Increasing Realism and Variety of Virtual Patient Dialogues for Prenatal Counseling Education Through a Novel Application of ChatGPT: Exploratory Observational Study.

BACKGROUND: Using virtual patients, facilitated by natural language processing, provides a valuable educational experience for learners. Generating a large, varied sample of realistic and appropriate responses for virtual patients is challenging. Artificial intelligence (AI) programs can be a viable source for these responses, but their utility for this purpose has not been explored. OBJECTIVE: In this study, we explored the effectiveness of generative AI (ChatGPT) in developing realistic virtual standardized patient dialogues to teach prenatal counseling skills. METHODS: ChatGPT was prompted to generate a list of common areas of concern and questions that families expecting preterm delivery at 24 weeks gestation might ask during prenatal counseling. ChatGPT was then prompted to generate 2 role-plays with dialogues between a parent expecting a potential preterm delivery at 24 weeks and their counseling physician using each of the example questions. The prompt was repeated for 2 unique role-plays: one parent was characterized as anxious and the other as having low trust in the medical system. Role-play scripts were exported verbatim and independently reviewed by 2 neonatologists with experience in prenatal counseling, using a scale of 1-5 on realism, appropriateness, and utility for virtual standardized patient responses. RESULTS: ChatGPT generated 7 areas of concern, with 35 example questions used to generate role-plays. The 35 role-play transcripts generated 176 unique parent responses (median 5, IQR 4-6, per role-play) with 268 unique sentences. Expert review identified 117 (65%) of the 176 responses as indicating an emotion, either directly or indirectly. Approximately half (98/176, 56%) of the responses had 2 or more sentences, and half (88/176, 50%) included at least 1 question. More than half (104/176, 58%) of the responses from role-played parent characters described a feeling, such as being scared, worried, or concerned. The role-plays of parents with low trust in the medical system generated many unique sentences (n=50). Most of the sentences in the responses were found to be reasonably realistic (214/268, 80%), appropriate for variable prenatal counseling conversation paths (233/268, 87%), and usable without more than a minimal modification in a virtual patient program (169/268, 63%). CONCLUSIONS: Generative AI programs, such as ChatGPT, may provide a viable source of training materials to expand virtual patient programs, with careful attention to the concerns and questions of patients and families. Given the potential for unrealistic or inappropriate statements and questions, an expert should review AI chat outputs before deploying them in an educational program.

Antenatal care of women who use opioids: a qualitative study of practitioners' perceptions of strengths and challenges of current service provision in Scotland.

BACKGROUND: The increasing rise of women using opioids during pregnancy across the world has warranted concern over the access and quality of antenatal care received by this group. Scotland has particularly high levels of opioid use, and correspondingly, pregnancies involving women who use opioids. The purpose of this study was to investigate the different models of antenatal care for women using opioids during pregnancy in three Scottish Health Board Areas, and to explore multi-disciplinary practitioners' perceptions of the strengths and challenges of working with women who use opioids through these specialist services. METHODS: Thirteen semi-structured interviews were conducted with health and social care workers who had experience of providing antenatal and postnatal care to women who use drugs across three Scottish Health Board Areas: NHS Greater Glasgow and Clyde, NHS Lothian, and NHS Tayside. Framework Analysis was used to analyse interview data. The five stages of framework analysis were undertaken: familiarisation, identifying the thematic framework, indexing, charting, and mapping and interpretation. RESULTS: Each area had a specialist antenatal pathway for women who used substances. Pathways varied, with some consisting of specialist midwives, and others comprising a multidisciplinary team (e.g. midwife, mental health nurse, social workers, and an obstetrician). Referral criteria for the specialist service differed between health board areas. These specialised pathways presented several key strengths: continuity of care with one midwife and a strong patient-practitioner relationship; increased number of appointments, support and scans; and highly specialised healthcare professionals with experience of working with substance use. In spite of this, there were a number of limitations to these pathways: a lack of additional psychological support for the mother; some staff not having the skills to engage with the complexity of patients who use substances; and problems with patient engagement. CONCLUSIONS: Across the three areas, there appears to be high-quality multi-disciplinary antenatal services for women who use opioids during pregnancy. However, referral criteria vary and some services appear more comprehensive than others. Further research is needed into the perceptions of women who use opioids on facilitators and barriers to antenatal care, and provision in rural regions of Scotland.

