR: 0.41, 95% CI (0.24, 0.71) for GDM. CONCLUSIONS: Attending more GPNC sessions could lead to a reduction in the risk of PTB and GDM, with an increasing amount of GPNC visits associated with even more risk reduction in PTB and GDM. The relationship between attending prenatal care as a group and mitigation of adverse pregnancy outcome risk is complex and warrants further study. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02640638.
Pregnancy-Related Risk and Birth Setting Trends: Insights From Indonesian Demographic Health Survey Data.
Hodgkin K, Joshy G, Lokuge K
Birth · 2026 Mar · PMID 41888631 · Publisher ↗
BACKGROUND: Most maternal and neonatal deaths occur in low- and middle-income countries and are largely preventable with quality care. In Indonesia, 98% of pregnant people receive antenatal care, and birth commonly occur...
BACKGROUND: Most maternal and neonatal deaths occur in low- and middle-income countries and are largely preventable with quality care. In Indonesia, 98% of pregnant people receive antenatal care, and birth commonly occurs in community settings or hospitals. Outside of high-income countries, few studies identify where women with pregnancy-related risk factors give birth. Accurate identification of pregnancy risk factors and referral to an appropriate birth setting is considered an essential element of quality antenatal care, though its efficacy in Indonesia is unknown. METHODS: This study aimed to identify suitable indicators of pregnancy risk for Indonesia and examine population-level patterns in pregnancy-related risk, care, and appropriateness of birth setting. Risk factors in pregnancy based on internationally relevant referral guidelines were identified through a literature search and mapped to available indicators. Using self-reported data from three waves of the Indonesian Demographic Health Survey (2007, 2012, 2017) a representative survey of women aged 15-49 years we examined receipt of maternity care, prevalence of pregnancy risk factors, and time trends in birth setting, overall and by presence of risk factors. RESULTS: In this weighted sample (n = 43,846), one quarter of women reported pregnancy risk factors. From 2002-2017, the number of births in hospitals doubled and births at home have halved. However, the proportions of women with pregnancy risk in each setting remained largely unchanged. DISCUSSION: Our findings suggest that there remain opportunities for shifting care in Indonesia to ensure women are receiving the appropriate level of care at birth.
Trial of Labor, Vaginal Birth After Cesarean Delivery, and Planned Repeat Cesarean: Measuring the Association of Delivery Method on Postpartum Hospital Encounter in the Fourth Trimester.
Barnard-Mayers R, Declercq E, Murray EJ … +2 more , Yarrington CD, Werler MM
Birth · 2026 Mar · PMID 41882930 · Publisher ↗
BACKGROUND: While trial of labor after cesarean delivery (TOLAC) and vaginal birth after cesarean delivery are considered safe options for birthing people with a prior cesarean delivery, current research investigating po...
BACKGROUND: While trial of labor after cesarean delivery (TOLAC) and vaginal birth after cesarean delivery are considered safe options for birthing people with a prior cesarean delivery, current research investigating postpartum outcomes is lacking. OBJECTIVE: Estimate the absolute association of trial of labor after cesarean and vaginal birth after cesarean delivery, compared to planned repeat cesarean delivery (PRCS) on 90-day postpartum hospital encounter. METHODS: We used data from the pregnancy and early life longitudinal data system, which includes all birth certificate and hospital discharge records for birthing people in Massachusetts, to estimate the effect of TOLAC on postpartum hospital encounter, compared to planned repeat cesarean delivery (PRCS). We then estimated the effect of vaginal birth after cesarean delivery (VBAC) compared to unplanned repeat cesarean deliveries (URCS) on postpartum hospital encounter and examined if hospital volume modified the observed association. RESULTS: We found that TOLAC was associated with a reduced risk of hospital encounter compared to PRCS. Similarly, VBAC was protective against hospital encounter compared to URCS. DISCUSSION: These results affirm VBAC and TOLAC as protective against hospital encounter in the first 90 days postpartum.
Midwives' Perspectives on a Program Supporting Spontaneous Pushing During the Second Stage of Labor: A Qualitative Study.
Yao J, Roth H, Anderson D … +2 more , Lu H, Baird K
Birth · 2026 Mar · PMID 41866797 · Publisher ↗
BACKGROUND: Maternal pushing during the second stage of labor plays a critical role to labor progression, with professional guidelines recommend supporting a natural, "spontaneous" approach to pushing. Midwives are key t...
