The impact of severe perinatal events on maternity care providers: a scoping review.

BACKGROUND: Severe events during the perinatal period can be experienced as traumatic by pregnant women, their partners or others who are closely involved. This includes maternity care providers who can be affected by being involved in or observing these events. This may have an impact on their personal well-being and professional practice, influencing quality of care. The aim of this study is to map research investigating the impact of severe events during the perinatal period on maternity care providers, and how these experiences affect their well-being and professional practice. METHOD: A scoping review following the manual of the Joanna Briggs Institute was undertaken. The electronic bibliographic databases included PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, SocINDEX, Cochrane, Scopus, Web of Science and databases for grey literature. Records passing the two-stage screening process were assessed, and their reference lists hand searched. We included primary research papers that presented data from maternity care professionals on the impact of severe perinatal traumatic events. A descriptive content analysis and synthesis was undertaken. RESULTS: Following a detailed systematic search and screening of 1,611 records, 57 papers were included in the scoping review. Results of the analysis identified four categories, which highlighted the impact of traumatic perinatal events on maternity care providers, mainly midwives, obstetricians and nurses: Traumatic events, Impact of traumatic events on care providers, Changes in care providers' practice and Support for care providers; each including several subcategories. CONCLUSION: The impact of traumatic perinatal events on maternity care providers ranged from severe negative responses where care providers moved position or resigned from their employment in maternity care, to responses where they felt they became a better clinician. However, a substantial number appeared to be negatively affected by traumatic events without getting adequate support. Given the shortage of maternity staff and the importance of a sustainable workforce for effective maternity care, the impact of traumatic perinatal events requires serious consideration in maintaining their wellbeing and positive engagement when conducting their profession. Future research should explore which maternity care providers are mostly at risk for the impact of traumatic events and which interventions can contribute to prevention.

Why mothers with midwifery-led vaginal births recommend that mode of birth: a qualitative study.

OBJECTIVE: This study aimed to examine why mothers with midwifery-led vaginal births recommend giving birth vaginally. METHOD: This qualitative study was conducted with 14 mothers who had a vaginal birth with midwives and recommended it to other women. The data were collected using an in-depth interview form and analysed with the thematic analysis technique. RESULTS: The reasons why these mothers recommend vaginal birth (VB) are discussed under five main themes: 'positive birth experience, postpartum comfort, beliefs and values, body image, and sexual life'. VB is mainly recommended to other women for emotional, medical, religious, and socio-cultural reasons, including pleasure/excitement related to the birth, newborn, and maternity, birth satisfaction, absence of interventions, early physical activity, early discharge from the hospital, beliefs and values, body image (easy weight loss, no incision, etc.), and early and safe sex life in the postpartum period. CONCLUSION: Vaginal birth is mainly recommended to other women for emotional, medical, religious, and socio-cultural reasons. To support similar favourable views of vaginal birth, it is necessary to prioritise midwifery care that upholds the physiology of childbirth, minimises unnecessary medical interventions, ensures ongoing physical and emotional support, and respects socio-cultural beliefs and values.

The prevalence and associated factors of fear of childbirth among Turkish pregnant women.

OBJECTIVE: This study was conducted to determine the prevalence of fear of childbirth and affecting factors in pregnant women in Turkey. MATERIALS AND METHODS: This was a cross-sectional study and included a total of 2025.    Pregnant Women Assessment, some variables related to previous and current perinatal processes and Wijma Delivery Expectancy/Experience Questionnaire (version A) were used for data collection. FINDINGS: In this sample, 42.4% of the women reported fear of childbirth. What the women were afraid of most was the development of unwanted conditions at childbirth, obscurity/uncertainty, and negative attitudes of health professionals. The factors causing fear of childbirth were the low education level, unemployment status, low financial status, stillbirth, unplanned pregnancy, indecisiveness about the type of delivery, not attending prenatal education programs, negative effects of other people, insufficient social support, confiding in the healthcare centre and health professional, negative, and indecisive birth perceptions, prior negative birth experiences and not feeling ready for childbirth (p < 0.001). CONCLUSIONS: The prevalence of fear of childbirth in this Turkish sample, especially in the multipara is higher than in Western countries. Causes of fear of childbirth can vary with countries and even with each region of a country.

Examination of the effect of the perceived stress in the coronavirus-19 pandemic on marital adjustment, sexual life and intimate partner violence.

