Birth (Berkeley, Calif.)[JOURNAL]
Sun
200 papers
Translation and Cross-Cultural Adaptation of the Quality Maternal and Newborn Care Framework Index for Its Use in China.
Zhai J, Tao J, Wang S … +3 more , Wen X, Wu R, Symon A
Birth · 2026 Jun · PMID 41189303 · Publisher ↗
BACKGROUND: The Quality Maternal and Newborn Care Framework index (QMNCFi) is a 44-item tool that assesses service users' perspectives of the quality of maternal and newborn care. Transforming a survey tool for use in an...
BACKGROUND: The Quality Maternal and Newborn Care Framework index (QMNCFi) is a 44-item tool that assesses service users' perspectives of the quality of maternal and newborn care. Transforming a survey tool for use in another language requires both linguistic and cultural adaptation. This study aimed to translate and cross-culturally adapt the QMNCFi into standard Chinese. METHODS: A standard translation and adaptation model was used, including independent translation, back translation, checking of the items' wording, applicability, and relevance by a senior panel. This was followed by purposive sampling of 30 mothers to participate in cognitive interviews and then verification of back translations by the original lead authors of QMNCFi. Finally, a further 16 mothers were purposively selected to participate in two rounds of cognitive interviews. Data were analyzed using content analysis to assess item, semantic, operational, conceptual, and measurement equivalence, ultimately resulting in a culturally adapted Chinese version. RESULTS: Adaptations were made to the QMNCFi covering item, semantic, operational, and conceptual equivalence. The item-level content validity index from the panel consultations ranged from 0.813 to 1.000 (first round) to 0.933 to 1.000 (second round). The average scale-level content validity index was 0.990 and 0.998, respectively, indicating strong content validity, so no revisions were made for measurement equivalence. CONCLUSION: This study achieved cultural equivalence through cross-cultural translation and adaptation of QMNCFi. The adapted Chinese version of QMNCFi will now be formally validated.
Provider Perceptions of Perinatal Mental Healthcare Access.
Sutherland S, Stone AL, Osmundson SS
Birth · 2026 Jun · PMID 41170876 · Full text
BACKGROUND: The consequences of untreated perinatal mental health conditions are well-established, yet fewer than one in five women experiencing perinatal mental health distress receive treatment. Although recommendation...
BACKGROUND: The consequences of untreated perinatal mental health conditions are well-established, yet fewer than one in five women experiencing perinatal mental health distress receive treatment. Although recommendations for evidence-based treatment are increasingly widespread, patients and providers still face substantial hurdles to accessing needed services. This study sought to update the literature with a report on providers' perceptions of the demand for and accessibility of mental health services for women in the perinatal period with the goal of pinpointing areas where quality improvement should be implemented. METHODS: An eight-item, mixed-methods (i.e., open choice, multiple choice, and open response) questionnaire assessing perceptions of patients' access and barriers to care was sent in a department-wide email at a large academic medical center. Forty-six providers completed the survey (n = 18 physicians, n = 14 nurse midwives, n = 13 advanced practitioner nurses, n = 2 other providers). RESULTS: Providers reported pervasive barriers to perinatal mental healthcare and that only occasionally are their perinatal patients able to access appropriate mental healthcare. DISCUSSION: The findings contribute to the growing body of knowledge regarding access to mental healthcare, ultimately aiming to improve the overall well-being of women during the perinatal period. The study emphasizes the ongoing critical need for researchers and the healthcare system to recognize and address the persistent challenges faced by obstetric providers, highlighting the pervasive nature of issues in accessing quality perinatal healthcare and underscoring the importance of acknowledging these challenges for justifying increased clinical access, rigorous intervention studies, and policy change.
Parental Involvement in Decision-Making About Planned Late Preterm and Early Term Birth (The "PIP" Study): Part 1-A Reflexive Thematic Analysis of Interviews With Parents.
Mielewczyk FJ, Mulvaney CA, Boyle EM
Birth · 2026 Jun · PMID 41170859 · Full text
INTRODUCTION: Late preterm and early term birth are associated with increased risks of adverse health outcomes throughout life. Where such births have been decided upon in advance, many parents are dissatisfied with the...
INTRODUCTION: Late preterm and early term birth are associated with increased risks of adverse health outcomes throughout life. Where such births have been decided upon in advance, many parents are dissatisfied with the input they are able to have in the decision-making process. This paper reports a qualitative investigation exploring the input parents want and expect in decision-making about possible planned LPET birth; how their experiences compare with these; and how they feel about the input they are able to have. METHOD: Semi-structured interviews were conducted with parents of babies up to 6 months old, who had been involved in discussions with doctors about the possibility of planned late preterm or early term birth. Data were analyzed using Reflexive Thematic Analysis. RESULTS: Twelve parents of nine singleton babies took part. Analysis generated three themes: (1) What matters most to us in this decision? (2) We are in a new and strange place, and (3) Can we work together to reach a decision? Each theme encompassed two or more sub-themes. CONCLUSION: Parents want to feel able to voice their questions and concerns; to understand why early birth is being considered, their options and the reason behind specific recommendations; and to work with healthcare professionals to reach a plan that is agreed by all as best for the baby, inclusive of other issues they consider important, and carried out as planned. Suggestions are made for what parents need if these wishes and expectations are to be met.
