Factors influencing respectful perinatal care among healthcare professionals in low-and middle-resource countries: a systematic review.

BACKGROUND: This review aimed to provide healthcare professionals with a scientific summary of best available research evidence on factors influencing respectful perinatal care. The review question was 'What were the perceptions of midwives and doctors on factors that influence respectful perinatal care?' METHODS: A detailed search was done on electronic databases: EBSCOhost: Medline, OAlster, Scopus, SciELO, Science Direct, PubMed, Psych INFO, and SocINDEX. The databases were searched for available literature using a predetermined search strategy. Reference lists of included studies were analysed to identify studies missing from databases. The phenomenon of interest was factors influencing maternity care practices according to midwives and doctors. Pre-determined inclusion and exclusion criteria were used during selection of potential studies. In total, 13 studies were included in the data analysis and synthesis. Three themes were identified and a total of nine sub-themes. RESULTS: Studies conducted in various settings were included in the study. Various factors influencing respectful perinatal care were identified. During data synthesis three themes emerged namely healthcare institution, healthcare professional and women-related factors. Alongside the themes were sub-themes human resources, medical supplies, norms and practices, physical infrastructure, healthcare professional competencies and attributes, women's knowledge, and preferences. The three factors influence the provision of respectful perinatal care; addressing them might improve the provision of this care. CONCLUSION: Addressing factors that influence respectful perinatal care is vital towards the prevention of compromised patient care during the perinatal period as these factors have the potential to accelerate or hinder provision of respectful care.

Awareness of postpartum depression among midwives and pregnant women in Arkhangelsk, Arctic Russia.

BACKGROUND: Postpartum depression (PPD) affects approximately 17% of the women worldwide with nearly half of all cases going undetected. More research on maternal mental health, particularly among healthcare professionals and pregnant mothers, could help identify PPD risks and reduce its prevalence. OBJECTIVE: Given that awareness of PPD is a crucial preventive factor, we studied PPD awareness among midwives and pregnant women in Arkhangelsk, Arctic Russia. METHODS: A qualitative study was conducted using in-depth semi-structured interviews. Midwives and pregnant women were recruited from the women's clinic of the Arkhangelsk municipal polyclinic. Seven midwives and 12 pregnant mothers were interviewed. RESULTS: Midwives described limited time for psychological counselling of pregnant women; they reported that their primary focus was on the physiological well-being of women. Pregnant women have expressed a desire for their families to share responsibilities. The participants considered PPD as a mix of psychological and physiological symptoms, and they also highlighted a discrepancy between the expectations of pregnant women and the reality of motherhood. The present study underscored the limited understanding of PPD identification. CONCLUSIONS: The findings suggest that there is a need for increased awareness among midwives and pregnant women regarding PPD. Prevention programs targeting PPD with a specific emphasis on enhancing maternal mental health knowledge are warranted.

Main findings: Pregnant women and midwives in an Arctic Russian setting have low awareness of postpartum depression.Added knowledge: Improved awareness among pregnant women and midwives about the mental health of women after childbirth, educating pregnant women about symptoms of postpartum depression, encourage them to express their needs and collaboration with family supporters may help to reduce postpartum depression burden.Global health impact for policy and action: Updated campaigns and prevention programs with the focus on increasing the knowledge on mental health among pregnant women and health personnel may be effective support for Primary health care.

'It's not me, it's them' - a report describing the weight-related attitudes towards obesity in pregnancy among maternal healthcare providers.

