Birth (Berkeley, Calif.)[JOURNAL]
Sun
200 papers
The Perinatal Experience of Women With a History of Intimate Partner Violence: The Birth Experience Study.
Keedle H, Phung M, Young K … +3 more , Keedle W, Baird K, Dahlen H
Birth · 2026 Mar · PMID 40888384 · Full text
BACKGROUND: Experiencing intimate partner violence impacts the ongoing physical and psychological health of women and can contribute to poorer maternal and neonatal health during the perinatal period. METHODS: In a natio...
BACKGROUND: Experiencing intimate partner violence impacts the ongoing physical and psychological health of women and can contribute to poorer maternal and neonatal health during the perinatal period. METHODS: In a national maternity experiences cross-sectional online survey, 1198 (13.6%) women identified as experiencing IPV in their lifetime. Using quantitative descriptive statistics, the maternity and mental health measures were explored for women who had experienced IPV and had a baby in Australia between 2016 and 2021. RESULTS: The findings demonstrated significant differences in the sociodemographic factors, mental health history, pregnancy and birth experiences, and negative interactions with health care providers. DISCUSSION: The findings in this study demonstrate how previously traumatized women can leave the maternity system retraumatized and identify the need for a trauma-informed approach to maternity care.
Professional Preferences Towards Vaginal Breech Delivery at Term: An International Discrete Choice Experiment.
van Dijk MR, van Wijk L, Van Rheenen-Flach LE … +3 more , Moll E, Ganzevoort W, Velzel J
Birth · 2026 Mar · PMID 40888381 · Full text
OBJECTIVE: To assess healthcare professionals' preferences for antepartum counseling on the mode of delivery for patients with term breech presentation and their preferences for intrapartum management of vaginal breech d...
OBJECTIVE: To assess healthcare professionals' preferences for antepartum counseling on the mode of delivery for patients with term breech presentation and their preferences for intrapartum management of vaginal breech delivery (VBD). STUDY DESIGN: A web-based international survey and Discrete Choice Experiment (DCE) were conducted among gynecologists and midwives. In the DCE for antepartum counseling, participants were presented with scenarios for antepartum counseling and asked to choose between VBD and elective cesarean delivery (CD). The scenarios differed in four attributes: maternal age, BMI, parity, and estimated fetal weight. Intrapartum management of VBD was evaluated through a questionnaire involving four distinct clinical scenarios. RESULTS: In antepartum counseling, the likelihood of being advised for a VBD was 43.9%. The strongest factors to opt for a CD compared to a VBD were a history of vaginal birth (OR 0.25, 95% CI 0.19-0.32) and a large estimated fetal weight (OR 5.89, 95% CI 4.07-8.54). Intrapartum management during breech deliveries did not differ among professionals and their annual number of self-reported VBD. CONCLUSIONS: The key factors driving professionals to recommend CD are a history of vaginal birth and average estimated fetal weight. Intrapartum management approaches during breech deliveries were consistent across professionals. Those with more experience managing VBDs were more likely to counsel patients towards VBD antepartum and proceed with VBD intrapartum.
Disrespectful Maternity Care During the COVID-19 Pandemic: A Retrospective Cross-Sectional Study in Chandigarh and Kalyani, West Bengal, India.
Gupta M, Das A, Sengupta P … +11 more , Majhi J, Afnan Z, Safvan K, Banerjee P, Kaur N, Rajeev T, Pocius S, Acharjee A, Mehta K, Agarwal S, Shet A
Birth · 2026 Jun · PMID 40888377 · Publisher ↗
INTRODUCTION: Respectful maternity care promotes dignity, privacy, and informed choices during childbirth, can improve maternal and newborn health outcomes, and broadly contributes to greater gender equality. In India, e...
INTRODUCTION: Respectful maternity care promotes dignity, privacy, and informed choices during childbirth, can improve maternal and newborn health outcomes, and broadly contributes to greater gender equality. In India, efforts like the JSY program and the LaQshya initiative are underway, bringing considerable progress in understanding this area. During the COVID-19 pandemic, several health program disruptions resulted in changes in healthcare experiences. This study aimed to estimate the prevalence of disrespectful maternity care and its associated factors before and during the COVID-19 pandemic. METHODS: To understand the experiences of families undergoing maternity care during the pandemic, we surveyed households in Chandigarh, a Union Territory in North India, and Kalyani, a town in West Bengal. This cross-sectional study was conducted among mothers with children less than 2 years old before March 2020 (pre-pandemic period, n = 413) and after March 2020 (pandemic period, n = 407). Disrespectful maternity care was studied across seven domains, which included physical abuse, non-dignified care, non-consented care, non-confidential care, discrimination, abandonment, and detention. Data was managed using REDCap and were analyzed using SPSS (version 25.0). Multivariable logistic regression analysis was used to evaluate differences in the type of maternity care experienced by the two groups. RESULTS: Of 776 mothers, 227 (29.3%) reported disrespectful maternity care. There were no statistically significant differences in disrespectful maternity care faced pre-pandemic and during the pandemic. Non-dignified care was experienced significantly more commonly during the pandemic as compared to pre-pandemic (aOR = 2.24; 95% CI: 1.23-4.08). During the pandemic, detention (which refers to the demand for bribery or detaining the mother or baby within the healthcare center for failure to pay) was experienced by a significantly higher proportion of women who did not receive financial assistance for delivery care (89.3% vs. 75.4%; aOR = 2.72, 95% CI: 1.13-6.58). CONCLUSION: Almost a third of the mothers in our study reported disrespectful maternity care, and the COVID-19 pandemic did not significantly impact this proportion. Our findings highlight the need to reduce non-dignified care and provide financial assistance to mothers during delivery to avoid detention during public health crises such as the COVID-19 pandemic.