Childbirth in Women Infected or in Close Contact With SARS-CoV-2 in Spain: A Qualitative Study.
Parás-Bravo P, Palacios-Ceña D, Moro-López-Menchero P … +4 more , Herrero-Montes M, Fernandez-de-Las-Peñas C, Cabero MJ, Lechosa-Muñiz C
Birth · 2026 Jun · PMID 41147702 · Publisher ↗
OBJECTIVE: To explore the perinatal and birth experiences of pregnant women infected, or in close contact with SARS-CoV-2 during the first wave of the pandemic in a hospital in northern Spain. METHODS: A qualitative desc...
OBJECTIVE: To explore the perinatal and birth experiences of pregnant women infected, or in close contact with SARS-CoV-2 during the first wave of the pandemic in a hospital in northern Spain. METHODS: A qualitative descriptive study was conducted. The Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research were followed. Purposeful and non-probabilistic sampling were used. Recruitment started in December 2022 and continued until February 2023. The inclusion criteria consisted of: (a) Women > 18 years old fluent in Spanish, (b) pregnant women infected with or in close contact with SARS-CoV-2 at the time of delivery, and (c) those who gave birth at HUMV during the first wave of COVID-19 (March-June 2020). In-depth interviews and researcher field notes were used for data collection. A thematic inductive analysis was performed. RESULTS: Nineteen participants were included. The mean age of participants was 34.94 years (standard deviation, SD: 4.17). Five themes emerged: (a) Uncertainty about COVID-19; (b) Loss of control of the situation; (c) Loss of normality; (d) Impact of restrictions on neonatal care and (e) Unexpected positive experiences. CONCLUSIONS: Participants infected or in isolation due to close contact with SARS-CoV2 who became mothers during the COVID-19 pandemic experienced the perinatal process and particularly childbirth as a traumatic event. Loss of control of the situation and separation from the partner and the baby were experienced with anguish, confusion, and uncertainty. This experience had a lasting emotional impact over time. CLINICAL IMPLICATIONS: In the future, respecting the woman's decisions in relation to childbirth, humanizing care throughout the process, not separating the mother from the baby except in extreme circumstances, and treating the couple as an inseparable and essential element during pregnancy, childbirth, and postpartum processes could help reduce trauma for people giving birth during pandemics.
Reducing Stigma Among Providers Caring for Pregnant Patients With Substance Use Disorders: A Systematic Review of Interventions.
Swenson K, Comstock S, Briley S
Birth · 2026 Mar · PMID 41088861 · Publisher ↗
BACKGROUND: The prevalence of substance use disorders (SUDs) among pregnant individuals has risen alongside the opioid epidemic, contributing to increased maternal morbidity and mortality. Many pregnant individuals with...
BACKGROUND: The prevalence of substance use disorders (SUDs) among pregnant individuals has risen alongside the opioid epidemic, contributing to increased maternal morbidity and mortality. Many pregnant individuals with SUDs experience significant stigma and bias from the healthcare system, which discourages them from seeking necessary care. This stigma, often exacerbated by fears of child protective services involvement, can prevent patients from engaging in treatment, thereby impacting maternal and fetal health. Reducing stigma among healthcare providers and nurses is critical to improving care and outcomes for this population. This systematic review aims to identify and compile primary literature on interventions designed to decrease stigma in providers and nurses caring for pregnant individuals with SUDs. METHODS: We conducted a systematic search of Google Scholar, Web of Science, and Embase using comprehensive terms related to substance use, healthcare providers, stigma, and pregnancy. Only primary research articles were included, with exclusions for review papers, meta-analyses, and commentaries, as well as studies focused on unrelated topics (e.g., prescriptions, schizophrenia, psychosis). Using Covidence software, we screened 2308 articles, with 558 duplicates removed automatically. Double-blind title and abstract screening resulted in the exclusion of 1330 articles, leaving 420 for full-text review. After applying inclusion criteria, 19 studies were included in the final analysis. RESULTS: The 19 included studies represented a wide range of educational interventions designed to reduce provider stigma toward pregnant individuals with SUDs. Interventions included online learning modules, professional development workshops, clinical immersion experiences, and one arts-based program. While training formats and evaluation tools varied widely, most studies reported improvements in provider knowledge, confidence, and attitudes. However, fewer demonstrated sustained behavior change, and only a minority used validated instruments or long-term follow-up. CONCLUSIONS: Stigma reduction interventions for providers caring for pregnant people with SUDs are becoming more common, particularly in response to rising perinatal substance use rates. Despite the effectiveness of many approaches, intervention and evaluation strategies remain non-standardized. Expanding access to training, especially in high-burden and under-resourced settings, and developing validated, scalable, and emotionally engaging education models will be critical to improving perinatal care quality and equity.