BACKGROUND: Maternal pushing during the second stage of labor plays a critical role to labor progression, with professional guidelines recommend supporting a natural, "spontaneous" approach to pushing. Midwives are key to facilitating this practice; however, there is limited of evidence regarding their perceptions of spontaneous pushing. This study was designed to explore midwives' perceptions of a program that supported a woman's spontaneous pushing during labor. METHOD: This study employed a descriptive qualitative approach using individual semi-structured interviews. Data were analyzed using thematic analysis. Participants comprised of nine midwives involved in a feasibility study conducted in China. RESULT: Three themes were identified from the midwives' interviews. "Returning to a physiological process of childbirth" depicts midwives' positive involvement and experience in supporting spontaneous pushing, viewing it as a way going back to normal labor and birth. "Creating a win-win situation by spontaneous pushing" highlights the benefits of this strategy for both midwives and women. "Reframing the approach to physiological labor and birth" outlines the challenges and efforts it requires in reframing physiological childbirth by supporting spontaneous pushing. CONCLUSION: Midwives identified a gap between current evidence and routine midwifery practice. Prenatal education for women and professional training for maternity staff would help to enhance the implementation of spontaneous pushing during labor.
Health Insurance Coverage and Rural-Urban Differences in Maternal Health Care Among Postpartum Women-National Health Interview Survey.
Interrante JD, Fritz AH, Handley SC … +2 more , Busse CE, Kozhimannil KB
Birth · 2026 Mar · PMID 41858262 · Publisher ↗
BACKGROUND: Rural-urban differences in access to and quality of health care shape health and well-being during pregnancy, childbirth, and the postpartum period. An important determinant of care access is health insurance...
BACKGROUND: Rural-urban differences in access to and quality of health care shape health and well-being during pregnancy, childbirth, and the postpartum period. An important determinant of care access is health insurance coverage, yet rural residents have higher rates of uninsurance and public insurance (vs. private insurance). This study examined rural-urban differences in maternal health and care among postpartum women, assessing how those differences vary by insurance coverage. METHODS: We used cross-sectional data from the 2013-2018 National Health Interview Surveys (NHIS) with restricted geographic data. The study population (n = 2664) included all non-pregnant female respondents ages 18-49 with an infant under age one. We determined patient rurality using the National Center for Health Statistics 2013 Urban-Rural Classification Scheme. Health insurance was self-reported. Study outcomes included: (1) sleep problems, (2) acute care utilization, (3) dissatisfaction with care, and (4) delayed or forgone care. RESULTS: From 2013 to 2018, postpartum rural residents were more likely to be publicly insured or uninsured than their urban counterparts. Sleep challenges were common and experienced by one-third of rural and one-fourth of urban postpartum women and were most frequently experienced by those publicly insured (compared with privately insured or uninsured). Delayed or forgone care was heightened for those uninsured (rural: 33%, urban: 41%) or publicly insured (rural: 19%, urban: 24%), compared to privately insured postpartum women (rural: 10%, urban: 13%). DISCUSSION: Some maternal health challenges were different for rural and urban residents, and challenges were more common for publicly insured or uninsured than privately insured postpartum women.
Sociocultural and Structural Determinants of Black Maternal Mental Health: A Scoping Review.
Boakye PN, Setordzi M, Etowa J … +13 more , Etowa E, Yoon R, Fung K, Desta F, Tiwaa-Boateng NA, Maxwell C, Byass MT, Yamada J, Clark CT, Wilson-Mitchell K, Mugambi D, Johnson D, Wong JP
Birth · 2026 Mar · PMID 41808612 · Publisher ↗
BACKGROUND: Black women face a disproportionate risk of perinatal mental mood disorders with significant implications for maternal and infant health outcomes. Identifying the determinants of Black maternal mental health...
BACKGROUND: Black women face a disproportionate risk of perinatal mental mood disorders with significant implications for maternal and infant health outcomes. Identifying the determinants of Black maternal mental health is needed to inform the development of culturally concordant programs and policy interventions. OBJECTIVE: This scoping review aims to identify and explore the sociocultural and structural determinants of Black maternal mental health. METHODS: Following the methodological frameworks proposed by Arksey and O'Malley and reworked by Levac et al., searches were conducted in four databases: CINAHL, MEDLINE, PsycINFO, and Google Scholar. Studies published in English between January 2010 and December 2024 were included. A total of 4280 studies were retrieved. Two team members independently screened the articles, and conflicts were resolved by a third member. The data were extracted and analyzed thematically to identify the socio-cultural and structural determinants of Black maternal mental health. RESULTS: Twenty-two studies were included in the final review. The review identified gendered racial stress, sociocultural expectations about strength, mental health-related stigma, racism in healthcare, health insurance coverage, socioeconomic status, relationship status, neighborhood conditions, level of educational attainment, and availability of social support as determinants of Black maternal mental health. These determinants are not mutually exclusive but intersect in complex ways to influence Black maternal mental health outcomes. CONCLUSION: Findings from this review underscore the need for designing community and equity-informed interventions and programs to address health inequities and promote maternal mental health. Future research should focus on culturally and contextually grounded approaches to guide the development of innovative maternal mental health interventions.
