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.

A multidisciplinary evaluation, exploration, and advancement of the concept of a traumatic birth experience.

BACKGROUND: Understanding a woman's traumatic birth experience benefits from an approach that considers perspectives from various fields of healthcare and social sciences. AIM: To evaluate and explore the multidisciplinary perspectives surrounding a traumatic birth experience to form a theory and to capture its structure. METHODS: A multidisciplinary advanced principle-based concept analysis was conducted, including the following systematic steps: literature review, assessment of concept maturity, principle-based evaluation, concept exploration and advancement, and formulating a multidisciplinary concept theory. We drew on knowledge from midwifery, psychology, childbirth education, bioethics, obstetric & gender violence, sociology, perinatal psychiatry, and anthropology. RESULTS: Our evaluation included 60 records which were considered as 'mature'. Maturity was determined by the reported concept definition, attributes, antecedents, outcomes, and boundaries. The four broad principles of the philosophy of science epistemology, pragmatics, linguistics, and logic illustrated that women live in a political, and cultural world that includes social, perceptual, and practical features. The conceptual components antecedents, attributes, outcomes, and boundaries demonstrated that a traumatic birth experience is not an isolated event, but its existence is enabled by social structures that perpetuate the diminished and disempowered position of women in medical and institutionalised healthcare regulation and management. CONCLUSION: The traumatic childbirth experience is a distinctive experience that can only occur within a socioecological system of micro-, meso-, and macro-level aspects that accepts and allows its existence and therefore its sustainability - with the traumatic experience of the birthing woman as the central construct.

Obstetric Violence as an Infringement on Basic Bioethical Principles. Reflections Inspired by Focus Groups with Midwives.

BACKGROUND: obstetric violence is still far too invisible; the word "violence" generates rejection and obstetric violence is complex to define and typify, as it is a subjective experience. It has been widely analyzed from legal, sociological, and clinical perspectives, but not equally so from the bioethical point of view. This article sets out to take a more in-depth look at the experiences of midwives in order to describe the ethical perspectives of obstetric violence. We intend to describe the effects that malpractice and violence within obstetric care have on American and European bioethical principles. METHODOLOGY: A qualitative methodology of the phenomenological tradition was used: 24 midwives participated in three focus groups. RESULTS AND DISCUSSION: four categories were arrived at; they are "the maleficence of forgetting my vulnerability", "beneficence requires respect for my integrity and dignity", "my autonomy is being removed from me" and "a problem of social justice towards us, women". CONCLUSION: obstetric violence infringes on the main bioethical principles (non-maleficence, beneficence, autonomy, justice, vulnerability, dignity, and integrity). Beyond whether it is called violence or not, what matters from an ethical perspective is that, as long as women have such negative experiences during pregnancy and childbirth, obstetric care needs better humanizing.

The COVID-19 Pandemic in Spain: Experiences of Midwives on the Healthcare Frontline.

BACKGROUND: Midwives look after women during pregnancy, childbirth and puerperium. In Spain, the first wave of COVID was particularly virulent. There are few studies about the experiences of midwives providing care during the COVID pandemic and very few have been undertaken in the countries of southern Europe such as Spain. This article sets out to take a more in-depth look at the experiences of midwives who were on the frontline of care during the early months of the COVID-19 pandemic as well as to identify new needs and resilience strategies that can help midwives. METHODS: A qualitative methodology of phenomenological tradition was used, interviewing 10 midwives from primary care, hospital and independent care. RESULTS: After content analysis, three central categories emerged: (a) cascade of emotions; (b) professional occupation and concern for the women; (c) resisting the day-to-day; resilience and resistance strategies. CONCLUSIONS: Despite the difficulties, midwives are concerned about the loss of rights and autonomy and about the increased vulnerability of women. Midwives have become aware of the power they have in their actions both in health management and administration, as well as in the care of women, creating strategies to provide dignified care to their users.

Birth cultures: A qualitative approach to home birthing in Chile.

