Maternal Concerns in Home Care for the Premature Newborn: An Integrative Review.

OBJECTIVE: To identify and analyze the scientific literature, both national and international, concerning the primary maternal concerns about caring for premature newborns at home. METHODS: This integrative review is based on the guiding question: "What scientific publications from 2012 to 2021 address maternal concerns about the care of premature newborns at home?". Searches were conducted in the electronic databases: Embase, Medline, Web of Science, Lilacs, Scielo, and Cochrane Library. RESULTS: A total of 21 articles were identified. The qualitative analysis showed that maternal concerns pertained to breastfeeding, hygiene, sunbathing practices, managing infant colic, identifying signs, symptoms, and clinical changes, temperature control, and the third phase of the kangaroo method. CONCLUSIONS: Maternal uncertainties underscore the importance of enhancing strategies focused on supporting families and ensuring continued care for neonates at home.

Volunteering in an emergency project in response to the COVID-19 pandemic crisis: the experience of Italian midwives.

OBJECTIVES: During the first wave of the COVID-19 pandemic, the Region of Lombardy in Italy and its Regional Emergency Service (Azienda Regionale Emergenza Urgenza [AREU]) created a dedicated 24/7 free phone service to help the Lombard population. After an invitation from their professional order, local midwives collaborated on the AREU project as volunteers to address the needs of women from antenatal to postnatal periods. The aim of this article was to explore the experiences of midwives who volunteered in the AREU project. STUDY DESIGN: This was a qualitative study using an interpretative phenomenological approach (IPA). METHODS: The experiences of midwives volunteering in AREU (N = 59) were explored using audio diaries. Written diaries were also offered as an alternative. Data collection took place between March and April 2020. Midwives were provided with semistructured guidance that indicated the main areas of interest of the study. The diaries were thematically analysed following a temporal criterion; a final conceptual framework was created from emerging themes and subthemes. RESULTS: The following five themes were identified: (1) choosing to join the volunteer project, (2) the day-to-day difficulties, (3) strategies to cope with the unexpected, (4) professional relationships and (5) reflecting on the personal experience. CONCLUSIONS: This is the first study to investigate the experiences of Italian midwives who volunteered in a public health project during a pandemic/epidemic. According to participants, taking part in the volunteer activities was informed by and impacted on both their professional and personal lives. Overall, the experiences of midwives who volunteered in AREU were positive and of humanitarian value. Providing midwifery services within a multidisciplinary team for the benefit of public health represented both a challenge and personal/professional enrichment.

Mothers' perspectives on the potential use of video-calling during early labour in the United Kingdom and Italy: A qualitative study.

PROBLEM: Women in early labour are typically encouraged to delay maternity unit admission, but they may find this challenging without appropriate professional support. BACKGROUND: Despite pre-pandemic research which identified potential advantages of video-calling in early labour, implementation of such service has not been reported. AIM: To explore mothers' perspectives on potential use of video-calls during early labour. METHODS: A multi-centre descriptive qualitative study was undertaken in UK and Italy. Ethical approval was gained and ethical processes were followed. Six virtual focus groups were conducted with 37 participants, 24 mothers who gave birth in the UK and 13 who gave birth in Italy. Line-by-line thematic analysis was performed and themes agreed. FINDINGS: Two themes emerged: 1) women's expectations of video-calls' content and features; 2) technological challenges and solutions. Mothers responded positively to the concept of video-calling in early labour. Receiving guidance, information on coping with pain and advice on timely access in early labour was perceived as key. Women highlighted the importance of accessible, reliable and user-friendly technology. Equitable access, technological literacy, acceptability and privacy were considered as challenges to implementation, with solutions proposed to overcome disparities. DISCUSSION AND CONCLUSION: Guidance and training should be provided to midwives, with designated resources to build a service that is accessible, acceptable, safe, individualised and respectful for mothers and birth companions. Further research should explore feasibility, acceptability, clinical and cost-effectiveness.

Midwives' experiences of providing maternity care to women and families during the COVID-19 pandemic in Northern Italy.

