The preventive health management self-efficacy related to preterm labor scale in reproductive-aged women: Validation of Turkish reliability and factor structure.

AIM: This study aims to test and adapt the Turkish psychometric properties of the preventive health management self-efficacy related to premature labor (PHMSE-PL) scale for women of reproductive age. METHODS: The study follows a methodological approach. The original scale comprises 34 items distributed across 5 subscales and is structured on a five-point Likert scale. The study sample consisted of 351 women aged 19 to 49, all without any physical or mental disabilities, irrespective of marital status or pregnancy status. Exclusion criteria encompassed women engaged in healthcare professions such as medical faculty, nursing, or midwifery, as well as those with a history of preterm birth during pregnancy. RESULTS: During the validity assessment of the scale, language, content, and construct validity were scrutinized. In the reliability phase, internal consistency and stability over time -analyses were conducted. Following confirmation of language validity, all items achieved a content validity index value exceeding 0.80. Exploratory and confirmatory factor analyses were employed to assess structural validity, revealing that the scale retained its original grouping into five sub-factors. These factors collectively accounted for 81.5% of the variance. The Cronbach's alpha coefficient for the entire scale reached 0.98, indicating high internal consistency. Test-retest analyses yielded a correlation coefficient of 0.99 between overall scale scores, demonstrating excellent consistency between the two measurement measurements. CONCLUSIONS: The PHMSE-PL scale adapted to Turkish culture demonstrated high levels of validity and reliability.

Disclosure Patterns of Opioid Use Disorders in Perinatal Care During the Opioid Epidemic on X From 2019 to 2021: Thematic Analysis.

BACKGROUND: In 2021, the United States experienced a 14% rise in fatal drug overdoses totaling 106,699 deaths, driven by harmful opioid use, particularly among individuals in the perinatal period who face increased risks associated with opioid use disorders (OUDs). Increased concerns about the impacts of escalating harmful opioid use among pregnant and postpartum persons are rising. Most of the current limited perinatal OUD studies were conducted using traditional methods, such as interviews and randomized controlled trials to understand OUD treatment, risk factors, and associated adverse effects. However, little is known about how social media data, such as X, formerly known as Twitter, can be leveraged to explore and identify broad perinatal OUD trends, disclosure and communication patterns, and public health surveillance about OUD in the perinatal period. OBJECTIVE: The objective is 3-fold: first, we aim to identify key themes and trends in perinatal OUD discussions on platform X. Second, we explore user engagement patterns, including replying and retweeting behaviors. Third, we investigate computational methods that could potentially streamline and scale the labor-intensive manual annotation effort. METHODS: We extracted 6 million raw perinatal-themed tweets posted by global X users during the opioid epidemic from May 2019 to October 2021. After data cleaning and sampling, we used 500 tweets related to OUD in the perinatal period by US X users for a thematic analysis using NVivo (Lumivero) software. RESULTS: Seven major themes emerged from our thematic analysis: (1) political views related to harmful opioid and other substance use, (2) perceptions of others' substance use, (3) lived experiences of opioid and other substance use, (4) news reports or papers related to opioid and other substance use, (5) health care initiatives, (6) adverse effects on children's health due to parental substance use, and (7) topics related to nonopioid substance use. Among these 7 themes, our user engagement analysis revealed that themes 4 and 5 received the highest average retweet counts, and theme 3 received the highest average tweet reply count. We further found that different computational methods excel in analyzing different themes. CONCLUSIONS: Social media platforms such as X can serve as a valuable tool for analyzing real-time discourse and exploring public perceptions, opinions, and behaviors related to maternal substance use, particularly, harmful opioid use in the perinatal period. More health promotion strategies can be carried out on social media platforms to provide educational support for the OUD perinatal population.

Shaping Adoption and Sustained Use Across the Maternal Journey: Qualitative Study on Perceived Usability and Credibility in Digital Health Tools.

