Experiences of childbirth care in Lithuania and Romania: Insights from the European Babies Born Better survey.

BACKGROUND: Data on experience and satisfaction of users are essential for improvement of health care, especially in the field of childbirth. The aim of this study was to compare childbirth care experiences in Lithuania and Romania. METHODS: Data derived from the EU Babies Born Better online survey were analyzed. Parturients from Lithuania (N = 373) and Romania (N = 359) who had given birth within the last 5 years were included. Participants were asked to (1) describe the best things in childbirth care and (2) suggest changes in the care received at their birthplace. Qualitative data were analyzed using a previously developed deductive coding framework. RESULTS: In agreement with previous findings from Austria, positive experiences mainly addressed care experienced at an individual level (in particular healthcare practitioners' competence and personality traits) and suggested changes mainly addressed services at birthplace (issues related to infrastructure, information and counseling, and empowerment). Responses not initially included in the coding framework addressed aspects such as informal payment (in both countries), desire for home birth (particularly in Lithuania), or mistreatment of parturients (particularly in Romania). CONCLUSIONS: We conclude that similar trends in childbirth care exist in Lithuania and Romania with regard to parturients' personal experiences and psychosocial needs and that addressing the needs of parturients is important for improving service provision.

[Peripartal COVID-19-Related Restrictions and Psychological Burden - A Quantitative Survey in Austria]. / Peripartale COVID-19-bedingte Restriktionen und psychische Belastungen ­ eine quantitative Erhebung in Österreich.

INTRODUCTION: The period from pregnancy to postpartum is a vulnerable time with an increased risk of mental illness. The COVID-19 pandemic led to restrictions in peripartum care, such as infection control measures, or restrictions regarding accompanying persons. MATERIAL AND METHODS: Effects of COVID-19-related restrictions on the psyche and well-being during the peripartum period in Austria were retrospectively assessed using a partially standardized online questionnaire. In addition to closed questions on restrictions and psychological stress, this also contained the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Data from 850 women who had given birth during the pandemic were included in the analysis. In 8.5% of cases, appointments were canceled during prenatal care, 10.7% had to wear a face mask during the birth. One in 10 women had to cope with the birth and one in 5 with the puerperium without a companion. Unaccompanied women were significantly less likely to feel well cared for during the birth, more likely to feel alone in the puerperium and, according to the EPDS score, were more likely (39% vs. 20%; p<0.001) to have a high probability of postpartum depression. CONCLUSIONS: The pandemic-related restrictions led to anxiety, worry, loneliness and an increased risk of depression during the peripartum period. The balance of mental health was negatively affected by measures and restrictions. Even in times of pandemic, more attention needs to be paid to the vulnerable peripartum period.

Cesarean delivery after non-medically indicated induction of labor: A population-based study using different definitions of expectant management.

INTRODUCTION: Most observational studies found that non-medically indicated induction of labor (IOL) is not associated with an increased risk of cesarean delivery compared with expectant management, defined as all births at a later gestation. However, given the higher rate of cesarean delivery at late term, this definition of the expectant management group might bias the results of observational studies in favor of IOL at early or full term when estimating the risk of short-term (eg up to 1 week) expectant management. MATERIAL AND METHODS: We conducted a retrospective cohort study including 447 066 singleton term and post-term hospital births that occurred in Austria between 2008 and 2016. Multivariate logistic regression was used to test the association of IOL and cesarean delivery at each week of gestation from 37-41. Expectant management was either defined as all births at "next week or beyond" or "at next week". RESULTS: Non-medically indicated IOL was associated with increased odds for cesarean delivery at 37 and 38 weeks, and reduced odds at 40 and 41 weeks. At 39 weeks, IOL resulted in comparable cesarean rates compared with expectant management defined as "next week or beyond" (17.2% vs 16.2%; adjusted odds ratio [OR] 0.93; 95% confidence interval [CI] 0.86-1.00; P = .059). However, when defined as births "at the next week", expectant management was associated with significantly reduced odds for cesarean delivery (13.6%; adjusted OR 0.76; 95% CI 0.70-0.82; P < .001). Comparison of the cesarean delivery rates for the two definitions of expectant management showed that the "next week and beyond" model underestimates the benefit of short-term expectant management by up to 1 week, particularly for IOL at weeks 38 and 39. CONCLUSIONS: Our findings demonstrate that the definition of the expectant management group has a significant impact when analyzing the outcome of IOL in retrospective cohort studies. Non-medically indicated IOL is not an all-or-none choice between "elective" induction and indefinite expectant management. Thus, to define the control group as all births at the next week could be useful for clinical decision-making, as it allows to estimate the risks of expectant management until the next appointment compared with immediate IOL.