Women's Experience of Continuity During Antenatal Care: A Cross-Sectional Study in The Netherlands.
Cellissen E, Hendrix MJC, Budé L … +3 more , Shareef N, Vogels-Broeke M, Nieuwenhuijze MJ
Birth · 2026 Mar · PMID 40878882 · Full text
BACKGROUND: Continuity of maternity care contributes to improved birth experiences and health outcomes among women and newborns. To improve continuity of maternity care in the Netherlands, the Integrated maternity care s...
BACKGROUND: Continuity of maternity care contributes to improved birth experiences and health outcomes among women and newborns. To improve continuity of maternity care in the Netherlands, the Integrated maternity care standard recommends a maternity care plan and a coordinating care professional for all care settings. This study aimed to gain insights into women's experiences of continuity during antenatal care in the Netherlands in both community and hospital settings and whether a maternity care plan and coordinating care professional are associated with continuity of care as experienced by women. METHODS: We conducted a cross-sectional study in 2019 to 2020 among pregnant women (> 32 weeks) in the Netherlands. Experienced continuity of care was measured using the Nijmegen Continuity Questionnaire. We used regression analyses to explore the association between a maternity care plan, coordinating care professional, and experience of continuity during the antenatal period in multiple care settings. RESULTS: We included 1165 women in this study. Most women reported moderate to high levels of continuity, with higher scores reported for care provided by community midwives compared to hospital staff. Having a maternity care plan, a coordinating care professional, and experiencing few care professionals were significantly associated with higher scores on continuity when care was provided by community midwives, but these associations were not found when care was provided by hospital staff. DISCUSSION: Our findings emphasize the critical role of community midwives in promoting antenatal continuity. A maternity care plan, coordinating care professionals, and fewer care professionals contribute to this experience of continuity.
Adopting Early Essential Newborn Care (EENC) in the Delivery Room: An Implementation Study From China.
Yang M, Wang C, Cao L … +2 more , Zhu X, Lu J
Birth · 2026 Mar · PMID 40851329 · Publisher ↗
BACKGROUND: Early Essential Newborn Care (EENC) is a highly beneficial and cost-effective set of evidence-based interventions for newborns and their mothers. However, the implementation of EENC as part of routine clinica...
BACKGROUND: Early Essential Newborn Care (EENC) is a highly beneficial and cost-effective set of evidence-based interventions for newborns and their mothers. However, the implementation of EENC as part of routine clinical practice in the delivery room has not yet been achieved in China. The purpose of this study was to describe the adoption of EENC in general hospitals in China and to evaluate its implementation impacts. METHODS: This study was an implementation study. The design of the implementation process was guided by a Knowledge-to-Action Framework and the conceptual model of implementation research. Mixed methods were used to evaluate the implementation of EENC with qualitative and quantitative data collection methods, including implementation outcomes, service outcomes, and patient outcomes. RESULTS: A total of 279 patients and 25 nurse-midwives were evaluated in this study. Both the implementation and service outcomes in this study were satisfactory. Obstacles were reported in the acceptability, feasibility, adoption, and fidelity of EENC, such as the acceptance of evidence by nurse-midwives, the support of managers to implement EENC in staff under their management, and the allocation of adequate resources. For patient outcomes, the rates of exclusive breastfeeding during hospitalization (27.1% vs. 39.6%, p < 0.05) and early initiation of breastfeeding (51.4% vs. 64.0%, p < 0.05) improved after EENC was implemented. Furthermore, the amount of vaginal bleeding after 2 h by subjects in the EENC implementation group [(283.92 ± 71.31 mL) vs. (308.78 ± 84.42 mL), t = 2.694, p < 0.05] was also significantly reduced. CONCLUSION: EENC can be effectively implemented in general hospitals, but some factors affecting the implementation of EENC included the acceptance of evidence by nurse-midwives, support from managers, and resource allocation. The implementation of EENC was found to be beneficial to newborns and their mothers. Our findings indicate that EENC should be incorporated as part of routine maternity care and nursing practice.
The Impact of Lunar Phases During Day and Night Cycles on Perinatal Outcomes: A Nationwide Cohort Study.
Windsperger K, Dorittke T, Muin DA … +4 more , Kiss H, Oberaigner W, Leitner H, Farr A
Birth · 2026 Mar · PMID 40847652 · Full text
BACKGROUND: Light changes during the lunar cycle affect rhythms in diverse species. Human studies focusing on whether the moon influences human health have so far neglected the effects of light/dark cycles. The purpose o...