BACKGROUND: Birth cultures have been transforming in recent years mainly affecting birth care and its socio-political contexts. This situation has affected the feeling of well-being in women at the time of giving birth. AIM: For this reason, our objective was to analyse the social meaning that women ascribe to home births in the Chilean context. METHOD: We conducted thirty semi-structured interviews with women living in diverse regions ranging from northern to southern Chile, which we carried out from a theoretical-methodological perspective of phenomenology and situated knowledge. Qualitative thematic analysis was used to analyse the information collected in the field work. FINDINGS: A qualitative thematic analysis produced the following main theme: 1) Home birth journeys. Two sub-categories: 1.1) Making the decision to give birth at home, 1.2) Giving birth: (re)birth. And four sub-categories also emerged: 1.1.1) Why do I need to give birth at home? 1.1.2) The people around me don't support me; 1.2.1) Shifting emotions during home birth, 1.2.2) I (don't) want to be alone. CONCLUSION: We concluded that home births involve an intense and diverse range of satisfactions and tensions, the latter basically owing to the sociocultural resistance surrounding women. For this reason, they experienced home birth as an act of protest and highly valued the presence of midwives and their partners.

Effectiveness and Safety of Acupuncture and Moxibustion in Pregnant Women with Noncephalic Presentation: An Overview of Systematic Reviews.

BACKGROUND: Breech presentation at the time of delivery is 3.8-4%. Fetuses that maintain a noncephalic presentation beyond 32 weeks will have a lower probability of spontaneous version before labor. Given the increasing interest in exploring the use of complementary medicine during pregnancy and childbirth, the moxibustion technique, a type of traditional Chinese medicine, could be another option to try turning a breech baby into a cephalic presentation. OBJECTIVES: To review the evidence from systematic reviews (SR) on the efficacy and safety of acupuncture and moxibustion in pregnant women with noncephalic presentation. MAIN RESULTS: Our SR synthesizes the results from five clinical trials on pregnant women with a singleton noncephalic presentation. There is evidence that moxibustion reduces the number of noncephalic presentations at the time of birth compared with no treatment. The adverse effects that acupuncture and moxibustion can cause seem to be irrelevant. Most SRs agree that there are no adverse effects directly related to acupuncture and moxibustion. CONCLUSIONS: Even though the results obtained are positive and the five reviews conclude that moxibustion reduces the number of noncephalic presentations at birth (alone or combined with postural techniques or acupuncture), there is considerable heterogeneity between them. Better methodologically designed studies are required in the future to reaffirm this conclusion.

The experiential expertise of primary care midwives in the detection of gender violence during pregnancy. Qualitative study. / El saber experiencial de las matronas de Atención Primaria en la detección de violencia de género durante el embarazo. Estudio cualitativo.

AIM: To use the reflections of primary care midwives to find out the barriers and facilitators for detecting IPV during pregnancy. The second aim is to determine proposals for measures to improve detection of IPV. METHOD: Qualitative methodology with a interpretative phenomenological approach. In-depth interviews were conducted with 12midwives, working in the sexual and reproductive health care centres of Hospitalet de Llobregat (Barcelona). RESULTS: The difficulties in detection relate to the system of visits, the situation of women and barriers of practitioners themselves, such as fear. Follow-up of pregnancy and the relationship of trust with the midwife stand out as facilitators. The proposals for improvement were to increase training and use safe and reliable health care procedures. CONCLUSIONS: The complexity of IPV makes it likely that IPV during pregnancy is undetected. It would be desirable to implement actions such as expanding training and agreeing on an internal work circuit that includes objective instruments to detect IPV, coordination with other services and ethical and legally appropriate way of recording in the clinical record.

Ansiedad y depresión en las madres de recién nacidos prematuros. Estrategias de intervención y revisión de la bibliografía / Anxiety and depression in mothers of preterm infants. Intervention strategies and literature review

INTRODUCCIÓN: El parto prematuro es una situación muy estresante para las mujeres que lo sufren, ya que supone enfrentarse a una realidad no esperada, en la que se pierden sus expectativas sobre la vivencia del embarazo y el parto normal. Además, deberán afrontar no sólo la separación inicial de su hijo, sino también la pérdida de su rol maternal, ya que los cuidados se asumirán en la unidad neonatal (UNN). Por todo ello, durante el puerperio estas mujeres serán especialmente vulnerables a los problemas de salud mental, y tendrán más riesgo de sufrir niveles altos de ansiedad, depresión e incluso síntomas de estrés postraumático. OBJETIVOS: Conocer y valorar las estrategias de intervención que han demostrado ser eficaces para prevenir, mejorar y/o tratar los riesgos para la salud mental de las madres que pasan por el proceso de tener un hijo prematuro. METODOLOGÍA: Se ha realizado una búsqueda de la bibliografía publicada en los últimos 5 años en las bases de datos CINHAL, PubMed, Web of Science y PsycINFO. RESULTADOS: Las estrategias que han demostrado ser eficaces para mejorar la salud mental son las que incluyen a las madres como cuidadoras, ya sea a través de la promoción de la lactancia materna, el método canguro o los masajes en la UNN, y también las intervenciones que aumentan los conocimientos, tanto en referencia al ambiente de la UNN como a los cuidados y progresos de sus hijos. CONCLUSIONES: La matrona, como profesional de referencia del cuidado del puerperio, ha de conocer el riesgo para la salud mental de estas puérperas, con el fin de detectarlo precozmente y promover actividades preventivas que faciliten su rol maternal, y así contribuir a mejorar la experiencia de tener un hijo prematuro