Impact of Traumatic Childbirth and Birth-Related Posttraumatic Stress Disorder on Breastfeeding Outcomes: A Systematic Review of Longitudinal and Cohort Studies.
Cavallé-Abasolo E, Dikmen-Yildiz P, Gómez-Gómez I … +2 more , Barros-Martins L, Motrico E
Birth · 2025 Dec · PMID 41054020 · Full text
BACKGROUND: Breastfeeding is the most recommended form of infant nutrition during the first months of life. Mother's perception of childbirth as traumatic, or birth-related diagnosis of Posttraumatic Stress Disorder (PTS...
BACKGROUND: Breastfeeding is the most recommended form of infant nutrition during the first months of life. Mother's perception of childbirth as traumatic, or birth-related diagnosis of Posttraumatic Stress Disorder (PTSD) or symptoms (PTSS), may negatively affect breastfeeding outcomes, but there is not enough evidence about its influence. The aim of this study was to examine and summarize the available literature on the impact of traumatic childbirth and/or PTSD/PTSS related to childbirth on breastfeeding outcomes. METHODS: Following PRISMA guidelines (PROSPERO: CRD42023407019), a systematic review of prospective longitudinal and cohort studies was conducted, involving searches across PubMed, PsycINFO, Scopus, Web of Science, and PsycARTICLES. The PICOS model guided inclusion criteria, and the Newcastle-Ottawa Quality Assessment Scale (NOS) was used to assess study quality. RESULTS: From the 1471 identified records, eight studies (involving 3091 participants) met our inclusion criteria and demonstrated an overall low risk of bias, according to NOS. Results consistently revealed a negative association between traumatic childbirth and/or birth-related PTSS/PTSD and breastfeeding outcomes, including initiation, duration, self-efficacy, and exclusive breastfeeding in the baby's early months. DISCUSSION: A traumatic birth can have lasting effects on both maternal mental health and breastfeeding outcomes. LIMITATIONS: Potential omission of relevant studies despite searches across five databases and the absence of a calculated size effect, preventing the determination of the strength of the studied variables' relationship. Predominant focus on European studies questions the generalizability of the results. CONCLUSION: Mothers suffering from traumatic childbirth and/or childbirth-related PTSS or PTSD have an increased risk of poorer breastfeeding outcomes. REGISTRATION AND PROTOCOL: The systematic review protocol was registered in PROSPERO. The registration number is: CRD42023407019.
Pathways to Birth Trauma: Prenatal PTSD as a Mediator Between Adverse Childhood Experiences and Childbirth-Related PTSD Symptoms.
Addante S, Hinckley E, Garza GE … +4 more , Creech KF, Quigley A, Shreffler KM, Ciciolla L
Birth · 2026 Jun · PMID 41044892 · Full text
BACKGROUND: Extensive research highlights the risk of PTSD following traumatic childbirth. However, PTSD during pregnancy-whether preexisting or emerging prenatally-receives far less attention despite its associated harm...
BACKGROUND: Extensive research highlights the risk of PTSD following traumatic childbirth. However, PTSD during pregnancy-whether preexisting or emerging prenatally-receives far less attention despite its associated harmful effects on maternal and infant well-being. To fill this gap, the current study examines predictors of childbirth-related PTSD symptoms, including maternal ACEs and prenatal PTSD symptoms in 91 mothers from a diverse community sample (47% particpants of c) within the United States. METHODS: Participants completed questionnaires on ACEs and PTSD symptoms during their third trimester of pregnancy and childbirth-related PTSD symptoms at 6-weeks postpartum. The current study used a path analysis model to examine the mediating effects of prenatal PTSD on the relationship between ACEs and childbirth-related PTSD symptoms at 6-weeks postpartum. RESULTS: Findings indicated that ACEs have implications for childbirth-related PTSD symptoms at 6-weeks postpartum with a significant indirect effect through prenatal PTSD, standardized indirect effect = 0.20, 95% CI = [0.02, 0.36], p = 0.03. CONCLUSION: Screening for childhood adversity during pregnancy may have dual benefits for prenatal and postpartum health, such that screening can help identify women at risk for prenatal PTSD as well as those at risk for later childbirth-related trauma symptoms who may benefit from trauma-informed targeted prevention and intervention efforts.
A Concept Analysis on Failure to Rescue in Maternal Health: Implications for Practice and Policy.
Post W
Birth · 2025 Dec · PMID 41025670 · Full text
BACKGROUND: Although "Failure to Rescue" (FTR) has been widely studied in general healthcare contexts, and a few clinical specialties, its definition and implications remain underexplored within maternal health, particul...