Individual and Community-Level Predictors of Anemia in Chicago-Area Pregnancies: A Multi-Level Analysis of Electronic Health Record Data.
Campbell RK, Balakumar P, Pobee R … +3 more , Huang Y, Peñalver Bernabé B, Koenig MD
Birth · 2026 Mar · PMID 41797274 · Full text
BACKGROUND: Anemia is associated with pregnancy complications, including preterm birth, peripartum hemorrhage, and maternal and fetal mortality. Pregnant people of color have higher anemia prevalence compared with White...
BACKGROUND: Anemia is associated with pregnancy complications, including preterm birth, peripartum hemorrhage, and maternal and fetal mortality. Pregnant people of color have higher anemia prevalence compared with White pregnant people, contributing to disparities in pregnancy outcomes. Social determinants of health (SDoH), place-based characteristics that negatively influence health, may help explain anemia disparities. OBJECTIVES: We aimed to quantify community-level variation in prenatal anemia prevalence and identify associated individual- and community-level characteristics. METHODS: Electronic health records for 3,800 pregnant patients at a tertiary academic medical center in 2015-2019 were linked using home location with community variables from the Chicago Health Atlas. Multilevel log Poisson regression models were used to assess individual and community characteristics predictive of anemia prevalence. RESULTS: Anemia prevalence was 20%. Higher rates were concentrated in Chicago's South and West Sides, regions with greater health disparities and lower access to resources. In bivariate analyses, community-level poverty, crime, and food access measures were associated with anemia. However, in multilevel models, only 3% of the variance in anemia prevalence was explained by differences between community areas. Individual characteristics-age, race, and ethnicity-remained significant predictors, while community-level characteristics were not independently associated with anemia. CONCLUSION: Prenatal anemia prevalence was high and varied across Chicago neighborhoods. Yet, community-level characteristics did not provide additional explanatory insight. Stark racial disparities in anemia prevalence highlight the need for research into both SDoH in more geographically diverse samples and individual-level clinical risk factors. These insights inform intervention targets to improve pregnancy outcomes and reduce disparities.
Personal Birth Experiences and Clinician Attitudes About Cesarean Birth: A Cross-Sectional Study With Female Labor and Delivery Unit Staff.
Tiwari T, VanGompel EW, Selig JP … +4 more , Manning N, Smith D, Greenfield W, Callaghan-Koru JA
Birth · 2026 Mar · PMID 41792899 · Publisher ↗
INTRODUCTION: Increasing vaginal birth rates is a quality improvement goal in the United States, where nearly one-third of all births are cesarean deliveries. Evidence from other clinical areas suggests that healthcare w...
INTRODUCTION: Increasing vaginal birth rates is a quality improvement goal in the United States, where nearly one-third of all births are cesarean deliveries. Evidence from other clinical areas suggests that healthcare workers' experience as patients can influence their clinical attitudes. This study explores whether personal birth experiences of labor and delivery unit staff are associated with attitudes regarding hospital labor culture and care practices. METHODS: We conducted a cross-sectional survey of female labor and delivery staff at 29 Arkansas hospitals. Using multilevel linear models, we estimated the association between staff's personal birth experiences and their attitudes across six subscales of the validated Labor Culture Survey (LCS). RESULTS: Survey data from 378 female labor and delivery staff (nurses, 90.2%; physicians, 9.8%) with different personal birth experience (vaginal only, 49.2%; cesarean only, 20.6%; both vaginal and cesarean, 9.3%; no experience, 20.0%) were analyzed. Compared to staff with vaginal births only, average individual scores for staff who had cesarean births were significantly less supportive of vaginal birth for four Labor Culture Survey subscales: cesarean safety (p < 0.05), best practices to reduce cesarean overuse (p < 0.001), physician oversight (p < 0.001) and fear of vaginal birth (p < 0.001). CONCLUSION: Directly addressing personal birth experiences of labor and delivery staff, such as through self-awareness education and reflection in trainings related to quality improvement efforts, may contribute to implementing practices that support vaginal birth. Further research is needed to elucidate the psychosocial mechanisms through which personal birth experiences influence staff attitudes.
