Birth (Berkeley, Calif.)[JOURNAL]
Sun
200 papers
Enhancing Perinatal Cannabis Use Counseling: Insights From Taiwan's Addiction Treatment Practice.
Tsai YY, Wei LC
Birth · 2024 Dec · PMID 39526636 · Publisher ↗
This letter responds to Cernat et al.'s study on counseling about cannabis use during pregnancy and lactation, drawing parallels with addiction treatment practices in Taiwan. We highlight the importance of open, non-judg...
This letter responds to Cernat et al.'s study on counseling about cannabis use during pregnancy and lactation, drawing parallels with addiction treatment practices in Taiwan. We highlight the importance of open, non-judgmental approaches and harm reduction strategies in counseling pregnant women with substance use disorders. Our experience at a psychiatric center in Taiwan emphasizes the need for continuous counseling throughout pregnancy and postpartum, particularly given the observed increase in cannabis use among new mothers. We support the study's emphasis on exploring patients' perceived benefits from cannabis use and addressing underlying reasons for use. By integrating insights from qualitative studies on patient perspectives, we have improved patient engagement and outcomes in our practice. This commentary underscores the global relevance of the study's findings and calls for continued research to bridge the gap between clinician and patient experiences in perinatal cannabis use counseling.
Validating the Quality Maternal and Newborn Care Framework Index: A Global Tool for Quality-of-Care Evaluations.
Symon A, Mortensen B, Pripp AH … +8 more , Chhugani M, Adjorlolo S, Badzi C, Kharb R, Prussing E, McFadden A, Gray NM, Cummins A
Birth · 2025 Jun · PMID 39526632 · Full text
BACKGROUND: Quality maternity care is known to improve a range of maternal and neonatal outcomes. The Lancet Series on Midwifery's Quality Maternal and Newborn Care (QMNC) Framework is a high-level synthesis of the globa...
BACKGROUND: Quality maternity care is known to improve a range of maternal and neonatal outcomes. The Lancet Series on Midwifery's Quality Maternal and Newborn Care (QMNC) Framework is a high-level synthesis of the global evidence on quality maternity care. Initial qualitative work demonstrated the Framework's adaptability in evaluating service user and provider perceptions of the quality of maternity care. However, evaluating services at scale requires a survey instrument. This paper reports the validation of the QMNC Framework index (QMNCFi), a five-part survey for the evaluation of maternity care across diverse settings. METHODS: International online English language survey of women who had given birth in the previous year in Australia, Ghana, India and the United Kingdom (UK). It was distributed through service user networks (UK and Australia) and at postnatal clinics (Ghana and India). All forms were completed online. Test-retest was conducted to assess reliability. RESULTS: Five hundred and forty mothers completed the survey (Australia 136; Ghana 131; India 153; UK 120). Construct validity: Cronbach's α in 12 of the survey's 13 sections ranged from 0.795 to 0.986; for the remaining section the alpha was 0.594. Reliability: 55 participants completed the QMNCFi a second time. Intraclass correlation coefficient results ranged from 0.657 to 0.939 across the 13 sections. Field researchers in Ghana and India reported that the survey was easily understood and completed. CONCLUSION: This survey has shown that, across diverse contexts, the QMNCFi is a valid, reliable, and comprehensive tool for measuring service user perceptions of the quality of care over time.
Sociodemographic and Health-Related Risk Factors Associated With Planned and Emergency Cesarean Births in Mexico.
Contreras JI, Suárez-López L, Hubert C
Birth · 2025 Jun · PMID 39526630 · Publisher ↗
BACKGROUND: Cesarean delivery is a contributing factor to many delivery care and postpartum maternal morbidities, especially when a cesarean delivery is unnecessary. Mexico has one of the highest cesarean birth rates in...
BACKGROUND: Cesarean delivery is a contributing factor to many delivery care and postpartum maternal morbidities, especially when a cesarean delivery is unnecessary. Mexico has one of the highest cesarean birth rates in Latin America, and as such, our objective was to identify the sociodemographic, reproductive, maternal care, and health-related characteristics associated with the prevalence of planned and emergency cesarean births in Mexico. METHODS: Using nationally representative data from a Mexican probabilistic survey (ENSANUT 2021), we examined and developed a cross-sectional analysis of women aged 12 to 19 with a live-birth and women 20 to 49 years who had their last live-birth within five years before the survey (n = 1330). We used multinomial logistic regression analysis to examine predictors associated with planned and emergency cesarean births. RESULTS: The live-births within our sample included 50.7% vaginal, 27.5% emergency cesarean births, and 21.8% planned cesarean births. Younger age groups at delivery, speaking an indigenous language, and receiving delivery care at open public services are negatively associated with having any cesarean birth. Receiving delivery care at private institutions and having hypertension during pregnancy increases the odds of having both planned and emergency cesarean births. Emergency cesarean births are positively associated with tertiary education and negatively correlated with the parity of three or more children, while planned cesarean births are more likely for women with a parity of two. DISCUSSION: Efforts to reduce unnecessary cesarean births should include evidence-based medicine recommendations, actions to avoid the first cesarean birth, and providing pregnant women with counseling to support informed decisions.