BACKGROUND: Occurrences of weight stigma have been documented in prenatal clinical settings from the perspective of pregnant patients, however little is known from the viewpoint of healthcare providers themselves. Reported experiences of weight stigma caused by maternal healthcare providers may be due to negative attitudes towards obesity in pregnancy and a lack of obesity specific education. The objective of this study was to assess weight-related attitudes and assumptions towards obesity in pregnancy among maternal healthcare providers in order to inform future interventions to mitigate weight stigma in prenatal clinical settings. METHODS: A cross-sectional survey was administered online for maternal healthcare providers in Canada that assessed weight-related attitudes and assumptions towards lifestyle behaviours in pregnancy for patients who have obesity. Participants indicated their level of agreement on a 5-point likert scale, and mean scores were calculated with higher scores indicating poorer attitudes. Participants reported whether they had observed weight stigma occur in clinical settings. Finally, participants were asked whether or not they had received obesity-specific training, and attitude scores were compared between the two groups. RESULTS: Seventy-two maternal healthcare providers (midwives, OBGYNs, residents, perinatal nurses, and family physicians) completed the survey, and 79.2% indicated that they had observed pregnant patients with obesity experience weight stigma in a clinical setting. Those who had obesity training perceived that their peers had poorer attitudes (3.7 ± 0.9) than those without training (3.1 ± 0.7; t(70) = 2.23, p = 0.029, Cohen's d = 0.86). CONCLUSIONS: Weight stigma occurs in prenatal clinical environments, and this was confirmed by maternal healthcare providers themselves. These findings support advocacy efforts to integrate weight stigma related content and mitigation strategies in medical education for health professionals, including maternal healthcare providers. Future work should include prospective examination of weight related attitudes among maternal healthcare providers and implications of obesity specific education, including strategies on mitigating weight stigma in the delivery of prenatal care.

Perception and reasons for the choice of informal provider among women receiving antenatal care services from traditional birth attendants in rural communities of Lagos state, Nigeria.

BACKGROUND: Unskilled delivery, particularly the use of traditional birth attendants, is a major threat to reducing maternal mortality in Africa. Despite the associated risks, there is insufficient evidence on the major reasons why pregnant women in Nigeria continue to use traditional birth attendant (TBA) services, especially in rural areas. This study, therefore, assessed the perception, reasons for use, and utilization of only TBA services in current pregnancy among rural-dwelling pregnant women in Lagos, Nigeria. METHODS: A descriptive cross-sectional study was conducted among 347 pregnant women recruited from traditional birth attendant facilities at Ikorodu Local Government Area, Lagos. Data were collected with an interviewer-administered questionnaire and analyzed using SPSS version 25. Bivariate and multivariate analyses were conducted with a significance level set at p<0.05. The outcome measures included perception, utilization of only TBA services in current pregnancy, and reasons for use. Positive perception refers to positive thought, belief, or opinion held by the participants towards the TBA. RESULTS: All the respondents had a positive perception of TBAs, majority (70.3%) utilized TBA only while 29.7% combined TBA and healthcare facilities services in the current pregnancy. Recommendations from previous users (81.6%), welcoming and hospitable staff (77.2%), perceived spiritual protection (75.2%), and past use (68.6%), were some of the reasons cited by the respondents for utilizing only TBA services. Predictors of utilizing only TBA services were respondents' level of education, those with secondary (aOR = 0.261; 95% CI; 0.108-0.629) and tertiary (aOR = 0.352; 95% CI; 0.162-0.769) had lower utilization while the lack of health insurance coverage (aOR = 3.017; 95% CI; 1.476-6.166) were associated with higher utilization of TBAs. CONCLUSION: Respondents in this study had a positive perception of TBA services. Continuous training and an effective monitoring system of TBAs by the government and other healthcare stakeholders to improve women's birthing experiences is recommended.

Factors associated with skilled birth attendance in 37 low-income and middle-income countries: a secondary analysis of nationally representative, individual-level data.