BACKGROUND: Light changes during the lunar cycle affect rhythms in diverse species. Human studies focusing on whether the moon influences human health have so far neglected the effects of light/dark cycles. The purpose of this study was to investigate whether lunar phases impact perinatal outcomes by considering illumination levels due to day/night rhythms. METHODS: To assess the influence of moon phases, this nationwide cohort study identified cases with a singleton pregnancy that involved daytime (06:00 a.m. to 08:59 p.m.) and nighttime (09:00 p.m. to 05:59 a.m.) delivery at ≥ 23 + 0 gestational weeks with a birthweight of ≥ 500 g. Data on women who underwent elective cesarean or labor induction were excluded from the analyses. The lunar cycle was categorized as full moon, new moon, or other lunar phases. The standardized birth ratio (SBR) was chosen as the primary outcome parameter, while the duration of labor and adverse neonatal short-term health (pH of < 7.2 and/or a 5-min Apgar score of < 7) were chosen as the secondary outcome variables. RESULTS: We identified a total case number of 462,947 births, of which 242,518 (52.4%) occurred during the day and 220,429 (47.6%) at night. Different moon phases did not appear to influence either the SBR or adverse neonatal outcomes. However, nighttime births may show a trend toward a prolonged maximum duration of labor related to moon phases (62 vs. 65 vs. 70 h for new/full/other moon phases, p = 0.05). DISCUSSION: Considering illumination levels, some moon phases may increase the risk for prolonged births during nighttime. However, assessing the effect of lunar phases on health variables is complex. Co-environmental agents should be incorporated into future analyses.
Optimal Timing of Term Births by Maternal Region of Birth: Elective Induction of Labor Compared to Expectant Management in Victoria, Australia.
Weerasingha SD, Selvaratnam RJ, Davey MA … +3 more , Butler SE, Palmer KR, Davies-Tuck ML
Birth · 2026 Mar · PMID 40810466 · Full text
BACKGROUND: Induction of labor (IOL) has been suggested to mitigate the elevated risks of perinatal mortality in migrant women. The aim was to estimate the rates of perinatal mortality, cesarean, instrumental birth, and...
BACKGROUND: Induction of labor (IOL) has been suggested to mitigate the elevated risks of perinatal mortality in migrant women. The aim was to estimate the rates of perinatal mortality, cesarean, instrumental birth, and admission to the special care nursery or neonatal intensive care unit (SCN/NICU) for births following IOL compared to expectant management at 37-41 weeks' gestation by maternal region of birth. METHODS: A population-based retrospective cohort of all vertex singleton, uncomplicated pregnancies, 37 to 41 weeks' gestation in Victoria, Australia, from 2012 to 2019. Perinatal mortality rates were reported by region of birth. Multivariable log binomial regression models were used to estimate the association between outcomes and IOL compared to expectant management by region of birth. RESULTS: There was no improvement in the perinatal mortality rate with IOL at any gestation for non-Australian region of birth groups. IOL at 38 weeks was associated with an increasing risk of cesarean birth for Australian, New Zealand, Oceanic, African, and South-East Asian and East Asian-born women, with a higher risk for South Asian-born women at 39 weeks. Compared to expectant management, the risk of instrumental birth was similar at each gestational week for Australian-born women; whereas for African and South Asian-born women, the risk was highest at 37 weeks; for Oceanic-born women, this occurred at 38 weeks. An inverse relationship between the week of IOL and admission to the SCN/NICU was observed for all births. CONCLUSIONS: IOL was associated with an increased risk of cesarean birth, instrumental birth, and admission to the SCN/NICU in many situations without an improvement in perinatal mortality rates.
Developing a Co-Designed Strategy to Improve Labor Monitoring and Management in India Using the World Health Organization Labour Care Guide: A Mixed-Methods Formative Study.
Armari E, Vernekar SS, Pujar Y … +22 more , Pingray V, Althabe F, Gibbons L, Berrueta M, Ciganda A, Rodriguez R, Kumar JA, Patil SB, Karinagannanavar A, Anteen RR, M R P, Bendigeri S, Shetty S, Latha B, H M M, Gaddi SS, Chikkagowdra S, Raghavendra B, Homer CSE, Somannavar M, Goudar SS, Vogel JP
Birth · 2026 Mar · PMID 40801467 · Full text
INTRODUCTION: Nearly half of all perinatal deaths occur during the intrapartum period due to inadequate labor monitoring and intervention. The partograph, a paper-based labor monitoring tool, can assist providers in reco...
