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1.
J Glob Health ; 14: 04164, 2024 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-39238363

RESUMO

Background: Health workers' (HWs') perspectives on the quality of maternal and newborn care (QMNC) are not routinely collected. In this cross-sectional study, we aimed to document HWs' perspectives on QMNC around childbirth in 12 World Health Organization (WHO) European countries. Methods: HWs involved in maternal/neonatal care for at least one year between March 2020 and March 2023 answered an online validated WHO standards-based questionnaire collecting 40 quality measures for improving QMNC. A QMNC index (score 0-400) was calculated as a synthetic measure. Results: Data from 4143 respondents were analysed. For 39 out of 40 quality measures, at least 20% of HWs reported a 'need for improvement', with large variations across countries. Effective training on healthy women/newborns management (n = 2748, 66.3%), availability of informed consent job aids (n = 2770, 66.9%), and effective training on women/newborns rights (n = 2714, 65.5%) presented the highest proportion of HWs stating 'need for improvement'. Overall, 64.8% (n = 2684) of respondents declared that HWs' numbers were insufficient for appropriate care (66.3% in Portugal and 86.6% in Poland), and 22.4% described staff censorship (16.3% in Germany and 56.7% in Poland). The reported QMNC index was low in all countries (Poland median (MD) = 210.60, interquartile range (IQR) = 155.71, 273.57; Norway MD = 277.86; IQR = 244.32, 308.30). The 'experience of care' domain presented in eight countries had significantly lower scores than the other domains (P < 0.001). Over time, there was a significant monthly linear decrease in the QMNC index (P < 0.001), lacking correlation with the coronavirus disease 2019 (COVID-19) pandemic trends (P > 0.05). Multivariate analyses confirmed large QMNC variation by country. HWs with <10 years of experience, HWs from public facilities, and midwives rated QMNC with significantly lower scores (P < 0.001). Conclusions: HWs from 12 European countries reported significant gaps in QMNC, lacking association with COVID-19 pandemic trends. Routine monitoring of QMNC and tailored actions are needed to improve health services for the benefit of both users and providers. Registration: ClinicalTrials.gov NCT04847336.


Assuntos
Organização Mundial da Saúde , Humanos , Feminino , Estudos Transversais , Europa (Continente) , Recém-Nascido , Gravidez , Adulto , Qualidade da Assistência à Saúde , Pessoal de Saúde , Inquéritos e Questionários , Melhoria de Qualidade , Atitude do Pessoal de Saúde , Serviços de Saúde Materno-Infantil/normas , Serviços de Saúde Materno-Infantil/organização & administração , Parto
2.
Sex Reprod Healthc ; 41: 101016, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39159502

RESUMO

BACKGROUND: Women in socially disadvantaged positions face increased risk of fear of birth, birth complications, and postpartum depression, highlighting the need for targeted interventions for this group. Doula support is associated with positive emotional and medical outcomes for mother and child. Experience of doula support for women in socially disadvantaged positions in Sweden remains unexplored. AIM: To describe experiences of doula support within a project for women in socially disadvantaged positions in Sweden. METHODS: In-depth interviews with seven women and focus group discussions with twelve doulas in a Doula support project were conducted. Data was analysed with inductive content analysis. RESULTS: Women and doulas described experiences of doula support as a significant relationship with challenges, due to unclear boundaries for the support, and the time and trust needed to establish the relationship. The support was perceived as comprehensive, far exceeding traditional doula support, with extensive assistance provided postpartum. The project was regarded as meaningful, and that it led to positive birth experiences. CONCLUSIONS: Women in socially disadvantaged positions may benefit from doula support during the perinatal period. The support fosters feelings of calmness, security and empowerment, and alleviates feelings of isolation, which is crucial for a positive birth experience. Support for these women is complex due to increased social needs, leading to unclear expectations of the doula's role. Support from colleagues is deemed crucial. Future projects should establish clear frameworks and a supportive structure for doulas.


