European Association of Perinatal Medicine (EAPM), European Board and College of Obstetricians and Gynaecologists (EBCOG), European Midwives Association (EMA). Joint position statement: Substandard and disrespectful care in labour - because words matter.

Substandard or disrespectful care during labour should be of serious concern for healthcare professionals, as it can affect one of the most important events in a woman's life. Substandard care refers to the use of interventions that are not considered best-practice, to the inadequate execution of interventions, to situations where best-practice interventions are withheld from patients, or there is lack of adequate informed consent. Disrespectful care refers to forms of verbal and non-verbal communication that affect patients' dignity, individuality, privacy, intimacy, or personal beliefs. There are many possible underlying causes for substandard and disrespectful care in labour, including difficulties in modifying behaviours, judgmental or paternalistic attitudes, personal interests and individualism, and a human tendency to make less arduous, less difficult, or less stressful clinical decisions. The term "obstetric violence" is used in some parts of the world to describe various forms of substandard and disrespectful care in labour, but suggests that it is mainly carried out by obstetricians and is a serious form of aggression, carried out with the intent to cause harm. We believe that this term should not be used, as it does not help to identify the underlying problem, its causes, or its correction. In addition, it is generally seen by obstetricians and other healthcare professionals as an unjust and offensive term, generating a defensive and less collaborative mindset. We reach out to all individuals and institutions sharing the common goal of improving women's experience during labour, to work together to address the underlying causes of substandard and disrespectful care, and to develop common strategies to deal with this problem, based on mutual comprehension, trust and respect.

Validity and reliability of the Greek version of Wijma delivery expectancy/experience questionnaire (Version A) among low-risk pregnant women.

BACKGROUND: Fear of childbirth is a frequent health issue for pregnant women. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is a widely used instrument to measure the fear of childbirth during the antenatal period. The aim of the study was to assess the psychometric properties of the W-DEQ (version A) in a sample of Greek pregnant women. METHODS: Low-risk pregnant women in the second or third trimester of pregnancy (N = 201) were invited to participate in the study and to complete a booklet of questionnaires including the Greek versions of W-DEQ-A, State-Trait Anxiety Inventory (STAI), Coping Orientations to Problems Experienced (Brief COPE), Perceived Stress Scale (PSS-10) and Edinburgh Postnatal Depression Scale (EPDS). Exploratory (EFA) and confirmatory factor analysis (CFA) was performed. RESULTS: The mean age of participants was 34.2 years (SD = 4.3 years). EFA yielded six factors ("Lack of self-efficacy", "Lack of positive anticipation", "Lack of feeling lonely", "Concerns about delivery and losing control", "Calmness", and "Concern for the child") of 33 items of W-DEQ-A. CFA confirmed the multidimensionality of the instrument. All Cronbach's alpha were over 0.7, indicating acceptable reliability of the factors. All factors were significantly correlated with each other, and convergent validity was demonstrated by a significant association with stress, anxiety, and depression among low-risk pregnant women. CONCLUSION: The Greek version of W-DEQ-A proved to be a valid and reliable instrument of fear of childbirth among Greek low-risk pregnant women.

Breastfeeding During Pregnancy: A Systematic Review of the Literature.

Objectives: Breastfeeding during pregnancy has unintended repercussions that have yet to be determined. Previous research employed various approaches and reached varied outcomes, with some emphasizing on advantages and others focusing on hazards. With this study we aim at shedding light on the effects of breastfeeding during pregnancy on the outcome of pregnancy and the risk of miscarriage. Materials and methods: We conducted a systematic review of relevant papers which have been published in English between 2014 and 2022 by using the PubMed, Scopus and Google Scholar search engines. Databases identified 257 records, which were checked for their relatedness to the topic (title and abstract), and compliance with the selection criteria. Only 10 records met all requirements and were included in the present review. Results:The results revealed that breastfeeding during pregnancy appeared to be unrelated to pregnancy outcome and miscarriage risk, notwithstanding the need for caution in women at risk of preterm birth and high-risk pregnancies. Conclusion:All studies recognized the high nutritional requirements of lactating pregnant women as well as the importance of proper nutrition for a safe breastfeeding for both the mother and child (children). Further research, with larger samples and adequate methodology, is expected to lead to safer conclusions for breastfeeding during pregnancy.

Social determinants of health and vaccine uptake during the first wave of the COVID-19 pandemic: A systematic review.

