The Social Context of Pregnancy, Respectful Maternity Care, Biomarkers of Weathering, and Postpartum Mental Health Inequities: A Scoping Review.

Background: Mental health disorders are the number one cause of maternal mortality and a significant maternal morbidity. This scoping review sought to understand the associations between social context and experiences during pregnancy and birth, biological indicators of stress and weathering, and perinatal mood and anxiety disorders (PMADs). Methods: A scoping review was performed using PRISMA-ScR guidance and JBI scoping review methodology. The search was conducted in OVID Medline and Embase. Results: This review identified 74 eligible English-language peer-reviewed original research articles. A majority of studies reported significant associations between social context, negative and stressful experiences in the prenatal period, and a higher incidence of diagnosis and symptoms of PMADs. Included studies reported significant associations between postpartum depression and prenatal stressors (n = 17), socioeconomic disadvantage (n = 14), negative birth experiences (n = 9), obstetric violence (n = 3), and mistreatment by maternity care providers (n = 3). Birth-related post-traumatic stress disorder (PTSD) was positively associated with negative birth experiences (n = 11), obstetric violence (n = 1), mistreatment by the maternity care team (n = 1), socioeconomic disadvantage (n = 2), and prenatal stress (n = 1); and inverse association with supportiveness of the maternity care team (n = 5) and presence of a birth companion or doula (n = 4). Postpartum anxiety was significantly associated with negative birth experiences (n = 2) and prenatal stress (n = 3). Findings related to associations between biomarkers of stress and weathering, perinatal exposures, and PMADs (n = 14) had mixed significance. Conclusions: Postpartum mental health outcomes are linked with the prenatal social context and interactions with the maternity care team during pregnancy and birth. Respectful maternity care has the potential to reduce adverse postpartum mental health outcomes, especially for persons affected by systemic oppression.

"I had no choice": A mixed-methods study on access to care for vaginal breech birth.

INTRODUCTION: Although current recommendations support vaginal breech birth as a reasonable option, access to breech birth in US hospitals is limited. This study explored the experiences of decision-making and perceptions of access to care in people who transferred out of the hospital system to pursue home breech birth. METHODS: We conducted a mixed methods study of people with a singleton, term breech fetus who transferred out of the US hospital system to pursue home breech birth. Twenty-five people completed an online demographic and psychosocial survey, and 23 (92%) participated in semi-structured interviews. We used an interpretive description approach informed by situational analysis to analyze qualitative data about participants' experiences and perceived access to care. RESULTS: Of 25 individuals who left the hospital system to pursue a home breech birth, most felt denied informed choice (64%) and threatened or coerced into cesarean (68%). The majority reported low or very low autonomy in decision-making (n = 20, 80%) and high decisional satisfaction using validated measures. Many participants felt safer in a hospital setting but were not able to access care for planned vaginal breech hospital birth, despite extensive efforts. Participants felt "backed into a corner" and "forced into homebirth," perceiving a lack of access to safe and respectful care in the hospital system. CONCLUSION: Some service users believe that home birth is their only option when they cannot access hospital-based care for vaginal breech birth. Current barriers to care for breech birth limit birthing people's autonomy and may be placing them and their infants at increased risk.

American College of Nurse-Midwives Clinical Bulletin Number 18: Induction of Labor.

Induction of labor is an increasingly common component of intrapartum care in the United States. This rise is fueled by a nationwide escalation in both medically indicated and elective inductions at or beyond term, supported by recent research showing some benefits of induction over expectant management. However, induction of labor medicalizes the birth experience and may lead to a complex cascade of interventions. The purpose of this Clinical Bulletin is twofold: (1) to guide clinicians on the use of person-centered decision-making when discussing induction of labor and (2) to review evidence-based practice recommendations for intrapartum midwifery care during labor induction.

Group B Streptococcal Bacteriuria in Pregnancy: An Evidence-Based, Patient-Centered Approach to Care.

Screening and management of group B streptococcus (GBS) bacteriuria in pregnancy aims to reduce the incidence of pyelonephritis and GBS-related neonatal morbidity and mortality. Universal screening and management of GBS bacteriuria in pregnancy are standards of care in the United States; however, some women may decline guideline-based recommendations for screening, treatment, or intrapartum antibiotic prophylaxis. This article uses a case study approach to discuss evidence-based, patient-centered care for GBS bacteriuria in pregnancy as well as ethical incorporation of individual patient preferences and values.

Herpes Zoster in Pregnancy.

Herpes zoster (shingles) is the reactivation of dormant varicella zoster virus in individuals who previously experienced varicella infection or vaccination. Herpes zoster can occur in pregnancy, although it is rare. This case report describes the clinical presentation and diagnosis of herpes zoster and reviews current recommendations for treatment. Preventative measures and the role of immunization are discussed in addition to clinical implications for intrapartum, postpartum, and newborn care to guide practitioners in caring for women experiencing or exposed to herpes zoster in pregnancy.

Physiologic Breastfeeding: A Contemporary Approach to Breastfeeding Initiation.

Early initiation of breastfeeding has numerous benefits for maternal-child health. Maternity care providers have been shown to play a significant role in establishing breastfeeding, yet there is limited research about clinical approaches that support breastfeeding initiation in the immediate postpartum. Traditional methods that focused on position and attachment have not demonstrated consistent, positive effects on breastfeeding outcomes. Contemporary approaches to breastfeeding initiation emphasize innate maternal and neonatal breastfeeding abilities and the importance of breastfeeding self-efficacy, dyad-centered care, and a supportive breastfeeding environment free from unnecessary interventions. Recommendations for clinical practice for physiologic breastfeeding initiation are provided.

Umbilical cord avulsion in waterbirth.

Umbilical cord avulsion (or "cord snapping") is often cited as a risk associated with waterbirth. This article discusses a case study in which a cord avulsed during a waterbirth and uses it as a basis to explore the incidence, etiology, and associated risk factors of umbilical cord avulsion. The diagnosis, clinical presentation, and management of cord avulsion in waterbirth is presented along with a thorough review of the literature and relevant professional standards. This article offers recommendations for clinical practice to minimize the risk of a cord avulsion and highlights the need for additional research and provider education to ensure optimal care of women and newborns.