BACKGROUND: Progress on skilled birth attendance (SBA) has been very uneven across low-income and middle-income countries (LMICs). There is scant empirical evidence on the role of fundamental development processes in explaining differences in SBA outcomes across world regions over time in these settings. We therefore aimed to estimate how these processes have contributed to observed changes in SBA across Latin America and the Caribbean, South Asia, Southeast Asia, and sub-Saharan Africa. METHODS: We pooled all available Demographic and Health Survey (DHS) rounds that contained detailed birth attendance information. The compiled data covers about 1·1 million births (1·1 million female individuals) from 103 DHS rounds in 37 countries. We estimated the determinants of SBA using multivariable regression techniques and Oaxaca-Blinder decompositions for different world regions and time periods (1990s, 2000s, and 2010s). FINDINGS: We show that progress in SBA is associated with improvements in terms of household-level wealth, mothers' education, urbanisation, contraceptive knowledge, and proxies of female empowerment. Furthermore, we show that changes in the underlying relationship between SBA and specific development indicators (wealth, education, and rural residence status) have further contributed to the observed rise in SBA across LMICs. Our findings further suggest that certain determinants of improvements in SBA are region-specific (eg, importance of rural residence status in sub-Saharan Africa), whereas some of the studied processes (eg, poverty, maternal education, and urbanisation) have become less predictive for the uptake of SBA over time. INTERPRETATION: Although substantial progress has been made in increasing SBA rates over the past three decades across LMICs, further efforts for continued progress are still needed to achieve international targets on SBA as part of the Sustainable Development Goals, the Every Newborn Action Plan, and the Ending Preventable Maternal Mortality initiative. According to our findings, these efforts can include general policies (eg, female empowerment) and region-specific policies (eg, poverty reduction programmes in Southeast Asia). FUNDING: Bernhard Nocht Institute for Tropical Medicine. TRANSLATIONS: For the French and Indonesian translations of the abstract see Supplementary Materials section.

Nursing and midwifery students' attitudes towards addressing patient sexual health in their future profession: Polish adaptation and validation of the students' attitudes towards addressing sexual health extended questionnaire (SA-SH-Ext).

The aim of the study was to assess the success of an adaption of the Students' Attitudes Towards Addressing Sexual Health Extended Questionnaire (SA-SH-Ext) in meeting Polish linguistic and cultural norms, as well as to ascertain the nursing and midwifery students' attitudes towards addressing sexual health using the SA-SH-Ext questionnaire. The sample size of the cross-sectional validation study consisted of 570 Polish nursing and midwifery students. The collected data was used to examine the internal consistency reliability and construct validity using exploratory factor analysis (EFA). Internal consistency reliability showed a Cronbach's alpha value of 0.91, and construct validity measured by exploratory factor analysis (EFA) demonstrated good results. The Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) was high and amounted to 0.923, and the Bartlett's test of sphericity was significant (p = 0.000). The analysis of construct validity demonstrated five major factors: "Present feelings of comfortableness" (Factor 1), "Future working environment" (Factor 2), "Fear of negative influence on future patient relation" (Factor 3), "Educational needs-Awareness of knowledge gap" (Factor 4), "Educational needs-Awareness of the needs for competences" (Factor 5). The SA-SH-Ext v.PL questionnaire is a reliable and valuable instrument for assessing the level of perceived preparedness among nursing and midwifery students in addressing patient sexual health, a field often neglected in health and holistic care.

The experiences and perceptions of rural and remote nurses who provide care to pregnant women in the absence of midwives.

INTRODUCTION: Maternity unit closures in rural and remote settings of Australia have left a substantial gap in services for pregnant women. In the absence of midwives, and when women are unable to attend a maternity facility, registered nurses (RNs) are required to fill the void. While maternity education can attempt to prepare RNs for such encounters, there is little documented to suggest it meets all their physical and psychological needs. The existing challenges for health professionals, practising a vast generalist scope of practice while living and working in a rural and remote location, have been well researched and documented. How nurses feel about the expectation that they work outside their scope of practice to provide maternity care in a rural and remote setting in Australia has not been asked until now. This study explores the perceptions and experiences of RNs who find themselves in this situation. METHODS: The study utilised a hermeneutic phenomenological methodology to examine the experiences and perceptions of rural and remote nurses providing care for pregnant women. RNs working in rural and remote health facilities that had no maternity services were recruited by a purposive sampling method. Semistructured conversational interviews were recorded and transcribed verbatim. Data analysis was guided by van Manen's analytical approach. RESULTS: Eight nurses participated, and from the data three themes, each with several subthemes, emerged: 'being-in-the-world of the rural and remote nurse' - described how participants viewed rural and remote nursing as an entity with unchangeable aspects that could not be considered in isolation; 'scope of practice - unprepared or underprepared' described how, despite their existing and extensive nursing skills, participants felt ill-equipped theoretically, practically and mentally to care for pregnant women; 'moral distress' - participants expanded their feelings of unpreparedness to include inadequacy, fear, and appropriateness of care delivery. DISCUSSION: The realism of rural and remote nursing practice demonstrates that at some point in their career, rural and remote nurses will care for a labouring and/or pregnant woman at high risk for complications. Participants in this study appeared open and honest in their interviews, displaying pride at their extensive nursing skills and job satisfaction. However, they were unanimous in their discussions of what being a nurse and providing maternity care in a rural and remote setting meant to themselves and to pregnant women. They suggested care was fragmented and inadequate from a workforce that is inadequately prepared and stressed. CONCLUSION: This study has highlighted another concerning aspect of rural and remote midwifery care - the experiences and perceptions of eight nurses delivering care that has previously been overlooked. The united voice of the RNs in this study warrants a platform to speak from and deserves acknowledgement and attention from government and midwifery policy drivers. These nurses, and the women receiving their care, deserve more.