Digital transformation of antenatal education: A descriptive exploratory study of women's experiences of online antenatal education.

PROBLEM: Research on how women experience online antenatal education is currently limited. A more nuanced understanding may assist organisations to tailor future digitalisation that best meets the needs of users. BACKGROUND: COVID-19 emergency measures forced a rapid implementation of online antenatal education. Women are known to enjoy some aspects of online antenatal education, but still desire social interaction. A marked digital divide is evident for more vulnerable populations. AIM: To explore how pregnant women experience an online antenatal education program. METHODS: A descriptive exploratory study was undertaken through collection of two concurrent data-sets. Quantitative data was collected from the online Parent Education Feedback Form (n = 38) Based on the six-stage process of Braun & Clarke, reflexive thematic analysis was used to analyse data sourced from semi-structured interviews with women (n = 5) who had undertaken online antenatal education. FINDINGS: Four themes, and eight associated sub-themes, were identified to better understand how women experience online antenatal education. The four primary themes identified were: Experiential Digital Learning; Desired Journey; Contemporary Representation; and Human Connection in the Digital Age. DISCUSSION: Well-designed digital platforms provide opportunities for interaction, content personalisation and self-tailored approaches in online antenatal education. Women require caregivers who hold specialist digital capabilities. Further research is warranted to better understand how digitalisation of antenatal education impacts women disadvantaged by digital exclusion. CONCLUSION: The digital transformation of antenatal education impacts a vast array of factors in women's experiences during pregnancy. A specialist skill-set from midwives is needed to champion quality antenatal education in the digital age.

Sífilis na gestação: conhecimento de gestantes e puérperas / Syphilis in pregnancy: knowledge of pregnant and puerperous women / Sífilis durante el embarazo: conocimientos de las mujeres embarazadas y puérperas

Objetivo: identificar o conhecimento de gestantes e puérperas acerca da sífilis. Método: pesquisa descritiva, com abordagem qualitativa. A coleta de dados ocorreu por meio de instrumento semiestruturado, entre abril a julho de 2021, com 18 gestantes/puérperas com diagnóstico de sífilis na gestação. As respostas foram gravadas e transcritas na íntegra, sendo utilizado para análise a técnica do Discurso do Sujeito Coletivo. Resultados: identificou-se três ideias centrais: 1) Conhecimento sobre a sífilis, 2) Buscando conhecimento sobre a sífilis e 3) Falsa prevenção. O conhecimento das participantes mostrou-se conflitante, pois algumas apresentaram algum conhecimento e outras nenhum, sendo que todas deveriam ter sido orientadas sobre a doença. Considerações finais: identificou-se uma falha no atendimento ofertado nos serviços de saúde. Assim, estratégias voltadas à educação em saúde devem ser incentivadas e implementadas no acompanhamento de pré-natal, ofertando a promoção e prevenção da saúde, a fim de reduzir os casos de sífilis na gestação.

Objective: to identify the knowledge of pregnant and postpartum women about syphilis. Method: descriptive research, with a qualitative approach. Data collection took place using a semi-structured instrument, between April and July 2021, with 18 pregnant/postpartum women diagnosed with syphilis during pregnancy. The responses were recorded and transcribed in full, using the Collective Subject Discourse technique for analysis. Results: three central ideas were identified: 1) Knowledge about syphilis, 2) Seeking knowledge about syphilis and 3) False prevention. The knowledge of the participants was conflicting, as some had some knowledge and others none, and all of them should have been educated about the disease. Final considerations: a flaw in the care offered in health services was identified. Therefore, strategies aimed at health education should be encouraged and implemented in prenatal care, offering health promotion and prevention, in order to reduce cases of syphilis during pregnancy.