INTRODUCTION: Preterm birth represents a stressful situation for women who suffer it. They have to face an unexpected reality. A new reality far from their initial expectations about pregnancy and birth, as well as the separation from their baby after giving birth. Premature babies need special cares assumed by the neonatal intensive care unit so mothers have to delegate her maternal role to health professionals. Therefore, all women who have to face a preterm birth are especially vulnerable during the postpartum period to develop mental health problems and to present more anxiety, depression and even post-traumatic stress. OBJECTIVE: Identify and evaluate intervention strategies that proved to be effective in order to prevent, improve and/or treat the risks in mental health of all mothers who have to face a preterm baby. METHODOLOGY: Bibliographic research in the scientific literature published during the last five years in the databases CINHAL, PubMed, Web of Science and PsycINFO. RESULTS: The strategies which demonstrated to be more effective to improve the mental health are interventions that included mothers as the responsible of giving care to the baby. There are different strategies such the promotion in breastfeeding, the kangaroo method or the introduction in massage techniques in the neonatal unit. The activities that help them to increases the knowledge about the function of the neonatal intensive care unit and giving them all the information about the care and progress of their baby are effective options as well. CONCLUSIONS: The midwife is the responsible to take care of mothers during the postpartum. This professional has to know the risk of this women to develop mental health problems during this process. In that case, they have to detect it early and work to promote preventive activities that help mothers to develop her maternal role in this way they will contribute to improve the experience of having a premature baby

Intimate partner violence as a subject of study during the training of nurses and midwives in Catalonia (Spain): A qualitative study.

While nurses and midwives are in a unique position to identify and help victims of IPV, since they are often their first point of contact in the healthcare system, they need appropriate training. This study sought to examine the presence of IPV-related contents and the depth to which they are addressed in the bachelor's degree in Nursing and in the Midwifery specialisation programme. The study also explored lecturers' motivations for including IPV in their subjects. The methodology employed was qualitative. In-depth interviews were conducted with 16 university lecturers who teach IPV contents in the Nursing degree and Midwifery specialisation programme. The study took place in Catalonia (Spain). The research shows that lecturers feel personally committed in the training for prevention and detection of IPV. The main teaching methodology is active, experiential and requires student activity. In all cases, the lecturers call for more time and spaces to be made available to carry out this training. It would be desirable for more time to be dedicated to nurses and midwives' university training in IPV. The topic should be approached with a more cross-disciplinary, systematised focus from all perspectives: health, psychological, social, ethical and legal. It is important that the training of teaching staff in IPV should be fostered and methodised.

Impact of maternity care policy in Catalonia: a retrospective cross-sectional study of service delivery in public and private hospitals.

BACKGROUND: As a result of the growing number of interventions that are now performed in the context of maternity care, health authorities have begun to examine the possible repercussions for service provision and for maternal and neonatal health. In Spain the Strategy Paper on Normal Childbirth was published in 2008, and since then the authorities in Catalonia have sought to implement its recommendations. This paper reviews the current provision of maternity care in Catalonia. METHODS: This was a descriptive study. Hospitals were grouped according to their source of funding (public or private) and were stratified (across four strata) on the basis of the annual number of births recorded within their respective maternity service. Data regarding the distribution of obstetric professionals were taken from an official government survey of hospitals published in 2010. The data on obstetric interventions (caesarean, use of forceps, vacuum or non-specified instruments) performed in 2007, 2010 and 2012 were obtained by consulting discharge records of 44 public and 20 private hospitals, which together provide care in 98% of all births in Catalonia. Proportions and confidence intervals were calculated for each intervention performed in all full-term (37-42 weeks) singleton births. RESULTS: Analysis of staff profiles according to the stratification of hospitals showed that almost all the hospitals had more obstetricians than midwives among their maternity care staff. Public hospitals performed fewer caesareans [range between 19.20% (CI 18.84-19.55) and 28.14% (CI 27.73-28.54)] than did private hospitals [range between 32.21% (CI 31.78-32.63) and 39.43% (CI 38.98-39.87)]. The use of forceps has decreased in public hospitals. The use of a vacuum extractor has increased and is more common in private hospitals. CONCLUSIONS: Caesarean section is the most common obstetric intervention performed during full-term singleton births in Catalonia. The observed trend is stable in the group of public hospitals, but shows signs of a rise among private institutions. The number of caesareans performed in accredited public hospitals covers a limited range with a stable trend. Among public hospitals the highest rate of caesareans is found in non-accredited hospitals with a lower annual number of births.