Translating Priorities Into Practice: Midwifery Care for Uninsured Migrant Populations Across Canada.
Elias H, Larios L
Birth · 2025 Sep · PMID 39508802 · Full text
BACKGROUND: Immigrants and newcomers are identified by many provincial midwifery associations as "priority populations." Recently, newcomer populations have shifted considerably, with more people coming to Canada with pr...
BACKGROUND: Immigrants and newcomers are identified by many provincial midwifery associations as "priority populations." Recently, newcomer populations have shifted considerably, with more people coming to Canada with precarious immigration status who are increasingly ineligible for public healthcare insurance and facing barriers to accessing care. Our aims were to: (1) gain an understanding of the policies related to equitable access to midwifery care and how they may apply to migrant groups without public healthcare insurance and (2) identify existing policy themes, gaps, and regulatory barriers that limit access for this vulnerable population in Canada. METHODS: We conducted a high-level document content analysis using a health equity framework. We aimed to identify language related to equitable access in midwifery services, with particular emphasis on uninsured populations. A total of 64 documents were analyzed, including legislation and publicly available statements from midwifery regulatory bodies and associations. RESULTS: Midwifery regulatory authorities and associations across Canada are consistent in establishing an expectation that midwives will provide accessible care to diverse clientele. However, how these commitments are put into practice varies considerably between jurisdictions. We compared the cases of Manitoba and Ontario to illustrate the disconnect between commitments to priority populations and implementation. DISCUSSION: While there is a clearly demonstrated intention to provide equitable access to midwifery care to all people, including "priority populations" like migrants and newcomers, in practice, these commitments have not been fully realized. Equity is encumbered by broader structural issues, such as the growth in the number of newcomers without access to public health insurance. Moves toward equity within midwifery and healthcare more broadly need to meaningfully engage with other policy sectors, such as immigration, to be able to adapt to emerging issues affecting reproductive care, such as the growing precarity of newcomer populations in Canada.
The Incidence of Postpartum Post-Traumatic Stress Disorder in Women Exposed to Adverse Childhood Experiences: A Systematic Review and Meta-Analysis.
Zou L, Wang S, Chen J … +4 more , Krewski D, Wen SW, Lai X, Xie RH
Birth · 2025 Mar · PMID 39494964 · Publisher ↗
BACKGROUND: Adverse childhood experiences (ACEs) are known contributors to lifelong mental health challenges. Despite studies linking ACEs to increased risk of adverse postpartum mental health outcomes, a systematic revi...
BACKGROUND: Adverse childhood experiences (ACEs) are known contributors to lifelong mental health challenges. Despite studies linking ACEs to increased risk of adverse postpartum mental health outcomes, a systematic review on the occurrence of postpartum post-traumatic stress disorder (PTSD) in women with ACEs is lacking. METHODS: A systematic search was conducted in seven databases to retrieve studies from inception to January 31, 2024. A random-effects model was used to quantify weighted estimates of postpartum PTSD incidence. Statistical analysis was conducted using R software. RESULTS: Seven studies were included in the system review. One study was identified as an outlier and excluded from the meta-analysis. Among the six remaining studies, 1186 women exposed to ACEs were identified, with 249 of them experiencing postpartum PTSD. The estimated incidence of postpartum PTSD among women exposed to ACEs was 22.6% (95% confidence interval [CI] 16.1%-29.8%). Subgroup analysis revealed significant variations in incidence depending on study settings (p < 0.01) and PTSD assessment methods (p < 0.01). Due to multicollinearity among the primary variables, a meta-regression to identify factors influencing study heterogeneity was not conducted. CONCLUSION: The incidence of postpartum PTSD was 22.6% in women with ACEs, higher than that observed in the general obstetric population. This finding suggests the need to provide comprehensive postpartum care for these women.