Social determinants of health significantly impact population health status. The aim of this systematic review was to examine which social vulnerability factors or determinants of health at the individual or county level affected vaccine uptake within the first phase of the vaccination program. We performed a systematic review of peer-reviewed literature published from January 2020 until September 2021 in Medline and Embase (Bagaria et al., 2022) and complemented the review with an assessment of pre-print literature within the same period. We restricted our criteria to studies performed in the EU/UK/EEA/US that report vaccine uptake in the general population as the primary outcome and included various social determinants of health as explanatory variables. This review provides evidence of significant associations between the early phases of vaccination uptake for SARS-CoV-2 and multiple socioeconomic factors including income, poverty, deprivation, race/ethnicity, education and health insurance. The identified associations should be taken into account to increase vaccine uptake in socially vulnerable groups, and to reduce disparities in uptake, in particular within the context of public health preparedness for future pandemics. While further corroboration is needed to explore the generalizability of these findings across the European setting, these results confirm the need to consider vulnerable groups and social determinants of health in the planning and roll-out of SARS-CoV-2 vaccination programs and within the context of future respiratory pandemics.

Can the Day of the Week and the Time of Birth Predict the Mode of Delivery According to Robson Classification?

Worldwide, the cesarean section rate has steadily increased from 6.7% in 1990 to 21.1% in 2018 and is expected to rise even more. The World Health Organization propose the adoption of the Robson classification system as a global standard for monitoring, evaluating, and comparing delivery rates. The purpose of the current study is to use the Robson classification system to investigate how, independently of medical factors, the day of the week and time of delivery may be related to the mode of birth. In the sample analysis, we included the records of 8572 women giving birth in one private health facility in Greece. Over 60% of deliveries during the study period were performed by cesarean section, 30.6% by vaginal delivery, and 8.5% of deliveries were performed by operative vaginal delivery. The results of this study indicate that the lowest birth rates are observed on Monday, Saturday, and Sunday. Nulliparous women with no previous cesarean delivery, with a singleton in cephalic presentation ≥37 weeks with spontaneous labor (group 1) are 73% more likely to deliver by cesarean section between 08:00 A.M. and 03:59 P.M. compared to those who give birth between 12:00 A.M. and 07:59 A.M. Also, multiparous women with a single cephalic term pregnancy and one previous cesarean section (group 5.1) are 16.7 times more likely to deliver by cesarean section in the morning compared to overnight deliveries. These results point out two non-clinical variables that influences the CS rate. The Robson classification system was a useful tool for the above comparisons.

Implementation of the Robson Classification in Greece: A Retrospective Cross-Sectional Study.

Cesarean sections have become the most commonly performed operations around the world. The World Health Organization recommended the use of the Robson classification system as a universal standard to establish a joint control system in healthcare facilities. The aim of this study was to implement the Robson classification for the first time in Greece to identify trends in cesarean births and examine the groups of women who are the main contributors to the increasing rates. Moreover, the indicators for cesarean sections will be evaluated as per the Robson classification. In the sample analysis, we included the records of 8572 women giving birth in one private health facility in Greece. A total of 8572 women gave birth during the study period, of which 5224 (60.9%) were cesarean section births and 3348 (39.1%) were vaginal births. In our study, according to the Robson classification, the largest contributors to the overall CS rate were as follows: (a) nulliparous women with a single cephalic term pregnancy, who were either labor induced or delivered by cesarean section before labor-Group 2 (34.6%); (b) multiparous women with a single cephalic term pregnancy and at least one previous cesarean section-Group 5 (30.7%); (c) women with a single cephalic preterm pregnancy-Group 10 (11.7%); (d) women with multiple pregnancies-Group 8 (7.0%). Our study is expected to assist policymakers in Greece in planning further interventions for each subgroup of women in order to reduce the overall CS rate and unnecessary CSs.

Pregnancy during the pandemic: The psychological impact of COVID-19 on pregnant women in Greece.

INTRODUCTION: The COVID-19 outbreak has affected the overall health of people worldwide. Historically, pandemics pose a challenge to psychological resilience, causing heightened stress levels. This study aimed to investigate the impact of the COVID-19 pandemic on the psychological state of pregnant women in Greece. METHODS: A survey study was conducted on a sample of 149 pregnant women in late 2020, including the 'fear of COVID-19' scale, a self-report instrument that assess fear of COVID-19 among the general population and the State-Trait Anxiety Inventory (STAI) scale which measures state and trait anxiety. RESULTS: Pregnant women with a mental health history tended to score higher on the 'fear of COVID-19' scale (mean ± SD: 19.48 ± 4.35) compared to pregnant women who had never had mental health problems before (17.12 ± 5.27). Moreover, pregnant women with anxiety as part of their personality tended to also score higher on the 'fear of COVID-19' scale. In all, 48.3% of pregnant women reported that their psychological state had been severely affected by the COVID-19 outbreak. CONCLUSIONS: Pregnant women were highly affected by the COVID-19 pandemic. A significantly increased 'fear of COVID-19' scale score was associated with self-reported pre-existence mental health conditions. Pregnant women with higher levels of 'trait anxiety' tended to report higher scores on the 'fear of COVID-19' scale.