Interventions to Optimize Dietary Patterns in Black Pregnant Individuals: An Integrative Review.
Erbe K, Thorndike AN, Nelson M … +2 more , Lydston M, Looby SE
Birth · 2026 Mar · PMID 41772755 · Publisher ↗
INTRODUCTION: Black pregnant individuals bear an inequitable burden of maternal morbidity and mortality in many high income countries (HICs). Adverse social determinants of health and health-related factors, including di...
INTRODUCTION: Black pregnant individuals bear an inequitable burden of maternal morbidity and mortality in many high income countries (HICs). Adverse social determinants of health and health-related factors, including dietary patterns, influence these disproportional rates. Dietary patterns are highly individualized and are associated with health and pregnancy outcomes in distinctive ways across to races and ethnic groups. While nutrition interventions are effective in improving dietary patterns in pregnant individuals, trial participants are predominantly non-Hispanic White. The objective of this integrative review is to identify and evaluate research exploring interventions to optimize dietary patterns in Black pregnant individuals in HICs. METHODS: Electronic searches were conducted in October, 2023 and June, 2025 and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement. Eligibility was determined based on select criteria specific to the study participants, setting, methodological approach, intervention, and publication type. Final articles were critically appraised using the Joanna Briggs Institute and Consolidated Standards of Reporting Trials tools. Data extraction and synthesis of eligible articles was conducted as outlined by Whittemore and Knafl. RESULTS: Fourteen articles from ten studies were included in the final review and were overall favorably appraised. Half of these studies enrolled Black or African American pregnant women exclusively. Interventions included nutrition education, behavioral counseling, and nutritious food delivery and were delivered in a variety of settings and modalities. Measurement and analysis of dietary assessments were inconsistently reported, and change in diet quality was the primary outcome for only three articles. Only one intervention was effective in improving participants' dietary intake. CONCLUSION: Results from this integrative review illustrate the paucity of research on interventions to optimize dietary patterns in Black pregnant individuals in (HICs). Future nutrition intervention studies are needed among Black pregnant individuals, that include comprehensive reporting of participant demographics, social determinants of health, and dietary patterns. This will allow better understanding of the relationship between these factors and pregnancy and health outcomes for Black pregnant individuals.
The Soothing Touch of Water: Maternal Comfort and Neonatal Outcomes in Hydrotherapy-Assisted Labor.
Elmas B, Zorlu U, Başarir U … +5 more , Bariş Akcan BN, Derme T, Kurtaran G, Türker Ergün G, Moraloğlu Tekin Ö
Birth · 2026 Feb · PMID 41735799 · Publisher ↗
BACKGROUND: This study aims to evaluate the impact of hydrotherapy-assisted labor on maternal and neonatal outcomes compared to conventional vaginal delivery. METHODS: A retrospective cohort study was conducted at Bilken...
BACKGROUND: This study aims to evaluate the impact of hydrotherapy-assisted labor on maternal and neonatal outcomes compared to conventional vaginal delivery. METHODS: A retrospective cohort study was conducted at Bilkent City Hospital between 2019 and 2024, including 408 women divided into four groups: 102 primiparous and 102 multiparous women in the hydrotherapy group and 102 primiparous and 102 multiparous women in the conventional delivery group. Maternal outcomes included labor pain (VAS scores), labor duration, perineal trauma, and postpartum complications, while neonatal outcomes included Apgar scores, NICU admission rates, and birth weights. Systemic inflammatory markers (NLR, PLR) were analyzed for their association with cesarean delivery risk. Statistical analyses were performed using SPSS 25.0, with a significance level of p < 0.05. RESULTS: Hydrotherapy-assisted labor was associated with significantly higher vaginal delivery rates in both primiparous (85.29% vs. 80.39%, p = 0.04) and multiparous women (85.29% vs. 81.37%, p = 0.04). VAS pain scores at 6 cm cervical dilation and at 6 h postpartum were significantly lower in the hydrotherapy groups across both parity strata (all p = 0.01). The incidence of third- and fourth-degree perineal tears and postpartum infection-related hospitalization was significantly reduced in the hydrotherapy groups. Neonatal outcomes were favorable, with higher Apgar scores at 1 and 5 min and lower NICU admission rates among women undergoing hydrotherapy-assisted labor. Within the hydrotherapy cohort, women who required cesarean delivery exhibited significantly higher PLR and WBC/neutrophil ratio values and distinct NLR patterns compared with those who achieved vaginal birth. ROC analyses demonstrated moderate discriminatory performance of NLR, PLR, and WBC/neutrophil ratio for predicting cesarean delivery. CONCLUSION: Hydrotherapy-assisted labor provides significant maternal pain relief, reduced perineal trauma, and improved neonatal outcomes, with no increased risks. The association between systemic inflammatory markers and labor progression highlights the need for further research. Hydrotherapy should be considered a safe and effective alternative for labor management in properly selected cases.