BACKGROUND: Although "Failure to Rescue" (FTR) has been widely studied in general healthcare contexts, and a few clinical specialties, its definition and implications remain underexplored within maternal health, particularly given the heightened risks for marginalized women. The quality measure was retired as a national quality metric before formal adoption into obstetric care, leaving significant gaps in maternal patient safety. High rates of preventable maternal morbidity and mortality, highlight the urgent need to explore and define this concept specifically within maternal health. OBJECTIVE: To conduct a concept analysis of FTR in obstetrics, examining systemic patient safety failures using both Charles Vincent's patient safety framework and Reason's Swiss Cheese Model of human error, and propose strategic improvements for maternal care delivery. METHODS: A comprehensive literature search guided by Walker and Avant's concept analysis method was performed, synthesizing evidence from multidisciplinary sources on failure to rescue, and maternal morbidity, and mortality on national patient safety. A systematic review of obstetric and patient safety literature was conducted using PubMed, CINAHL, MEDLINE, Google Scholar, and The Cochrane Library. In total, 30 articles met the inclusion criteria, including those outside of U.S. health systems. Key themes relating to system failures, nurse staffing, and obstetric complications were extracted to refine FTR's defining attributes, antecedents, and outcomes for maternal care. RESULTS: Analysis revealed FTR in obstetrics involves multiple, intersecting system-level breakdowns rather than isolated provider errors. The failure to rescue factors identified include inadequate recognition of clinical deterioration, delayed escalation of care, fragmented interdisciplinary communication, and biases exacerbating health disparities. Amber Rose Isaac's model case exemplified intersection of the following factors: critical lab results were missed, warnings of severe complications were ignored, and pandemic-induced care constraints further compromised and compounded timely intervention. CONCLUSIONS: Although the formal FTR measure was retired prior to adoption in obstetrics, addressing many of the underlying systemic failures described in this analysis is essential. Integrating proactive, standardized maternal early-warning systems, surveillance monitoring systems, and robust policies to ensure equitable care is crucial. Re-envisioning maternal safety through the lens of FTR not only addresses immediate clinical gaps, but also aligns healthcare practice with its fundamental ethical duty to protect every woman, family, and community from preventable harm.
Inequities in Care During Pregnancy Loss: Empirical Insights From Experiences With Canadian Perinatal Care.
Hall WA, Malhotra N, Clark E … +3 more , Hodge K, Griffith G, Vedam S
Birth · 2026 Mar · PMID 41025151 · Full text
BACKGROUND: Individuals experiencing perinatal loss are entitled to respectful maternity care, but a paucity of research examines respectful care at the time of pregnancy loss. METHOD: We used data from an online cross-s...
BACKGROUND: Individuals experiencing perinatal loss are entitled to respectful maternity care, but a paucity of research examines respectful care at the time of pregnancy loss. METHOD: We used data from an online cross-sectional survey (July 2020-February 2022), where 172 individuals reported on early (miscarriage) and late (late second trimester, stillbirth, neonatal death) losses since 2009. We aimed to explore inequities in respectful care experiences among individuals experiencing a late versus early perinatal loss in Canada. We assessed their experiences using the Mothers' Autonomy in Decision Making (MADM) scale and the Mothers on Respect Index (MORi). We created the Compassionate Disclosure of (perinatal) Loss (CDL) index to measure respectful care at the time of a loss. A single separate item, provider not listening to the individual's expression of concerns during pregnancy, was also analyzed. RESULTS: The early and late loss groups differed in education levels. Individuals who self-identified as Indigenous/Black/People of Color (IBPOC) had lower odds of scoring in the top quartile on MADM and MORi scales (AOR = 0.31, 95% CI 0.13, 0.75; AOR = 0.34, 95% CI 0.13, 0.86); and higher odds of reporting that providers did not listen to their concerns prior to the loss (AOR = 2.61, 95% CI 1.24, 5.48). Psychometric analysis supported the CDL index. Participants experiencing late loss had higher odds of reporting top quartile CDL scores than those experiencing early loss (AOR = 3.08, CI 1.22, 7.77). CONCLUSION: Canadian individuals with perinatal loss report disproportionately poorer care when they are experiencing a miscarriage and when they identify as IBPOC.
The Role of Support and Communication on Postpartum Pain: A Qualitative Analysis of Patient Experiences.
DiTosto JD, Merchant T, Leziak K … +2 more , Yee LM, Badreldin N
Birth · 2026 Jun · PMID 41002005 · Full text
BACKGROUND: Postpartum pain, a common symptom after a cesarean birth, is influenced by psychosocial factors. This exploratory qualitative study examined patient perspectives on social support and healthcare communication...