Which classification system could empower the understanding of caesarean section rates in Greece? A review of systematic reviews.

INTRODUCTION: Worldwide there is an alarming increase in the caesarean delivery rate which has become a controversial topic. However, the reasons for this tendency are not clear. For example, in Greece alone, rates increased by almost 50% from 1983 to 1996. In order to better understand the causes of this phenomenon, we need to examine closely what groups of women undergo caesarean section (CS). To achieve this, it is essential to use a system that will enable us to monitor and compare caesarean delivery rates. Such a classification system should be easily adopted by obstetricians, midwives, and public health services. METHODS: A review search of electronic databases concerning medical care was held from December 2020 to January 2021 in order to find systematic reviews which describe either theoretical or practical CS classification systems. RESULTS: The most common classification systems fall into three main categories based on indication, urgency and maternal-based characteristics. According to users the highest rated classification system was women-based classifications in general. In particular the Robson Ten Group Classification System was considered to be the most valid to meet current local and international standards. The Robson classification system is praised for its robustness, simplicity, flexibility, and reproducibility. CONCLUSIONS: The right implementation of the Robson Ten Group Classification System can facilitate an in-depth analysis of the main groups that increase CS rates and can be used to both review and monitor delivery practices both in Greece and abroad.

A fuzzy intelligent system to assess midwives' burnout conditions.

INTRODUCTION: Midwives' burnout affects their effectiveness and the quality of the services they provide to pregnant women as well as the quality of the collaboration with medical staff. The burnout depends on a number of factors that can exhibit high variability over time. This creates the necessity of introducing intelligent approaches that assess changes in behavior, environmental factors, working conditions, and to make decisions to optimize the physical and mental health of midwives. The aim of this study was to employ fuzzy logic to design a Fuzzy Intelligent or Inference System (FIS) that assesses midwives' burnout level by emulating the reasoning of human experts. METHODS: The proposed FIS addresses the assessment of midwives' burnout comprehensively since it incorporates findings following a thorough analysis of the relevant literature, as well as assimilates experts' knowledge elicited through semi-structured interviews. Additionally, fuzzy rules are more intuitive and thus easier to understand and modify by human users than dealing and translating numerical results. The FIS performance is compared and evaluated against experienced midwives. RESULTS: Findings confirm the ability of the proposed FIS to produce judgments that are closer to experts' consensus, as expressed by their aggregated assessment. CONCLUSIONS: The proposed FIS is evaluated by comparing its results with judgments made by experts, suggesting that fuzzy logic allows precise and personalized assessment of midwives' burnout levels. The proposed FIS can be used to evaluate burnout, support organizations to develop burnout policies as well as used as a research instrument to investigate interrelationships of burnout factors.

Breast cancer and social relationship coping efficacy: validation of the Greek version.

The Social Relationship Coping Efficacy scale (SRCE) was designed to assess cancer patients' efficacy for maintaining social support and social relationships. The purpose of the study was to confirm the psychometric quality and utility of a Greek-language version of the (SRCE) scale. The study included 116 women with breast cancer, who underwent surgery at a public hospital In Greece. The SRCE scale was translated using standard procedures and then culturally adapted for use in Greece. Psychometric evaluation of the SRCE-Greek scale included reliability, structural validity and convergent validity analyses. The SRCE-Greek scale demonstrated strong internal consistency (Cronbach a 0.87), and split-half reliability (Spearman-Brown, 0.747; Guttman, 0.742). The structural construct validity was confirmed with factor analysis using principal axis factor analysis. Construct validity was further supported with convergent validity with the Family Crisis Oriented Personal Evaluation Scales (F-COPES) (Acquiring Social Support, Reframing) and Family Support scale. The Greek language SRCE has strong internal consistency reliability and construct validity, as well as satisfactory convergent validity. Results provide support for the use of the SRCE-GR as a research and clinical instrument for the assessment of breast cancer patient's self-efficacy with regard to maintaining and enhancing close social relationships and social support.