Assuntos
Doulas , Grupos Focais , Pesquisa Qualitativa , Apoio Social , Populações Vulneráveis , Humanos , Feminino , Suécia , Populações Vulneráveis/psicologia , Adulto , Gravidez , Mães/psicologia , Parto/psicologia , Depressão Pós-Parto/psicologia , Período Pós-Parto/psicologia , Entrevistas como Assunto , Medo
3.
Glob Health Action ; 17(1): 2372906, 2024 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-38993149

RESUMO

BACKGROUND: As notions of masculinity evolve globally, it is important to understand their dimensions within geographic regions and life contexts. African men's involvement in their partners'pregnancy and childbirth has been explored to a limited extent in the peer-reviewed literature. This analysis provides a comprehensive examination of the existing literature on the diverse experiences of fathers across the African continent. AIM: This study aims to provide an overview of fathers' experience of involvement in their partners' pregnancies andchildbirth in Africa. METHODS: A systematic integrative literature review guided the process. The review comprised problem identification, literature search, data evaluation, data analysis and presentation of results. Systematic searches were conducted in the Cinahl, PubMed and Scopus databases. RESULTS: The search identified 70 articles of which 31, relating to 11 African countries, were used. Of these, 20 were qualitative, 9 were quantitative and 2 were mixed-methods studies. Men's alienation from health services, and traditional gender norms that discourage fathers' supportive role during pregnancy were prevalent themes. Financial pressures also dominated fathers'experiences. At the same time, in 18 studies fathers expressed motivation to be involved partners and supportive fathers, despite stigma and exclusion from maternity services. CONCLUSION: This integrative review shows that fathers' experiences of their involvement in their partners' pregnancy and childbirth across African countries are influenced by multiple factors. While unwelcoming health services, traditional gender norms, and low income are barriers to male involvement, education, younger age, and modern gender norms are associated with greater male involvement.


Main findings: There is a diversity of experiences among fathers across the African continent, with healthcare system alienation, influential gender norms, and financial pressure being common themes.Added knowledge: Unwelcoming health services, traditional gender norms, and low income were found to be impediments to male involvement in their partners' pregnancy and childbirth, while education, younger age, and modern gender norms were associated with greater male involvement.Global health impact for policy and action: Information and education for men and conducive healthcare environments would enable more positive experiences for men and encourage their greater involvement.


Assuntos
Pai , Parto , Humanos , Pai/psicologia , Feminino , Gravidez , África , Masculino , Parto/psicologia , Masculinidade
4.
Sex Reprod Healthc ; 40: 100958, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38492272

RESUMO

INTRODUCTION: Obstetric emergency triage is a relatively new form of emergency triage and is not yet implemented in Sweden. Adaptations enables safe assessment of the childbearing woman, fetus and labor status. Failure to identify severely ill childbearing women and women post childbirth has repeatedly led to adverse outcomes. Introducing obstetric emergency triage constitutes a profound alteration in management that may challenge preconceived notions on how to provide best care. This study aimed at exploring and describing obstetric staff's experiences of working with obstetric emergency triage. MATERIALS AND METHODS: Thirteen obstetricians, midwives and auxiliary nurses at an obstetric emergency department in eastern Sweden were recruited by purposeful sampling. Individual qualitative interviews underwent inductive qualitative content analysis according to Graneheim and Lundman. RESULTS: An overarching theme - A new mindset - emerged from the analysis, comprising the four categories: Implications for the individual caregiver's own work, An improved organization, Improved patient care. Initial skepticism to triage changed towards a positive attitude during implementation, identifying barriers and facilitators for successful implementation. CONCLUSIONS: This first study exploring Swedish obstetric staff's perception of obstetric emergency triage as a working method suggests that, given time for implementation, a new mindset in obstetric emergency care might develop. Triage provides structure and a sense of control through a clear and quick overview of childbearing women seeking emergency care and enhances teamwork by improving communication. Triage directs attention toward aberrations and promotes reflection and action, improving patient safety.


Assuntos
Atitude do Pessoal de Saúde , Tocologia , Obstetrícia , Pesquisa Qualitativa , Triagem , Adulto , Feminino , Humanos , Gravidez , Serviço Hospitalar de Emergência , Enfermeiras e Enfermeiros/psicologia , Obstetra , Médicos/psicologia , Suécia , Triagem/métodos
5.
Birth ; 51(3): 612-619, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38288558