BACKGROUND: Postpartum pain, a common symptom after a cesarean birth, is influenced by psychosocial factors. This exploratory qualitative study examined patient perspectives on social support and healthcare communication behaviors in the postpartum setting in relation to the pain experience. METHODS: In-depth, semi-structured, qualitative interviews about postpartum pain experiences were conducted 2-3 days and 2-6 weeks postpartum with individuals who underwent a cesarean birth (2020-2021). Data were analyzed using the constant comparative method. RESULTS: Among 49 postpartum individuals, themes related to social support and healthcare communication were identified in relation to postpartum pain. Participants discussed the impact of non-healthcare social support (e.g., partners, extended family, other children) on postpartum pain, highlighting emotional and practical assistance. Most commonly mentioned were the positive impacts of emotional and logistical support with household activities and childcare on postpartum pain recovery. The second theme covered individuals' views on how healthcare support and communication affected postpartum pain, with themes of both positive and negative experiences. Some participants discussed positive experiences of shared decision-making and responsiveness of the healthcare team, whereas others recounted negative experiences of lack of counseling and poor outpatient communication. DISCUSSION: Social support and healthcare communication are integral influences on pain recovery after a cesarean birth. These findings highlight the need for interventions to address psychosocial support and healthcare team communication in the immediate postpartum period.
Patient Perceptions of Informed Consent for Operative Vaginal Birth: A Qualitative Analysis.
Diskin L, Burcher P, Meisles D … +2 more , Gabriel J, Cheyney M
Birth · 2026 Mar · PMID 40996105 · Publisher ↗
BACKGROUND: Operative vaginal birth (OVB) is a potentially life-saving intervention, but as a procedure with potential risks and benefits, it must first be preceded by an informed consent discussion. Informed consent is...
BACKGROUND: Operative vaginal birth (OVB) is a potentially life-saving intervention, but as a procedure with potential risks and benefits, it must first be preceded by an informed consent discussion. Informed consent is one aspect of patient involvement in the decision to deliver with the assistance of instruments, such as forceps or vacuum. However, it is unclear whether patients undergoing operative vaginal delivery consider informed consent to be adequate; and whether the adequacy of consent impacts their birth experience. METHODS: Using open-ended, semi-structured interviews (n = 20), the purpose of this study was to characterize patient perceptions of the informed consent process for OVB and to evaluate the role pre-procedure communication might play in influencing assisted birth experiences. Patients who had undergone an operative vaginal delivery were invited to share their birth experiences and to provide suggestions for improving the consent process when relevant. Using consensus coding, three investigators independently evaluated the transcribed interviews and identified emergent codes. These codes were then compared, and any disparate ideas were discussed until consensus was reached. RESULTS: Three primary themes emerged from patient narratives: (1) the difficulty of engaging in the consent process during the second stage of labor; (2) no perceived loss of agency; nonetheless, and (3) acceptance of limited consent discussions because OVB is preferred over a cesarean. CONCLUSION: The three key themes identified in the study suggest that patients are satisfied with their birth experience following an OVB, despite significant limitations in informed consent. Findings suggest that patients are accepting a substandard consent process, and that renewed attention should be paid to improving information sharing, even during relatively urgent care encounters. Even though patients expressed satisfaction with the consent process, the adequacy of informed consent is not determined by patient satisfaction. Improving information sharing during urgent care encounters could improve the quality of informed consent for patients undergoing operative vaginal delivery.
Viability of Successful Vaginal Delivery in Triplet Pregnancies: A Retrospective Cohort Study Over 20 Years.
van Baar PM, van Dijk MR, van de Mheen L … +3 more , de Boer MA, Pajkrt E, Velzel J
Birth · 2026 Jun · PMID 40988512 · Full text
BACKGROUND: Triplet pregnancies are increasingly leaning toward planned cesarean deliveries (CD), yet data on determining factors and outcomes remain limited. OBJECTIVE: To assess the success of vaginal delivery (VD) in...
BACKGROUND: Triplet pregnancies are increasingly leaning toward planned cesarean deliveries (CD), yet data on determining factors and outcomes remain limited. OBJECTIVE: To assess the success of vaginal delivery (VD) in triplet pregnancies and compare neonatal and maternal outcomes with those of CD. METHODS: A retrospective cohort study included triplet pregnancies from 26 weeks' gestation onward in a tertiary center between 2000 and 2020. The primary outcome was the actual mode of delivery (successful VD, planned CD, or unplanned CD). Secondary outcomes included indications for CD, as well as neonatal and maternal outcomes. RESULTS: Seventy-one women were included. Of these, 41% attempted VD, with 90% successfully delivering vaginally. Planned CD was chosen by 59%, mainly for fetal (64%) or maternal (19%) indications, or patient preference (17%). Neonatal mortality did not differ significantly between planned VD and CD (aOR: 0.29; 95% CI: 0.06-1.50; p = 0.14). However, neonates born via VD compared to CD had lower risks for sepsis (aOR: 0.19; 95% CI: 0.04-0.94; p = 0.04) and retinopathy of prematurity (aOR: 0.17; 95% CI: 0.03-0.93; p = 0.04). Neonates born after VD had higher risks of infant respiratory distress syndrome (OR: 2.70; 95% CI: 1.03-7.08; p = 0.04) and interventricular hemorrhage (OR: 4.00; 95% CI: 1.20-13.35; p = 0.02), though these associations were not significant after adjusting for gestational age (p = 0.92 and p = 0.32, respectively). CONCLUSIONS: Women opting for VD in triplet pregnancies had a 90% success rate. VD can be safe after careful case selection and access to highly trained personnel at a tertiary center. Centralization might enhance safety and outcomes, offering essential insights for clinicians.