AIMS: The aim of the study was to explore the effects of perceived stress during the pandemic on marital adjustment, sexual life and intimate partner violence. DESIGN: A cross-sectional design was employed in this study. METHODS: The data were collected with an online survey between October and December 2020 from 901 participants in Turkey. Participants completed the Descriptive Information Form, the Marital Adjustment Scale and the Perceived Stress Scale. Multivariate analysis of variance and moderation analysis were used in the analysis of the data. RESULTS: The pre-pandemic marital adjustment scores of the participants significantly decreased during the pandemic. The marital adjustment and sexual life of those with high perceived stress levels were found to be negatively affected, and they were exposed to violence during the pandemic. In the moderation analysis, a non-standardized coefficient of the marital adjustment variable in the model turned out to be significant, and the perceived stress decreased as marital adjustment increased. The marital adjustment was low, and the stress level was high in individuals exposed to violence. Besides, perceived stress was found to be effective in being exposed to intimate partner violence. CONCLUSION: The stress perceived by individuals during the COVID-19 pandemic negatively affected their marital adjustment and sexual life. Besides, perceived stress was found to be effective in being exposed to intimate partner violence, and marital adjustment decreased during the pandemic compared to the pre-pandemic period. IMPACT: During the pandemic period, health care providers should routinely screen the psychosocial health of individuals. Continuous, accessible, free psychosocial support services should be available in order to increase the psychosocial health and marital adjustment of people with high-stress levels and prevent exposure to violence. PATIENT OR PUBLIC CONTRIBUTION: The conduct of this study is based on an online survey with participants living in the same house with their spouses during the pandemic.

The effect of pregnant women's health-seeking behavior and preference for mode of birth on pregnancy distress during the COVID-19 pandemic.

In this study, the researchers investigated to the impact of pregnant women's health-seeking behavior and mode of birth preferences on pregnancy distress during the COVID-19 pandemic. This study was conducted with 351 pregnant women. The risk rate of pregnancy distress using the Tilburg Pregnancy Distress Scale (TPDS) cut-off point was 16.5%. 13.3% of pregnant women changed their mode of birth preferences due to the pandemic. The risk of pregnancy distress in women who changed their mode of birth preferences due to the pandemic increased 5.4 times more than in those who preferred vaginal birth before and during the pandemic (OR: 5.4, p<0.001). We determined that the increase in the Health Seeking Behavior Scale total scores had a reducing effect on pregnancy distress due to a lack of partner involvement for TPDS.

An investigation of women's pregnancy experiences during the COVID-19 pandemic: A qualitative study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected the physical and psychosocial health of pregnant women and their access to antenatal care and health services. AIM: To examine women's pregnancy experiences during the COVID-19 pandemic. MATERIALS AND METHODS: The study was conducted in a qualitative design with 14 pregnant women who were admitted to a state hospital pregnancy outpatient clinic for antenatal control. The data were collected using a semi-structured individual interview form and were analysed using the thematic analysis technique. COREQ checklist guide was followed in the study. RESULTS: The pregnancy experiences of women in the COVID-19 pandemic were examined under 7 main themes: "physical health, psychosocial health, adaptation to pregnancy, pregnancy follow-ups, social life, spouse relationship and coping methods". Pregnant women have both positive and negative pregnancy experiences in the COVID-19 pandemic. CONCLUSION: The study concluded that the pandemic has affected both the physical and psychosocial health of pregnant women, their social life, marital relationship and access to antenatal care services. Health professionals need to evaluate psychosocial health as well as the physical health of pregnant women, especially during the pandemic, and create a care plan accordingly. Midwives and other health professionals should improve the bio-psychosocial health of the pregnant/family via telehealth and counselling services.

The effect of maternal functional and postpartum depression status on breastfeeding self-efficacy of the mothers: A cross-sectional study.

In this study, the researchers investigated the effect of maternal functioning and postpartum depression status on breastfeeding self-efficacy of mothers. The study was conducted with 254 mothers with babies aged 2-6 months old. The total mean scores of the mothers were found to be 57.201 ± 7.612 on the breastfeeding self-efficacy scale, 8.516 ± 5.304 on the postpartum depression scale, and 74.055 ± 11.738 on the maternal functioning scale. 21.3% of mothers had a risk of postpartum depression. A negative relationship was found between breastfeeding self-efficacy and postpartum depression scores (p < 0.001), and a positive relationship was seen between breastfeeding self-efficacy and maternal functioning scores (p < 0.001). Maternal functioning and postpartum depression status were found to have a cumulative effect of 31.5% on maternal breastfeeding self-efficacy (F = 59.086 R2=0.315).