Effects of the Covid-19 pandemic on maternity staff in 2020 - a scoping review.

In the spring of 2020, the SARS-CoV-2 virus caused the Covid-19 pandemic, bringing with it drastic changes and challenges for health systems and medical staff. Among the affected were obstetricians and midwives, whose close physical contact with pregnant women, women who recently gave birth, and their children was indispensable. In the obstetric setting, births cannot be postponed, and maternity staff had to adapt to assure obstetric safety while balancing evidence-based standards with the new challenges posed by the pandemic. This scoping review gives a comprehensive overview of the effecs the Covid-19 pandemic had on maternity staff. We followed the evidence-based approach described by Arksey & O'Malley: we searched several databases for English and German articles published between January 2020 and January 2021 that discussed or touched upon the effects the pandemic had on maternity staff in OECD countries and China. We found that structural challenges caused by the crisis and its subjective effects on maternity staff fell into two main topic areas. Structural challenges (the first main topic) were divided into five subtopics: staff shortages and restructuring; personal protective equipment and tests; switching to virtual communication; handling women with a positive SARS-CoV-2 infection; and excluding accompanying persons. The pandemic also strongly affected the staff's mental health (the second main topic.) Attempting to meet challenges posed by the pandemic while afraid of contamination, suffering overwork and exhaustion, and struggling to resolve ethical-moral dilemmas had severe negative subjective effects. Several studies indicated increased depression, anxiety, stress levels, and risk of post-traumatic stress symptoms, although the crisis also generated strong occupational solidarity. Care for pregnant, birthing, and breast-feeding women cannot be interrupted, even during a pandemic crisis that requires social distancing. Maternity staff sometimes had to abandon normal standards of obstetric care and were confronted with enormous challenges and structural adjustments that did not leave them unscathed: their mental health suffered considerably. Researchers should study maternity staff's experiences during the pandemic to prepare recommendations that will protect staff during future epidemics.

[Factors Influencing the Paternal Experience of Birth in the Labour Ward: A Qualitative Study]. / Einflussfaktoren auf das väterliche Erleben der Geburt im Kreißsaal: Eine qualitative Studie.

INTRODUCTION: Today the majority of fathers-to-be are present at the birth of their children in the labour ward. Their presence at the birth is a significant event in their lives. The aim of this study is to identify factors influencing the paternal birth experience in the labour ward. MATERIAL AND METHODS: The experiences of 12 first-time fathers during pregnancy and birth and their perception of birth in the labour ward were gathered through problem-centred interviews. The transcribed and anonymised interviews were analysed by means of content analysis according to Mayring. RESULTS: All fathers retrospectively assessed the experience of the birth of their child positively. A large number of potential factors influencing the paternal birth experience were identified, both biographical factors and factors during pregnancy and birth. In particular, the medical staff, especially the midwife, proved to be of importance. CONCLUSION: Medical professionals should pay more attention to the paternal birth experience. The focus for further research could lie on concepts to promote a positive birth experience for fathers.

Health professionals' views on maternity care for women with physical disabilities: a qualitative study.