BACKGROUND: Maternal and child health outcomes are positively influenced by early intervention, and digital health (DH) tools provide the potential for a low-cost and scalable solution such as informational platforms or digital tracking tools. Despite the wide availability of DH tools out there for women from before to after pregnancy, user engagement remains low. OBJECTIVE: This study aims to explore the factors that shape women's DH adoption and sustained use across the maternal journey from preconception to postbirth, to improve user engagement with DH tools. METHODS: One-hour semistructured qualitative interviews were conducted with 44 women from before to after pregnancy (age range 21-40 years) about their experiences with DH. This study is part of a larger study on women's maternal experiences with health care and DH and focuses on the factors that affected women's DH adoption and sustained use. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive thematic analysis. RESULTS: Five main themes and 10 subthemes were identified that affected women's adoption and sustained use of DH tools. These included themes on their preexisting attitudes to DH, perceived ease of use, perceived usefulness, perceived credibility, and perceived value of the tool. CONCLUSIONS: The themes that emerged were fully or partially mapped according to the Unified Theory of Acceptance and Use of Technology 2 model. The applicability of the model and the need to consider specific cultural nuances in the Asian context (such as the importance of trust and social influence) are discussed. The interaction of the 5 themes with DH adoption and sustained use are explored with different themes being relevant at various points of the DH adoption journey. The insights gained serve to inform future DH design and implementation of tools for women to optimize their DH engagement and the benefits they derive from it. TRIAL REGISTRATION: ClinicalTrials.gov NCT05099900; https://clinicaltrials.gov/study/NCT05099900.

Population perinatal substance use and an environmental scan of health services in British Columbia, Canada.

BACKGROUND: Substance use during pregnancy is underreported globally and there is limited data on its prevalence and the availability of supportive services. This study determined population perinatal substance use in British Columbia (BC) by region and examined the availability of clinical and community-based programs. METHODS: Using linked provincial health administrative data, we conducted a population-based retrospective cohort study including all BC residents accessing care for substance use (alcohol, opioids, stimulants, sedatives, and cannabis) within 12 months of first perinatal care record to delivery during 2016-2021. We also conducted an environmental scan to identify all programs offering perinatal care and substance use treatment/support in BC as of December 2022 and described program components by region. RESULTS: The population included 12,439 people with perinatal substance use with 13,814 linked livebirths during the study period. The incidence rate of perinatal substance use was nearly eight times higher in rural/remote Northern BC compared to the metropolitan Vancouver Coastal region (1044.2 vs. 131.3 per 100,000 population, respectively). We identified 29 related services (19 wrap-around programs, 8 supportive housing, and only 2 acute care programs). Residents outside of Metro Vancouver accounted for 60 % (N=1745) of people with perinatal substance use; however, these regions represented only 35 % of BC's specialized acute care and supportive housing beds (N=140). CONCLUSIONS: Expanding supports for perinatal substance use - particularly acute care and supportive housing within more rural/remote regions in BC - will be critical to address geographic inequities in access to perinatal care and improve health outcomes for pregnant people who use substances and their infants.

The translation and validation of the MES for an Austrian sample.

INTRODUCTION: Empathy plays an important role in midwifery care, not only for the women but also for midwives. The Midwifery Empathy Scale (MES) was developed to assess the empathy levels of midwives and midwifery students. The purpose of this study was the translation and validation of the MES for an Austrian sample. METHODS: A total of 277 midwives working in Austria completed the questionnaire of the MES. The psychometric measurements that were performed included explanatory factor analysis using a varimax rotation and principal components analysis. Moreover, the internal consistency of the MES was assessed with reliability coefficients. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and a Bartlett's test of sphericity were carried out. RESULTS: Principal components analysis showed seven orthogonal factors. KMO measure of sample adequacy = 0.724 and Bartlett's test of sphericity = 1058.904 (df=231, p<0.0001). The MES showed an acceptable overall internal consistency: Cronbach's alpha was found to be 0.721 and the Guttman split-half coefficient was 0.611. The findings of our study confirm the multidimensionality of MES, demonstrating a seven-factor structure which contained subscales reflecting empathy and emotional connection. The mean total score of Austrian midwives' responses to the MES was 44.80 with scores ranging from 24 to 81. CONCLUSIONS: This study shows that the German version of the Midwifery Empathy Scale is a reliable instrument for evaluating the empathy levels of midwives and midwifery students in Austria. The German MES could be used in the selection and education of future midwives as well as in connection with empathy trainings of midwives.