Objetivos:identificar el conocimiento de las mujeres embarazadas y puérperas sobre la sífilis. Método: investigación descriptiva, con enfoque cualitativo. La recolección de datos se realizó mediante un instrumento semiestructurado, entre abril y julio de 2021, con 18 mujeres embarazadas/puérperas diagnosticadas con sífilis durante el embarazo. Las respuestas fueron grabadas y transcritas en su totalidad, utilizando para su análisis la técnica del Discurso del Sujeto Colectivo. Resultados: se identificaron tres ideas centrales: 1) Conocimiento sobre sífilis, 2) Búsqueda de conocimiento sobre sífilis y 3) Falsa prevención. El conocimiento de los participantes fue contradictorio, ya que algunos tenían algún conocimiento y otros ninguno, y todos deberían haber sido educados sobre la enfermedad. Consideraciones finales: se identificó una falla en la atención ofrecida en los servicios de salud. Por lo tanto, se deben fomentar e implementar estrategias orientadas a la educación en salud en la atención prenatal, ofreciendo promoción y prevención de la salud, con el fin de reducir los casos de sífilis durante el embarazo.

Enhancing antenatal education in Pakistan: an audit and recommendations.

BACKGROUND: Antenatal Education equips parents with knowledge for safe maternal health and infant care. It also reduces fear and anxiety during childbirth. ANE curriculum can vary according to country and institute. It can include classes focusing on childbirth, pain relief techniques, mode of birth, parenting, breastfeeding, breathing techniques, etc. Although ANE is widely practiced in developed countries, there is no standard program in developing countries like Pakistan. This study aims to improve antenatal education at a tertiary care hospital in Karachi, Pakistan potentially proposing an upgraded curriculum as a national standard. METHODS: This multiphase study used mix-method design was conducted in the Obstetrics and Gynaecology Department of a tertiary care hospital of Karachi, Pakistan from 2019 to 2021. Phase 1 of the study included reviewing and comparing the hospital's antenatal curriculum with existing literature, followed by Phase 2, which was a desk review of attendance and patient feedback. The 3rd phase involved IDIs (in depth interviews) from health care workers (Obstetrics experts) to understand their perspectives regarding the ANE and the conducted classes. For phase one, gaps were identified and reported theoretically. For phase two, the annual attendance was recorded and participants' satisfaction with the classes assessed. Qualitative data from phase 2 and 3 was converted into themes and sub-themes. RESULTS: The audit showed a decline in the attendance of antenatal classes due to the pandemic and consequent shift to online sessions. The low attendance in online courses could be attributed to various factors. Patient feedback was generally positive, with a majority expressing high satisfaction levels. Expert feedback highlighted the need for additional topics such as mental health and COVID in pregnancy, as well as fathers' involvement. The curriculum was updated to include these topics and made more interactive with printed handouts for parents. CONCLUSION: A standardized antenatal education covering various topics surrounding pregnancy, childbirth, and postnatal care must be available to parents nationwide.

Challenges and Strategies of Providing Effective Antenatal Education Services in Oman's Public Healthcare System: Perspectives of service providers and pregnant women.

Objectives: This study aimed to explore the challenges of providing quality antenatal education from the perspectives of the healthcare service providers and pregnant women. Globally, maternal mortality is considered a critical healthcare issue because statistics consistently show that many deaths and injuries that occur during pregnancy and childbirth are avoidable. Methods: This qualitative study was conducted from January 2021 to March 2021 at 9 outpatient antenatal clinics located in the public health centres of Muscat governorate, Oman. A purposive sampling technique was used, and data were collected through in-depth interviews and field notes and analysed manually using thematic analysis. Results: A total of 30 participants were included in this study. The challenges identified by the healthcare service providers included the lack of a consultation room and designated space for health education, work overload, time constraints, under-staffing, lack of educational materials, language barriers, lack of authority and negative attitude. The pregnant women identified lack of focus on women's needs, superficial antenatal education, overcrowding, lack of educational facilities, use of medical jargon and unprofessional staff attitude towards women as key barriers to receiving quality antenatal service. Suggested solutions included improving staffing levels, designating a space for antenatal education, expanding educational activities, continuing education for caregivers, establishing midwife-led units, providing focused antenatal education and improving communication between the providers and users. Conclusion: Both healthcare service providers and pregnant women experience significant barriers that hinder them from providing and accessing quality antenatal education services, respectively. Therefore, policymakers, health planners and hospital administrators should remove these barriers and integrate some of the recommendations in this study to promote better health outcomes.