The childbirth experiences of Syrian refugee mothers living in Turkey: a qualitative study.

Objective:The study aims to examine the childbirth experiences of Syrian refugee mothers living in Turkey.Methods: This qualitative study was conducted with 12 mothers who had a vaginal birth and were assisted by midwives. The data were collected using an in-depth interview form and analyzed with the thematic analysis technique.Results: The childbirth experiences of the mothers were grouped under two main headings as negative and positive experiences. "Negative childbirth experiences" were divided into 4 main themes as "negative emotions experienced during childbirth, lack of effective communication due to the language barrier, difficulties experienced related to hospital policies and dissatisfaction with midwives". "Positive birth experiences", were categorized under three main themes as "satisfaction with the midwife, finding the country safe to give birth, and mother' s positive attitude towards birth process". The mothers were satisfied with "the attitudes and behaviors of the midwives and their professional practices", and the positive attitude of mothers towards birth in religious and cultural terms contributed to the positive birth perception.Conclusion: Refugee mothers were found to have both positive and negative childbirth experiences. Individualized, empathic communication-based, culturally sensitive and evidence-based care may contribute to the positive childbirth experiences of refugee women.

Correlation between Infantile Colic and Maternal Breastfeeding Self-Efficacy, Breastfeeding Success and Breast Milk Amount.

AIM: The study was conducted to determine the correlation between infantile colic and maternal breastfeeding self-efficacy, breastfeeding success and breast milk amount. MATERIALS AND METHODS: This descriptive study included 154 mothers, with infants of age between 3 weeks and 6 months who were diagnosed with infantile colic and who were admitted to the paediatric outpatient clinics of a hospital located in northern Turkey. RESULT: A negative correlation was found between 'parent-infant interaction + problem infant' and 'immature gastrointestinal system' subscales of the Infantile Colic Scale (ICS) and the total mean scores of mothers on the Breastfeeding Self-Efficacy Scale. In addition, correlation analysis showed a statistically significant negative correlation between mean scores of mothers in breastfeeding success and subscale and total mean scores of ICS. CONCLUSION: The breastfeeding self-efficacy and breastfeeding success is low in mothers of infants with infantile colic.

The analysis of negative birth experiences of mothers: a qualitative study.

OBJECTIVE: The aim of this study is to analyse the factors associated with a negative childbirth experience from the perspective of the women who gave birth vaginally. BACKGROUND: A negative birth experience can pose a risk for both the maternal/newborn health and the health of the community by disturbing the physical and spiritual health of the woman/family. METHODS: This qualitative study was conducted with 11 mothers who gave birth vaginally assisted by midwives in a state hospital. The data were collected using in-depth interviews and analysed using the thematic analysis technique. RESULTS: The factors causing the women to have negative birth perceptions were analysed under four main themes: challenges/difficulties encountered, the inadequate communication of health professionals, embarrassment/privacy and inadequate hospital facilities. The mothers indicated that they had experienced their births negatively due to personal reasons such as the inability to cope with labour pain, inability to push, hospital policies such as interventions at birth and hunger. In addition, some of the participants stated that they had difficulty and felt embarrassed during vaginal examinations. CONCLUSION: The sociocultural characteristics of mothers, hospital facilities and rules, medical and traditional practices at birth, inadequate empathic communication of health professionals and reproductive health policies can lead to negative childbirth experiences.

The Effect of Labor Dance in the First Stage of Labor on Labor Pain, Anxiety, Duration of Labor, and Maternal Satisfaction with Labor: A Randomized Controlled Study.