BACKGROUND: During pregnancy, childbirth and puerperium, women receive care from a range of health professionals, particularly midwives. To assess the current situation of maternity care for women with physical disabilities in Austria, this study investigated the perceptions and experiences of health professionals who have provided care for women with disabilities during pregnancy, childbirth and postpartum. METHODS: The viewpoints of the participating health professionals were evaluated by means of semistructured interviews followed by an inductive qualitative content analysis of the interview transcripts, as proposed by Mayring. RESULTS: Four main categories emerged from the inductive content analysis: (i) structural conditions and accessibility, (ii) interprofessional teamwork and cooperation, (iii) action competence, and (iv) diversity-sensitive attitudes. According to the participating health professionals, the structural conditions were frequently not suitable for providing targeted group-oriented care services. Additionally, a shortage of time and staff resources also limited the necessary flexibility of treatment measures in the care of mothers with physical disabilities. The importance of interprofessional teamwork for providing adequate care was highlighted. The health professionals regarded interprofessionalism as an instrument of quality assurance and team meetings as an elementary component of high-quality care. On the other hand, the interviewees perceived a lack of action competence that was attributed to a low number of cases and a corresponding lack of experience and routine. Regarding diversity-sensitive attitudes, it became apparent that the topic of mothers with physical disabilities in care posed challenges to health professionals that influenced their natural handling of the interactions. CONCLUSION: The awareness of one's own attitudes towards diversity, in the perinatal context in particular, influences professional security and sovereignty as well as the quality of care of women with disabilities. There is a need for optimization in the support and care of women with physical disabilities during pregnancy, childbirth and puerperium.

Experiences of Austrian mothers with mobility or sensory impairments during pregnancy, childbirth and the puerperium: a qualitative study.

BACKGROUND: Approximately 8% of all women of childbearing age in Austria live with permanent impairments. In everyday life, women with disabilities face various challenges and discrimination, among which the issue of pregnancy and motherhood, in particular, is often considered taboo, and their parenting abilities are doubted. Knowledge in the medical field about the experiences of women with disabilities during pregnancy, childbirth and the puerperium is limited. METHODS: To investigate the personal meanings and experiences of women with disabilities in regard to pregnancy, childbirth and the puerperium, in-depth individual, semi-structured interviews were conducted with ten mothers with various mobility or sensory impairments who reside in Austria. The qualitative interview data were analyzed using the qualitative content analysis proposed by Mayring. RESULTS: Three main themes or categories emerged from the inductive content analysis, namely, (i) the social network, (ii) self-efficacy and self-awareness and (iii) communication, transparency and information. Participants reported limited acceptance of their life decisions and experienced an environment of discriminatory attitudes. They experienced a lack of support and lack of confidence in their parenting abilities, which negatively influenced their self-efficacy and self-awareness. Violations of personal borders and a feeling of being watched and controlled were reported. Communication with health care professionals was often characterized by mutual aspects of fear, uncertainty and awkwardness, as perceived by women with disabilities. Adequate information about pregnancy, childbirth and the puerperium, particularly about measures taken and interventions applied, was frequently missing. CONCLUSION: Heath care facilities need to be structured to ensure ease of access for women with disabilities. Education should be offered to health care professionals to improve knowledge about care for women with disabilities and to strengthen communication skills. All necessary information needs to be prepared and provided in an adequate manner. The establishment of a health-promoting environment for mothers, their children and their families requires a sensitive, respectful and non-judgmental attitude of society toward women with disabilities during pregnancy, childbirth and the puerperium.

Maternal and neonatal outcomes after induction of labor: a population-based study.