Antenatal cardiotocography in primary midwife-led care: a budget impact analysis.

OBJECTIVES: In many countries, the healthcare sector is dealing with important challenges such as increased demand for healthcare services, capacity problems in hospitals and rising healthcare costs. Therefore, one of the aims of the Dutch government is to move care from in-hospital to out-of-hospital care settings. An example of an innovation where care is moved from a more specialised setting to a less specialised setting is the performance of an antenatal cardiotocography (aCTG) in primary midwife-led care. The aim of this study was to assess the budget impact of implementing aCTG for healthy pregnant women in midwife-led care compared with usual obstetrician-led care in the Netherlands. METHODS: A budget impact analysis was conducted to estimate the actual costs and reimbursement of aCTG performed in midwife-led care and obstetrician-led care (ie, base-case analysis) from the Dutch healthcare perspective. Epidemiological and healthcare utilisation data describing both care pathways were obtained from a prospective cohort, survey and national databases. Different implementation rates of aCTG in midwife-led care were explored. A probabilistic sensitivity analysis was conducted to estimate the uncertainty surrounding the budget impact estimates. RESULTS: Shifting aCTG from obstetrician-led care to midwife-led-care would increase actual costs with €311 763 (97.5% CI €188 574 to €426 072) and €1 247 052 (97.5% CI €754 296 to €1 704 290) for implementation rates of 25% and 100%, respectively, while it would decrease reimbursement with -€7 538 335 (97.5% CI -€10 302 306 to -€4 559 661) and -€30 153 342 (97.5% CI -€41 209 225 to -€18 238 645) for implementation rates of 25% and 100%, respectively. The sensitivity analysis results were consistent with those of the main analysis. CONCLUSIONS: From the Dutch healthcare perspective, we estimated that implementing aCTG in midwife-led care may increase the associated actual costs. At the same time, it might lower the healthcare reimbursement.

Evaluating the implementation of person-centred care and simulation-based learning in a midwifery education programme in the Democratic Republic of Congo: a study protocol.

BACKGROUND: Investing in midwives educated according to international standards is crucial for achieving Sustainable Development Goals in maternal and newborn health. Applying a person-centred care approach and using simulation-based learning to improve the learning experience for midwifery students may enhance the quality of childbirth care. This protocol describes a study evaluating the implementation of person-centred approach and simulation-based learning in childbirth as part of a midwifery education programme at the Evangelical University in Africa, DRC. METHODS: The research will be exploratory and guided by an implementation research framework. Ethical approval has been obtained. Facilitators working at the programme's five clinical practice sites will be trained in: 1) Introducing person-centred childbirth care using a training programme called'Mutual Meetings'; and 2) integrating simulation-based learning, specifically by using the three courses: Essential Care of Labor, Bleeding after Birth, and Vacuum Extraction. Data will include interviews with midwifery students, facilitators and clinical preceptors, and maternal and neonatal outcomes from birth registers. DISCUSSION: By integrating a validated and culturally adapted person-centred care training programme and simulation-based learning into a midwifery education programme and clinical practice sites, the findings from the study anticipate an improvement in the quality of childbirth care. Training facilitators in these methodologies aim to effectively mitigate maternal and neonatal adverse outcomes. The findings are expected to provide valuable recommendations for governments, policymakers, and healthcare providers in the DRC and beyond, contributing to significant improvements in midwifery education and aligning with global health priorities, including the Sustainable Development Goals. TRIAL REGISTRATION: The study was registered retrospectively with the ISRCTN registry on the 23rd of February 2024. The registration number is: ISRCTN10049855.