Reduction of Noise Levels During Caesarean Births Through Audiovisual Feedback is Associated With Lower Stress Levels for Patients.
Gabrysch CH, Anders SI, Dressler-Steinbach I … +3 more , Braun T, Efe I, Henrich W
Birth · 2025 Mar · PMID 39485060 · Full text
OBJECTIVE: Noise reduction during surgical procedures leads to improved surgical performance and results. The caesarean birth (CB) is an exceptional operation and a life changing experience. Through the introduction of s...
OBJECTIVE: Noise reduction during surgical procedures leads to improved surgical performance and results. The caesarean birth (CB) is an exceptional operation and a life changing experience. Through the introduction of staff education and implementation of audiovisual feedback, we intended to reduce noise, and subsequently reduce surgical complications and increase the well-being of patients and staff. METHODS: During Phase I, blinded baseline measurements of noise were conducted. Phase II started after staff education and structured questionnaires on subjective noise and stress were added, and in Phase III audiovisual feedback was introduced. Mean and peak noise levels over the time of the procedure were obtained in A-weighted decibels (dB(A)). Kruskal-Wallis H tests were performed to evaluate the impact of interventions on noise levels. Questionnaires were evaluated using descriptive statistics; stress-scores were compared using independent sample t-tests. RESULTS: Ninety planned CBs were included. Median noise levels were 62.85 dB(A) at baseline. They decreased significantly to 60.60 dB(A) (Phase II) and 59.25 dB(A) (Phase III), respectively. This reduction of 3.6 dB(A) leads to a subjective noise reduction of around 20%. Significant differences for A-weighted and peak noise levels during actual surgery were found after combining staff education with audiovisual feedback. In Phase III, staff reported less stressful noise. Stress also decreased significantly in the patient group. Beeping machines and telephones were identified as the most stressful sources of noise. CONCLUSION: We show that noise reduction during CB is both necessary and possible. Diminished subjective perception of noise and stress are positive impacts of this intervention. Staff education and audiovisual feedback can help to provide a calm and lower stress environment for patients and staff during caesarean births.
Midwifery Continuity of Care During Pregnancy, Birth, and the Postpartum Period: A Matched Cohort Study.
Lundborg L, Åberg K, Liu X … +6 more , Norman M, Stephansson O, Pettersson K, Ekborn M, Cnattingius S, Ahlberg M
Birth · 2025 Mar · PMID 39465909 · Full text
OBJECTIVE: To compare pregnancy outcomes in a midwifery continuity of care (MCoC) model to standard midwifery care in Sweden. DESIGN: Matched cohort study. SETTING: Public healthcare during pregnancy and childbirth, Stoc...
OBJECTIVE: To compare pregnancy outcomes in a midwifery continuity of care (MCoC) model to standard midwifery care in Sweden. DESIGN: Matched cohort study. SETTING: Public healthcare during pregnancy and childbirth, Stockholm, Sweden. POPULATION: Women giving birth at Karolinska University Hospital site Huddinge in Stockholm between January 1, 2019, and August 31, 2021. METHODS: Data on all births including MCoC and standard care, during the time period, were retrieved from the national Swedish Pregnancy Register. Propensity score matching was applied to obtain a matched set from the standard care group for every woman in the MCoC model. Based on the matched cohort, we estimated risk ratios (RR) for binary outcomes with 95% confidence intervals (CI). MAIN OUTCOME MEASURES: Interventions during labor, mode of birth, and preterm birth (< 37 gestational weeks). RESULTS: Compared with standard care, women in the MCoC model were more likely to give birth spontaneously (RR 1.06 95% CI 1.02-1.10) and less likely to have an elective cesarean on maternal request (RR 0.24 95% CI 0.11-0.51). The risk of preterm birth was also reduced in the MCoC group (RR 0.51 95% CI 0.32-0.82). CONCLUSION: The MCoC model was associated with fewer medical interventions and improved pregnancy outcomes.
Parity Moderates the Socioeconomic Predictors of Birth Setting Choice.
Dembélé A, Peters B, Tumin D
Birth · 2025 Jun · PMID 39463095 · Publisher ↗
BACKGROUND: The increase in the number of people choosing community birth has raised interest in understanding the factors that influence birth setting choices. This study investigates how parity influences the associati...