Fostering childbirth education on upright positions and mobility during labor in nulliparous women.

BACKGROUND: Upright labor positions and movement during labor have a positive effect on childbirth, yet the predominant labor positions are still horizontal. Therefore, it is important to explore how it is possible to improve childbirth education, particularly its instructional design, to strengthen women's self-efficacy toward the use of upright positions and mobility during labor. The aim of the study was to evaluate the impact of an instructional approach based on a cognitive engagement ICAP (Interactive, Constructive, Active, Passive) framework on the development of knowledge, attitudes, and self-efficacy expectations toward upright positions and mobility during labor. METHODS: A prospective quasi-experimental study was conducted among nulliparous women from the ultra-orthodox Jewish community (n = 74). While the control group (n = 34) participated in routine childbirth education, the intervention group (n = 36) learned with childbirth education that included interactive and constructive cognitive engagement activities. Participants in both groups completed a set of questionnaires regarding knowledge, attitudes, and self-efficacy. RESULTS: The post-test analysis revealed that women in the intervention group compared to the control group gained significantly higher knowledge scores (p < 0.05), more positive attitudes (p < 0.001), and stronger self-efficacy expectations toward upright positions and mobility during labor (p < 0.01). CONCLUSIONS: The findings suggest that by fostering women's cognitive engagement levels during childbirth education toward the interactive and constructive modes of the ICAP framework, women's self-efficacy to move during labor and to use upright positions can be induced. These results can serve as a foundation to improve the overall effectiveness of childbirth instruction. TRIAL REGISTRATION: The study was registered retrospectively.

Mobile Prenatal Education and Its Impact on Reducing Adverse Pregnancy Outcomes: Retrospective Real-World Study.

BACKGROUND: Pregnancy is a pivotal phase in a woman's life, demanding special attention to ensure maternal and fetal health. Prenatal education plays a vital role in promoting healthy pregnancies and reducing adverse outcomes for pregnant women. Mobile prenatal education programs have gained traction due to their accessibility and timeliness, especially in light of finite health care resources and the constraints imposed by the COVID-19 pandemic. OBJECTIVE: This study aims to develop and evaluate the effectiveness of a mobile-based prenatal education program in improving pregnancy outcomes. METHODS: We developed a mobile-based prenatal education curriculum in collaboration with a multidisciplinary maternal care team from Peking Union Medical College Hospital (PUMCH) in Beijing, China. Data were retrospectively collected from 1941 pregnant women who had registered for the PUMCH mobile prenatal education program and subsequently delivered at PUMCH between May 2021 and August 2022. The study compared pregnancy outcomes between the completing group, which were pregnant women who had completed at least 1 course, and the noncompleting group. We also analyzed differences among course topics within the completing group and assessed course topic popularity among pregnant women. RESULTS: The PUMCH mobile prenatal education curriculum consists of 436 courses across 9 topics. Out of the participants, a total of 1521 did not complete any courses, while 420 completed at least 1 course. Compared with the noncompleting group, pregnant women who completed courses exhibited a significant reduction in the risk of gestational diabetes mellitus, induced abortion, postpartum infection, fetal intrauterine distress, and neonatal malformation. Among those in the completing group, a total of 86% (361/420) started course completion during the first and second trimesters. Furthermore, completing courses related to topics of pregnancy psychology and pregnancy nutrition was associated with reduced risks of premature rupture of membranes and small for gestational age infants, respectively. Pregnancy psychology and postpartum recovery were the preferred topics among pregnant women. CONCLUSIONS: The study demonstrates the potential of mobile-based prenatal education programs in improving pregnancy outcomes and supporting health care providers in delivering effective prenatal education. The rise of mobile prenatal education presents an opportunity to improve maternal and child health outcomes. Further research and broader implementation of such programs are warranted to continually improve maternal and child health.