Objective: The study aimed to examine the effects of labor dance applied in the first stage of labor on perceived labor pain, anxiety, duration of labor, and maternal satisfaction with labor. Design: This study is a randomized controlled trial. Methods: A sample size of 128 pregnant women was randomly assigned to a control (n = 64) or experimental (n = 64) group while ensuring equal numbers of primiparous and multiparous participants in each group. After admission to the hospital for parturition, and during the first stage of labor, the women in the experimental group were exposed to a 15-min labor dance every hour when the cervical dilation was between 3 and 8 cm. The labor dance included movements of the sacrum and waist massaged by a partner using a massage glove, which was accompanied by self-selected music. Outcome measures included the Visual Analogue Scale (VAS), the State Anxiety Scale (SAS), and the Scale for Measuring Maternal Satisfaction (SMMS)-normal birth and labor duration. These were administered before the labor dance and at the end of the labor dance at three points of cervical dilation: 3, 5-6, and 7-8 cm for the experimental group, and at similar points in the control group: at the start of dilation and 15 min later. The data were analyzed using the generalized linear model and Mann-Whitney U tests. Results: In comparison to the control group, for the group performing the labor dance, the mean VAS scores were lower (p < 0.05) at each evaluation period, and the mean scores of total SMMS and some of its subdivisions were significantly higher in the experimental group (p < 0.05). There was no statistically significant difference between the SAS scores at any evaluation point, including postpartum (p > 0.05). Similarly, there were no significant differences in labor time (p > 0.05) between groups. Conclusions: The practice of labor dance was found to be effective in reducing the perceived labor pain in pregnant women and increasing maternal satisfaction at birth, but not on the duration of labor, and anxiety. Trial registration: ClinicalTrials.gov (NCT04746170).

An Investigation of the Relationship between Health Literacy Levels of Pregnant Women and Their Perceptions of Traumatic Childbirth.

The researchers aimed to investigate the relationship between the health literacy levels of pregnant women and their perceptions of traumatic childbirth. The sample consisted of 384 pregnant women. The data were collected using the 'Pregnancy Information Form", the "Health Literacy-32 Scale," and the "Traumatic Birth Perception Scale." Health literacy levels of pregnant women were found to be inadequate (44%) and limited (43.5%). 56.8% of pregnant women had moderate, and 27.1% had a high perception of traumatic birth. A negative correlation was determined between the total score and sub-dimensions of the Health Literacy Scale of pregnant women (i.e. access to health information, understanding health information, protection from diseases, and health promotion) and their perceptions of traumatic birth (p < .001).

The effect of empathy training given to midwives on the empathic communication skills of midwives and the birth satisfaction of mothers giving birth with the help of these midwives: A quasi-experimental study.

RATIONALE, AIMS, AND OBJECTIVES: Empathic attitudes and behaviours of midwives directly affect obstetric outcomes. The study aims to examine the effect of empathy training on the empathic communication skills of midwives and the childbirth satisfaction of primiparous mothers. METHODS: This quasi-experimental study has two sample groups including midwives working in the delivery unit (n = 15) and mothers giving birth with the help of these midwives (n = 134). Empathy training was given to the midwives through a 32-hour program involving didactic narrative, creative drama, and psychodrama techniques. A "Descriptive Information Form," and the "Empathic Communication Skills" and "Empathic Tendencies" scales were used to collect data from the midwives, and another "Descriptive Information Form" and the "Scale for Measuring Maternal Satisfaction in Normal Birth" were used for the maternal data. RESULTS: Empathic communication skills and empathic tendencies of the midwives were found to be higher right after and 8 weeks after the training than before the training (P = .001, P = .040, respectively). The total score and sub-dimensions of the maternal satisfaction scale (ie, midwifery care, respect for privacy, meeting expectations, postpartum care) were found to be higher in mothers giving birth after the midwives' empathy training than those giving birth before (P < .001). A higher level of maternal birth satisfaction was seen in mothers giving birth right after the training (94%) than those giving birth before training (3%). CONCLUSION: The empathy training improved both the empathy skills of midwives, and translated to improved maternal satisfaction with birth among their mothers. It is recommended to increase the number of follow-ups to evaluate the long-term effect of empathy training.

Midwives' experiences of traumatic births: A systematic review and meta-synthesis.

INTRODUCTION: Midwives experiencing traumatic births are emotionally affected by this process, lose their self-confidence, and may intend to leave the profession. This study aims to carry out a meta-synthesis of current qualitative research exploring the experiences of midwives witnessing traumatic births. METHODS: The meta-synthesis consisted of 18 full-text studies in English, obtained from PubMed, Scopus, Web of Sciences, Cumulative Index of Nursing and Allied Health Literature (CINAHL), EMBASE, and PsycINFO databases. The results of the studies were analyzed using the thematic analysis technique. The study includes qualitative, mixedmethod, and full-text studies published between 2000 and 2020 that explored the experiences of midwives and obstetric nurses witnessing birth trauma. RESULTS: The thematic analysis identified seven themes: post-traumatic feelings, posttraumatic stress symptoms, the impact of trauma on professional values, social support, learning from experience, legal process, and reflection of emotions of women experiencing traumatic birth on the midwife. CONCLUSIONS: Midwives who witnessed traumatic birth were mostly emotionally affected. They lost their self-confidence and intended to leave their profession. They emphasized the importance of peer support through which they could share their experiences after trauma. Psychological education should be provided to midwives who witness the trauma by specialists, and midwives should be strengthened against the effects of trauma in terms of both the institutional policies where the birth takes place and midwifery-specific legal policies.