INTRODUCTION: Nearly half of all perinatal deaths occur during the intrapartum period due to inadequate labor monitoring and intervention. The partograph, a paper-based labor monitoring tool, can assist providers in recognizing and acting on early signs of fetal-maternal distress if used effectively. In 2020, the World Health Organization (WHO) developed a "next generation" partograph called the Labour Care Guide. There is limited evidence of how to optimize the use and impact of this new tool. This study describes the development of a co-designed LCG implementation strategy in Karnataka, India. METHODS: A targeted literature review, primary research across four public maternity hospitals (provider survey and facility assessment), and a 2-day co-design workshop with stakeholders were conducted. Findings were mapped to six target behaviors using the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation-Behavior (COM-B) model to identify potential barriers and facilitators to LCG use. Consultations with local stakeholders explored these factors, and a 1-week pilot informed final refinements of the strategy. RESULTS: The LCG implementation strategy comprised an evidence-based provider training program centered on "low dose, high frequency" principles, and monthly audit and feedback cycles, which in turn, relies on an enabling practice environment (supportive national policy frameworks, facility-level guidelines, external partnerships, senior support, defining provider roles and expectations and adequate equipment and resources) to support its implementation. CONCLUSION: Effective use of the LCG needs a robust, context-sensitive implementation strategy. We present the first evidence-based, co-designed LCG implementation strategy which can be used to support LCG dissemination and uptake.
Childbirth Experiences in the United Kingdom Compared to the Netherlands: A Cross-Sectional Survey Study.
van den Berg LMM, Henrichs J, van Dillen J … +3 more , Downe S, Verhoeven C, de Jonge A
Birth · 2026 Mar · PMID 40801454 · Full text
INTRODUCTION: This study was performed to compare childbirth experiences in the United Kingdom (UK) and the Netherlands (NL) and identify determinants of positive childbirth experiences in both countries. METHODS: Women...
INTRODUCTION: This study was performed to compare childbirth experiences in the United Kingdom (UK) and the Netherlands (NL) and identify determinants of positive childbirth experiences in both countries. METHODS: Women who gave birth in the UK (n = 1303) or the NL (n = 900) between January 2017 and December 2020 who filled in the cross-sectional Babies Born Better survey were included in this study. Fully adjusted logistic regression models were used to assess differences in the odds of a positive childbirth experience between the two countries. Hierarchical logistic regression analyses were performed to identify determinants of a positive childbirth experience, including socio-demographic factors, pregnancy and childbirth outcomes, and care-related determinants. RESULTS: Respondents giving birth in the UK had decreased odds of a positive childbirth experience compared to NL respondents (66% vs. 85%, AOR 0.45, CI 0.35-0.57). Significant determinants for a positive childbirth experience were multiparity, absence of pregnancy complications, a spontaneous vaginal birth, and giving birth at home. UK respondents who had a planned caesarean section had a higher likelihood of reporting a positive childbirth experience when adjusted for confounders. Having a doctor as the primary birth care provider was less likely to be associated with a positive childbirth experience in the UK. CONCLUSIONS: Most women in both the NL and the UK reported positive childbirth experiences, but NL respondents were more likely to do so. Determinants of a positive birth experience were mostly factors associated with uncomplicated labor and birth, or linked with fulfilled choices and with being multiparous.
Consensus Guidelines for Intermittent Auscultation in United States Community Birth Settings.
Akerson S, Bradbury S, Davis R … +3 more , Gordon W, Romano A, Scholles H
Birth · 2026 Mar · PMID 40613630 · Full text
BACKGROUND: Intermittent auscultation is the gold standard for fetal assessment in uncomplicated pregnancies and labors and is used universally in the community birth setting. Great variation exists in intermittent auscu...
BACKGROUND: Intermittent auscultation is the gold standard for fetal assessment in uncomplicated pregnancies and labors and is used universally in the community birth setting. Great variation exists in intermittent auscultation practices and language used by community birth midwives across the country. Current standards, as defined by midwifery schools, state midwifery licensing boards, and individual midwifery practices, differ significantly and sometimes contradict each other. Community birth midwives, nurses and birth assistants, midwifery educators and those working in community birth quality improvement have been in need of common language and guidance on best practices in intermittent auscultation. OBJECTIVE: Develop and disseminate consensus standards for intermittent auscultation in the community birth setting in the United States. METHODOLOGY: Creation of guidelines through a 21-month consensus process with a workgroup of educators, leaders, quality improvement experts, and practicing midwives by identifying practices supported by evidence or clinical experience, evaluating current evidence and guidelines, eliciting feedback from education, midwifery, nursing, and birth center organizations, and incorporating revisions to create the final document. RESULTS: Consensus was reached on various elements of intermittent auscultation and guidelines were created. These guidelines address readiness, assessment, interpretation, and documentation of fetal heart tones, clinical decision making, and areas for future research. These guidelines provide a minimum standard for performance and documentation of intermittent auscultation in community birth midwifery practice.
Birth Outcomes After Sexual Violence and the Role of Disclosure to the Maternity Care Provider.
de Klerk H, Gitsels J, de Jonge A … +5 more , Montgomery E, Hooft JV, van der Pijl M, Hollander M, Verhoeven C
Birth · 2026 Mar · PMID 40590529 · Full text
BACKGROUND: Sexual violence (SV) history is associated with various birth outcomes. Yet, the underlying mechanisms of these associations have not been sufficiently explained. Disclosure of SV history to a maternity care...