Podcast RP Convida: O que o pediatra precisa saber sobre amamentação?

Primeiro episódio especial Agosto Dourado 2022 aborda o tema “O que o pediatra precisa saber sobre amamentação”. Este programa da série “RP Convida”, da revista Residência Pediátrica, conta com a participação da dra. Maria Beatriz Reinert do Nascimento, presidente do Departamento Científico de Aleitamento Materno da Sociedade Catarinense de Pediatria.

Women's experiences of changes to childbirth and parenting education in Australia during the COVID-19 pandemic: The birth in the time of COVID-19 (BITTOC) study.

OBJECTIVE: As changes to Childbirth and Parenting Education (CBPE) classes during the COVID-19 pandemic remain unexplored in Australia, our objective was to understand how changes to CBPE in Australia during the COVID-19 pandemic impacted on women's birth and postnatal experiences. METHODS: Survey responses were received from 3172 women (1343 pregnant and 1829 postnatal) for the 'Birth In The Time Of Covid-19 (BITTOC)' survey (August 2020 to February 2021) in Australia. One of the survey questions asked women if they had experienced changes to CBPE class schedules or format during the pandemic, with a follow up open ended text box inviting women to comment on the impact of these changes. The majority of women experienced changes to CBPE, with only 9 % stating they experienced no changes to classes. A content analysis was undertaken on the 929 open text responses discussing the impact these changes had on women's experience of pregnancy, birth and postpartum. RESULTS: 929 women (29 %) made 1131 comments regarding changes to CBPE classes during the pandemic. The main finding 'I felt so unprepared', highlights how women perceived the cessation or alteration of classes impacted their birth preparation, with many reporting an increased sense of isolation. Some women reported feeling 'It was good enough' with adequate provision of online classes, and others feeling 'I was let down by the system' due to communication and technological barriers. CONCLUSIONS: Results highlight the importance of ensuring continued provision of hybrid/online childbirth education models to enable versatility during times of crisis. Gaps in service provision, communication and resources for childbirth and parenting education need addressing.

Parental experiences of prenatal education when preparing for labor and birth of infant with a lethal diagnosis.

AIM: The aim of this study was to describe the unique experiences of parents facing a Life Limiting Fetal Conditions (LLFC) diagnosis, who chose to continue with their pregnancy, as they prepare for childbirth through individual and group prenatal education. DESIGN: A qualitative study. METHODS: We employed the phenomenological approach and the Colaizzi strategy to analyse semi-structured interviews. Thirteen persons were interviewed. The participants were couples (n = 6) and women (n = 7) who received LLFC and were preparing for birth. RESULTS: We described three main paths of prenatal education chosen by parents with LLFC: 'Searching for normality' concerned people participating in conventional prenatal classes (AC) who tried to avoid confronting the situation they faced; 'Searching for communitas' concerned the participation in special AC selected for the opportunity of sharing experiences; 'Searching for an individual way' concerned people who resorted to individual preparation for childbirth, often as a result of delayed planning. Parents should have a choice of various paths of birth preparation, that best meet their preferences.

Effect of goal-oriented prenatal education on birth preparedness, complication readiness and institutional delivery among semi-urban pregnant women in Nigeria: A quasi-experimental study.

BACKGROUND: High maternal mortality has been associated with inadequate Birth preparedness and Complication Readiness (BPCR) and non-institutional delivery in developing countries. Therefore, there is a need for proven interventions that will improve BPCR and institutional delivery to reduce maternal mortality. Therefore, this study evaluated the effects of Goal-Oriented Prenatal Education (GOPE) on pregnant women's BPCR and institutional delivery. METHODS: The study adopted a quasi-experimental two-group pre and post-test design. Two Local Government Areas (LGAs) were randomly selected from the six semi-urban LGAs in Ibadan. These LGAs were randomized into an intervention and control group. Two Primary Healthcare Centres (PHCs) were randomly selected from each LGA, and 400 pregnant women who registered for antenatal care in the selected PHCs, and met the inclusion criteria were purposively selected to participate in the study. A validated questionnaire and checklist were adapted for data collection at baseline and post-intervention. The pregnant women in the intervention group received GOPE focusing on knowledge and attitude to BPCR. Participants' place of birth was documented at delivery. Data were analyzed using descriptive statistics, and the Mann-Whitney U test at α0.05. RESULTS: Good knowledge of BPCR was found in 65.5% of pregnant women at baseline and 91.8% post-intervention. Good BPCR practice was found in 95.3% and 73.1% of women in the intervention and control groups respectively. At delivery, 93.5% and 53.5% had institutional delivery in the intervention and control groups respectively. A significant difference (p<0.001) was observed in BPCR knowledge and attitude post-intervention, as well as in BPCR practice and institutional delivery between women in the intervention and control group. CONCLUSIONS: Goal-oriented prenatal education improved birth preparedness and complication readiness as well as institutional delivery among pregnant women. This should be integrated into routine prenatal education in Nigeria.