Unraveling the Tapestry: Variations in Midwifery and Community Birth Utilization Among Asian Subgroups.
Roth LM, Lee JH, Morris T
Birth · 2026 Jun · PMID 40977433 · Publisher ↗
BACKGROUND: This article examines the utilization patterns of community birth (CB) and midwife-attended birth (MAB) among Asian/Pacific Islander (API) populations in the United States. It highlights the presence of signi...
BACKGROUND: This article examines the utilization patterns of community birth (CB) and midwife-attended birth (MAB) among Asian/Pacific Islander (API) populations in the United States. It highlights the presence of significant racial-ethnic disparities and discusses cultural variations that influence these birth choices. OBJECTIVES: To describe variation in the probability of CB and MAB in low-risk pregnancies across API communities and to explore contributors to these variations, including traditional birth practices and cultural beliefs. METHODS: The study employs logistic regression analysis of 2010-2020 birth certificate data to examine the probability of CB and MAB across pan-ethnic groups and API subgroups. The data include information on place of birth, birth attendant, maternal demographics, and race-ethnicity, providing a comprehensive view of perinatal care utilization among diverse populations. RESULTS: The findings reveal that CB and MAB rates are significantly lower among API groups compared to other pan-ethnic groups. Among API subgroups, there is substantial heterogeneity in the uptake of CB and MAB, with lower rates in Asian Indian and Chinese populations and higher rates in Hawaiian, Japanese, and Guamanian populations. CONCLUSION: The study underscores the importance of addressing racial-ethnic disparities in perinatal care and promoting culturally sensitive approaches. Factors such as traditional birth customs, cultural beliefs, and conditions of immigration may influence the choice of perinatal care among API communities. Efforts to promote CB and MAB should consider how cultural differences and values across different API subgroups may promote or inhibit the adoption of evidence-based low-intervention perinatal care models.
Assessing Maternal Breastfeeding Plans and Perceived Barriers to Optimal Breastfeeding in Kumasi, Ghana.
Baffoe-Bonnie AA, Rent S, Ofori-Amanfo G … +6 more , Appiah JA, Goldberg R, Seim B, Owusu LD, Plange-Rhule G, Hertz JT
Birth · 2026 Jun · PMID 40964708 · Publisher ↗
INTRODUCTION: Despite overwhelming evidence of the benefits of breastfeeding (BF) and its potential to decrease infant mortality, BF rates are low in many low- and middle-income countries like Ghana. We sought to assess...
INTRODUCTION: Despite overwhelming evidence of the benefits of breastfeeding (BF) and its potential to decrease infant mortality, BF rates are low in many low- and middle-income countries like Ghana. We sought to assess Ghanaian mothers' BF plans and their rationale for these plans. METHODS: We conducted a mixed method study via face-to-face interviews administered in 2019. We included pregnant or recently delivered maternity ward patients at a tertiary care center in Kumasi, Ghana. Semi-structured interviews were conducted to collect sociodemographic information, BF plans, and reasons for BF preferences. In accordance with World Health Organization recommendations, optimal BF was defined as 6 months of feeding an infant with breastmilk only (exclusive BF) followed by at least 18 months of feeding an infant the combination of breast milk and supplementary liquids and/or solid foods (complementary BF). Demographic characteristics of the cohort were compared by maternal BF plan using Pearson's chi-squared and t-test. Simple thematic analysis was performed to identify reasons for BF preferences. RESULTS: During the study period, 126 participants were enrolled. Forty-two (33.3%) participants planned to practice optimal BF. Participants who were married were more likely to have optimal BF plans than unmarried participants (OR 0.17; 95% CI 0.04, 0.53). There was no association between optimal BF plans and age, education, religion, and pre- or post-delivery status. Reasons for not practicing optimal BF included concern about the nutritional sufficiency and infants' enjoyment of breastmilk, logistical challenges of optimal BF, milk underproduction, and medical concerns for mother or baby. CONCLUSIONS: Only one-third of our cohort planned to practice optimal BF. Strengthening family support systems and improving patient education may increase optimal BF rates in Ghana.
Welcome to Birth's Special Issue on Critical Midwifery Studies.
Goodarzi B, Sharma P, Farajallah H … +2 more , Justiniano R, Cheyney M
Birth · 2025 Sep · PMID 40947587 · Publisher ↗
Abstract loading — click title to view on PubMed.
A Simultaneous Concept Analysis to Provide Clarity Between Obstetric Violence and Birth Trauma.
Patel K, Newnham L, Gillett K … +1 more , Cummins A
Birth · 2026 Jun · PMID 40937503 · Full text
BACKGROUND: In perinatal care, obstetric violence and birth trauma are two distinct yet often conflated concepts. This confusion can obscure the specific harms of obstetric violence, as its impact is frequently subsumed...