Las matronas y la detección de la violencia en el embarazo / Midwives and intimate partner violence during pregnancy

La violencia de género es un grave problema social en todo el mundo, por su gravedad y su elevada prevalencia. Puede provocar patologías, incapacidad e incluso la muerte, y tiene repercusiones sobre la salud física, psíquica, social y sexual-reproductiva de la mujer. Si la violencia se ejerce durante el embarazo, puede tener consecuencias no sólo para la mujer, sino también para el feto en desarrollo y el futuro hijo. Existen una serie de funciones mínimas que los profesionales deben desarrollar, como preguntar sobre violencia de género con regularidad, informar y remitir a las mujeres que la sufran a los recursos disponibles de la comunidad, registrar los casos y conocer la legislación vigente del país

Gender violence is a major social problem at global level due to its serious nature and prevalence. It can lead to pathologies, disabilities and even death, and has repercussions for women’s physical, mental, social and sexual/reproductive health. If it occurs during pregnancy it can have consequences not only for the woman but for the developing foetus and the future child. There are a series of minimum functions professionals can perform, such as asking regularly about gender violence, informing women who suffer it about and referring them to the resources available in the community, recording cases and being familiar with current legislation in the country

Use of alternative and complementary therapies in labor and delivery care: a cross-sectional study of midwives' training in Catalan hospitals accredited as centers for normal birth.

BACKGROUND: The use of complementary and alternative medicine (CAM) and complementary and alternative therapies (CAT) during pregnancy is increasing. Scientific evidence for CAM and CAT in the field of obstetrics mainly covers pain relief in labor. Midwives are responsible for labor and delivery care: hence, their knowledge of CAM and CAT is important. The aims of this study are to describe the professional profile of midwives who provide care for natural childbirth in Catalan hospitals accredited as centers for normal birth, to assess midwives' level of training in CAT and their use of these therapies, and to identify specific resources for CAT in labor wards. METHODS: A descriptive, cross-sectional, quantitative method was used to assess the level of training and use of CAT by midwives working at 28 hospitals in Catalonia, Spain, accredited as public normal birth centers. RESULTS: Just under a third of midwives (30.4%) trained in CAT after completion of basic training. They trained in an average of 5.97 therapies (SD 3.56). The number of CAT in which the midwives were trained correlated negatively with age (r = - 0.284; p < 0.001) and with their time working at the hospital in years (r = - 0.136; p = 0.036). Midwives trained in CAT considered that the following therapies were useful or very useful for pain relief during labor and delivery: relaxation techniques (64.3%), hydrotherapy (84.8%) and the application of compresses to the perineum (75.9%). The availability of resources for providing CAT during normal birth care varied widely from center to center. CONCLUSIONS: Age may influence attitudes towards training. It is important to increase the number of midwives trained in CAM for pain relief during childbirth, in order to promote the use of CAT and ensure efficiency and safety. CAT resources at accredited hospitals providing normal childbirth care should also be standardized.