PROBLEM: The COVID-19 pandemic has significantly challenged maternity provision internationally. Rapid and radical changes were implemented, with midwives facing anxiety and moral distress if not able to provide optimal and woman-centred care in line with professional values. BACKGROUND: Healthcare professionals' stress and burnout are commonly reported during other global emergencies, which may eventually contribute to reduced quality of care. There is lack of evidence of the challenges faced by midwives in Italy during the COVID-19 pandemic. AIM: To explore midwives' experiences of providing care to women and families during the COVID-19 pandemic. METHODS: Qualitative interpretive phenomenological approach, using semi-structured interviews and thematic analysis. The sample included 15 midwives. Ethical approval was obtained. FINDINGS: Four themes were identified: 1) adjusting to the ever-evolving organisation of care; 2) physical, psychological and relational challenges; 3) support network; 4) deferred sense of awareness. DISCUSSION: Midwives faced professional and personal challenges during the pandemic, displaying feelings of fear, anxiety, uncertainty, discomfort, lack of support and knowledge with potential long-term effects. Adjusting to the continuous, rapid and drastic re-organisation of maternity services was particularly challenging. Factors facilitating a safe, supportive and empowering workplace included support from colleagues and managers, access to appropriate PPE, reliable guidelines, good communication and emotional support. Positive aspects of personal and professional development included communication skills, establishment of trusting relationships, sense of empowerment and teamwork. CONCLUSION: In the context of a pandemic, optimisation of midwives' physical, emotional and psychological wellbeing should be considered. Timely and comprehensive guidelines and appropriate resources should be provided to assist midwives in facilitating family-centred respectful maternity care and preserving childbirth as a bio-psychosocial event.

Intimate partner violence screening during pregnancy: midwives' perspective.

Violence during pregnancy has serious health consequences. Several scientific societies recommend introducing domestic violence screening in clinical practice, but it is poorly employed. This study aimed to explore midwives' perspective regarding how, where, and when to conduct intimate partner violence screening during pregnancy to increase its clinical application. We performed a qualitative study using a hermeneutic phenomenological approach. Eleven midwives were recruited, and semi-structured interviews were conducted. The interviews were audio recorded and transcribed verbatim. Content analysis was conducted. Six main themes emerged: "the healthcare providers involved," "the best place to investigate," "the best time to ask," "how to investigate," "what facilitates investigations and women's disclosure," and "what hinders investigations and women's disclosure." Most interviewees believed that midwives are the most suitable healthcare providers to investigate violent situations during pregnancy because the continuity of midwifery care can facilitate women's disclosure. Midwives emphasized the importance of an environment where women's privacy is respected. Midwives did not consider it appropriate to ask about domestic violence at the first antenatal appointment. Most believed that the best way to investigate domestic violence depends on the context and the woman's personal history.

The unpredictable nature of labour and birth: A qualitative investigation regarding expectations of Italian parents to-be.

OBJECTIVE: to explore first-time Italian parents' expectations of labour and birth. DESIGN: qualitative Husserlian phenomenological approach, using face-to-face focus groups for parents during the late third trimester of pregnancy. Data analysis, using Colaizzi's phenomenological method, included the processes of reading and re-reading the text to extract relevant statements in order to identify themes and finally member checking was performed to validate participants' expressions SETTING: consultant-led maternity unit in Northern Italy, with approximately 2500 births per annum. PARTICIPANTS: purposive sample of eight first-time parents-to-be, with a straightforward singleton pregnancy, who participated in two focus groups during pregnancy, one for women and one for their partners, to explore their expectations of birth. FINDINGS: uncertainties, doubts and fears were reported by all women. Although they expected to have a normal birth, they remained open-minded due to the awareness of the unpredictable nature of childbirth. One of the strongest emotions expressed by women was that of fear, especially of labour. They found different strategies to cope with those fears and to anticipate their potential disappointment and frustration regarding a childbirth experience that potentially could differ from their expectations. Women wanted their partner with them to share the birth experience and they valued their presence as essential. The midwife was expected to be a supportive guide. Fathers-to-be, although happy about the idea to be present at birth, were also concerned about their reaction to an unknown experience, about the woman's labour pain and were worried about not being helpful to her. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: to our knowledge this is the first such study to be conducted in Italy. In order to support families as a whole, the importance of the father in a supportive role and as an essential parent himself should be addressed, considering his wishes. Midwives should strive to provide family centre-care, to be supportive and sensitive. Antenatal education classes should be conducted with both parents in order to understand their expectations, give information about duration and stages of labour and birth, prepare for parenthood, addressing fears and enhancing a positive experience of birth.