Main findings: It is anticipated that the implementation of both person-centred care and simulation-based learning in a midwifery education programme will improve the quality of care in childbirth practice.Added knowledge: The use of facilitators has the potential to enhance the implementation of person-centred care and simulation-based learning in a midwifery education programme, both at campus and in clinic.Global health impact for policy and action: The expected findings could inform global health policy development and practice, promising advancements in midwifery education and consequently enhance the maternal and newborn health outcomes.

Midwifery students' spiritual and ethical values and their views and attitudes towards uterine transplantation: A qualitative study.

This qualitative study was conducted to examine the relationship between Muslim midwives' spiritual values and ethical orientations and their attitudes towards uterine transplantation. The phenomenological study sample group consisted of students in the Midwifery undergraduate programme of a public university in Istanbul (n:26). The data were collected in semi-structured focus group interviews. It was among the student midwives, it was determined that some students rejected uterine transplantation with thoughts such as "I am a Muslim, according to my religious belief, I should go to the grave without damaging my organs" or "This transplantation is not a vital necessity", as well as students who considered uterine transplantation as religious and ethically appropriate. It was determined that midwife candidates who will provide reproductive health services have different ethical and moral views regarding uterus transplantation, and there are some who see this method as religiously acceptable, and there are also students who emphasize that it is not suitable for Islam. In addition, training programs are planned to increase students' awareness and knowledge on this subject, aiming to be beneficial to the women they will care for in the future.

Cette étude qualitative a été menée pour examiner la relation entre les valeurs spirituelles et les orientations éthiques des sages-femmes musulmanes et leurs attitudes à l'égard de la transplantation utérine. Le groupe échantillon de l'étude phénoménologique était composé d'étudiants du programme de premier cycle de sages-femmes d'une université publique d'Istanbul (n : 26). Les données ont été recueillies lors d'entretiens de groupe semi-structurés. Parmi les étudiantes sages-femmes, il a été déterminé que certaines étudiantes rejetaient la transplantation utérine avec des pensées telles que "Je suis musulmane, selon ma croyance religieuse, je devrais aller dans la tombe sans endommager mes organes" ou "Cette transplantation n'est pas une nécessité vitale", ainsi que des étudiants qui considéraient la transplantation utérine comme religieusement et éthiquement appropriée. Il a été déterminé que les candidates sages-femmes qui fourniront des services de santé reproductive ont des opinions éthiques et morales différentes concernant la transplantation d'utérus. Certaines personnes considèrent cette méthode comme religieusement acceptable, et d'autres étudiants soulignent qu'elle n'est pas adaptée à l'Islam. De plus, des programmes de formation sont prévus pour accroître la sensibilisation et les connaissances des étudiants sur ce sujet, dans le but d'être bénéfiques aux femmes dont elles s'occuperont à l'avenir.

Understanding maternal Ethnomedical Folklore in Central Uganda: a cross-sectional study of herbal remedies for managing Postpartum hemorrhage, inducing uterine contractions and abortion in Najjembe sub-county, Buikwe district.