RESUMO

BACKGROUND: To prevent the spread of SARS-CoV-2, hospitals around the world adopted protocols that, in varying ways, resulted in the exclusion of partners from hospital postnatal care wards. The objective of this study was to examine the effect this exclusion had on partners' satisfaction with postnatal care. METHODS: An online survey (the Swedish Pregnancy Panel) including free-text comments was conducted before and during the first wave of the COVID-19 pandemic; partners of pregnant women were recruited at an early ultrasound appointment and followed until 2 months after childbirth. Data were linked to the Swedish Pregnancy Register. RESULTS: The survey was completed by 524 partners of women who gave birth during the pandemic and 203 partners of women who gave birth before. Partners' satisfaction with hospital postnatal care dropped 29.8 percent (-0.94 OLS, 95% CI = -1.17 to -0.72). The drop was largest for partners of first-time mothers (-1.40 OLS, 95% CI = -1.69 to -1.11), but unrelated to clinical outcomes such as mode of birth and most social backgrounds, except higher income. The qualitative analysis showed that partners (1) felt excluded as partners and parents, (2) thought the strain on staff led to deficiencies in the care provided, and (3) perceived the decision about partner restrictions as illogical. CONCLUSIONS: The exclusion of partners from the hospital postnatal wards clearly impaired satisfaction with care, and partners of first-time mothers were particularly affected. Planning for future restrictions on partners from hospital wards should factor in these consequences.


Assuntos
COVID-19 , Cuidado Pós-Natal , Humanos , COVID-19/prevenção & controle , COVID-19/psicologia , Feminino , Suécia , Cuidado Pós-Natal/métodos , Adulto , Gravidez , Masculino , Inquéritos e Questionários , Cônjuges/psicologia , SARS-CoV-2 , Satisfação Pessoal , Satisfação do Paciente
6.
BMC Pregnancy Childbirth ; 23(1): 714, 2023 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-37803316

RESUMO

BACKGROUND: In Sub-Saharan Africa, the postnatal period is associated with high mortality and accounts for a substantial proportion of maternal deaths. Although postnatal care has been identified as critical in reducing maternal mortality, the quality of care provided is often inadequate. Tanzania and Zanzibar have not made sufficient progress towards achieving the Sustainable Development Goals on maternal health, and there is limited knowledge about the utilization and quality of postnatal follow-up. The aim of this study was therefore to explore factors affecting the provision of high-quality postnatal care services in the urban area of Zanzibar. METHODS: Five focus group discussions were performed in Swahili with 25 healthcare providers from primary healthcare units in urban Zanzibar. Interviews were audio-recorded, transcribed verbatim, translated into English, and analysed using qualitative content analysis with an inductive approach. RESULTS: Factors affecting provision of high-quality postpartum care services could be divided into three generic categories. Difficulty achieving high attendance comprised three subcategories: long waiting times, low awareness among women, and out-of-pocket payment. Lack of basic resources also comprised three subcategories: shortage of healthcare providers, lack of adequate space, and inadequate medical equipment. Insufficient care routines comprised two subcategories: lack of guidelines and deficient chain of information. CONCLUSIONS: The present findings suggest that the women's perceptions of postnatal care do not align with the intended purpose of routine postnatal care. Instead, the postnatal period primarily leads to visits to health facilities only when urgent care is required, and there is a lack of awareness about the importance of postnatal care. Moreover, limited resources, including equipment, staff, and space, as well as long waiting times, hinder the delivery of high-quality care and contribute to a negative reputation of postnatal care services. To effectively reach all women and improve postnatal care, it is necessary to increase basic resources, modify health education approaches, and enhance the flow of information between different levels of care using context-specific strategies.


Assuntos
Serviços de Saúde Materna , Cuidado Pós-Natal , Gravidez , Feminino , Humanos , Tanzânia , Pesquisa Qualitativa , Grupos Focais
7.
Sex Reprod Healthc ; 36: 100847, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37080010

RESUMO

BACKGROUND: Pre-eclampsia affects 3-5% of all pregnant women and is among the leading causes of maternal morbidity and mortality as well as iatrogenic preterm birth worldwide. Little is known about the experience of partners of women whose pregnancy is complicated by pre-eclampsia. AIM: To describe partners' experience of having a spouse whose pregnancy was complicated by pre-eclampsia. METHODS: A qualitative study with in-depth interviews. Eight partners of women whose pregnancy was complicated by pre-eclampsia were interviewed and data were analysed using content analysis. FINDINGS: Partners found themselves in an unfamiliar and unexpected situation. They experienced an information gap in which they tried to make sense of the situation by interpreting subtle signs. The situation left them feeling emotionally stretched, feeling like an outsider while trying to provide support for their extended family. The partners experienced a split focus after the baby was born, prioritising the baby while worrying about their spouse. Post-partum, they expressed needing time to process and heal after childbirth. A need for professional support was highlighted and concerns about a future pregnancy were voiced. CONCLUSION: Having a spouse who is diagnosed with pre-eclampsia is challenging and overwhelming. Our findings imply a need to develop a model of care for women with pre-eclampsia that includes their partner, i.e., the other parent.