BACKGROUND: In perinatal care, obstetric violence and birth trauma are two distinct yet often conflated concepts. This confusion can obscure the specific harms of obstetric violence, as its impact is frequently subsumed under the broader idea of birth trauma, leading to underreporting of obstetric violence. Simultaneous concept analysis is used to clarify two related concepts by comparing their unique elements and identifying overlaps. AIM: To compare the antecedents, attributes, and consequences of both the concepts and to identify their intersections. METHODS: A comprehensive search across PubMed, Google Scholar, CINAHL, and ProQuest yielded 98 articles on obstetric violence and 62 on birth trauma. Thematic analysis of antecedents, attributes, and outcomes informed a comparative validity matrix. RESULTS: Obstetric violence and birth trauma have different causes and characteristics but lead to similar outcomes. Birth trauma arises from experiences like fear or unmet expectations, while obstetric violence involves abuse by providers and systemic failures. Both result in emotional distress, anxiety, and fear of future childbirth. CONCLUSION: Existing literature uses the term "birth trauma" as a euphemism for what is essentially obstetric violence. Considering the conceptual confusion between the subjective trauma arising from childbirth experiences and the trauma specifically resulting from abuse by healthcare providers, we are suggesting a new term, "Obstetric Trauma" This would specifically indicate the structural and institutional consequences of obstetric violence on women. It would also help guide targeted interventions, policy changes, and support systems aimed at preventing obstetric violence and promoting respectful maternity care.
Birth Outcomes for Obstetrician- or Midwife-Led Intrapartum Care.
Simon NT, Agarwal T, Lijewski V … +6 more , Flores K, Anderson J, Smith D, Sheeder J, Schulkin J, Hurt KJ
Birth · 2026 Mar · PMID 40936417 · Publisher ↗
BACKGROUND: Studies suggest that midwifery care can decrease the rate of unplanned cesarean birth. In this study, we compared unplanned cesarean rates, labor interventions, and birth outcomes for mixed-risk patients rece...
BACKGROUND: Studies suggest that midwifery care can decrease the rate of unplanned cesarean birth. In this study, we compared unplanned cesarean rates, labor interventions, and birth outcomes for mixed-risk patients receiving intrapartum care from obstetricians or midwives. METHODS: We conducted a retrospective cohort study using perinatal data from a single academic tertiary center from 2013 to 2018. The sample included nulliparous and multiparous patients with a term, singleton, vertex fetus. We included induced and spontaneous labor as well as trial of labor after cesarean. We excluded patients with planned cesarean delivery or any high-risk diagnosis requiring obstetrician care. RESULTS: Our cohort included 7694 patients. Of those, 3543 (46.0%) received intrapartum care from an obstetrician and 4151 (54.0%) from a midwife. The overall cesarean rate was 11.8%. Patients receiving midwifery care had significantly lower cesarean rates (8.9% vs. 15.2%; p < 0.01) overall and by adjusted analysis [aOR 0.49 (0.40-0.60) 95% CI]. Patients receiving obstetrician care more frequently experienced induction/augmentation, neuraxial anesthesia, and operative vaginal delivery. Obstetrician-led care was associated with increased lacerations, intra-amniotic infection, and severe maternal morbidity, while midwifery-led care was associated with increased rates of postpartum hemorrhage, blood transfusion, and shoulder dystocia. DISCUSSION: Midwifery intrapartum care was associated with lower rates of unplanned cesarean birth in this mixed-risk cohort of laboring and induced patients. Wider integration of midwives for intrapartum care could increase vaginal delivery rates. Additional studies are needed to explore underlying mechanisms and implications for systems- and practice-based changes in the United States.
Exploring Maternity Related Emergencies in Prehospital Settings and Available Obstetric Training for Emergency Medical Services Personnel: An Integrative Review of Literature.
Almubarak A, Alshibani A, Walker S
Birth · 2026 Mar · PMID 40936412 · Publisher ↗
OBJECTIVES: The vulnerability of maternity patients is exacerbated by the prehospital setting. EMS providers are often underexposed and undertrained for maternal emergencies, which further complicates care delivery. This...
OBJECTIVES: The vulnerability of maternity patients is exacerbated by the prehospital setting. EMS providers are often underexposed and undertrained for maternal emergencies, which further complicates care delivery. This review aimed to explore prehospital maternity-related emergencies encountered by EMS providers, their experiences, and the training available for such cases. METHODS: Medline, EMBASE, Maternity, Scopus, and Web of Science were searched for published studies in English from 01/01/2002 to 10/08/2024 using a pre-set list of terms. Studies concerning prehospital maternity-related events attended by EMS, the description or evaluation of maternity care training courses for EMS providers, were included. Eligible studies were critically appraised using the (MMAT) tool. An integrative synthesis was used in this review as the heterogeneity of the studies prevented a meta-analysis. RESULTS: From 9678 identified studies, 35 studies were included. Prehospital maternity-related emergencies remain infrequent, less than 1% of EMS emergency calls globally, with a higher incidence rate in low-income countries. Most of these were labor and childbirth-related emergencies. Maternal and neonatal outcomes were positive, with less than 0.1% of maternal and infant mortality. Qualitative data highlighted providers' lack of confidence when attending to maternal emergencies. Language barriers and cultural competency should be considered when caring for maternal patients. Training courses included common maternal emergencies, and post-training evaluations showed improvements in knowledge and skills for EMS providers. CONCLUSIONS: EMS providers showed critical involvement during prehospital maternity-related emergencies, indicating the importance of high-quality training. When designing training courses, the unique environments of prehospital settings and the needs of their targeted population should be considered. Further research should explore the impact of training courses on patient outcomes.