The effect of prenatal education on fear of childbirth, pain intensity during labour and childbirth experience: a scoping review using systematic approach and meta-analysis.

BACKGROUND: Antenatal education provides parents with strategies for pregnancy, childbirth, and parenthood. There is not enough evidence of the positive effect of prenatal education on childbirth and maternal outcomes. The present scoping review using a systematic approach, evaluates the effectiveness of prenatal education on fear of childbirth, pain intensity during labour, childbirth experience, and postpartum psychological health. METHODS: We used Google Scholar and systematically reviewed databases such as PubMed, Web of Science, Cochrane, Scopus, and SID (Scientific Information Database). Randomized controlled and quasi-experimental trials examining the effect of structured antenatal education and routine prenatal care compared to routine prenatal care were reviewed. The participants included pregnant women preferring a normal vaginal delivery and had no history of maternal or foetal problems. The outcomes considered in this study included fear of childbirth, pain intensity during labour, childbirth experience (as primary outcomes) and postpartum psychological health (as secondary outcomes). The grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence. RESULTS: Overall, 3242 studies were examined, of which 18 were qualified for the final analysis. The meta-analysis showed that providing prenatal education and routine care compared to only routine care may decrease the fear of childbirth, postpartum depression, and pain intensity during labour. However, we found no study examining the outcome of the childbirth experience. In addition, the inconsistency of included studies prevented conducting a meta-analysis on the rest of the outcomes. CONCLUSIONS: Our investigations showed that there are very few or no studies on the effect of prenatal education on outcomes such as childbirth experience, postpartum anxiety, and maternal attachment, and the existing studies on the effect of prenatal education on outcomes such as the fear of childbirth, postpartum depression, and pain intensity during labour lack sufficient quality to make definitive conclusions. Therefore, high-quality, randomized trials with a more extensive sample size are suggested to provide clear reports to make definitive decisions. PROSPERO ID: CRD42022376895.

Effects of mindfulness-based childbirth education on prenatal anxiety: A quasi-experimental study.

Pregnancy and childbirth represent a sequence of challenging events, and adaptive coping strategies are necessary to maintain emotional wellbeing. The present study aimed to assess the effectiveness of applying a mindfulness-based intervention (MBI) for pregnant Saudi women with anxiety in the third trimester. A quasi-experimental, within- and between-subject design was used for this study. Data were collected at two points between February and August 2021 from 88 participants using the Pregnancy-Related Anxiety Questionnaire and the Five Facet Mindfulness Questionnaire. A large, statistically significant reduction was observed in the mean scores of participants' anxiety post-intervention. Furthermore, the anxiety level in the intervention group was very low post-intervention compared to that in the control group. Level of education and spontaneous or medically necessary abortion significantly influenced participants' anxiety. The MBI sessions helped nulliparous women experience less anxiety during pregnancy. Healthcare providers' awareness about the importance of incorporating mindfulness in childbirth education should be increased. Future research should examine the long-term effects of mindfulness-based techniques on maternal health.

The Effect of Clinical Pilates Exercises and Prenatal Education on Maternal and Fetal Health.