BACKGROUND: The increase in the number of people choosing community birth has raised interest in understanding the factors that influence birth setting choices. This study investigates how parity influences the association between maternal socioeconomic factors and choice of community versus hospital birth. METHODS: We used 2009-2021 US birth certificate data to identify community births (planned home or birth center births), parity, and maternal characteristics, including Women, Infants, and Children (WIC) program participation, race, ethnicity, educational attainment, marital status, body mass index (BMI), and age. Parity was interacted with each covariate in a multivariable logistic regression model of birth setting. RESULTS: Among 26,526,010 eligible births, 58% were to multiparous mothers, with 1.9% occurring in a birth center or at home. For most maternal characteristics, associations with community birth were stronger in the multiparous group compared to the nulliparous group. For example, being married was associated with greater odds of community birth in both groups, but the strength of this association was greater within the multiparous group (odds ratio 4.00 vs. 1.94, interaction p < 0.001). The same pattern (stronger association with community birth in the multiparous group than in the primiparous group) was observed for race/ethnicity, educational attainment, and WIC participation, all of which were associated with lower odds of community birth. CONCLUSION: This study shows that parity significantly moderates associations between maternal socioeconomic characteristics and birth setting, implying studies of decision-making in this context should purposively stratify samples and analyses by parity.
Status of Horizontal Violence, Level of Psychological Empowerment, and Their Correlation Among Obstetric Nurses: A Cross-Sectional Survey.
Huang S, Kong G, Li Q … +2 more , Lilenga HS, Zhai J
Birth · 2025 Jun · PMID 39462967 · Publisher ↗
BACKGROUND: China's maternity policy has led to an increase in work pressure, which has prompted horizontal violence among obstetric nurses. To understand this phenomenon better, we attempted to identify the factors that...
BACKGROUND: China's maternity policy has led to an increase in work pressure, which has prompted horizontal violence among obstetric nurses. To understand this phenomenon better, we attempted to identify the factors that influence horizontal violence as well as the level of psychological empowerment among obstetric nurses. METHODS: This cross-sectional survey was conducted among 522 obstetric nurses from December 2022 to February 2023. RESULTS: The findings revealed that 40.42% (211) of the obstetric nurses had experienced horizontal violence in the past 3 months. The overall level of psychological empowerment of obstetric nurses was relatively low. Regression analysis indicated that being a formal worker, being from the area where one serves, the meaning attributed to work, and perceptions of autonomy, self-efficacy, and work impact acted as protective factors against the risk of horizontal violence among obstetric nurses. When compared with the 20-29-year-old age group, those in the 30-39-year-old age group showed a lower risk of experiencing horizontal violence (odds ratio [OR] = 0.369, p < 0.01). Compared with nurses who had worked in obstetrics for < 3 years, those who had worked for 3-5, 6-10, 11-20, and > 20 years showed lower risks of experiencing horizontal violence than the reference level (OR = 0.234, p < 0.05; OR = 0.182, p < 0.05; OR = 0.105, p < 0.05; and OR = 0.056, p < 0.05, respectively). DISCUSSION: The incidence of horizontal violence among obstetric nurses is high, and the overall level of psychological empowerment is low. Nursing managers can alleviate the occurrence of horizontal violence by augmenting the psychological empowerment level of obstetric nurses.
Wait, What? What's Going On?- Pregnancy Experiences of Deaf and Hard of Hearing Mothers Who Do Not Sign.
Ratakonda S, Panko TL, Albert S … +4 more , Smith LD, Cooley MM, Mitra M, McKee M
Birth · 2025 Jun · PMID 39462948 · Full text
OBJECTIVE: Deaf and hard of hearing (DHH) women experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared to their hearing peers. This study explores the pregnancy experiences of DHH...
OBJECTIVE: Deaf and hard of hearing (DHH) women experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared to their hearing peers. This study explores the pregnancy experiences of DHH women who do not sign to better understand their barriers and facilitators to optimal perinatal health care. DESIGN: Qualitative study using thematic analysis. SETTING: Semi-structured, individual remote, or in-person interviews in the United States. SAMPLE: Twenty-two DHH English speakers (non-signers) who gave birth in the United States within the past 5 years. METHODS: Semi-structured interviews explored how DHH women experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access, and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted. MAIN OUTCOME MEASURES: The barriers and facilitators related to a positive perinatal care experience among DHH women. RESULTS: Five key themes emerged. For barriers, healthcare communication breakdowns and loss of patient autonomy highlighted DHH women's struggle with perinatal health care. In contrast, DHH participants outlined the importance of accessible health communication practices and accommodations, use of patient advocacy or self-advocacy, and assistive technologies for DHH parents for more positive perinatal care experiences. CONCLUSIONS: Perinatal healthcare providers and staff should routinely inquire about ways to ensure an inclusive and accessible healthcare experience for their DHH patients and provide communication accommodations for optimal care. Additionally, healthcare providers should be more aware of the unique parenting needs and resources of their DHH patients.