The neurodivergent perinatal experience - A systematic literature review on autism and attention deficit hyperactivity disorder.

BACKGROUND: Neurodivergent individuals often face unique challenges during the perinatal period, which can significantly impact their experiences of pregnancy, childbirth, and early parenting. Despite growing awareness of neurodiversity, there remains a gap in perinatal care that fully addresses the lived experiences and needs of those with neurodivergent conditions such as Autism (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). OBJECTIVE: To compile and analyse recent literature on the perinatal experiences of neurodivergent parturients. To provide an overview of current knowledge, identify prevalent challenges, and suggest opportunities for improving perinatal services. Additionally, we aim to highlight research gaps that guide future studies and enhance care quality for neurodivergent individuals during the perinatal period. METHODS: The Systematic Reviews methodological process was utilised to search relevant scientific databases to gather current research articles on neurodivergent perinatal experiences. Eleven studies met the inclusion criteria and were appraised using a rigorous quality checklist. Thematic analysis identified recurring themes across the selected papers. RESULTS: Three major themes emerged: Care provider support, Perinatal mental health needs, and Resilience and growth of neurodivergent parturients. These themes highlight significant differences in perinatal experiences between neurodivergent and neurotypical individuals, underscoring the need for tailored care approaches. CONCLUSION: The findings reveal that current perinatal care practices do not adequately address the specific challenges faced by perinatal neurodivergent individuals. There is a critical need for perinatal care systems to integrate neurodiversity-affirming practices. Future research should consider intersectionality to include marginalised and underrepresented neurodivergent voices.

Thinking on the purposes, roles and activities of networks for research on maternal and perinatal health: opinions of coordinators and members.

Objective: To identify the opinion of coordinators and members about the essential characteristics and to understand the research networks characteristics, to facilitate their implementation, sustainability and effectiveness so it can be replicated in low and middle-income countries. Methods: A qualitative study using a semi-structured interview technique was conducted. We selected potential members, managers and participants of networks from publications identified in PubMed. After checking the FIGO congress program, we identified authors who were assigned as speakers at the event. An invitation was sent and interviews were scheduled. Results: In total, eleven interviews were performed. Coordinators and members of networks have the same goal when they decide to participate in a network. In general, they cited that these individuals had to be committed, responsible and enthusiastic people. The network should be composed also of postgraduate students. A network should allow multi-leadership, co-responsibility, autonomy and empowerment of its members. Effective communication was mentioned as an important pillar for network maintenance. Another motivation is being an author or coauthor in publications. One way to maintain a network running is social or governmental commitment, after resources expire, studies continue. Conclusion: Networks are different due to the social context where they are inserted, however, some characteristics are common to all of them, such as having engaged leaders. For an effective and sustainable network, commitment and motivation in a leader and members are more in need than financial resources. Ideally, to ensure the operation of the network, the institution where the leader is linked should support this network.

Genome sequences of 70 multidrug-resistant Gram-negative isolates in high-risk neonates in the Northeast of Mexico.

Infections by multidrug-resistant pathogens are steadily increasing worldwide. A considerable proportion of neonatal intensive care admissions have a bacterial infection with multidrug-resistant bacteria during their hospital stay. In this work, we report draft genome sequences of 70 selected isolates from high-risk neonates in the Northeast of Mexico.

Uncovering the Complexity of Perinatal Polysubstance Use Disclosure Patterns on X: Mixed Methods Study.