The Effect of Foot Reflexology on the Anxiety Levels of Women in Labor.

OBJECTIVES: This research was conducted to analyze the effect of foot reflexology on the anxiety levels of women during labor. DESIGN, SETTING AND SUBJECTS: The study was conducted as a semiexperimental study. It was conducted with 154 nulliparous pregnant women who applied to a maternity unit of a state hospital in the north-western part of Turkey to give birth. INTERVENTIONS: Foot reflexology was applied once to the pregnant women in the experimental group when cervical dilation was 3-4 cm. The treatment was applied to the right foot and left foot reflex points for 15 min, for a total of 30 min. The data in the study were collected using the "Pregnant Women Introductory Information Form" and the "Spielberger State-trait Anxiety Inventory" (STAI TX-1). In evaluating the data, number, percentage, Chi-square, independent samples t-test, and repeated measure analysis of variance test were used. MAIN OUTCOME MEASURES: The mean scores of the STAI TX-1 were used to analyze the results. RESULTS: The mean STAI TX-1 scores were measured before reflexology, in the latent and active phases of labor and early in postpartum period (four times in total). The mean STAI TX-1 scores were higher in the experimental group than in the control group (p < 0.001). The mean STAI TX-1 scores postreflexology application (when cervical dilation was 3-4 cm) and during the active phase of the labor (when cervical dilation was 6-8 cm) of the pregnant women in the experimental group were lower than those of the control group (respectively p = 0.010, p < 0.001). In the experimental group, there was no statistically significant difference between the mean STAI TX-1 scores pre- and postreflexology (p = 0.820). The mean STAI TX-1 scores in the early postpartum period were similar in the experimental and control groups (p = 0.080). CONCLUSION: Foot reflexology was found to have a positive effect in lowering the total anxiety scores of the pregnant women. Reflexology is a noninvasive and economical method, which may be used by health professionals to reduce problems during labor. A decrease in anxiety experienced at birth improves women's positive birth experiences, promotes a secure mother-infant attachment, and protects postpartum mental health.

Factors Affecting Depression During Pregnancy and the Correlation Between Social Support and Pregnancy Depression.

BACKGROUND: Women are seriously subjected to psychiatric diseases during pregnancy and depression is the most prevailing one among these diseases. There is a relation between the social support and depression in pregnancy whose predisposing factors are genetic, psychological, biological, environmental, and hormonal. OBJECTIVES: This study aimed to determine the frequency of depression symptoms, and its risk factors. Also it studied the correlation between social support and pregnancy depression. PATIENTS AND METHODS: This research is a descriptive cross-sectional study. It was conducted on 266 pregnant women selected by simple random method from all pregnant women admitted at the Maternity Hospital of Trabzon, Turkey from May 21 to June 13, 2008. The data were collected with a questionnaire form, the Beck depression inventory (BDI), and the multidimensional scale of perceived social support (MSPSS). RESULTS: The mean BDI score of the pregnant women was 11.12 ± 6.65. According to the BDI, 46.2% of the pregnant women had no depression symptoms, 34.59% of them had mild, 13.91% had moderate, and 4.89% had severe level of depression symptoms. It was found that such factors as the educational level of the pregnant women and their husbands, having an undesired pregnancy, suffering from a chronic disease before pregnancy, presence of pregnancy-related problems, having a child with disability or having relatives whose children had disability, and smoking during pregnancy were the risk factors affecting the severity of the depression symptoms and these results were statistically significant (P < 0.05). On the other hand, the mean MSPSS score was 67.89 ± 14.26 and it was found that the pregnant women got the highest social support from their husbands. It was found that there was a significant correlation between BDI and MSPSS total score and its subscale scores (P < 0.05). CONCLUSIONS: According to this study, one-fifth of pregnant women were found to experience depressive symptoms, which require treatment during pregnancy, and the factors such as having no support from relatives was found to be associated with the severity of depressive symptoms during pregnancy.