BACKGROUND: Sexual violence (SV) history is associated with various birth outcomes. Yet, the underlying mechanisms of these associations have not been sufficiently explained. Disclosure of SV history to a maternity care provider may play an important role in maternity care providers' choice for birth interventions and in women's birth experience. METHODS: A cross-sectional nationwide survey was conducted among women who had given birth in the 5 years prior to completing the questionnaire. Logistic regression analysis was performed to compare the associations between SV history (total, disclosed, and undisclosed) and birth outcomes. RESULTS: Of 10,867 respondents, 1121 (10.3%) reported SV, of whom 582 (52%) disclosed to their maternity care provider. Respondents who disclosed their SV history had lower adjusted odds of episiotomy than respondents without an SV history (adjusted odds ratio [AOR] 0.71, 95% confidence intervals [95% CI] 0.56-0.90). Primiparous respondents who disclosed their SV history had increased odds of unplanned cesarean birth compared to spontaneous (OR 1.37, 95% CI 1.04-1.81) and assisted vaginal birth (OR 1.75, 95% CI 1.17-2.61). Primiparous respondents with both a disclosed and undisclosed SV history had increased adjusted odds of negative birth (AOR 1.78, 95% CI 1.50-2.12). There were no differences in referral to obstetrician-led care, home birth, preterm labor, and pharmaceutical pain relief between groups. CONCLUSIONS: When people disclose their SV history, maternity care providers are less likely to perform an episiotomy, and more likely to choose an unplanned cesarean birth over vaginal birth. However, disclosure of SV history does not ameliorate the birth experience and we therefore recommend better implementation of trauma-informed birth support for women with an SV history.
Interventions and Strategies for Reducing Episiotomy Rates Globally: A Systematic Review.
Chen AW, Hall MJ, Altman MR
Birth · 2025 Dec · PMID 40552752 · Publisher ↗
INTRODUCTION: Episiotomy is still commonly practiced during childbirth worldwide, despite decades of scientific evidence that indicates no justification for its routine use. Routine episiotomy is associated with increase...
INTRODUCTION: Episiotomy is still commonly practiced during childbirth worldwide, despite decades of scientific evidence that indicates no justification for its routine use. Routine episiotomy is associated with increased risk of serious maternal morbidity and no improvements in neonatal outcomes. We sought to analyze this gap between evidence-based knowledge and implementation surrounding reducing episiotomy practice. We systematically reviewed the literature to identify practices that have resulted in a change in episiotomy rates. METHODS: We searched three databases (PubMed/MEDLINE, CINAHL Complete, Embase) using key words and subject headings with no time restriction. Any studies published in English and reporting an original empirical analysis in any global, regional, or country-specific context that examined practice changes that were implemented and reported episiotomy as an outcome were included in our review. Studies were excluded if they only reported on trends or changes in episiotomy rates without examining the specific practices implemented. We sought to identify practices that resulted in a change in episiotomy rates, rather than to evaluate or compare the effectiveness of these practices. RESULTS: Search results returned 1265 records; 40 papers met the inclusion criteria for a full review. Twenty-five papers were included in our final analysis. All included studies documented a decrease in episiotomy rates, with 21 studies reporting a statistically significant reduction. Most studies were mixed interventions, often a combination of an educational intervention and audit and feedback. CONCLUSIONS: Specific practice changes have been shown to effectively decrease the incidence of episiotomy. The findings from our review provide actionable insights for implementing evidence-based interventions to improve obstetric care. Prioritizing respectful birthing practices and reducing the routine use of episiotomy are critical steps toward addressing obstetric violence and promoting equitable, patient-centered maternity care globally.
Characteristics and Outcomes Among Asian Birthing People in the American Association of Birth Centers Perinatal Data Registry.
Goh AH, Kapoor DA, Nguyen A … +2 more , Soman D, Jolles DR
Birth · 2026 Mar · PMID 40492660 · Full text
BACKGROUND: Asian birthing people have the second highest rates of cesarean birth (CB), lowest rates of community (home and birth center), and midwife-attended births compared to other racial and ethnic groups in the Uni...
BACKGROUND: Asian birthing people have the second highest rates of cesarean birth (CB), lowest rates of community (home and birth center), and midwife-attended births compared to other racial and ethnic groups in the United States. METHODS: The American Association of Birth Centers Perinatal Data Registry (PDR) was used to abstract socio-demographic and clinical data. Logistic regression analyses identified the drivers of cesarean birth among Asian birthing people in the overall and community birth eligible samples. RESULTS: Between 2007 and 2021, 2983 people self-identified as Asian within the PDR. The Asian sample had a lower percentage of birth center births and a higher percentage of hospital births, CB, gestational diabetes, and postpartum hemorrhage compared to the overall sample. The cesarean rate in the Asian sample was 12.4%. Asian multiparous birthing people were at 1.5 greater odds of CB compared to White multiparous birthing people (OR = 1.54; 95% CI, 1.19-2.03; p < 0.01). Asians in the community birth eligible group had higher odds of CB compared to their White counterparts (OR = 1.54; 95% CI, 1.23-1.93; p < 0.01). Asian and White multiparous birthing people admitted to the hospital from the community birth eligible group had five times higher odds of CB compared to the total sample of Asian and White multiparous birthing people (OR = 5.18; 95% CI, 3.77-7.12; p < 0.01). DISCUSSION: There were lower rates of CB among Asians who birthed in PDR user sites compared to the national average. Future research is needed in community birth outcomes among different Asian ethnicities and Asian birthing people's perspective on community birth.