Birth-Related Experiences and Postpartum Depression: The Protective Role of Self-Compassion.
Moreira H, Martin CR
Birth · 2026 Feb · PMID 41730578 · Publisher ↗
BACKGROUND: The experience of childbirth can significantly impact the well-being and mental health of postpartum women, potentially contributing to the development of postpartum depression (PPD) symptoms. Identifying mod...
BACKGROUND: The experience of childbirth can significantly impact the well-being and mental health of postpartum women, potentially contributing to the development of postpartum depression (PPD) symptoms. Identifying modifiable factors that can protect women's mental health in the postpartum period is critical to devise more tailored interventions for this period. This study aims to investigate how self-compassion moderates the relationship between birth satisfaction levels, type of birth, and early skin-to-skin contact (SSC) in women's PPD symptoms. METHODS: A total of 987 postpartum women completed an online survey assessing sociodemographic and obstetric variables, birth satisfaction, self-compassion, and postpartum depression symptoms. On average, women were 31.98 years old (SD = 4.36), and their babies were 2.48 months old (SD = 1.24; range = 0-5). RESULTS: Higher levels of PPD symptoms were significantly correlated with lower birth satisfaction, having a caesarian delivery, and not engaging in SSC after birth. Moderation analyses indicated that PPD symptom levels were not significantly associated with delivery type at average and higher levels of self-compassion and were not significantly associated with birth satisfaction at higher levels of self-compassion. DISCUSSION: Self-compassion appears to play an important buffering role in women's mental health during the postpartum period. Moderation findings suggest that average and higher levels of self-compassion may attenuate the negative effects of a cesarean delivery and lower birth satisfaction on PPD symptom levels. These findings suggest that psychological interventions targeting postpartum mental health or PPD may benefit from incorporating strategies aimed at fostering self-compassion.
Midwifery Students' Definitions of Normal Labor and Birth: A Study From Five Countries.
International Network Exploring Midwifery Students' Confidence in Physiological Birth, Lazar J, Wood J … +10 more , Fry J, Baranowska B, Tataj-Puzyna U, Dole D, Ritchie E, Davison C, Farley CL, Kalu FA, Healy M, Węgrzynowska M
Birth · 2026 Feb · PMID 41693605 · Publisher ↗
INTRODUCTION: Internationally, many women and birthing people are receiving maternity care interventions as a routine with no medical indication for their use. This medicalized environment influences midwives' practice a...
INTRODUCTION: Internationally, many women and birthing people are receiving maternity care interventions as a routine with no medical indication for their use. This medicalized environment influences midwives' practice and, by extension, midwifery students' clinical learning experiences, gaining knowledge and confidence in facilitating normal labor and birth. To educate midwifery students in the provision of high-quality maternal and newborn care, it is important to explore their understanding of normal labor and birth, as this underpins their philosophy of care and will inform their future practice. METHODS: An online survey was developed from a review of current evidence. Following ethical approval, the survey was disseminated at midwifery education programs across five countries-Australia, England, Northern Ireland, Poland, and the United States-between February 2019 and December 2023. RESULTS: In total, 664 midwifery students responded to the open-ended question: "What do you consider the phrase 'normal labour and birth' to mean?" Reflexive thematic analyses resulted in seven themes, representing the key components of the midwifery students' definitions of normal labor and birth. These included: "Vaginal birth with no or minimal intervention in labour; Spontaneous onset of labour; Respectful women-centered care; The concept of normal is disputed; The midwife's role; Birth outcomes define normality; and Environment and freedom to move." CONCLUSIONS: Despite some differences in maternity care and midwifery education across the five countries, midwifery students develop a comparable understanding of normal labor and birth gained through their education and clinical experiences, which has implications for the future of midwifery practice and identity.
Quality Care in Midwifery-Led Birth Centers: Assessing the Disconnect Between Reimbursement and Perinatal Outcomes.
Bradbury S, Jolles D, Hoehn-Velasco L … +4 more , Stapleton S, Bauer K, Alliman J, Stapleton J
Birth · 2026 Feb · PMID 41657007 · Publisher ↗
BACKGROUND: Health care financing is thought to be a driver of health care quality. The purpose of this research was to analyze reimbursement for midwifery-led US birth centers and to evaluate the association between rei...