Pregnant women in rural Uganda largely rely on medicinal plants for inducing labor, treating postpartum hemorrhage (PPH), and inducing abortion. 90% of the women in both rural and urban Uganda use plants to manage pregnancy symptoms like constipation, heartburn, morning sickness, body aches, nausea, and vomiting. After delivery women continue using plants to manage postpartum complications and for infant care especially herbal baths. This study documented how ethnomedical folklore has been used to aid childbirth, manage postpartum hemorrhage, and induce abortion. METHODS: A cross-sectional ethnobotanical survey was conducted from May - December 2023 in Najjemebe sub-county, Buikwe district. 206 respondents from 12 villages were selected using snowball sampling. Key informants included Traditional Birth Attendants (TBAs) and herbalists. Data was collected using semi-structured questionnaires and focus group discussions. Voucher specimens of the plants were identified and authenticated at Makerere University Herbarium. Data were analyzed using descriptive statistics, Informant Consensus factor (ICF), Use Reports (URs), paired comparisons, and GraphPad Prism® version 9.0.0 software. RESULTS: All respondents (N = 206, 100%), used plants to induce labour, treat PPH, and induce abortion. One hundred four plant species were documented: most cited or preferred were: Hoslundia opposita (N = 109, 53%), Phytolacca dodecandra (N = 72, 35%), and Commelina erecta (N = 47, 23%). The plants belonged to 49 families, Lamiaceae (16.3%) and Fabaceae (14.3%) having the majority of the species. Herbs were 42 (40%) and trees 23 (22%). Oral administration 95(72%) was the commonest, then topical 19 (14.4%) and vaginal 14(10.6%). CONCLUSION: Health surveys revealed that about 27% of deliveries in Uganda take place outside a health facility. Due to the oxytocic effects of plant species reported in this study, they play a triple role of being uterotonics, abortifacients, and treating postpartum haemmorhage. The dilemma lies in the unknown dosages and toxicity levels that could endanger both the mother's and the unborn child's lives. Due to Uganda's high rates of population growth, overall fertility, maternal mortality, and morbidity, policies, and programmes on gendered health provision need to be reevaluated. Integrating herbal medicine into health care systems appears to be a feasible solution.

Knowledge and utilization of family planning services among tertiary students in Northern Ghana: The case of College of Nursing and Midwifery, Nalerigu.

Though tertiary students studying health-related programs are assumed knowledgeable about family planning, this does not always translate to increased use of family planning services. In a cross-sectional survey, this study assessed 411 nursing, midwifery and allied health students' knowledge of family planning, contraceptive use, perceptions, and factors affecting the utilisation of family planning services. Each student completed a 24-itemised questionnaire in a Computer-Assisted Personal Interviewing Survey. The data was analysed with Stata /IC version 16. Statistical significance was set at p<0.05. Overall knowledge of family planning was 99.7%, commonly gained in school (51.8%), followed by clinics and hospitals (41.4%). Only 21.7% of the students used family planning services. Menstrual cramps (57.9%), infertility (33.1%), and weight gain (32.5%) were the commonly perceived side effects of contraceptive use. The high proximity of participants to family planning service providers and lack of community, family, and partner acceptance of modern contraceptives were associated with underutilisation. Despite the high level of knowledge of family planning, the student's utilisation of family planning services was poor. To boost family planning service uptake among tertiary health students, it is essential to tackle barriers related to community, family, and partner acceptance. This can be achieved through educational programs that involve men in family planning discussions and by enhancing service accessibility.

Même si les étudiants du supérieur qui étudient dans des programmes liés à la santé sont censés connaître la planification familiale, cela ne se traduit pas toujours par une utilisation accrue des services de planification familiale. Dans le cadre d'une enquête transversale, cette étude a évalué les connaissances de 411 étudiants en soins infirmiers, obstétricaux et paramédicaux en matière de planification familiale, d'utilisation des contraceptifs, de perceptions et de facteurs affectant l'utilisation des services de planification familiale. Chaque étudiant a rempli un questionnaire en 24 points dans le cadre d'une enquête par entretien personnel assisté par ordinateur. Les données ont été analysées avec Stata/IC version 16. La signification statistique a été fixée à p<0,05. La connaissance globale de la planification familiale était de 99,7 %, généralement acquise à l'école (51,8 %), suivie par les cliniques et les hôpitaux (41,4 %). Seulement 21,7% des étudiants ont utilisé les services de planification familiale. Les crampes menstruelles (57,9 %), l'infertilité (33,1 %) et la prise de poids (32,5 %) étaient les effets secondaires couramment perçus de l'utilisation de contraceptifs. La grande proximité des participants avec les prestataires de services de planification familiale et le manque d'acceptation des contraceptifs modernes par la communauté, la famille et les partenaires étaient associés à la sous-utilisation. Malgré le niveau élevé de connaissances en matière de planification familiale, l'utilisation des services de planification familiale par les étudiants était faible. Pour stimuler le recours aux services de planification familiale parmi les étudiants de l'enseignement supérieur en santé, il est essentiel de s'attaquer aux obstacles liés à l'acceptation par la communauté, la famille et les partenaires. Cet objectif peut être atteint grâce à des programmes éducatifs qui impliquent les hommes dans les discussions sur la planification familiale et en améliorant l'accessibilité des services.