Variables related to maternal satisfaction with intrapartum care in Northern Italy.

BACKGROUND: The experience of labour and birth is complex, multidimensional and subjective and has the potential to affect the women and their families physically and emotionally. However, there is a lack of research around maternal satisfaction in Italy. AIM: To evaluate mothers' satisfaction with their childbirth experience in relation to socio-demographic characteristics, obstetric history and intrapartum care variables. METHODS: A cross-sectional study involving 277 women who had given birth in a low risk maternity unit in Northern Italy was undertaken. Satisfaction with birth was measured using the Italian version of the Birth Satisfaction Scale-Revised (I-BSS-R). The scale comprises three Sub-Scales: quality of care provided, personal attributes of women and stress experienced during childbirth. FINDINGS: No socio-demographic variables were related to maternal satisfaction. Multiparous women had a higher satisfaction score (p=0.020; CI:0.23;2.75). Antenatal class attendance was negatively associated with maternal satisfaction (p=0.038; CI:-2.58; -0.07). Intrapartum variables that significantly reduced maternal satisfaction were: epidural usage (p=0.000; CI:-4.66; -2.07), active phase >12h (p=0.000; CI:-6.01; -2.63), oxytocin administration (p=0.000; CI:-5.08; -2.29) and vacuum assisted birth (p=0.001; CI:-6.50; -1.58). Women with an intact perineum were more likely to be satisfied (p=0.008; CI:-4.60; -0.69). DISCUSSION: In accordance with other research, we showed that intrapartum interventions are negatively associated with maternal outcomes and therefore also with maternal satisfaction with birth. The sub-scale that measured Quality of Care provided scored higher than the other two Sub-Scales. CONCLUSION: Further studies on maternal satisfaction in Italy should be conducted, using the I-BSS-R with the aim to compare outcomes and understand what matters to women during childbirth.

Self-efficacy in breastfeeding support: a research on Italian midwifery students.

BACKGROUND AND AIM OF THE STUDY: Maternal breastmilk represents the best nourishment for the newborn baby during its first six months, as it offers several benefits for the health and well-being of babies and mothers. In order to promote, protect and support effectively mother and child during breastfeeding, it is essential for midwives to be properly educated and to acquire highly professionalizing skills. This study aimed to evaluate the level of self-efficacy of the students attending the Degree Course of Midwifery, regarding the support of mother and child in breastfeeding. METHOD: A questionnaire of 37 items (Blackmanet al, 2015) validated in Italian by Mazzeo Melchionda (2019), was sent on-line to students of ten different Midwifery Degree Courses to assess their level of self-efficacy regarding the management of breastfeeding. Statistical analysis was carried out using statistic software R3.4.3 (The Foundation for Statistical Computing). RESULTS: 158 questionnaires were collected from ten Italian Midwifery Degree Courses. The areas in which students showed a high level of self-efficacy in managing breastfeeding include: the benefits of breastfeeding; the child's tendency to take the breast within an hour from childbirth and the relevance of skin to skin contact and rooming-in. Low levels of self-efficacy concerned the comfortably breastfeeding in public places and avoiding giving formula to the baby in its first six weeks of life. CONCLUSIONS: Generally the students attending Midwifery Degree Courses show a high level of self-efficacy in assisting mothers during breastfeeding and they prove to have a good knowledge of the benefits of breastfeeding to improve the health of mothers and their children. (www.actabiomedica.it).