BACKGROUND: According to the Morbidity and Mortality Weekly Report, polysubstance use among pregnant women is prevalent, with 38.2% of those who consume alcohol also engaging in the use of one or more additional substances. However, the underlying mechanisms, contexts, and experiences of polysubstance use are unclear. Organic information is abundant on social media such as X (formerly Twitter). Traditional quantitative and qualitative methods, as well as natural language processing techniques, can be jointly used to derive insights into public opinions, sentiments, and clinical and public health policy implications. OBJECTIVE: Based on perinatal polysubstance use (PPU) data that we extracted on X from May 1, 2019, to October 31, 2021, we proposed two primary research questions: (1) What is the overall trend and sentiment of PPU discussions on X? (2) Are there any distinct patterns in the discussion trends of PPU-related tweets? If so, what are the implications for perinatal care and associated public health policies? METHODS: We used X's application programming interface to extract >6 million raw tweets worldwide containing ≥2 prenatal health- and substance-related keywords provided by our clinical team. After removing all non-English-language tweets, non-US tweets, and US tweets without disclosed geolocations, we obtained 4848 PPU-related US tweets. We then evaluated them using a mixed methods approach. The quantitative analysis applied frequency, trend analysis, and several natural language processing techniques such as sentiment analysis to derive statistics to preview the corpus. To further understand semantics and clinical insights among these tweets, we conducted an in-depth thematic content analysis with a random sample of 500 PPU-related tweets with a satisfying κ score of 0.7748 for intercoder reliability. RESULTS: Our quantitative analysis indicates the overall trends, bigram and trigram patterns, and negative sentiments were more dominant in PPU tweets (2490/4848, 51.36%) than in the non-PPU sample (1323/4848, 27.29%). Paired polysubstance use (4134/4848, 85.27%) was the most common, with the combination alcohol and drugs identified as the most mentioned. From the qualitative analysis, we identified 3 main themes: nonsubstance, single substance, and polysubstance, and 4 subthemes to contextualize the rationale of underlying PPU behaviors: lifestyle, perceptions of others' drug use, legal implications, and public health. CONCLUSIONS: This study identified underexplored, emerging, and important topics related to perinatal PPU, with significant stigmas and legal ramifications discussed on X. Overall, public sentiments on PPU were mixed, encompassing negative (2490/4848, 51.36%), positive (1884/4848, 38.86%), and neutral (474/4848, 9.78%) sentiments. The leading substances in PPU were alcohol and drugs, and the normalization of PPU discussed on X is becoming more prevalent. Thus, this study provides valuable insights to further understand the complexity of PPU and its implications for public health practitioners and policy makers to provide proper access and support to individuals with PPU.

Facilitating home birth in perinatal palliative care: A case report.

BACKGROUND: Perinatal palliative care can offer compassionate support to families following diagnosis of a life-limiting illness, to enable them to make valued choices and the most of the time that they have with their newborn. However, home birth is usually only offered in low-risk pregnancies. CASE: A couple who received an antenatal diagnosis of hypoplastic left heart syndrome and who had made a plan to provide palliative care to their baby after birth requested the option of a home birth. POSSIBLE COURSES OF ACTION: Recommend birth at hospital or explore the possibility of a home birth with perinatal palliative care support. FORMULATION OF A PLAN: Multidisciplinary discussion and collaboration enabled a plan for home birth to be made which anticipated potential complications. OUTCOME: The baby was born at home and died on day 5 of life receiving outreach nursing, paediatric and palliative care support and buccal and oral opioids for symptom management. We include reflections from the family on the importance of this experience. LESSONS: We provide a list of potential criteria for considering home birth in the setting of perinatal palliative care. VIEW: Facilitating a home birth in the setting of perinatal palliative care is an option that can be hugely valued by families, but this service may be practically difficult to deliver in many contexts. Further research is needed to understand the preferences of women and families receiving perinatal palliative care.

Midwives' Knowledge and Attitudes Regarding Perinatal Care for Women With Disabilities.