PURPOSE: To evaluate maternal and neonatal outcomes at and beyond term associated with induction of labor compared to spontaneous onset of labor stratified by week of gestational age. METHODS: In this retrospective cohort study, data form 402,960 singleton pregnancies from the Austria Perinatal Registry were used to estimate odds ratios of secondary cesarean delivery, operative vaginal delivery, epidural analgesia, fetal scalp blood testing, episiotomy, 3rd/4th-degree lacerations, retained placenta, 5-min APGAR <7, umbilical artery pH <7.1, and admission to neonatal intensive care unit. Multivariate logistic regression models based on deliveries with gestational age ≥37 + 0 were applied for adjustment for possible confounders. RESULTS: Induction of labor was associated with increased odds for cesarean delivery (adjusted OR; 99% confidence interval: 1.53; 1.45-1.60), operative vaginal delivery (1.21; 1.15-1.27), epidural analgesia (2.12; 2.03-2.22), fetal scalp blood testing (1.40; 1.28-1.52), retained placenta (1.32; 1.22-1.41), 5-min APGAR <7 (1.55; 1.27-1.89), umbilical artery pH <7.1 (1.26; 1.15-1.38), and admission to neonatal intensive care unit (1.41; 1.31-1.51). In a subgroup of induction of labor with the indication, "post-term pregnancy" induction was similarly associated with adverse outcomes. CONCLUSIONS: In Austria, induction of labor is associated with increased odds of adverse maternal and neonatal outcomes. However, due to residual confounding, currently, no recommendations for treatment can be derived.

[Simulation Training in Obstetrics: Survey of participants in a low-fidelity training]. / Simulationstraining in der Geburtshilfe: eine Befragung von Teilnehmenden eines low fidelity Trainings.

Background Childbirth is a physiological process. However a normal delivery may suddenly turn into a life-threatening emergency. In this case, maternal and infant health depends largely on appropriate and timely interventions, and effective teamwork of all professionals. In order to meet the complex requirements, different concepts for interdisciplinary simulation training in obstetric emergencies have been developed and evaluated mainly in Scandinavian and English-speaking countries. In this context, both high-fidelity and low-fidelity trainings have been found to be effective. In German-speaking countries, the effectiveness of simulation in obstetric emergency training for multidisciplinary teams has not been evaluated extensively or systematically. The objective of this study was to explore whether or not simulation training is effective in improving obstetric emergency management. Method Quantitative and qualitative data was derived and evaluated via questionnaire from obstetric pre-training and 4 months post-training. Participants were asked how they perceived their own competence and how confident they felt in emergency situations, how they rated their team's cooperation and communication, whether they felt secure in how to proceed in emergencies, and how important they considered the patient's perspective in such situations to be. Results 48 questionnaires pre- and post-training were analysed. Nearly all items changed significantly. In open questions, participants were invited to suggest potential for improvement to their work environment; these suggestions were analysed descriptively. Conclusion Professionals felt that simulation training was effective. They experienced better management of obstetric emergencies post-training.

Health workers' perspectives on the quality of maternal and newborn health care around the time of childbirth: Results of the Improving MAternal Newborn carE in the EURO Region (IMAgiNE EURO) project in 12 countries of the World Health Organization European Region.

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.

Midwives Perceiving and Dealing With Violence Against Women: Is It Mostly About Midwives Actively Protecting Women? A Modified Grounded Theory Study.

Violence against women (VAW) affects pregnancy, birthing, and puerperium. In this sense, domestic violence (DV) or intimate partner violence (IPV) may increase during pregnancy, sexual child abuse may affect the birthing process, and obstetric violence may occur during birthing. Thus, consideration of violence during pregnancy and puerperium is essential to providing optimal care for women. This implies that midwives should be able to identify women affected by VAW. Therefore, this study explored VAW as perceived by midwives in one region of Austria. Interviews with 15 midwives (mean age 38.7 years) were conducted in Tyrol, Austria, between December 2014 and December 2015. Data were analyzed with a modified version of Grounded Theory. The core category "protecting but walking on eggshells" showed the caution with which midwives approached VAW and in particular DV or IPV. Including VAW in midwifery was connected to midwives being active protectors of women in their care. This meant being an intuitive, sensible, guiding, and empowering midwife to the woman. Staying active was necessary to fulfill the protective role also with regard to DV. However, this was influenced by the visibility of the connection between VAW, pregnancy, childbirth, and puerperium. The key to including VAW and particularly DV was midwives' professional role of actively protecting women. Neglecting DV during pregnancy, labor, and puerperium meant further silencing DV, and keeping it hidden. Considering these aspects in planning and implementing actions to prevent VAW is expected to support sustainability and motivation to ask women about all forms of violence during and after pregnancy.