Roles and challenges encountered by midwives in the management of postpartum haemorrhage following normal vaginal delivery: A scoping review.

AIMS: To establish a comprehensive understanding of the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of postpartum haemorrhage (PPH) following normal vaginal delivery. DESIGN: We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) recommendations. METHODS: We considered studies related to the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of PPH during vaginal delivery. We excluded guidelines, consensuses, abstracts of meetings and non-English language studies. Databases, including the Cochrane Library, PubMed, Web of Science, Ovid, Medline, Embase, JBI EBP and BIOSIS Previews, were searched on January 1, 2023, with no time limitations. RESULTS: We included 28 publications. Midwives play important roles in the prevention, diagnosis and management of postpartum haemorrhage during vaginal delivery. In the prevention of PPH, midwives' roles include identifying and managing high-risk factors, managing labour and implementing skin-to-skin contact. In the diagnosis of PPH, midwives' roles include early recognition and blood loss estimation. In the management of PPH, midwives are involved in mobilizing other professional team members, emergency management, investigating causes, enhancing uterine contractions, the repair of perineal tears, arranging transfers and preparation for surgical intervention. However, midwives face substantial challenges, including insufficient knowledge and skills, poor teamwork skills, insufficient resources and the need to deal with their negative emotions. Midwives must improve their knowledge, skills and teamwork abilities. Health care system managers and the government should give full support to midwives. Future research should focus on developing clinical practice guidelines for midwives for preventing, diagnosing and managing postpartum haemorrhage.

Informed consent to midwifery practices and interventions during the second stage of labor-An observational study within the Oneplus trial.

OBJECTIVES: To study informed consent to midwifery practices and interventions during the second stage of labor and to investigate the association between informed consent and experiences of these practices and interventions and women's experiences of the second stage of labor. METHODS: This study uses an observational design with data from a follow-up questionnaire sent to women one month after giving birth spontaneously in the Oneplus trial, a study aimed at evaluating collegial midwifery assistance to reduce severe perineal trauma. The trial was conducted between 2018-2020 at five Swedish maternity wards and trial registered at clinicaltrials.gov, no NCT03770962. The follow-up questionnaire contained questions about experiences of the second stage of labor, practices and interventions used and whether the women had provided informed consent. Evaluated practices and interventions were the use of warm compresses held at the perineum, manual perineal protection, vaginal examinations, perineal massage, levator pressure, intermittent catheterization of the bladder, fundal pressure, and episiotomy. Associations between informed consent and women's experiences were assessed by univariate and multivariable logistic regression. FINDINGS: Of the 3049 women participating in the trial, 2849 consented to receive the questionnaire. Informed consent was reported by less than one in five women and was associated with feelings of being safe, strong, and in control. Informed consent was further associated with more positive experiences of clinical practices and interventions, and with less discomfort and pain from interventions involving physical penetration of the genital area. CONCLUSION: The findings indicate that informed consent during the second stage is associated with feelings of safety and of being in control. With less than one in five women reporting informed consent to all practices and interventions performed by midwives, the results emphasize the need for further action to enhance midwives' knowledge and motivation in obtaining informed consent prior to performance of interventions.

Cultural competences among future nurses and midwives: a case of attitudes toward Jehovah's witnesses' stance on blood transfusion.