Findings from the Italian Babies Born Better Survey.

BACKGROUND: The most recent WHO recommendations "Intrapartum care for a positive childbirth experience" highlight the need to identify women-centered interventions and outcomes for intrapartum care, and to include service users' experiences and qualitative research into the assessment of maternity care. Babies Born Better (B3) is a trans-European survey designed to capture service user views and experiences of maternity care provision. Italian service users contributed to the survey. METHODS: The B3 Survey is an anonymous, mixed-method online survey, translated into 22 languages. We separated out the Italian responses and analyzed them using computer-assisted qualitative software (MAXQDA) and SPSS and STATA for quantitative data analysis. Simple descriptives were used for the numeric data, and content analysis for the qualitative responses. Geomapping was based on the coded qualitative data and postcodes (using Tableau Public). RESULTS: There were 1000 respondents from every region of Italy, using a range of places of birth (hospital, birth center, home) and experiencing care with both midwives and obstetricians. Most identified positive experiences of care, as well as some practices they would like to change. Both positive and critical comments included provision of care based on the type of providers, clinical procedures, the birth environment, and breastfeeding support. There were clear differences in the geomapped data across Italian regions. CONCLUSIONS: Mothers highly value respectful, skilled and loving care that gives them a strong sense of personal achievement and confidence, and birth environments that support this. There was distinct variation in the percentage of positive comments made across Italian regions.

Intrapartum care quality indicators: a literature review.

INTRODUCTION: Quality of care is increasingly recognized as a critical aspect of the maternal and newborn health, mainly with respect to care around labor and delivery and in the immediate postnatal period. The aim of this review was to identify the recommended intrapartum care indicators in order to measure the quality of midwifery care. EVIDENCE ACQUISITION: A structured literature search was conducted in August 2017 incorporating English and Italian language studies from 1993 and onwards to identify published articles on quality standards of intrapartum care. Research was performed into the area of enquiry in electronic database (Medline, Cochrane Library, CINAHL, Trip) and in relevant midwifery websites. EVIDENCE SYNTHESIS: We identified 369 quality indicators to measure the intrapartum care. Following a systematic process that allows to classify all indicators in domains and categories, we analyzed 268 outcome and process indicators specifically designated to monitor the intrapartum care in a low risk population. Through the identification of further exclusion criteria and semantic analogies we obtained 80 final quality indicators (39 outcome indicators and 41 process indicators). CONCLUSIONS: We identified 80 indicators that should be used to measure the quality of low risk intrapartum care. Although the majority of indicators we could monitor through hospital databases and the Italian Birth Register-CeDAP are outcome indicators, it is important to give attention also to process indicators that measure the activities performed and whether or not they are evidence-based. For a low risk population they could measure adherence with guidelines that promote and support the normality of the process.

First-time mothers' experiences of early labour in Italian maternity care services.

OBJECTIVE: The aim of this study is to explore first-time mothers' experiences of early labour in Italian maternity care services when admitted to hospital or advised to return home after maternity triage assessment. SETTING: The study was conducted in a second-level maternity hospital in northern Italy with an obstetric unit for both low- and high-risk women. PARTICIPANTS: The participants included 15 first-time mothers in good general health with spontaneous labour at term of a low-risk pregnancy who accessed maternity triage during early labour, and were either admitted to hospital or advised to return home. DESIGN: A qualitative interpretive phenomenological study was conducted. A face-to-face recorded semi-structured interview was conducted with each participant 48-72h after birth. FINDINGS: Four key themes emerged from the interviews: (a) recognising signs of early labour; (b) coping with pain at home; (c) seeking reassurance from healthcare professionals; and (d) being admitted to hospital versus returning home. Uncertainty about the progression of labour and the need for reassurance were cited by women as the main reasons for hospital visit in early labour. An ambivalent feeling was reported by the participants when admitted to hospital in early labour. In fact, while the women felt reassured in the first instance, some women subsequently felt dissatisfied due to the absence of one-to-one dedicated care during early labour. When advised to return home, a number of women reported feelings of disappointment, anger, fear, discouragement and anxiety about not being admitted to hospital; however, some of these women reported a subsequent feeling of comfort due to being at home and putting in place the suggestions made by the midwives during the maternity triage assessment. The guidance provided by midwives during triage assessment seemed to be the key factor influencing women׳s satisfaction when advised either to return home or to stay at the hospital during early labour. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: During antenatal classes and clinics, midwives should provide clear information and advice about early labour in order to increase women׳s confidence and self-efficacy, and decrease their anxiety and fear. During early labour, appropriate maternity care services should be offered according to individual needs. When home visits are not provided by midwives, a telephone triage run by midwives should be considered as a routine service for the first point of contact with women during early labour.