Assuntos
Pré-Eclâmpsia , Nascimento Prematuro , Humanos , Feminino , Gravidez , Recém-Nascido , Pré-Eclâmpsia/diagnóstico , Suécia , Parto , Gestantes
8.
BMC Womens Health ; 23(1): 182, 2023 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-37069560

RESUMO

BACKGROUND: Effective family planning is associated with substantial benefits, including reductions in maternal and neonatal mortality due to the avoidance of unintended pregnancies, and contributions to spacing, timing, and limiting births. However, in Zanzibar, Tanzania, the utilization of modern contraceptive methods is low. This study therefore aimed to identify barriers to using postpartum family planning among women in Zanzibar. METHODS: Five focus group discussions were conducted with 24 women who gave birth in the maternity unit at a reference hospital in Zanzibar during the first quarter of 2022. The discussions took place in Swahili, were performed with the assistance of an interview guide, and were audio recorded, transcribed in Swahili, and translated to English. Data were analysed with qualitative content analysis using an inductive approach. RESULTS: Barriers to using postpartum family planning in Zanzibar could be summarized in three generic categories. Inadequate knowledge about postpartum family planning is expressed in the subcategories: inadequate knowledge about contraceptive methods and their mode of action, insufficient quality of family planning services, and belief in traditional and natural medicine for family planning. Perceived risks of modern contraceptive methods are described in the subcategories: fear of being harmed, and fear of irregular bleeding. Limited power in one's own decision about contraceptive use consist of the subcategories: the need to involve the husband, and opposition and lack of interest from the husband. CONCLUSIONS: The participants' current knowledge of postpartum family planning was insufficient to either overcome the fear of side-effects or to understand which side-effects were real and likely to happen. The woman's power in her own decision-making around her sexual reproductive rights is of critical importance. Given the barriers identified in this study, the findings call for increased knowledge about family planning methods and their mode of action, and involvement of the husband throughout pregnancy, childbirth, and the postpartum period in postpartum family planning education and counselling, in Zanzibar and in similar settings.


Assuntos
Serviços de Planejamento Familiar , Educação Sexual , Recém-Nascido , Humanos , Feminino , Gravidez , Tanzânia , Anticoncepção/métodos , Período Pós-Parto , Comportamento Contraceptivo
9.
Sex Roles ; 88(5-6): 210-224, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36855639

RESUMO

Parents are not only caregivers to their children; they also have leisure routines that can impact their own well-being. However, little is known about how leisure activities change within the context of a couple during the transition to parenthood. This study uses latent growth curve models and data from the Swedish Pregnancy Panel to examine how often 918 first-time, heterosexual couples participated in six leisure activities from around pregnancy week 19 to one year postpartum. Compared to fathers, mothers less frequently exercised and listened to news, and more frequently read newspapers, spent time for themselves, and spent time with friends. Over time, mothers increased their frequency of praying to God and decreased spending time for themselves and with friends. Fathers decreased frequency of exercise. Within couples, there was a positive correlation between mothers' and fathers' frequency of engaging in leisure activities, although most changes over time were not associated. Our finding that two individuals within a couple may change their leisure activities independently of each other during the transition to parenthood can help healthcare professionals and researchers prepare expectant couples for upcoming changes (or lack thereof) and promote parent well-being. Our findings also highlight the possibility that in contexts with more state support for families, parenthood may not exacerbate gender gaps in leisure.