BACKGROUND: Transcultural nursing recognises the significance of cultural backgrounds in providing patients with quality care. This study investigates the opinions of master's students in nursing and midwifery regarding the attitudes of Jehovah's Witnesses towards refusing blood transfusions. METHODS: 349 master's students in nursing and midwifery participated in a quantitative study and were surveyed via the Web to evaluate their awareness of the stance of Jehovah's Witnesses on blood transfusions and the ethical and legal dilemmas associated with caring for Jehovah's Witness (JW) patients. RESULTS: The study yielded three significant findings. It unequivocally demonstrates that nursing and midwifery students possess inadequate knowledge regarding Jehovah's Witnesses' stance on blood transfusions and their acceptance of specific blood products and medical procedures. Despite being cognisant of the ethical and legal dilemmas of caring for JW patients, students lack an understanding of patients' autonomy to reject blood transfusions and their need for bloodless medicine. Students also articulated educational needs regarding cultural competencies regarding the Jehovah's Witnesses' beliefs on blood transfusions and non-blood management techniques. CONCLUSIONS: Healthcare professionals need the knowledge and skills necessary to provide holistic, patient-centred and culturally sensitive care. This study emphasises the urgent need for university curricula and nursing postgraduate training to include modules on transcultural nursing and strategies for minimising blood loss.

Maternity care for women from ethnic minority backgrounds in North-West England: A grounded theory study.

AIM: To understand the maternity experiences of women from minority ethnic groups who had given birth in an NHS trust in the North-West of England, and experiences of midwives caring for them. BACKGROUND: Women from minority ethnic groups have poorer maternity outcomes compared with other women. Research about maternity experiences of women from minority ethnic groups is limited but suggests that they have poorer experiences. METHOD: Constructivist grounded theory was used as the framework for the study. Thirteen women and sixteen midwives were interviewed to elicit views and maternity experiences of women from minority ethnic groups. Interviews were transcribed, analysed, and focused codes developed into theoretical codes resulting in an emergent grounded theory. FINDINGS: Four sub-categories emerged: 'I was feeling protected', 'it is just literally empowering them, 'it will affect them more', and 'if people speak out it will help other people'. These sub-categories generated a substantive theory: 'striving towards equity and women centred care'. DISCUSSION: Culturally sensitive, relational care made women feel safe and trust their care providers. Information provision led to reassurance and enabled women to make choices about their care. Midwives' workload compromised care provision and disproportionally affected women from minority ethnic groups, especially those who do not speak English. Women from minority groups are less likely to complain and be represented in feedback. CONCLUSION: Culturally sensitive care is meeting the individual needs of many women; however, non- English speakers are disproportionally and negatively affected by midwives' workload, attitudes, or service challenges, reducing their reassurance and choice.

Model of perinatal care but not prenatal stress exposure is associated with birthweight and gestational age at Birth: The Australian birth in the time of COVID (BITTOC) study.

OBJECTIVE: The present study aimed to understand, relative to standard care, whether continuity of care models (private midwifery, continuity of care with a private doctor, continuity of care with a public midwife), and women's experience of maternity care provision, during the perinatal period buffered the association between prenatal maternal stress (PNMS) and infant birth outcomes (gestational age [GA], birth weight [BW] and birth weight for gestational age [BW for GA]). METHODS: 2207 women who were pregnant in Australia while COVID-19 restrictions were in place reported on their COVID-19 related objective hardship and subjective distress during pregnancy and provided information on their model of maternity care. Infant birth outcomes (BW, GA) were reported on at 2-months postpartum. RESULTS: Multiple linear regressions showed no relationship between PNMS and infant BW, GA or BW for GA, and neither experienced continuity of care, nor model of maternity care moderated this relationship. However, compared with all other models of care, women enrolled in private midwifery care reported the highest levels of experienced continuity of care and birthed infants at higher GA. BW and BW for GA were higher in private midwifery care, relative to standard care. CONCLUSION: Enrollment in continuous models of perinatal care may be a better predictor of infant birth outcomes than degree of PNMS exposure. These results highlight the possibility that increased, continuous support to women during pregnancy may play an important role in ensuring positive infant birth outcomes during future pandemics.