The Impact of Midwife Experience and Time of Birth on the Risk of Obstetric Anal Sphincter Injuries (OASIS).
Abu Shqara R, Mustafa Mikhail S, Nahir Biderman S … +3 more , Ganem N, Lowenstein L, Frank Wolf M
Birth · 2026 Jun · PMID 40922397 · Full text
INTRODUCTION: Obstetric anal sphincter injuries (OASIS) are a significant complication of vaginal birth. While most studies focus on patient-related risk factors, the impact of midwife experience and shift timing remains...
INTRODUCTION: Obstetric anal sphincter injuries (OASIS) are a significant complication of vaginal birth. While most studies focus on patient-related risk factors, the impact of midwife experience and shift timing remains understudied. We examined the association between these factors and OASIS risk in spontaneous vaginal deliveries. METHODS: This retrospective cohort study analyzed term, singleton, cephalic, spontaneous vaginal deliveries at the Galilee Medical Center (March 2020-February 2025), excluding operative vaginal births and cesarean deliveries. Deliveries were categorized by midwife experience: inexperienced (< 2 years), moderately experienced (2-10 years), and highly experienced (> 10 years). Shift timing and delivery patterns within shifts were also examined. The primary outcome was OASIS incidence. Multivariate logistic regression adjusted for confounders such as parity, macrosomia, and second-stage duration. RESULTS: Among 13,651 term spontaneous vaginal deliveries, OASIS occurred in 0.6%, with the highest rate among early-career midwives (1.9%) compared to mid-career (0.6%) and experienced midwives (0.5%) (p < 0.001). Associations remained significant after multivariate adjustment. Early-career midwives had a higher risk of OASIS (aOR 3.29, 95% CI 1.49-7.26), while mid-career midwives had a comparable risk to experienced midwives (aOR 1.05, 95% CI 0.60-1.85). Evening shift deliveries (aOR 1.73, 95% CI 1.01-2.96) and deliveries during the last 2 h of a shift (aOR 1.82, 95% CI 1.05-3.14) were also independently associated with increased OASIS risk. CONCLUSIONS: Patients delivered by experienced midwives had lower rates of OASIS. This protective effect was especially evident in deliveries without episiotomy. Strengthening midwifery training and optimizing staffing may help improve perineal outcomes.
Birthing Cultural Humility: A Transformation of Reproductive Justice in the Military Health System.
Wyatt-Nash BJ, Drumm CM, Konopasky A … +3 more , Haischer-Rollo G, Lutgendorf MA, Vereen RJ
Birth · 2026 Mar · PMID 40916612 · Publisher ↗
BACKGROUND: Rising disparities in maternal-child healthcare are linked explicitly to outcomes based on patients' cultural identities. Those who receive universally available health care in the military are not immune fro...
BACKGROUND: Rising disparities in maternal-child healthcare are linked explicitly to outcomes based on patients' cultural identities. Those who receive universally available health care in the military are not immune from these disparities. Practicing cultural humility has been proposed as a tool for advancing equity through improved understanding of cultural factors that may impact a patient's healthcare. How cultural humility impacts healthcare remains unexplored from the patient perspective. METHODS: To examine the relationship between patient identity and experience within the Military Health System, from their own perspectives, we conducted 31 semi-structured interviews with birthing individuals who delivered a child utilizing military health insurance within the last 5 years. Participants were recruited through physical flyers and social media blasts, with additional purposive sampling. Data was coded, and repeating patterns of experience were identified and interrogated through thematic analysis. RESULTS: Three predominant findings were identified via the interviews. First, participants with minoritized backgrounds described instances of racism, sexism, and homophobia attributed to a lack of cultural humility and ultimately to the delivery of oppressive medical care by providers. Second, this lack of cultural humility was described further through a lack of communication, feeling unheard or dismissed, and exposure to judgment and paternalism. Third, there were described instances of shared decision making as well as autonomy and respect that contributed to culturally humble care provided to a portion of participants, which positively impacted their care. DISCUSSION: Experiences of birthing individuals in the Military Health System qualitatively support prior quantitative studies and offer insight into the lack of cultural humility underlying care provided over the last several years. Ultimately, providers should use this information as a framework for understanding the sources of cultural humility and how they address it in individual patient-provider interactions.
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