INTRODUCTION: Women with disabilities (WWD) face significant barriers to accessing quality perinatal care, resulting in adverse outcomes for mothers and newborns. Midwives are crucial in providing this care, but their knowledge and attitudes can impact the quality of services delivered. This study aims to examine midwives' knowledge and attitudes toward perinatal care for WWD and identify factors influencing these aspects. METHODS: A cross-sectional study was conducted from January to April 2023, involving 149 midwives from various healthcare settings. Data were collected using a self-administered questionnaire addressing demographics, knowledge, attitudes, and perceived barriers related to perinatal care for WWD. Descriptive statistics and non-parametric tests were used for analysis, with a significance level set at 0.05. RESULTS: The sample comprised predominantly female midwives (146, 98%), with a mean age of 33.7 years and a mean of 9.8 years of work experience. Only 48 (32.2%) reported workplaces equipped for perinatal care for WWD. Most participants rated the perinatal care services in Greece for WWD as moderate (87, 58.4%) and believed that the medical staff's knowledge in this area was insufficient (148, 99.3%). The mean knowledge score was 35 points out of 100, indicating a low level of knowledge. Key barriers included the lack of adapted services (148, 99.3%) and insufficient infrastructure (143, 96%). Despite these challenges, 142 (95.3%) midwives supported the right of WWD to have children. Significant correlations were found between higher knowledge scores and less specialized attitudes, while more perceived barriers correlated with a greater need for further education. CONCLUSIONS: This study highlights the urgent need for improved education and training programs for midwives to enhance their knowledge and attitudes toward perinatal care for WWD. Addressing educational and structural barriers is essential to provide equitable and high-quality care. Policymakers should prioritize creating inclusive healthcare environments and support ongoing professional development for midwives.

Fungibility, accessibility and clinical utility of remote electronic fetal monitoring in improving maternal emotional status compared with traditional method: A multicenter prospective cohort analysis.

OBJECTIVE: Supported by remote signal processing techniques and wireless communication technology, remote electronic fetal monitoring (REFM) has emerged as a promising alternative to traditional electronic fetal monitoring (TEFM) in clinical practice. The aim of this study was to evaluate the comparability, accessibility, and clinical utility of REFM in contrast to TEFM. METHODS: This was a multicenter prospective cohort study. A cohort of 2900 pregnant women were enrolled from three medical centers between June 1, 2021 and June 31, 2022. Among them, 800 utilized REFM, with 760 of them completing the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) assessments using the devices for 1 month. The control group comprised 2100 pregnant women who did not use REFM. Additionally, 80 pregnant women concurrently employed both REFM and TEFM, and their respective curve coincidence rates were determined through curve fitting. Primary outcomes encompassed pregnancy outcomes in both groups, average curve coincidence rates between REFM and TEFM, as well as SDS and SAS scores. RESULTS: Among the 760 pregnant women who completed SAS and SDS assessments, their average SAS scores before and after 1 month of REFM usage were 43.09 ± 8.04 and 41.58 ± 6.59, respectively. Concurrently, the average SDS scores before and after 1 month of REFM usage were 45.45 ± 9.60 and 44.80 ± 9.17, respectively. A statistically significant decrease was observed in SAS scores (P = 0.005), whereas no significant difference was noted in SDS scores (P = 0.340). Furthermore, a statistically significant difference in the rate of adverse pregnancy outcomes (neonatal asphyxia) emerged between the two groups, those who employed REFM and those who did not (P = 0.021). In the subset of 80 pregnant women employing both REFM and TEFM, all 80 results showed precise congruence between the two methods. The average coincidence rate was determined to be 79.45% ± 12.64%. CONCLUSION: REFM contributes to improved pregnancy outcomes and exhibits a high level of concordance with TEFM, thereby accurately reflecting the quality of fetal heart monitoring. Additionally, REFM effectively mitigates pregnant women's anxiety. Thus, REFM demonstrates comparability, accessibility, and clinical utility.

Influence of perinatal factors on full-term low-birth-weight infants and construction of a predictive model.