10.
Acta Obstet Gynecol Scand ; 102(1): 76-81, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36345990

RESUMO

INTRODUCTION: Obstetric brachial plexus palsy (OBPP) is a serious form of neonatal morbidity. The primary aim of this population-based registry study was to examine temporal trends, 1997-2019, of OBPP in infants delivered vaginally in a cephalic presentation. The secondary aim was to examine temporal changes in the incidence of associated risk factors. MATERIAL AND METHODS: This was a population-based registry study including singleton, cephalic, vaginally delivered infants, 1997-2019, in Sweden. To compare changes in the incidence rates of OBPP and associated risk factors over time, univariate logistic regression was used and odds ratios (OR) with 95% confidence intervals (CI) were calculated. RESULTS: The incidence of OBPP in infants delivered vaginally in a cephalic presentation decreased from 3.1 per 1000 births in 1997 to 1.0 per 1000 births in 2019 (OR 0.31, 95% CI 0.24-0.40). Conversely, the incidence of shoulder dystocia increased from 2.0 per 1000 in 1997 to 3.3 per 1000 in 2019 (OR 1.64, 95% CI 1.34-2.01). Over time, the proportion of women with body mass index of 30 kg/m2 or greater increased (14.5% in 2019 compared with 8.0% in year 1997, OR 1.96, 95% CI 1.89-2.03), more women had induction of labor (20.5% in 2019 compared with 8.6% in 1997, OR 2.74, 95% CI 2.66-2.83) and epidural analgesia (41.2% in 2019 compared with 29.0% in 1997, OR 1.72, 95% CI 1.68-1.75). In contrast, there was a decrease in the rate of operative vaginal delivery (6.0% in 2019, compared with 8.1% in 1997, OR 0.72, 95% CI 0.69, 0.75) and in the proportion of infants with a birthweight greater than 4500 g (2.7% in 2019 compared with 3.8% in 1997, OR 0.70, 95% CI 0.66-0.74). The decline in the incidence of these two risk factors explained only a small fraction of the overall decrease in OBPP between 1997-2002 and 2015-219. CONCLUSIONS: The incidence of OBPP in vaginally delivered infants in a cephalic presentation at birth decreased during the period 1997-2019 despite an increase in important risk factors including shoulder dystocia.


Assuntos
Traumatismos do Nascimento , Neuropatias do Plexo Braquial , Plexo Braquial , Distocia , Distocia do Ombro , Recém-Nascido , Feminino , Lactente , Gravidez , Humanos , Distocia do Ombro/epidemiologia , Incidência , Traumatismos do Nascimento/epidemiologia , Traumatismos do Nascimento/etiologia , Distocia/epidemiologia , Neuropatias do Plexo Braquial/epidemiologia , Neuropatias do Plexo Braquial/complicações , Plexo Braquial/lesões , Parto Obstétrico/efeitos adversos , Paralisia/complicações , Fatores de Risco , Ombro
11.
Int J Gynaecol Obstet ; 161(2): 343-355, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36522151

RESUMO

BACKGROUND: Induction of labor is increasing worldwide, and some countries have started to introduce outpatient induction in low-risk women. OBJECTIVES: To assess current knowledge concerning the safety, efficacy, women's experience, and economic costs of outpatient induction compared with inpatient induction. SEARCH STRATEGY: Multiple databases were last searched on October 19, 2021. Studies were selected according to our pre-specified inclusion, selection, and exclusion criteria. SELECTION CRITERIA: PICO; P-women with low-risk pregnancy planned for induction of labor. I-Outpatient induction C-Inpatient induction O-Outcomes according to the core outcome set for induction of labor (COSIOL). DATA COLLECTION AND ANALYSIS: Pooled in meta-analyses. The certainty of evidence was assessed using the GRADE system. MAIN RESULTS: The 20 included studies, including 7956 women, showed an overall low incidence of adverse events and indicated comparable results for inpatient and outpatient induction, but the studies were underpowered for safety-related outcomes. Women's experiences of outpatient induction were mostly positive. Based on three studies, the economic costs consequence is inconclusive. CONCLUSIONS: Due to early randomization, heterogenic study design, and underpowered studies regarding safety outcome, the certainty of evidence is very low. It is uncertain whether outpatient induction affects the risk for neonatal and maternal complications.


Assuntos
Ocitócicos , Gravidez , Recém-Nascido , Feminino , Humanos , Pacientes Ambulatoriais , Assistência Ambulatorial/métodos , Maturidade Cervical , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto Induzido/métodos
12.
Int J Gynaecol Obstet ; 159 Suppl 1: 22-38, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36530007

RESUMO

OBJECTIVE: To explore the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic by facility type among 16 European countries, comparing rates of instrumental vaginal birth and cesarean. METHODS: Women who gave birth in the WHO European Region from March 1, 2020, to February 7, 2022, answered a validated online questionnaire. Rates of instrumental birth, instrumental vaginal birth, and cesarean, and a QMNC index were calculated for births in public versus private facilities. RESULTS: Responses from 25 206 participants were analyzed. Women giving birth in private compared with public facilities reported significantly more frequent total cesarean (32.5% vs 19.0%; aOR 1.70; 95% CI 1.52-1.90), elective cesarean (17.3% vs 7.8%; aOR 1.90; 95% CI 1.65-2.19), and emergency cesarean before labor (7.4% vs 3.9%; aOR 1.39; 95% CI 1.14-1.70) (P < 0.001 for all comparisons), with analyses by country confirming these results. QMNC index results were heterogeneous across countries and regions in the same country and were largely affected by geographical distribution of regions rather than by type of facility alone. CONCLUSION: The study confirms that births in private facilities have higher odds of cesarean. It also suggests that QMNC should be closely monitored in all facilities to achieve high-quality care, independent of facility type or geographical distribution. GOV IDENTIFIER: NCT04847336.