BACKGROUND: Health care financing is thought to be a driver of health care quality. The purpose of this research was to analyze reimbursement for midwifery-led US birth centers and to evaluate the association between reimbursement ratios and clinical outcomes. METHODS: Secondary analysis of the American Association of Birth Centers Site Survey and the American Association of Birth Centers Perinatal Data Registry was completed. Descriptive statistics and logistic regression were used to analyze reimbursement ratios and their relationship to clinical outcomes. RESULTS: Between 2012 and 2020, 107 participating birth centers cared for 78,773 enroled pregnant people. Public payors (Medicaid, Tricare, CHIP) were reported to pay less than a third of all charges. Comparing private payors to public payors, lower reimbursement ratios were demonstrated for professional services (77% vs. 43%), facility fees (89% vs. 45%), and newborn care (66% vs. 40%). Core clinical outcomes demonstrated high quality without significant variation between public and private payor groups: cesarean birth (10.2 vs. 9.2%), NICU admissions (0.9% vs. 1.1%). The median reimbursement ratio for public payors was 0.379. For every 1000 dollars increase in reimbursement, the odds of cesarean birth increased by a factor of 1.39 for nulliparous women (aOR 1.39; 95% CI, 1.10-1.75) and 2.15 for multiparous women (aOR 2.15; 95% CI 1.54-3.01). DISCUSSION: Despite poor reimbursement ratios, birth centers consistently exceeded national quality benchmarks in perinatal outcomes. Low reimbursement ratios for time-intensive, midwifery-led care without consideration of quality outcomes limit the potential for sustainability and spread of the birth center model of care.
Midwifery Care Studies: A Reflexive Methodology for a Practice-Based Science.
Skeide A
Birth · 2026 Feb · PMID 41640323 · Publisher ↗
BACKGROUND: Midwifery research is increasingly understood as shaped by the specific social, political, and historical contexts, with scientific practices actively co-producing realities. This recently developed perspecti...
BACKGROUND: Midwifery research is increasingly understood as shaped by the specific social, political, and historical contexts, with scientific practices actively co-producing realities. This recently developed perspective highlights the need for discipline-specific approaches that reflect the diversity and creativity of midwifery care. AIM: This contribution introduces Midwifery Care Studies as a novel, reflexive approach to studying midwifery as a practice-based science. FINDINGS: Building on analyses inspired by feminist science studies, Midwifery Care Studies examine midwifery care in practice. Using participatory methods, this approach aimed to investigate midwifery care practices on their own terms. DISCUSSION: Midwifery Care Studies share the sensitivities and response-abilities that shape everyday midwifery care practices. Acknowledging the relational character of midwifery care, Midwifery Care Studies articulate modes and techniques of becoming-with that involve birth givers, fetuses, midwives, technologies, words, values, and birthing environments. By carving out the material, social, and ethical specificities of situated midwifery care practices, Midwifery Care Studies examine unfolding and shifting "goods" and "bads" in practice, as well as how tensions between them are handled. CONCLUSION: Sensitive to the ontological politics of care and research practices, Midwifery Care Studies aim at providing the analytical and conceptual resources needed to foster generative engagements with the multitude of lived realities of being pregnant and giving birth.
Migration and Caesarean Section Birth in the United Kingdom: A Secondary Analysis of Born in Bradford Data.
Cadman V, Spencer R, Soltani H
Birth · 2026 Feb · PMID 41636088 · Publisher ↗
BACKGROUND: Caesarean section (C-section) rates in the United Kingdom continue to increase and are a concern. Births to migrants account for 30.3% of live births in England and Wales. Other international studies have obs...
BACKGROUND: Caesarean section (C-section) rates in the United Kingdom continue to increase and are a concern. Births to migrants account for 30.3% of live births in England and Wales. Other international studies have observed varying rates of C-section for migrant populations in comparison to women born within the country itself. Comparison of incidence rates of Caesarean section birth between migrant populations and women born in the United Kingdom (UK) was undertaken to inform the UK context and address an existing dearth of data. METHODS: This study included analysis of 11,361 records from the Born in Bradford cohort study. Binomial logistic regression analysis was performed to estimate crude and adjusted odd ratios (aOR) with 95% confidence intervals (CI) for the incidence of total, elective, and emergency C-section births between migrant populations and UK-born women. RESULTS: Women from "South Asia" and "Central Europe, Eastern Europe, and Central Asia" demonstrate lower incidences of total C-section with a significantly lower elective C-section. Women from Sub-Saharan Africa demonstrate significantly high rates of total C-section (38% increased odds). DISCUSSION: High variation in the incidence of C-section amongst migrant populations was observed, replicating findings from the few other international studies. Further in-depth exploration is required to understand the impact of this variation on maternal and neonatal health disparities, and to assess the contribution of potential pathophysiological and sociocultural factors on related decision-making processes.