BACKGROUND: Being too light at birth can increase the risk of various diseases during infancy. AIM: To explore the effect of perinatal factors on term low-birth-weight (LBW) infants and build a predictive model. This model aims to guide the clinical management of pregnant women's healthcare during pregnancy and support the healthy growth of newborns. METHODS: A retrospective analysis was conducted on data from 1794 single full-term pregnant women who gave birth. Newborns were grouped based on birth weight: Those with birth weight < 2.5 kg were classified as the low-weight group, and those with birth weight between 2.5 kg and 4 kg were included in the normal group. Multiple logistic regression analysis was used to identify the factors influencing the occurrence of full-term LBW. A risk prediction model was established based on the analysis results. The effectiveness of the model was analyzed using the Hosmer-Leme show test and receiver operating characteristic (ROC) curve to verify the accuracy of the predictions. RESULTS: Among the 1794 pregnant women, there were 62 cases of neonatal weight < 2.5 kg, resulting in an LBW incidence rate of 3.46%. The factors influencing full-term LBW included low maternal education level [odds ratio (OR) = 1.416], fewer prenatal examinations (OR = 2.907), insufficient weight gain during pregnancy (OR = 3.695), irregular calcium supplementation during pregnancy (OR = 1.756), and pregnancy hypertension syndrome (OR = 2.192). The prediction model equation was obtained as follows: Logit (P) = 0.348 × maternal education level + 1.067 × number of prenatal examinations + 1.307 × insufficient weight gain during pregnancy + 0.563 × irregular calcium supplementation during pregnancy + 0.785 × pregnancy hypertension syndrome - 29.164. The area under the ROC curve for this model was 0.853, with a sensitivity of 0.852 and a specificity of 0.821. The Hosmer-Leme show test yielded χ 2 = 2.185, P = 0.449, indicating a good fit. The overall accuracy of the clinical validation model was 81.67%. CONCLUSION: The occurrence of full-term LBW is related to maternal education, the number of prenatal examinations, weight gain during pregnancy, calcium supplementation during pregnancy, and pregnancy-induced hypertension. The constructed predictive model can effectively predict the risk of full-term LBW.

The Impact of Obesity on Childbirth Expectations.

INTRODUCTION: Positive childbirth expectations are crucial for fostering a positive labor experience and enhancing the health and well-being of both the woman and her newborn. However, the impact of obesity on childbirth expectations remains underexplored. We aim to assess childbirth expectations in women living with obesity to enhance perinatal care tailored to their specific needs. METHODS: Using an adapted version of the Childbirth Expectation Questionnaire (CEQ) in a nationwide online survey, we assessed expectations on childbirth of pregnant women living in Switzerland. We performed one-way analysis of variance and independent t tests to analyze associations between childbirth expectations and women's characteristics such as body mass index (BMI). Binomial logistic regressions estimated the likelihood of positive birth expectations occurring based on individual and contextual factors. RESULTS: In total, 961 pregnant women responded to the CEQ through social media. Increased BMI was associated with lower mean scores in overall birth expectations (P = .008), whereas women accompanied by midwives during pregnancy showed significantly increased mean scores (P < .001). Regression analysis revealed that women living with obesity were less likely to have positive expectations for their upcoming childbirth when compared with others (adjusted odds ratio [aOR], 0.63; 95% CI, 0.42-0.95; P = .027). Conversely, midwifery care and plans for nonclinical births were associated with increased positive childbirth expectations (aOR, 3.65; 95% CI, 2.11-6.32; P < .001 and aOR, 4.77; 95% CI, 3.37-6.74; P < .001, respectively). DISCUSSION: Women living with obesity exhibited significantly lower childbirth expectations compared with other women, impacting birth outcomes and satisfaction. Midwife involvement correlated with more positive expectations, emphasizing their role in improving women's realistic expectations and fostering well-being. Enhanced accessibility to models of care with midwifery continuity may be a crucial factor in promoting positive expectations among women living with obesity.

Exploring perinatal care and birth experiences in women with visual impairment: A retrospective study.