Low Social Support is Associated With Postpartum Depression Symptoms Among Illinois Postpartum Women.
Holicky A, Horne A, Bennett AC
Birth · 2025 Jun · PMID 39422516 · Full text
BACKGROUND: Postpartum depression (PPD) occurs after delivery, with severity and onset varying by individual. Women with low social support may be at higher risk for PPD. This study examined the association between socia...
BACKGROUND: Postpartum depression (PPD) occurs after delivery, with severity and onset varying by individual. Women with low social support may be at higher risk for PPD. This study examined the association between social support and self-reported postpartum depression symptoms (PDS) among Illinois postpartum women. METHODS: Using 2016-2020 data from the Illinois Pregnancy Risk Assessment Monitoring System (PRAMS) (n = 5886), instrumental support (physical, hands-on support) and partner emotional support were each categorized as high/low and were combined in a composite measure (high = high on both types, moderate = high on one type, and low = low on both types). PDS were self-reported. Crude and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated using logistic regression. RESULTS: Overall, 9.6% (95% CI = 8.8-10.4) of Illinois postpartum women experienced PDS. Of Illinois postpartum women, 63.5% (95% CI = 62.1-64.9) had high composite support, 29.3% (95% CI = 28.0-30.6) had moderate composite support, and 7.1% (95% CI = 6.4-7.9) had low composite support. After adjustment for maternal characteristics, instrumental support, partner emotional support, and a composite measure of support were each significantly associated with PDS. Compared to women with high composite support, women with low composite support had six times the odds of PDS (aOR = 6.1, 95% CI = 4.5-8.2), and women with moderate composite support had nearly three times the odds of PDS (aOR = 2.7, 95% CI = 2.2-3.4). CONCLUSION: PDS was associated with instrumental support, partner emotional support, and a composite measure of support in Illinois postpartum women. This suggests the importance of addressing social support for postpartum individuals.
Postpartum Women's Experiences of Postnatal Care in Sub-Saharan Africa: A Qualitative Evidence Synthesis.
Moyo E, Moyo P, Dzinamarira T … +1 more , Ross A
Birth · 2025 Mar · PMID 39417286 · Full text
BACKGROUND: Postnatal care (PNC) is a critical service for the health and well-being of new mothers and newborns. However, in sub-Saharan Africa (SSA), most efforts to improve maternal and child health have been directed...
BACKGROUND: Postnatal care (PNC) is a critical service for the health and well-being of new mothers and newborns. However, in sub-Saharan Africa (SSA), most efforts to improve maternal and child health have been directed toward enhancing skilled birth attendance and urgent obstetric and neonatal care. This is despite the fact that more than half of maternal deaths globally occur in the postnatal period, with 65% of these occurring in the first week following birth. One of the health system factors influencing PNC utilization is the women's previous PNC experience at healthcare facilities. The aim of this review was to gain a better understanding of women's experiences of PNC in SSA. METHODS: This study followed a qualitative evidence synthesis design. The phenomenon of interest was postpartum women's experiences of PNC in SSA. PubMed, CINAHL, EMBASE, Science Direct, Africa Journals Online (AJOL), SCOPUS, and Google Scholar were searched for peer-reviewed articles published in English between 2013 and 2023. To assess the quality of the included studies, we used an appraisal tool developed by the Evidence for Policy and Practice Information and Co-ordinating Centre. Two authors independently extracted relevant data from the included studies. Thomas and Harden's thematic synthesis framework was used to synthesize the data. RESULTS: Eight articles were used in this review. Seven articles reported on qualitative studies, and one reported on a mixed-method study. All the included studies fully or partially met the 12 quality assessment criteria. Synthesis of the data resulted in the development of five analytical themes. The five themes were the adequacy of physical examination and communication of the findings, adequacy of PNC information, the quality of interactions with healthcare workers (HCWs), the availability of resources and adequacy of HCWs, and denial of care. The overall confidence in the review's findings was either moderate or high. CONCLUSION: Based on our findings, we recommend that countries in the region address staff shortages, implement task shifting, electronic medicine stock management systems, optimal supply chain policies, and train HCWs on PNC and interpersonal communication skills.