Midwives' perception of patient safety culture-A qualitative study.

OBJECTIVE: To explore midwives' experiences with and perceptions of patient safety culture in the German-speaking countries. DESIGN AND SETTING: Semi-structured interviews with midwives were conducted between December 2013 and March 2014, whereby the narrative nature of the questions on patient safety culture provided the space for the interviewed midwives to express their own wishes and thoughts freely. The interviews were recorded and transcribed, and the transcripts were anonymized with respect to personal and institutional names. The analysis of the transcripts was based on the methods of qualitative content analysis with the goal to consider all of the remarks with open coding, following a strictly inductive approach. Data analysis and categorization was performed using the software MAXQDA Release 12.2.1. PARTICIPANTS: 14 midwives from Austria, Germany and Switzerland. FINDINGS: The interviewed midwives provided insights into their thoughts and experiences on factors that promote and inhibit patient safety culture as well as superordinate topics related to patient safety culture in general. Their statements were assigned to seven main categories; (i) institutional circumstances, (ii) role of the management, (iii) interprofessional factors, (iv) meetings, (v) education and training, and (vi) psychosocial aspects. Moreover, the majority of statements assigned to these categories additionally related to two overarching core categories, communication and knowledge / skills. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It appears that patient safety culture is a personal matter for the majority of the participating midwives. However, it seems that at least at some institutions a discrepancy between the perceived importance of patient safety culture and an incomplete implementation into everyday work exists. A natural way of dealing with patient safety culture and an open blame-free discussion of critical incidences rely on the implementation of institutional circumstances that promote education, training as well as intra- and interprofessional exchange and transparent clear responsibilities.

Women's satisfaction with care at the birthplace in Austria: Evaluation of the Babies Born Better survey national dataset.

OBJECTIVE: to evaluate women's satisfaction with care at the birthplace in Austria and to provide reference data for cross-country comparisons within the international Babies Born Better project. DESIGN: a cross-sectional design was applied. The data were extracted from the Babies Born Better survey as a national sub-dataset that included all participants with Austria as the indicated country of residence. SETTING: an online survey targeting women who had given birth within the last five years and distributed primarily via social media. In addition to sociodemographic and closed-ended questions regarding pregnancy and the childbirth environment, the women's childbirth experiences and satisfaction with the birthplace were obtained with three open-ended questions regarding (i) best experience of care, (ii) required changes in care and (iii) honest description of the experienced care. PARTICIPANTS: five hundred thirty-nine women who had given birth in Austria within the last five years. MEASUREMENTS AND FINDINGS: based on the concepts of public health, salutogenesis and self-efficacy, a deductive coding framework was developed and applied to analyse the qualitative data of the Babies Born Better survey. Regarding honest descriptions of the experienced care at the birthplace, 82% were positive, indicating that most of the respondents were mostly satisfied with the care experienced. More than 95% of the survey participants' positive experiences and more than 87% of their negative experiences with care could be assigned to the categories of the deductive coding framework. Whereas positive experiences mainly addressed care experienced at the individual level, negative experiences more frequently related to issues of the existing infrastructure, breastfeeding counselling or topics not covered by the coding framework. Evaluation of these unassigned responses revealed an emphasis on antenatal and puerperal care as well as insufficient reimbursements of expenses by health insurance funds and the desire for more midwifery-led care. KEY CONCLUSIONS: although the participating women were mostly satisfied with perinatal care in Austria, it appears that shortcomings particularly exist in antenatal and puerperal care and counselling. IMPLICATIONS FOR RESEARCH: the established coding framework that covered the vast majority of the women's responses to the open-ended questions might serve as a basis for cross-country comparisons within the international Babies Born Better project.