OBJECTIVE: The mental, physical and sexual health of women as well as maternal and fetal health should be considered during the prenatal and postnatal periods. Investigating the effect of clinical Pilates exercises and prenatal education (CPE & PE) on obstetric and neonatal outcomes as well as the mental, physical, and sexual health of women was intended. METHODS: In the second trimester, mothers with singleton pregnancies who attended (n=79, study group) or did not attend (n=80, control group) CPE & PR were recruited to this prospective cohort study, and were evaluated in the prenatal and postnatal periods. Depression was assessed with Beck Depression Inventory (BDI), sexual functions with Female Sexual Function Index (FSFI), muscle strength with Gross Muscle Scales (GMS), and labor pain with Visual Analogue Scale (VAS). In addition, the presence of low back pain (LBP) was questioned. RESULTS: No significant association of CPE & PE with obstetric outcomes such as cesarean rates, preterm birth, and neonatal outcomes such as birth weight and Apgar scores were identified. Changes in VAS scores, the incidence of perineal trauma, and episiotomy were not associated with CPE & PE. However, CPE & PE was associated with lower BDI scores, a gradual increase in the total scores of FSFI, increased GMS, and reduced LBP. CONCLUSION: CPE & PE had no adverse effects on obstetric and neonatal outcomes and was associated with improved mental, physical, sexual health scores during pregnancy and postpartum.

Preferences for labor and childbirth, expressed orally or as a written birth plan: Prevalence and determinants from a nationwide population-based study.

BACKGROUND: Shared decision-making is an important component of a patient-centered healthcare system. We assessed the prevalence of parturients with preferences for their labor and childbirth, expressed verbally in the birthing room or as a written birth plan, and studied maternal, obstetric, and organizational factors associated with their expression. METHODS: Data came from the 2016 National Perinatal Survey, a cross-sectional nationwide population-based survey conducted in France. Preferences for labor and childbirth were studied in three categories: expressed verbally, in writing (birth plan), or unexpressed or nonexistent. Analyses used multinomial multilevel logistic regression. RESULTS: The analysis included 11,633 parturients: 3.7% had written a birth plan, 17.3% expressed their preferences verbally, and 79.0% either did not have or did not express any preferences. Compared with the latter group, written or verbal preferences were both significantly associated with prenatal care by independent midwives (respectively, adjusted odds ratio (aOR) 2.19; 95% confidence interval (CI), [1.59-3.03], and aOR 1.43; 95% CI [1.19-1.71]) and with attendance at childbirth education classes (respectively, aOR 4.99; 95% CI [3.49-7.15], and aOR 2.27; 95% CI [1.98-2.62]). As years in traditional schooling increased, so did its association with preferences. Conversely, parturients from African countries were significantly less likely than French mothers to express preferences. A written birth plan was also associated with characteristics of maternity unit organization. CONCLUSION: Only one in five parturients reported having expressed preferences for labor and childbirth to healthcare professionals in the birthing room. This expression of preferences was associated with maternal characteristics and the organization of care.

An interactive childbirth education platform to improve pregnancy-related anxiety: a randomized trial.