Globally, ~2.2 billion individuals suffer from visual impairment, with a large proportion of these individuals being women of reproductive age. This demographic often faces unique healthcare challenges, particularly during pregnancy, childbirth and the puerperium. However, despite the significant prevalence of visual impairment among women, there are only a limited number of studies available addressing their specific perinatal care needs. The present study aimed to fill this gap by exploring the perinatal experiences of women who are visually impaired, highlighting the existing care provisions and identifying areas for improvement. For this purpose, a retrospective study was conducted from January to June, 2021, involving 22 women with visual impairment who gave birth after 2005. The study participants were recruited through several organizations supporting individuals who are visually impaired and the participants completed a comprehensive electronic questionnaire designed to be accessible for individuals with visual impairments. The questionnaire covered demographical data, pregnancy, childbirth, puerperium period experiences and interactions with healthcare professionals. The participants included in the present study ranged in age from 29 to >35 years. The origins of their total or partial blindness varied. As shown by the results, ~45.5% of the participants considered they received equivalent levels of midwifery and gynecological care compared to women without visual impairments, and half of the participants reported that midwives and gynecologists were willing to provide such care. However, the majority (90.9%) indicated a lack of adequate knowledge among healthcare providers regarding the specific perinatal care needs of women who are visually impaired. These findings underscore the critical need for the specialized training for healthcare providers and the development of more inclusive, accessible healthcare practices to improve perinatal care for women who are visually impaired.

"It's just too far ": A qualitative exploration of the barriers and enablers to accessing perinatal care for rural Australian women.

PURPOSE: Rural women and their babies experience poorer perinatal outcomes than their urban counterparts and this inequity has existed for decades. This study explored the barriers and enablers that exist for rural women in Australia in accessing perinatal care. METHODS: A qualitative descriptive design, using reflexive thematic analysis, was employed. Semi-structured interviews were conducted in 2023 with women who had recently given birth in rural Victoria, Australia (n=19). A purposive sampling strategy was used, recruiting women via social media platforms from rural communities across the state. The Socioecological Model (SEM) was used as a framework to organise the findings. RESULTS: Study participants reported multilevel barriers and enablers to accessing perinatal care in their own communities. Intrapersonal factors included financial resources, transportation, self-advocacy, health literacy, rural stoicism, personal agency, and cost of care. Interpersonal factors included factors such as ineffective relationships, poor communication, and care provider accessibility. Organisational factors included inequitable distribution of services, under-resourcing of perinatal services in rural areas, technology-enabled care models and access to continuity of care. Community factors included effective or ineffective interprofessional or interorganisational collaboration. Policy factors included centralisation of perinatal care, lack of funded homebirth and midwifery care pathways and access to free perinatal care. CONCLUSION: Participants in this study articulated several key barriers influencing access to perinatal care in rural areas. These factors impede help-seeking behaviour and engagement with care providers, compounding the impact of rurality and isolation on perinatal outcomes and experience of care. Key enablers to accessing perinatal care in rural communities were also identified and included personal agency, health literacy, social capital, effective collaboration and communication between clinicians and services, technology enabled care and free perinatal care.

Identifying anticipated challenges when implementing group care: Context-analyses across seven countries to develop an anticipated challenges framework.

PROBLEM: Despite increasing interest in Group Care worldwide, implementation is challenging. BACKGROUND: Group Care is an evidence-based perinatal care model including three core components: health assessment, interactive learning, and community building. It has several advantages for service users and providers compared to individual perinatal care. AIM: We aimed to identify anticipated challenges when implementing Group Care, and to develop a supporting tool based on these challenges. METHODS: Context analyses through Rapid Qualitative Inquiries were conducted in 26 sites in seven countries to gain insight into the anticipated challenges when implementing Group Care. Data triangulation and investigator triangulation were applied. The context analyses generated 330 semi-structured interviews with service users and other stakeholders, 10 focus group discussions, and 56 review meetings with the research teams. FINDINGS: We identified six surface structure anticipated challenges categories (content, materials, facilitators, timing, location, group composition), and five deep structure anticipated challenges categories (health assessment, scheduling Group Care into regular care, enrolment, (possible) partner organisations, financials) occurring in all participating sites, leading to the development of the Anticipated Challenges Framework. CONCLUSION: Completing the Anticipated Challenges Framework raises awareness of anticipated challenges if sustainable Group Care implementation is to succeed and encourages the initiation of a concrete action plan to tackle these challenges. Application of the framework may offer important insights to health systems administrators and other key stakeholders before implementing Group Care. In the medium- and long-term, insights gained may lead to greater possibilities for sustainability and to the most cost-effective approaches for implementing Group Care.