One Hundred Years of Seeking Respectful Maternity Care: History and Evolution.
Tilden EL, Jungbauer R, Hart EL … +1 more , Cantor AG
Birth · 2025 Mar · PMID 39412007 · Publisher ↗
Growing awareness of poor maternal health outcomes and maternal health disparities in the United States has heightened urgency around the need to promote Respectful Maternity Care (RMC) as a fundamental tenet of obstetri...
Growing awareness of poor maternal health outcomes and maternal health disparities in the United States has heightened urgency around the need to promote Respectful Maternity Care (RMC) as a fundamental tenet of obstetric/midwifery care and standardize efforts to improve safety, eliminate obstetric violence and racism, and optimize health outcomes for all birthing people. The historical context of prior and contemporary perspectives around childbirth influences our understanding of RMC and are shaped by varying scholarly, clinical, and community standards (e.g., religion, human rights, government, public health, midwifery, ethics, activism, and the law), which have changed significantly since the mid-19th century. In this commentary, we share results of a contextual question scoped as part of a larger systematic review of RMC to help inform consensus around a shared definition and development of a metric to standardize delivery and evaluation of RMC. Synthesis of this literature identified landmark historical influences on RMC over the past 100 years, highlighting the multidisciplinary scholarship and historical context influencing the progress toward RMC. Further understanding of this history may also inform policies and guidance for ongoing efforts to center respect and accountability in all aspects of maternity care, with particular attention to populations who are disproportionally impacted by disrespectful care.
Self-Advocacy Among Black Women During the Perinatal Period: Prevalence and Relationship to Patient Experiences.
Thomas TH, Vetterly S, Kaselitz EB … +2 more , Doswell W, Braxter B
Birth · 2025 Jun · PMID 39411999 · Full text
INTRODUCTION: Black women experience many barriers to receiving high-quality maternal healthcare. The ability of Black women to self-advocate may mitigate these threats to their health. Limited research describes Black w...
INTRODUCTION: Black women experience many barriers to receiving high-quality maternal healthcare. The ability of Black women to self-advocate may mitigate these threats to their health. Limited research describes Black women's self-advocacy during the perinatal period and how self-advocacy related to other relevant concepts. The aim of this study was to describe the relationship between self-advocacy, patient-provider relationships, and mental health outcomes among Black women in the perinatal period. METHODS: This cross-sectional descriptive pilot study recruited Black women who were either in their 3 trimester of pregnancy or within a year postpartum to complete surveys describing their self-advocacy (Female Self-Advocacy in Cancer Survivorship Scale adapted for perinatal period) and maternal health outcomes (trust and comfort with maternal healthcare providers-Patient-Provider Relationship Scale; abuse and disrespect during childbirth-Mothers of Respect Index; experiences of discrimination-Experiences of Discrimination scale; depression-Edinburgh Postnatal Depression Scale; and postpartum posttraumatic stress-City Birth Trauma Scale). RESULTS: N = 40 participants were recruited between January and September 2022. Participants reported moderate levels of self-advocacy which were associated with trust and comfort with healthcare providers (r = 0.57-0.76, p < 0.001). Feeling respected by healthcare providers was positively associated with two self-advocacy subscales (r = 0.42-0.44, p < 0.01). Depression was inversely related to all self-advocacy subscales (r = -0.47-0.62, p < 0.001). CONCLUSION: Black women's self-advocacy during the perinatal period is associated with trust and comfort with healthcare providers, perceptions of respect from their providers, and perinatal depression. Future research should focus on promoting trusting, respectful relationships between Black women and their maternal health providers.
Tasks and responsibilities of clinical midwives in Dutch hospitals.
Harmsen van der Vliet-Torij HW, van Heijningen-Tousain HJM, Wingelaar-Loomans E … +4 more , Engeltjes B, Steegers EAP, Goumans MJBM, Posthumus AG
Birth · 2024 Dec · PMID 39387809 · Publisher ↗
BACKGROUND: The number of Dutch clinical midwives has increased substantially over the last 20 years, but their tasks, responsibilities, and formal positions remain unclear. This study aimed to gain insight into the curr...