Assuntos
COVID-19 , Cesárea , Feminino , Humanos , Recém-Nascido , Gravidez , COVID-19/epidemiologia , Saúde do Lactente , Pandemias , Logradouros Públicos
13.
Int J Gynaecol Obstet ; 159 Suppl 1: 9-21, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36530006

RESUMO

OBJECTIVE: To investigate potential associations between individual and country-level factors and medicalization of birth in 15 European countries during the COVID-19 pandemic. METHODS: Online anonymous survey of women who gave birth in 2020-2021. Multivariable multilevel logistic regression models estimating associations between indicators of medicalization (cesarean, instrumental vaginal birth [IVB], episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country level. RESULTS: Among 27 173 women, 24.4% (n = 6650) had a cesarean and 8.8% (n = 2380) an IVB. Among women with IVB, 41.9% (n = 998) reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% (n = 4048) had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalization. For example, women who reported having a cesarean, IVB, or episiotomy reported not feeling treated with dignity more frequently than women who did not have those interventions (odds ratio [OR] 1.37; OR 1.61; OR 1.51, respectively; all: P < 0.001). Country-level variables contributed to explaining some of the variance between countries. CONCLUSION: We recommend a greater emphasis in health policies on promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor medicalization of reproductive care.


Assuntos
COVID-19 , Medicalização , Feminino , Humanos , Gravidez , COVID-19/epidemiologia , Análise Multinível , Pandemias , Organização Mundial da Saúde
14.
Int J Gynaecol Obstet ; 159 Suppl 1: 39-53, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36530012

RESUMO

OBJECTIVE: To describe the perception of quality of maternal and newborn care (QMNC) around the time of childbirth among migrant and nonmigrant women in Europe. METHODS: Women who gave birth at a health facility in 11 countries of the WHO European Region from March 2020 to July 2021 were invited to answer an online questionnaire including demographics and childbirth experience. Data were analyzed and compared for 1781 migrant and 20 653 nonmigrant women. RESULTS: Migrant women who experienced labor perceived slightly more difficulties in attending routine antenatal visits (41.2% vs 39.4%; P = 0.001), more barriers in accessing facilities (32.9% vs 29.9%; P = 0.001), lack of timely care (14.7% vs 13.0%; P = 0.025), inadequate room comfort and equipment (9.2% vs 8.5%; P = 0.004), inadequate number of women per room (9.4% vs 8.6%; P = 0.039), being prevented from staying with their baby as they wished (7.8% vs 6.9%; P = 0.011), or suffering abuse (14.5% vs 12.7%; P = 0.022) compared with nonmigrant women. For women who had a prelabor cesarean, migrant women were more likely not to receive pain relief after birth (16.8% vs.13.5%; P = 0.039) and less likely to provide informal payment (1.8% vs 4.4%; P = 0.005) compared with nonmigrant women. Overall, the QMNC index was not significantly different for migrant compared with nonmigrant women. CONCLUSION: Gaps in overall QMNC were reported by both migrant and nonmigrant women, with improvements to healthcare necessary for all.


Assuntos
COVID-19 , Migrantes , Recém-Nascido , Feminino , Gravidez , Humanos , Pandemias , Parto , Organização Mundial da Saúde , População Europeia
15.
Int Breastfeed J ; 17(1): 83, 2022 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-36461061