Digital health in perinatal care: Exploring usage, attitudes, and needs among Swiss women in urban and rural settings.

Background: Switzerland's healthcare system is known for its quality but faces challenges such as slow digitalization and fragmentation, especially in perinatal care. This study investigates Swiss women's use, needs, and attitudes in respect of digital health tools during pregnancy and postpartum, focusing on any differences between rural and urban populations. Methods: A web-based cross-sectional survey targeted pregnant women and those who had given birth in the last 12 months. Participants were recruited through social media, and the data were analyzed using principal component analysis and multivariable regressions to explore factors affecting the use of digital tools and attitudes toward eHealth. Results: A total of 1160 participants completed the survey. Healthcare professionals (92%) and private networks (77%) were the primary sources of information. Women expressed a strong preference for app features such as data access (73%), prescription management (73%), and scheduling appointments with healthcare professionals (71%). However, they also raised concerns about the impersonal nature of digital healthcare interactions (71%). Overall, rural women had more negative attitudes toward online health information seeking, which can be attributed to differences in education levels. Conclusion: The findings indicate that while Swiss women in the perinatal period do utilize digital tools, they focus more on nonmedical topics such as tracking physiological development. The study underscores the importance of adapting digital health solutions to the specific needs of women in the perinatal period. Emphasis should be placed on developing applications that are not only informative but also empower women on their healthcare journey while ensuring data privacy and supporting personal interactions with healthcare providers.

Ohpikihâwasowin (grounding and guiding on the path to be a healthy parent): virtual adaptation of an Elders mentoring program to support maternal and child wellbeing during the COVID-19 pandemic.

BACKGROUND: The Elders Mentoring Program (EMP) is part of a strengths-based community-based participatory research partnership with the Cree communities of Maskwacîs, Alberta, Canada. The EMP objective is to promote maternal and child health through traditional Cree teachings and support from community Elders to pregnant women and their partners. During the COVID-19 pandemic, the Elders decided to shift the program to an online format in early 2021. The Elders continued to offer mentorship to program participants virtually by Zoom and telephone, and online workshops. The objective of this study was to qualitatively explore the experiences of women that took part in the virtual EMP. METHODS: We utilized qualitative description as our method, informed by our overarching community-led research partnership. Semi-structured phone interviews were conducted by Maskwacîs research assistants (RAs) with 11 women who participated in the virtual program. Interviews were conducted between December 2021 and June 2022. The participants were asked about their perceptions of the program and its benefits. The interviews were recorded, transcribed, and coded by four RAs using thematic analysis. RESULTS: Although cultural teachings are traditionally offered in person, the shift to the virtual platform was greatly appreciated by all the women. Technology can be a useful tool for cultural teachings and language to be shared among community members when they cannot be physically together. Four main themes emerged from the data, representing the participants' experiences, and learning through their interactions with the Elders from the EMP. The themes are: Ohpikihâwasowin (grounding and guiding on the path to be a healthy parent); Indigenous ways of healing; On the path of cultural learning; and Identity for self and baby. CONCLUSION: The virtual adaptation of the EMP allowed a space for Elders to offer support to women living in and out of the community to provide guidance with their pregnancies and into motherhood. The workshops and one-on-one calls allowed for cultural revitalization which is critical for Indigenous well-being. All the participants found that the teachings and interactions positively impacted their pregnancy and parenthood. Overall, the virtual program demonstrated a venue for intergenerational healing and resilience.