BACKGROUND: The number of Dutch clinical midwives has increased substantially over the last 20 years, but their tasks, responsibilities, and formal positions remain unclear. This study aimed to gain insight into the current tasks and responsibilities of clinical midwives in Dutch hospitals. We also aimed to determine whether these tasks varied among three types of hospitals in the Netherlands: secondary nonteaching hospitals, secondary teaching hospitals, and tertiary hospitals. METHODS: A cross-sectional national survey in which a questionnaire was sent to 810 clinical midwives from 78 hospitals was conducted. Responses from 412 (51%) clinical midwives from 77 hospitals were included in the analysis. RESULTS: Most respondents (97%) provided care in the delivery wards. They were often involved in the induction of labor (88%), requests for pain relief (87%), cases of meconium-stained fluid (59%), prolonged first-stage labor (56%), and maternal hypertensive disorders (43%). Daily tasks and responsibilities were determined by the type of pathology (60%), caseload in the ward (48%), and years of work experience (28%). The tasks varied according to hospital type, and the majority also conducted non-care-related tasks, such as auditing (83%) and teaching (67%). CONCLUSIONS: Dutch clinical midwives play important roles in obstetric care. They provide care for women with a wide range of pathologies they are not always trained for. In addition, they perform non-care-related tasks. Their tasks varied according to hospital type. To ensure that they are both skilled and authorized, compulsory training and formalization of their profession are possible interventions.
Settler Midwifery: A Colonial Tool in Canada's Reproductive Healthcare System.
Murdock M, Durant S
Birth · 2025 Sep · PMID 39394766 · Full text
INTRODUCTION: The land we call Canada is a settler colonial country where reproductive healthcare is used as a mechanism to control, subjugate, and erase Indigenous people and to advance the White settler state. Healthca...
INTRODUCTION: The land we call Canada is a settler colonial country where reproductive healthcare is used as a mechanism to control, subjugate, and erase Indigenous people and to advance the White settler state. Healthcare providers play an integral role in the healthcare system and contribute to Canada's colonization. In this piece, we critically analyze how settler midwifery is complicit with colonialism in reproductive healthcare by exploring the history of midwifery in Canada, midwifery education, and contemporary settler midwifery. DISCUSSION: European settlers omitted the history of Indigenous midwifery in Canada and to justify their erasure, they conceptualized Indigenous Peoples as uncivilized and their birthing practices as substandard. To establish a colonial healthcare system, settler midwives replaced traditional Indigenous birth attendants. When midwifery became regulated, midwives were required to train in formal post-secondary institutions that sustain colonial logics, systems, and practices. Midwifery education programs maintain colonialism by reinforcing medicalized Western practices and sustaining barriers to the growth of Indigenous midwifery. As a result, Western birthing practices are widespread among settler midwives and Indigenous Peoples face barriers to comprehensive and culturally sensitive care. To decolonize Canadian midwifery, we must dismantle stereotypes about Indigenous Peoples and their birthing practices in historical narratives, implement an anti-colonial approach to midwifery education, support Indigenous midwives in returning birth home, and improve the provision of culturally sensitive care. CONCLUSION: Settler midwifery in Canada is complicit in colonialism; building anti-colonial alliances can help support Indigenous midwives in leading a decolonial future for reproduction and birthing.
Why Aren't We Using Family Medicine to Help Confront the Maternal Mortality Crisis in the United States?
Hampton S
Birth · 2025 Jun · PMID 39394764 · Publisher ↗
Abstract loading — click title to view on PubMed.
Return-on-Investment Analysis of an Enhanced Community Doula Program: Pre- and Post-COVID-19 Considerations.
Mottl-Santiago J, Dukhovny D, Feinberg E … +5 more , Moore J, Parker V, Cabral H, Bowser D, Declercq G
Birth · 2025 Jun · PMID 39394757 · Publisher ↗
BACKGROUND: Community doulas are perinatal health workers who provide peer education, resource navigation, and support during pregnancy, childbirth, and the postpartum period. Evidence suggests that doulas improve the ex...
BACKGROUND: Community doulas are perinatal health workers who provide peer education, resource navigation, and support during pregnancy, childbirth, and the postpartum period. Evidence suggests that doulas improve the experience of care, reduce cesarean birth, and improve breastfeeding outcomes. However, people with low incomes cannot access affordable community doula support in most states due to lack of insurance reimbursement. To determine the affordability of Medicaid reimbursement for doula services, there is a need to fill a gap in research that employs real-world data and a return-on-investment (ROI) analysis approach. METHODS: We conducted a ROI analysis from the healthcare perspective of an enhanced community doula intervention, Best Beginnings for Babies (BBB). Healthcare and program cost data were collected alongside clinical outcomes from a randomized controlled trial of routine maternity care at Boston Medical Center with and without BBB. ROI was calculated as the net healthcare savings divided by the investment costs. Post-COVID-19 program costing estimates were also performed. RESULTS: Average healthcare costs per patient were $18,969 for the BBB group compared with $20,121 for routine care, a savings of $1,152. BBB program costs were an average of $971 per person. There was an 18% ROI. Lower costs for the birth hospitalization and NICU stays accounted for the largest areas of savings. Per-person program costs using proposed MassHealth fees produced a positive return on investment, although 2023 hospital doula program wages and salaries did not. DISCUSSION: The BBB-enhanced community doula program was cost-saving to payers and increased access to doula support for low-income people. Even with post-COVID-19 increases in program costs, analysis demonstrated doula support was still financially feasible. This study should reassure budget-conscious Medicaid payers that doula services are affordable.