Perceived Safety in Childbirth: Pregnancy Predictors of Women's Experiences During Childbirth.
Wynter K, Lewis AJ, Ball HL … +2 more , Power J, Galbally M
Birth · 2026 Jan · PMID 41566818 · Publisher ↗
BACKGROUND: Women's perceived safety during childbirth contributes to their childbirth experience, which can impact mental health and the experience of future pregnancies. Unexpected birth events may predict negative exp...
BACKGROUND: Women's perceived safety during childbirth contributes to their childbirth experience, which can impact mental health and the experience of future pregnancies. Unexpected birth events may predict negative experiences of childbirth, but there is limited evidence about the role of demographic, health, and psychological factors known during pregnancy. The aim of this paper was to model pregnancy predictors of women's perceived safety during childbirth. METHODS: Women (n = 313) < 20 weeks' gestation were recruited from a large maternity hospital in Melbourne, as part of the Mercy Pregnancy and Childbirth Study (MPEWS). The dependent variable was the Perceived Safety Scale score from the Childbirth Experience Questionnaire, administered at 6 months postpartum. Hierarchical linear regression was conducted to determine factors significantly associated with scores, in two steps: (1) Step 1: demographic and health factors, depression, anxiety symptoms, recalled childhood trauma, and sense of coherence in pregnancy and (2) Step 2: birth events and complications. RESULTS: Step 1 (p < 0.001) explained 20% and Step 2 (p < 0.001) an additional 3% of the variance in Perceived Safety scores. Higher trait anxiety (β = -0.255, p = 0.004), smoking during pregnancy (β = -0.124, p = 0.027), and emergency Caesarean births (β = -0.133, p = 0.048) predicted lower Perceived Safety. Multiparity was associated with significantly greater Perceived Safety (β = 0.116, p = 0.035). CONCLUSION: Although emergency Caesarean births contribute to poorer perceived safety during childbirth, other factors, which are known during pregnancy, can also impact negatively on women's perceived safety during childbirth. Targeted support during pregnancy may therefore facilitate higher perceived safety during childbirth.
Effect of Anxiety on Depression in Pregnant Women: The Mediating Role of Stress and Moderating Role of Social Support.
Liu J, Li Y, Duan J … +1 more , Tao Y
Birth · 2026 Jan · PMID 41560603 · Publisher ↗
BACKGROUND: Although anxiety is a well-established risk factor for depression during pregnancy, the mechanisms through which prenatal anxiety affects depression remain unclear. This study aims to investigate: (a) whether...
BACKGROUND: Although anxiety is a well-established risk factor for depression during pregnancy, the mechanisms through which prenatal anxiety affects depression remain unclear. This study aims to investigate: (a) whether perceived stress acts as a mediator between anxiety and depression, and (b) whether social support plays a moderating role in this relationship. METHOD: This cross-sectional study used a questionnaire-based design. Between April 2022 and June 2023, we surveyed pregnant women in their second trimester, collecting 521 valid questionnaires. The survey measured perceived stress, social support, depression, anxiety, as well as demographic characteristics. Data were processed and analyzed using SPSS 26.0 and PROCESS 4.1. RESULT: Anxiety was significantly associated with depression (β = 0.42, p < 0.001), and perceived stress mediated this relationship (β = 0.13, p < 0.001). Social support significantly moderated the effect of anxiety and depression, influencing both indirect (β = -0.25, p < 0.001) and direct pathways (β = -0.16, p < 0.001). Specifically, anxiety affected perceived stress and depression at both high and low levels of social support, but the effects were attenuated at higher levels of social support for perceived stress (simple slope = 0.11 vs. 0.37) and depression (simple slope = 0.3 vs. 0.47). CONCLUSION: Anxiety not only directly served as a risk factor for depression but also indirectly contributed to depression through perceived stress. Social support moderated both the initial (anxiety → perceived stress) and direct (anxiety → depression) paths of this mediation. Early screening and targeted interventions for anxiety-particularly among pregnant women experiencing high perceived stress and low social support-may help reduce the risk of depression.