RESUMO

BACKGROUND: Exclusive breastfeeding is the optimal infant nutrition, providing infants immunoprotection against many diseases including SARS-CoV-2 infection. Restrictions during the COVID-19 pandemic may have negatively affected breastfeeding practices in maternity care facilities. The aims of the study were to examine exclusive breastfeeding rates at discharge over time and to identify factors associated with exclusive breastfeeding during the pandemic. METHODS: A cross-sectional survey was conducted among mothers who gave birth in a maternity care facility in the World Health Organization (WHO) European Region countries during the COVID-19 pandemic. The socio-ecological model was employed to examine intrapersonal, interpersonal, organizational, and community/society factors associated with maternal report of exclusive breastfeeding at the time of discharge. RESULTS: There were 26,709 participating mothers from 17 European Region countries who were included in the analysis. Among the mothers, 72.4% (n = 19,350) exclusively breastfed and 27.6% (n = 7,359) did not exclusively breastfeed at discharge. There was an overall decline in exclusive breastfeeding rates over time (p = 0.015) with a significantly lower rate following the publication of the WHO breastfeeding guidelines on 23 June 2020 (AOR 0.88; 95% CI 0.82, 0.94). Factors significantly associated with exclusive breastfeeding outcomes in the logistic regression analysis included maternal age, parity, education, health insurance, mode of birth, inadequate breastfeeding support, lack of early breastfeeding initiation, lack of full rooming-in, birth attendant, perceived healthcare professionalism and attention, facility room cleanliness, timing of birth, and location of birth. CONCLUSIONS: Results from the study indicate the decline in exclusive breastfeeding rates in the WHO European Region during the COVID-19 pandemic. Using the socio-ecological model to identify factors associated with breastfeeding outcomes facilitates an integrated and holistic approach to address breastfeeding needs among women across the region. These findings demonstrate the need to augment breastfeeding support and to protect exclusive breastfeeding among mother-infant dyads, in an effort to reverse the declining exclusive breastfeeding rates. The study highlights the need to educate mothers and their families about the importance of exclusive breastfeeding, reduce maternal-infant separation, increase professional breastfeeding support, and follow evidence-based practice guidelines to promote breastfeeding in a comprehensive and multi-level manner. TRIAL REGISTRATION NUMBER: Clinical Trials NCT04847336.


Assuntos
COVID-19 , Serviços de Saúde Materna , Gravidez , Lactente , Feminino , Humanos , Aleitamento Materno , Alta do Paciente , COVID-19/epidemiologia , Pandemias , Estudos Transversais , SARS-CoV-2 , Organização Mundial da Saúde , Mães
16.
Soc Sci Med ; 312: 115362, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36155356

RESUMO

RATIONALE: Holistic antenatal care requires knowledge of individuals' emotional response to pregnancy. Little is known about how a pregnant woman and her partner influence each other emotionally during a pregnancy. OBJECTIVE: This study examines six discrete emotions that expectant couples experience during pregnancy, how these emotions change mid-to late-pregnancy, and whether the partners' emotional responses influence each other. METHODS: A longitudinal dyadic study where pregnant women and their partners (1432 couples) rated the extent to which the pregnancy evoked joy, strength, security, worry, shame, and anger at pregnancy week 12-19, 22-24, and 36. Latent curve models with structured residuals identify levels of and change in these emotions over time, while accounting for between- and within-couple variance. RESULTS: Pregnancy evoked mainly joy, strength, security, and worry, and lower levels of anger and shame. Pregnant women and partners felt similar levels of joy, strength, and security, but pregnant women felt more worry, shame, and anger. There was little to no mean-level change in all six measured emotions evoked by pregnancy (between-couple change), and no reciprocal effects between the partners (within-couple change). CONCLUSIONS: Emotions in mid-pregnancy were also felt in late pregnancy. Furthermore, the pregnant woman and her partner have individual emotional trajectories. The results can assist healthcare professionals and researchers target interventions to expectant mothers and partners, specifically by understanding emotional response to pregnancy as a stable confound and by not approaching the couple as one emotional unit.


Assuntos
Emoções , Parceiros Sexuais , Emoções/fisiologia , Feminino , Humanos , Pais , Gravidez , Gestantes/psicologia , Parceiros Sexuais/psicologia , Suécia
18.
Glob Health Action ; 15(1): 2067397, 2022 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-35762835