Birth Outcomes and Prenatal Care Use in the U.S. During the COVID-19 Pandemic in 2020 and 2021.
Lyu W, Wehby GL
Birth · 2025 Jun · PMID 39394754 · Publisher ↗
BACKGROUND: The COVID-19 pandemic has posed substantial social and economic disruptions that may have had adverse effects on maternal and infant health. This study examines the changes in birth outcomes and prenatal care...
BACKGROUND: The COVID-19 pandemic has posed substantial social and economic disruptions that may have had adverse effects on maternal and infant health. This study examines the changes in birth outcomes and prenatal care use during the COVID-19 pandemic in 2020 and 2021 compared to pre-pandemic years. METHODS: Data come from birth certificates from the U.S. Vital Statistics Natality Files. The analytical sample includes 18,678,327 births in the 50 states and Washington, DC between 2017 and 2021. An event study is employed to examine changes in multiple birth outcomes and prenatal care use over years adjusting for demographic/socioeconomic characteristics and state of residence. RESULTS: There were very small changes in birth outcomes during pandemic years in 2020 and 2021. Specifically, low birth weight odds were lower in 2020 (OR = 0.99; 95 CI: 0.98-0.99) but higher in 2021 (OR = 1.03; 95% CI: 1.03-1.04) compared to 2019. C-section odds were higher in 2021 (OR = 1.01, 95% CI: 1.002-1.008) than in 2019. The mean number of prenatal visits in both 2020 and 2021 relative to 2019 was lower by about 0.3 visits (95% CI: -0.31 to -0.30 in 2021). CONCLUSION: Overall, there is no evidence of broad pandemic effects on low birth weight and preterm birth in 2020-2021.
Counseling About Cannabis Use During Pregnancy and Lactation: A Qualitative Study of Patient and Clinician Perspectives.
Cernat A, Carruthers A, Taneja S … +8 more , Popoola A, Greyson D, Panday J, Darling E, McDonald SD, Black M, Murray-Davis B, Vanstone M
Birth · 2024 Dec · PMID 39394742 · Publisher ↗
INTRODUCTION: Legalization in many jurisdictions has increased the prevalence of cannabis use, including during pregnancy and lactation. Accordingly, clinicians providing perinatal and infant care are increasingly requir...
INTRODUCTION: Legalization in many jurisdictions has increased the prevalence of cannabis use, including during pregnancy and lactation. Accordingly, clinicians providing perinatal and infant care are increasingly required to counsel about this topic, even if they do not feel comfortable or prepared for this conversation. The aim of this research was to explore how prenatal clinicians and pregnant and lactating women interact with cannabis consumption. METHODS: Using qualitative description, we conducted semi-structured interviews with 75 individuals in Canada: 23 clinicians who provide pregnancy and lactation care, and 52 individuals who made cannabis consumption decisions during pregnancy and/or lactation. Data were analyzed using inductive content analysis. RESULTS: Three phases of the clinical encounter influenced decision-making about cannabis consumption: initiation of a discussion about cannabis, sense-making, and the outcome of the encounter. Patients and clinicians described similar ideals for a counseling encounter about cannabis consumption during pregnancy or lactation: open, patient-centered conversation grounded in an informed decision-making model to explore the benefits, risks, and alternatives to cannabis. While clinicians described these values as reflecting real clinical interactions, patients reported that in their experience, actual interactions did not live up to these ideals. CONCLUSION: Clinicians and pregnant and lactating people report desiring the same things from a counseling interaction about cannabis: sharing of information, identification of values, and facilitation of a decision. Both groups endorse an open, nonjudgemental counseling approach that explores the reasons why a patient is considering cannabis consumption and reflects these reasons against available evidence and alternatives known to be safe.
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