"The Very Best That It Could Be and a Lot Better Than I Would Have Imagined": Birthing People's Experiences of Transfer From Community to Hospital.
Neerland C, Skalisky A, Schafer R
Birth · 2025 Dec · PMID 40421515 · Full text
BACKGROUND: Community births (those in homes or freestanding birth centers) are increasing in the US, although they still represent a small percentage of total births. Research shows that community births can offer posit...
BACKGROUND: Community births (those in homes or freestanding birth centers) are increasing in the US, although they still represent a small percentage of total births. Research shows that community births can offer positive outcomes for low-risk individuals, such as fewer interventions and greater satisfaction. However, when perinatal complications arise, transfer to hospital can result in negative care outcomes and experiences. Effective integration of care and respectful communication between community and hospital providers during transfers are crucial for improving quality care measures. This study aimed to investigate the experiences and outcomes of individuals transferring from community settings to an urban US hospital with established transfer guidelines. METHODS: This multi-method study, utilizing descriptive statistics and a grounded theory approach, explores the outcomes and experiences of individuals transferring from planned home or birth center births to hospital care for intrapartum management from August 2019 to August 2020. We included participants who were 18 or older, English-speaking, and had experienced a live birth following transfer from home or birth center to hospital. Quantitative outcomes were obtained through chart review. Qualitative interviews were conducted within 6 weeks post-birth, recorded, transcribed, and analyzed using constant comparative analysis. RESULTS: A total of 82 individuals transferred during the study period, with 23 participating in qualitative interviews, we identified 5 major themes: seamless transfer, teamwork, respectful care, changing expectations, and a complex relationship with autonomy and decision-making. Participants valued smooth communication, midwife-to-midwife transfer of care, and the balance between autonomy and reliance on provider recommendations during transfers. DISCUSSION: Understanding the experiences of those who transfer from community settings to hospitals is crucial for improving perinatal care. With established guidelines for transfer in place to facilitate collaboration across care providers and birth settings, transfers can be managed effectively, resulting in respectful experiences of care with positive health outcomes.
Characteristics of Women, Intrapartum Interventions, and Maternal and Neonatal Outcomes Among Users of Intrapartum Water Immersion: The UK POOL Cohort Study.
Sanders J, Barlow C, Brocklehurst P … +13 more , Cannings-John R, Channon S, Cutter J, Hunter B, Jokinen M, Lugg-Widger F, Milosevic S, Gale C, Milton R, Morantz L, Paranjothy S, Plachcinski R, Robling M
Birth · 2026 Mar · PMID 40353564 · Full text
BACKGROUND: The POOL study explored intrapartum water immersion and associated maternal and neonatal outcomes at 26 UK sites 2015-2022. METHODS: Retrospective and prospective data captured in electronic maternity and neo...
BACKGROUND: The POOL study explored intrapartum water immersion and associated maternal and neonatal outcomes at 26 UK sites 2015-2022. METHODS: Retrospective and prospective data captured in electronic maternity and neonatal UK National Health Service (NHS) information systems. Analysis-(a) proportions of women using and factors associated with water immersion during labour or birth; (b) outcomes among "low-risk" women who used water immersion during labour or birth; (c) management and outcomes of the third stage of labour following waterbirth. RESULTS: Among 869,744 included births, 10% (n = 87,040) used water immersion during labour or birth and 4.6% (n = 39,627) gave birth in water, with rates falling over time. Being of white or multi-ethnicity, fluent in English, non-smokers or ex-smokers, from more affluent areas, and nulliparous were associated with higher rates of water use. Overall, 39.6% of nulliparous and 9.9% of parous women at low risk at labour onset, and who used water immersion during labour, received obstetric or anesthetic care during the intrapartum period. Physiological third stage management was used following 27.1% (n = 10,737) of waterbirths and following 8.6% (n = 2260) of waterbirths the placenta was delivered into water. The rate of recorded blood loss ≥ 1000 mL was not significantly different when the placenta was delivered in water compared to placental delivery out of water. CONCLUSION: This large UK study of water immersion during labour and birth provides important information for policymakers, maternity health professionals, and for women and families considering the option of intrapartum water immersion. Care providers need to ensure equal access to intrapartum water immersion across demographic groups and provide women with evidence-based rates of obstetric interventions that take into account their risk status and birth choices. TRIAL REGISTRATION: ISRCTN13315580.
Cultural Brokering in Pregnancy Care: A Qualitative Study.
Spigel L, Bazan M, Karlage A … +4 more , Schoenherr K, DiMeo A, Chakraborty S, Molina RL
Birth · 2026 Mar · PMID 40251872 · Full text
INTRODUCTION: Cultural brokers bridge cultural and linguistic differences between patients and healthcare teams, but their role in pregnancy care is not well understood. We aimed to identify and describe the roles cultur...