BACKGROUND: Perinatal anxiety is one of the most common conditions during pregnancy and is associated with adverse maternal and neonatal outcomes. Interventions that are focused on childbirth education and health literacy have been shown to help decrease pregnancy-related anxiety. These programs, however, have limitations. Transportation, childcare, and work conflicts pose barriers to patients. In addition, many of these programs have not been studied in high-risk patients, who are most at risk for pregnancy-related anxiety. Thus, it is uncertain whether an online childbirth education course can help to improve outcomes in a high-risk patient population. OBJECTIVE: This study aimed to compare an interactive online platform for childbirth education (Birthly) with usual prenatal education on anxiety, emergency healthcare utilization, and delivery outcomes for high-risk pregnancies. STUDY DESIGN: We performed a randomized trial comparing an interactive online childbirth education platform combined with usual prenatal education (intervention) with usual prenatal education alone (usual care). Nulliparous, English-speaking patients with internet access and a high-risk pregnancy (medical or mental health disorders) were included. Patients in 2 urban clinics that serve underresourced patients were enrolled at <20 weeks of gestation. The intervention included 3 interactive courses (prenatal bootcamp, breastfeeding, newborn care) and access to a clinician-moderated online community. Pregnancy-related Anxiety Scale questionnaires were administered at randomization and at 34 to 40 weeks. The primary outcome was third-trimester Pregnancy-related Anxiety Scale score. Secondary outcomes included change in Pregnancy-related Anxiety Scale score, unscheduled emergency visits, delivery, and postpartum outcomes. To demonstrate a 15% decrease in Pregnancy-related Anxiety Scale score, 37 patients would be needed per group. Accounting for a 20% loss to follow-up rate, we planned to recruit 90 total patients or 45 per group. RESULTS: A total of 90 patients were randomized with no differences in demographics or baseline Pregnancy-related Anxiety Scale scores. Most patients self-identified as Black and were publicly insured. More than 60% of patients (62.2%) in the intervention arm completed at least 1 Birthly course. Patients in the intervention arm had significantly lower third-trimester Pregnancy-related Anxiety Scale scores (indicating lower anxiety) compared with those receiving usual care (44.6±7.3 vs 53.9±13.8; P<.01), with a decrease in score of 8.3 points vs 0.7 for usual care (P<.01). Patients in the intervention arm also had fewer emergency visits (1 [0-2] vs 2 [1-3]; P=.003). There were no differences in delivery outcomes. Patients in the intervention arm were more likely to breastfeed at delivery, although this was not different by the postpartum visit. Finally, patients who received the intervention were more likely to be satisfied with their childbirth education (94.6% vs 64.9%; P<.01). CONCLUSION: An interactive online childbirth education platform can reduce pregnancy-related anxiety and emergency healthcare utilization while improving satisfaction in a high-risk patient population.

Associations between antenatal education program and mental health outcomes in Taiwan: A population-based cohort study.

Universal antenatal education has been offered to expectant mothers in Taiwan since 2014. Depression screening is included in the offered education sessions. This study aimed to examine the association of antennal education and depression screening with mental health outcomes, including perinatal depression diagnosis and psychiatrist visits. Data was obtained from the antenatal education records and Taiwan's National Health Insurance claims database. A total of 789,763 eligible pregnant women were included in the current study. The psychiatric-related outcomes were measured between antenatal education and the six-month after delivery. It was found that the antenatal education was widely used in Taiwan, and the attendance rate has increased to 82.6% since its launch. The attenders were more likely to be from disadvantaged backgrounds, and 5.3% of them were screened positive for depressive symptoms. They were also more likely to visit a psychiatrist but less likely to be diagnosed with depression than the non-attenders. Factors including young age, high healthcare utilization, and comorbid psychiatric disorder history were consistently associated with depression symptoms, perinatal depression diagnoses and psychiatrist visits. Further research is needed to understand the reasons for the nonattendance at antenatal education programmes and the barriers to utilizing mental health services.

"You are either with me on this or not": A meta-ethnography of the influence birth partners and care-providers have on coping strategies learned in childbirth education and used by women during labour.

BACKGROUND: Childbirth education, which includes providing information and practical techniques to help manage childbirth, aims to support women and their birth partners. It is unknown how birth partners and care providers influence the utilisation of childbirth education information and techniques during women's labour and birth. AIM: To explore the literature that investigates the influence that birth partners and care-providers have on the application of childbirth education information and techniques used by women during childbirth. METHODS: A meta-ethnography was performed using a systematic synthesis of reciprocal translation and refutational investigation. There were 22 papers included in the final synthesis. Quality appraisal was undertaken using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBIQARI) quality appraisal tool for qualitative studies. FINDINGS: An over-arching theme of 'you are either with me on this or not' emerged from the data, which expressed the positive and negative influences on the use of childbirth education information and techniques during labour and birth. The influence of birth partners was captured in the themes 'stepping up to their full potential' and 'a spare part'. The themes 'in alignment with the woman' and 'managed by another' were conceptualised from the data in relation to care-providers' influence. A theme, 'the right fit', described organisational and contextual influences. CONCLUSION: Birth partners and care-providers who are present during a woman's labour have significant potential to influence her use of childbirth education strategies in labour, which provides important insights for translation of evidence into practice.