Domestic violence during pregnancy: Midwives׳ experiences.

OBJECTIVE: the aim of this qualitative study was to explore midwives׳ knowledge and clinical experience of domestic violence among pregnant women, with particular emphasis on their perceptions of their professional role. DESIGN: the data collected for this phenomenological-hermeneutical qualitative study were collected using semi-structured interviews, and analysed according to Denzin and Lincoln (2011). SETTING AND PARTICIPANTS: fifteen hospital and community midwives working in the local health district of Monza and Brianza in northern Italy were recruited between July and October 2012. FINDINGS: three main themes emerged: 'it is difficult to recognise domestic violence' because of a limited knowledge of the most common signs and symptoms of violence, a lack of training, cultural taboos, and the women׳s unwillingness to disclose abuse; 'we have a certain number of means of identifying violence', such as relationships with the woman, specific professional training and screening tools, which have advantages and disadvantages; 'the professionals involved' in identifying and managing family violence highlight the importance of a interdisciplinary approach. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: midwives acknowledge their crucial role in identifying and managing domestic violence but are still unprepared to do so and indicate various barriers that need to be overcome. There is a need to implement basic university education on the subject and provide specific professional training.

Early pushing urge in labour and midwifery practice: a prospective observational study at an Italian maternity hospital.

OBJECTIVE: to investigate the early pushing urge (EPU) incidence in one maternity unit and explore how it is managed by midwives. The relation to some obstetric outcomes was also observed but not analysed in depth. DESIGN: prospective observational study. SETTING: Italian maternity hospital. SAMPLE: 60 women (44 nullips and 16 multips) experiencing EPU during labour. FINDINGS: the total EPU incidence percentage was 7.6%. The single midwives' incidences range had a very wide margin, noting an inverse proportion between the number of diagnoses of EPU and midwife's waiting time between urge to push and vaginal examination. Two care policies were adopted in relation to the phenomenon: the stop pushing technique (n=52/60) and the 'let the woman do what she feels' technique (n=8/60). In case of stop pushing techniques, midwives proposed several combined techniques (change of maternal position, blowing breath, vocalisation, use of the bath). The EPU diagnosis at less than 8cm of cervical dilatation was associated with more medical interventions. Maternal and neonatal outcomes were within the range of normal physiology. An association between the dilatation at EPU diagnosis and obstetric outcomes was observed, in particular the modality of childbirth and perineal outcomes. CONCLUSIONS AND IMPLICATION FOR PRACTICE: this paper contributes new knowledge to the body of literature around the EPU phenomenon during labour and midwifery practices adopted in response to it. Overall, it could be argued that EPU is a physiologic variation in labour if maternal and fetal conditions are good. Midwives might suggest techniques to woman to help her to stay with the pain, such as change of position, blowing breath, vocalisation and use of the bath. However, the impact of policies, guidelines and culture on midwifery practices of the specific setting are a limitation of the study because it is not representative of other similar maternity units. Thus, a larger scale work should be considered, including different units and settings. The optimal response to the phenomenon should be studied, considering EPU at different dilatation ranges. Future investigations could also focus on qualitative analysis of women and midwives' personal experience in relation to the phenomenon.