INTRODUCTION: Cultural brokers bridge cultural and linguistic differences between patients and healthcare teams, but their role in pregnancy care is not well understood. We aimed to identify and describe the roles cultural brokers fulfill throughout pregnancy care, moments of impact when they enhance care for patients with limited English proficiency (LEP), and how to integrate cultural brokering into pregnancy care teams. METHODS: We conducted a descriptive qualitative study nested within a human centered design process. We conducted 21 semi-structured, qualitative interviews among Spanish-speaking pregnancy care patients with LEP, cultural brokers, and pregnancy care clinicians in the Boston metropolitan area between December 2022 and May 2023. Data were coded and analyzed using qualitative content analysis to summarize themes about cultural brokering within pregnancy care. Data were used to create a journey map of an illustrative pregnancy experience. RESULTS: Cultural brokers played five key roles in pregnancy care for Spanish-speaking patients with LEP: cultural bridging, language support, social support, health system navigation, and advocacy. The journey map highlighted moments of impact when cultural brokers enhanced patient care: connecting patients to care, meeting the care team, making informed decisions, connecting to resources, childbirth, and transitioning to parenthood. Most participants wanted cultural brokers to be integrated into pregnancy care teams to diversify teaming and enable shared decision-making; however, additional training, clarifying cultural broker roles, and adequate compensation for cultural brokers would be needed to achieve integration. CONCLUSION: Cultural brokers fulfill a critical role during pregnancy care for patients with LEP. However, more work is needed to recognize, value, and integrate cultural brokering into pregnancy care.
Concordance of Self-Reported Obstetric Outcomes With Electronic Health Record Documentation: A Secondary Analysis of the Nulliparous Pregnancy Outcomes Study Monitoring Mothers-To-Be.
Barcelona V, Chen L, Erickson E
Birth · 2025 Dec · PMID 40219680 · Full text
BACKGROUND: To compare participants' perceptions of reasons for admission, labor induction, and rationale for cesarean birth to those documented by clinicians in the electronic health record (EHR) and if these comparison...
BACKGROUND: To compare participants' perceptions of reasons for admission, labor induction, and rationale for cesarean birth to those documented by clinicians in the electronic health record (EHR) and if these comparisons differed by race and ethnicity. METHODS: We conducted a secondary analysis of data from the Nulliparous Pregnancy Outcomes Study: Monitoring mothers-to-be (2010-2013). We calculated kappa to evaluate agreement between participant postpartum interviews and EHR notes (n = 6085). RESULTS: Overall, agreement was variable. There was substantial agreement (κ = 0.717, 95% CI 0.704, 0.724) on the reason for obstetric admission, but concordance for the admission reason was lower among preterm births. Only fair agreement was observed (κ = 0.290, 95% CI 0.220, 0.360) for whether labor was electively induced or medically indicated. As a whole, moderate agreement was observed between interview and EHR data on the indication for cesarean birth. EHR documentation on elective labor induction was moderately concurrent with interviews from non-Hispanic White participants; however, it was poor to fair among all other subgroups. DISCUSSION: There were varying degrees of concordance between patient perceptions and what is documented within the EHR. Clinicians should ensure effective communication regarding obstetric procedures and the rationale for interventions, particularly those that are elective. Decision making in later pregnancies should consider all sources of data (EHR and self-reported), particularly where patient and EHR data are discordant around labor dysfunction.
The Association Between Women's Perception of Birth During the Pandemic, Companion of Choice and Support From Health Professionals: A Cross-Sectional Study in 20 Countries in the WHO European Region.
Batram-Zantvoort S, Miani C, Mariani I … +45 more , Valente EP, Zaigham M, Nedberg IH, Kurbanović M, Pumpure E, Bohinec A, Sarantaki A, Baranowska B, Abderhalden-Zellweger A, de La Rochebrochard E, Costa R, Otelea MR, Liepinaitienė A, Radetic J, Ćerimagić A, Arendt M, König-Bachmann M, Vedove SD, Linden K, Kongslien S, Drandić D, Kreslina D, Drglin Z, Metallinou D, Tataj-Puzyna U, Gemperle M, Rozée V, Dias H, Mizgaitienė M, Ruzicic J, Simon I, Fumagalli S, Elden H, Vik ES, Ponikvar BM, Lykeridou A, Szlendak B, de Labrusse C, Pinto TM, Jazdauskienė S, Zenzmaier C, Chertok I, Sacks E, Lazzerini M, IMAgiNE EURO Study group
Birth · 2025 Dec · PMID 40183500 · Full text
BACKGROUND: Mitigation measures implemented in response to the COVID-19 pandemic led to significant changes in maternity care across Europe, including restrictions on companions during labor and birth. This cross-section...