Oferta formativa en terapias alternativas y complementarias para la asistencia al parto / Training programmes in complementary and alternative therapies for midwifery

Las terapias complementarias y alternativas (TCA) son las intervenciones y prácticas que no forman parte del sistema sanitario convencional. En la obstetricia, su uso es cada día más frecuente. Para asesorar a las gestantes es necesario tener unos conocimientos adecuados al respecto. El objetivo de este estudio es conocer la oferta formativa de las matronas en TCA para la atención al parto mediante una revisión bibliográfica y la consulta de fuentes documentales. El actual programa de formación no las contempla y su aprendizaje depende de motivaciones personales. Existe poca información al respecto. Para recomendarlas y utilizarlas con eficacia y seguridad, es necesario dedicar más recursos a la investigación e incorporarlas en los planes convencionales de estudio (AU)

Complementary and alternative therapies (CAM) are interventions and practices not used in the conventional healthcare system. The application of these therapies is becoming increasingly common in Obstetrics. An adequate knowledge of CAM is required to advise pregnant women. The aim of this study was to determine the training of midwives in TCA for delivery care through a literature review and consultation of documentary sources. The current training programme does not include such therapies and learning depends on personal motivation. There is little information. To recommend these therapies and use them effectively and safely, it is necessary to devote more resources to research and incorporate CAM in conventional plans of study (AU)

[Neonatal screening for congenital metabolic pathologies. Ethical and social aspects. Implications for nurses and midwives]. / Cribado neonatal de metabolopatías congénitas. Aspectos eticos y sociales. Implicaciones para enfermeras y matronas.

The authors describe the diseases which are detectable by means of neonatal screening programs available in the different Spanish Autonomous Communities. They analyze some of the ethical and social implications which may occur and they emphasize what those programs mean for nursing professionals, fundamentally midwives and nurses who work in primary health care units or pediatric units.

Atención al embarazo en mujeres africanas inmigrantes. Percepción de las matronas de asistencia primaria / Prenatal care in African immigrants. The perception of primary care midwives

Objetivo. Identificar las dificultades de las matronas de la provincia de Barcelona implicadas en el control del embarazo, en relación con la comunicación y atención a mujeres inmigradas procedentes de los países del Magreb o de Senegal y Gambia. Método. Estudio observacional descriptivo, con recogida de datos mediante cuestionario autocumplimentado, por parte de las matronas de la provincia de Barcelona, durante el año 2002. Resultados. El número medio de mujeres magrebíes visitadas por cada matrona fue de 14, y 11 el promedio para mujeres procedentes de Senegal y Gambia. El 68% de matronas consideraba que el desconocimiento del idioma suponía una dificultad importante para la realización de la educación sanitaria. El abordaje de temas como la sexualidad, el ejercicio físico o la alimentación resultó problemático. El 53% de matronas utilizaba material de soporte. El 66% había realizado algún tipo de actividad formativa en interculturalidad. Conclusiones. Los problemas de comunicación dificultan la realización de una actividad asistencial de calidad, y consideramos necesario potenciar las medidas para mejorar esta comunicación. El conocimiento de la diversidad y la interculturalidad se convierte en un tema de especial importancia en los albores del siglo xxi. Las matronas han demostrado especial interés en mejorar su formación en la materia

Objective. To identify the difficulties of midwives in Barcelona (Spain) involved in prenatal care in relation to communication with immigrant women from the Maghreb countries, Senegal and Gambia and their healthcare. Method. We performed an observational, descriptive study with data collection through a questionnaire self completed by midwives from the province of Barcelona throughout 2002. Results. The mean number of Maghrebi women visited by each midwife was 14 and the mean number from Senegal and Gambia was 11. Sixty-eight percent of the midwives believed that language barriers were a significant difficulty in providing health education. The approach to subjects such as sexuality, physical exercise and diet was problematical. Fifty-three percent of the midwives used additional material. Sixty-six percent had undergone cross-cultural training. Conclusions. Communication difficulties hampered the delivery of healthcare. Measures to improve communication should be implemented. Cross-cultural awareness is becoming increasingly important at the beginning of the twenty-first century. The midwives expressed special interest in increasing their knowledge of this subject

La salud reproductiva en el umbral del siglo XXI / Reproductive health on the threshold of the XXI century

En este trabajo se pretende realizar una reflexión sobre el tipo de asistencia que en materia de salud reproductiva demanda nuestra sociedad actual. Para ello es importante tomar en consideración el entorno sociocultural en el que se desarrollan los cuidados de enfermería en materia de salud reproductiva. Tras realizar un repaso a la evolución del concepto de salud como marco conceptual se llega a profundizar en el ámbito de salud reproductiva. En pocos años se ha pasado de una asistencia centrada en el proceso de embarazo, parto y puerperio a una visión más amplia y holística de la salud reproductiva. Consecuentemente los cuidados en la atención de salud a la mujer han tenido que evolucionar también (AU)