Childbirth Related Post-Traumatic Stress Disorder and Childbirth Trauma: A Systematic Review of Available Primary Antenatal Intervention.
MacMillan KK, Greenhalgh CF, Cleary DB … +4 more , Cahill J, Dedman K, Bright C, Watson SJ
Birth · 2026 Jun · PMID 41546447 · Publisher ↗
BACKGROUND: Growing evidence highlights maternal risk factors that can increase the likelihood of traumatic childbirth experience. Yet little is known about the availability of primary antenatal intervention for childbir...
BACKGROUND: Growing evidence highlights maternal risk factors that can increase the likelihood of traumatic childbirth experience. Yet little is known about the availability of primary antenatal intervention for childbirth trauma to facilitate optimal maternal and infant outcomes. The aim of this study was to conduct a systematic review of the literature and empirical evidence to identify antenatal interventions and their effectiveness for treatment of childbirth trauma, post-traumatic stress disorder (PTSD), subthreshold PTSD, or post-traumatic stress (PTS) from childbirth. METHODS: Four databases were accessed: PUBMED, CINAHL, ProQuest, and EBSCOHOST. PRISMA guidelines were followed for screening and reporting. Inclusion criteria were as follows: (1) peer reviewed articles; (2) samples of pregnant women; (3) published in English; (4) measure of PTSD, PTSD symptoms, PTS or fear of childbirth; (5) variable of childbirth trauma or childbirth experience; (6) antenatal intervention; and (7) human studies. RESULTS: We identified 2034 articles, with 12 articles in the final sample. The most common antenatal intervention in four studies was childbirth plans, which were associated with an increase in positive childbirth experience, childbirth control, mastery, and participation, as well as increased self-efficacy and reduced PTSD symptoms (p < 0.01). Other interventions included antenatal counseling and psychoeducation; eye movement desensitization and reprocessing; counseling; haptotherapy; trauma-informed care; cognitive behavioral therapy; and hypnosis for childbirth trauma. CONCLUSIONS: Methodological limitations as well as a lack of inclusion of women with perinatal mental health difficulties represent gaps in knowledge. Findings suggest promising evidence for the implementation of antenatal interventions in clinical and hospital contexts to treat childbirth trauma.
Early Pregnancy Body Mass Index and Experiences of Gendered Racial Microaggressions in a Multiracial, Multiethnic Prospective Cohort.
Glazer KB, Boychuk N, Howell FM … +12 more , Burdick M, Nowlin S, Maru S, Oshewa O, Monterroso M, Jackson E, McCarthy K, Rodriguez A, Lewey J, Howell EA, Levine L, Janevic T
Birth · 2026 Jan · PMID 41531368 · Full text
OBJECTIVE: Weight bias is a source of stigma in healthcare, and obesity is disproportionately prevalent among Black and Hispanic individuals of reproductive age. However, relationships between body size and other forms o...
OBJECTIVE: Weight bias is a source of stigma in healthcare, and obesity is disproportionately prevalent among Black and Hispanic individuals of reproductive age. However, relationships between body size and other forms of discrimination in perinatal settings remain poorly understood. Our objective was to examine the association between body mass index (BMI) and gendered racial microaggressions (GRM)-everyday discriminatory experiences related to race and gender-during perinatal care. METHODS: We studied a prospective cohort of Asian, Black, and Hispanic ("Global Majority") individuals who gave birth in four New York City and Philadelphia hospitals from March 2022-March 2023. Early pregnancy BMI was ascertained from weight and height recorded at first prenatal visit. Participants completed the validated GRM Scale, adapted for perinatal context by a community working group, during the birth hospitalization. We examined mean ± standard deviation (SD) GRM Scale score by BMI class and measured associations between BMI and GRM using multivariable Tweedie regression. RESULTS: Of 368 participants, 27.2% had normal weight (18.5 kg/m ≤ BMI < 25), 29.9% overweight (25 ≤ BMI < 30), 32.6% class I-II obesity (30 ≤ BMI < 40), and 10.3% class III obesity (BMI ≥ 40). Thirty-seven percent of participants reported experiencing at least one instance of GRM during perinatal care. Mean ± SD GRM Scale score (higher = more frequent) increased with BMI class, from 1.7 ± 3.8 among those with normal weight to 4.8 ± 9.3 with class III obesity; associations persisted after adjusting for age, education, parity, and late prenatal care. CONCLUSION: BMI is associated with perinatal GRM among Global Majority individuals. Intersectional research on weight bias and discrimination, incorporating patient and provider perspectives, is warranted for inclusive, respectful perinatal care.
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