BACKGROUND: Mitigation measures implemented in response to the COVID-19 pandemic led to significant changes in maternity care across Europe, including restrictions on companions during labor and birth. This cross-sectional study explores the association between the presence of a companion of choice and a positive perception of the birth experience. Additionally, it explores the association between health professionals' attention, assistance, and availability during labor and birth and a positive perception of birth. METHODS: We utilized a structured, validated online questionnaire, available in 25 languages, to assess the quality of maternal care during the COVID-19 pandemic from women's perspectives. We conducted logistic regression to explore associations between variables related to the presence of a companion of choice, health professionals' attention, assistance, and availability, and positive perceptions of birth, when controlled for confounders, including birth mode and medical interventions. RESULTS: Responses from 48,039 women across 20 countries in the WHO European Region were included. Always having a companion of choice during birth (aOR: 2.11) and always receiving adequate care from health professionals (assistance aOR: 2.12, attention aOR: 36.64, availability aOR: 2.12) were associated with positive birth perception. Instrumental births (aOR: 0.76), episiotomies (aOR: 0.74), fundal pressure (aOR: 0.52), and cesarean births (planned aOR: 0.80, unplanned prelabor aOR: 0.60, unplanned in-labor aOR: 0.52) were associated with less positive birth perceptions. DISCUSSION: This study highlights the critical role of having a chosen companion and receiving adequate attention, assistance, and availability from health professionals in promoting positive birth perceptions, even in times of crisis such as the COVID-19 pandemic. Ensuring the presence of a companion of choice and comprehensive professional support is crucial for delivering high-quality, respectful maternity care.
Pregnant and Homeless in the UK: A Qualitative Analysis of Maternal Experiences in Temporary Accommodation.
Cumming S, Symon A
Birth · 2025 Sep · PMID 40183469 · Full text
BACKGROUND: In the UK, families in temporary accommodation reached record numbers in 2023. Pregnant mothers experiencing homelessness are at risk of poor health outcomes, yet little is known about their experiences. Most...
BACKGROUND: In the UK, families in temporary accommodation reached record numbers in 2023. Pregnant mothers experiencing homelessness are at risk of poor health outcomes, yet little is known about their experiences. Most biomedical research emphasizes obstetric outcomes rather than maternal experiences. Our study aimed to explore maternal experiences of pregnancy while living in temporary accommodation in the UK. METHODS: Using an interpretivist paradigm and critical feminist theory, we collected and analyzed semi-structured interview narratives from pregnant and postnatal mothers experiencing homelessness. Interviews with key workers from relevant Third Sector Organisations provided complementary insights. Study planning included Patient and Public Involvement. Data were analyzed using reflexive thematic analysis. RESULTS: Fourteen mothers and six keyworkers were interviewed. Reflexive thematic analysis generated three themes. Theme one, Pregnant/postnatal bodies in unsafe spaces, described participants' experiences with unsafe accommodations, exposure to environmental hazards, and frequent moves which affected physical and mental health. In Undermining mothers, participants explained how the constant struggle to meet basic needs eroded opportunities to engage with caring roles and destabilized their sense of being "good" mothers. Together these contributed to pregnancy disengagement and feeling unprepared for birth. The third key theme, Feeling unseen in midwifery blind spots, describes barriers to accessing maternity services, as well as interactions with midwives that often reinforced feelings of being invisible. DISCUSSION: Living in temporary accommodations whilst pregnant negatively impacts physical, mental, and emotional well-being. Improving care for pregnant mothers experiencing homelessness requires systemic change within housing and maternity services to acknowledge housing security as an essential need for pregnant and parenting mothers.
Effect of Maternity Characteristics on Cesarean Birth Rates in Belgium: A Robson Classification Approach.
Leroy C, Fomenko E, Goemaes R … +3 more , Van Leeuw V, Racapé J, Alexander S
Birth · 2025 Dec · PMID 40167281 · Publisher ↗
OBJECTIVE: To assess the effect of maternity unit characteristics on the cesarean section (CS) rate, using Robson's Ten-Group Classification System (TGCS) and considering the sociodemographic and medical characteristics...
OBJECTIVE: To assess the effect of maternity unit characteristics on the cesarean section (CS) rate, using Robson's Ten-Group Classification System (TGCS) and considering the sociodemographic and medical characteristics of the mother. METHODS: The study, conducted in Belgium from 2011 to 2019, employed an analytical design utilizing a nationwide register of routine data and focused on hospital births. The CS rate was analyzed by neonatal intensive care unit (NICU) availability and by maternal unit size for TGCS groups 1, 2, and 5, which were the highest contributors to the total CS rate. Multivariable logistic regression models and generalized linear mixed-effects models were utilized to analyze the association between the maternity itself and CS. RESULTS: The overall CS rate was 20.8%, displaying a twofold variation across maternity units. This variation persisted irrespective of the presence or absence of a NICU and the maternity unit's size. Our findings highlighted a significant association between maternity unit characteristics (size and NICU availability) and the likelihood of performing CS in TGCS groups 1, 2, and 5. This association did not change after adjustment for sociodemographic and medical characteristics. However, the majority of odds ratios for maternity-related variables lost their significance in the multilevel analysis compared to simple logistic regressions. CONCLUSIONS: The CS rate seems to be more influenced by the "philosophy" of the maternity unit than its specific size and NICU characteristics. Future research is needed to explore the underlying mechanisms of this association and to identify potential interventions that could reduce CSs performed without clinical indication in different settings.
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