RESUMO

BACKGROUND: In Uganda, the uptake of maternal health services is very low, with only 41.1% of pregnant adolescent girls attending the eight antenatal visits that are recommended by the World Health Organisation. Uptake of maternal health services is essential in reducing the current level of adolescent pregnancies as well as its adverse effects on adolescent mothers and their babies, such as preterm deliveries, prolonged labour, death during pregnancy, and childbirth. No previous study has described pregnant adolescents' experiences with maternal health services in Uganda. OBJECTIVE: This study aimed to describe the barriers and strategies needed to improve maternal health services among pregnant adolescents in Uganda. METHODS: Data were collected in the Naguru Teenage Information and Health Centre in Uganda through individual interviews involving 31 pregnant adolescents. The transcribed interviews were inductively analysed through content analysis. RESULTS: The pregnant adolescents described difficulty in reaching, as well as lack of financial support to visit, the Naguru Teenage Information and Health Centre, which is a clinic providing youth friendly services. Feelings of being discriminated against and disrespected by health workers, and lack of privacy when receiving health services was major barriers that hindered their access to maternal health services. Pregnant adolescents' access to these services can be enhanced by improving health workers' working conditions, accelerating community and health worker awareness on ways to mitigate these barriers, and developing policies that encourage men's involvement in maternal health services. CONCLUSION: Adolescents in Uganda face considerable barriers to accessing improved and quality maternal health services. To mitigate these barriers, according to the adolescents, considerable efforts are required to tackle health workers' working conditions and sensitise the community on the importance of, as well as securing the availability of, maternal health services for pregnant adolescents. Future research should focus on pregnant adolescents who receive family support.


Assuntos
Serviços de Saúde Materna , Gravidez na Adolescência , Adolescente , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Recém-Nascido , Masculino , Gravidez , Gravidez na Adolescência/prevenção & controle , Gestantes , Uganda
19.
BMJ Open ; 12(4): e056753, 2022 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-35396296

RESUMO

OBJECTIVES: Develop and validate a WHO Standards-based online questionnaire to measure the quality of maternal and newborn care (QMNC) around the time of childbirth from the health workers' perspective. DESIGN: Mixed-methods study. SETTING: Six countries of the WHO European Region. PARTICIPANTS AND METHODS: The questionnaire is based on lessons learnt in previous studies, and was developed in three sequential phases: (1) WHO Quality Measures were prioritised and content, construct and face validity were assessed through a Delphi involving a multidisciplinary board of experts from 11 countries of the WHO European Region; (2) translation/back translation of the English version was conducted following The Professional Society for Health Economics and Outcomes Research guidelines; (3) internal consistency, intrarater reliability and acceptability were assessed among 600 health workers in six countries. RESULTS: The questionnaire included 40 items based on WHO Standards Quality Measures, equally divided into four domains: provision of care, experience of care, availability of human and physical resources, organisational changes due to COVID-19; and its organised in six sections. It was translated/back translated in 12 languages: Bosnian, Croatian, French, German, Italian, Norwegian, Portuguese, Romanian, Russian, Slovenian, Spanish and Swedish. The Cronbach's alpha values were ≥0.70 for each questionnaire section where questions were hypothesised to be interrelated, indicating good internal consistence. Cohen K or Gwet's AC1 values were ≥0.60, suggesting good intrarater reliability, except for one question. Acceptability was good with only 1.70% of health workers requesting minimal changes in question wording. CONCLUSIONS: Findings suggest that the questionnaire has good content, construct, face validity, internal consistency, intrarater reliability and acceptability in six countries of the WHO European Region. Future studies may further explore the questionnaire's use in other countries, and how to translate evidence generated by this tool into policies to improve the QMNC. TRAIL REGISTRATION NUMBER: NCT04847336.


Assuntos
COVID-19 , Feminino , Humanos , Recém-Nascido , Gravidez , Psicometria , Qualidade da Assistência à Saúde , Reprodutibilidade dos Testes , Inquéritos e Questionários , Organização Mundial da Saúde
20.
Int J Qual Stud Health Well-being ; 17(1): 2056958, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35403573

RESUMO

PURPOSE: There is a trend worldwide to induce pregnant women earlier. However, few studies have focused on women's experiences. The aim was to gain a deeper understanding of women's lived experiences of induction of labour in late- and post-term pregnancy. METHODS: Phenomenology with a reflective lifeworld approach was chosen as the method. Twelve women participating in a larger study in which women were randomized to either induction of labour in week 41 or to expectant management until week 42, were interviewed one to three months after giving birth. RESULTS: The essence is described as follows: labour becomes another journey than the intended one. The women adapted to this new journey by seeing the advantages and handing themselves over to the healthcare system, but at the same time something about giving birth could be lost. The result is further described by its four constituents: planning the unplannable, being a guest at the labour ward, someone else controlling the labour, and overshadowed by how it turned out. CONCLUSION: Induced labour presents a challenge to maternity personnel to support the birthing woman's normal progress, not to rush her through labour, and to involve her in the process.


Assuntos
Trabalho de Parto Induzido/psicologia , Trabalho de Parto/psicologia , Gestantes/psicologia , Feminino , Humanos , Trabalho de Parto Induzido/métodos , Parto/psicologia , Gravidez , Suécia
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