Psychometric Evaluation of the Persian Version of the Childbirth Experience Questionnaire (CEQ).

Women's childbirth experience is an outcome indicator for evaluating maternity care. This study evaluated the psychometric properties of the Persian version of the Childbirth Experience Questionnaire (P-CEQ). The study recruited two hundred and fifty primiparous postpartum women in the 1-3 months following birth from one private and three public hospitals in Mazandaran province, Iran. First, face validity and content validity were evaluated. Moreover, confirmatory factor analysis (CFA) was conducted, and discriminant validity was assessed by applying the known-groups method. Intraclass correlation coefficient (ICC) was measured to confirm the stability and Cronbach's alpha to confirm the internal consistency. CFA also confirmed the values of fit indices (RMSEA = 0.05, SRMSR = 0.06, CFI >0.93, χ 2/df = 1.80). ICC was 0.88 and Cronbach's alpha for all items was 0.85. Furthermore, discriminant validity of the P-CEQ was approved given that it effectively differentiated women whose stay in the labor unit exceeded twelve hours from those with a shorter stay. The P-CEQ questionnaire is a valid and reliable tool for assessing childbirth experiences. It is an easy-to-use questionnaire that can be used for evaluating quality of care in terms of women's childbirth experience. It can be used in maternity services that aim to improve quality of care during labor and childbirth.

Obstetrical Unit Response to the COVID-19 Pandemic: OUR Study.

OBJECTIVE: This study aimed to describe the response of labor and delivery (L&D) units in the United States to the novel coronavirus disease 2019 (COVID-19) pandemic and determine how institutional characteristics and regional disease prevalence affect viral testing and personal protective equipment (PPE). STUDY DESIGN: A cross-sectional survey was distributed electronically through the Society for Maternal-Fetal Medicine e-mail database (n = 584 distinct practices) and social media between April 14 and 23, 2020. Participants were recruited through "snowballing." A single representative was asked to respond on behalf of each L&D unit. Data were analyzed using Chi-square and Fisher's exact tests. Multivariable regression was performed to explore characteristics associated with universal testing and PPE usage. RESULTS: A total of 301 surveys (estimated 51.5% response rate) was analyzed representing 48 states and two territories. Obstetrical units included academic (31%), community teaching (45%) and nonteaching hospitals (24%). Sixteen percent of respondents were from states with high prevalence, defined as higher "deaths per million" rates compared with the national average. Universal laboratory testing for admissions was reported for 40% (119/297) of units. After adjusting for covariates, universal testing was more common in academic institutions (adjusted odds ratio [aOR] = 1.73, 95% confidence interval [CI]: 1.23-2.42) and high prevalence states (aOR = 2.68, 95% CI: 1.37-5.28). When delivering asymptomatic patients, full PPE (including N95 mask) was recommended for vaginal deliveries in 33% and for cesarean delivery in 38% of responding institutions. N95 mask use during asymptomatic vaginal deliveries remained more likely in high prevalence states (aOR = 2.56, 95% CI: 1.29-5.09) and less likely in hospitals with universal testing (aOR = 0.42, 95% CI: 0.24-0.73). CONCLUSION: Universal laboratory testing for COVID-19 is more common at academic institutions and in states with high disease prevalence. Centers with universal testing were less likely to recommend N95 masks for asymptomatic vaginal deliveries, suggesting that viral testing can play a role in guiding efficient PPE use. KEY POINTS: · Heterogeneity is seen in institutional recommendations for viral testing and PPE.. · Universal laboratory testing for COVID-19 is more common at academic centers.. · N95 mask use during vaginal deliveries is less likely in places with universal testing..

Perceptions of midwives on the quality of emergency obstetric care at hospitals in Ethiopia: A qualitative explanatory study.

BACKGROUND: In Ethiopia, maternal mortality remains an important public health concern. High maternal mortality is attributed in part to the poor quality of obstetric care. This study was designed to investigate perceptions of midwives about the quality of emergency obstetric care provided at hospitals in the Harari region of Ethiopia. METHODS: An explanatory qualitative study was conducted from December 2018 to February 2019 at public and private hospitals in the Harari region, Ethiopia. The data were obtained through in-depth interviews with 12 midwives working in maternity units. The interviewers took notes and audio-recorded the respondents' descriptions. Braun and Clarke's thematic analysis method was employed to analyse the data using Nvivo 12 qualitative data analysis software. RESULTS: Poorly designed infrastructure, including a scarcity of beds, rooms and ambulances challenged the provision of quality obstetric services. Midwives working at hospitals were inadequate in number and training opportunities were scarce. Language barriers affected effective communication between patients and caregivers. Frequent disruptions to medical supplies resulted in the provision of suboptimal obstetric care as it created an inability to provide appropriate medications. A lack of treatment protocols, poor supportive supervision, and poor staff motivation impaired the provision of quality obstetric care at hospitals, although disparities were observed among hospitals in this regard. CONCLUSIONS: Several interdependent factors limited the quality of emergency obstetric care at hospitals in the region. Quality improvement initiatives and equitable resource distribution for hospitals need to be enhanced while the existing health infrastructure, resources and service delivery management need to be strengthened.

Culture of patient safety in hospital units of gynecology and obstetrics: a cross-sectional study.

OBJECTIVES: to assess the patient safety culture of the health team working in three maternity hospitals. METHODS: observational, cross-sectional, comparative study. 301 professionals participated in the study. The Hospital Survey on Patient Safety Culture questionnaire validated in Brazil was used. For data analysis, it was considered a strong area in the patient safety culture when positive responses reached over 75%; and areas that need improvement when positive responses have reached less than 50%. To compare the results, standard deviation and thumb rule were used. RESULTS: of the 12 dimensions of patient safety culture, none obtained a score above 75%, with nine dimensions scoring between 19% and 43% and three dimensions between 55% and 57%. CONCLUSIONS: no strong dimensions for safety culture were identified in the three maternity hospitals. It is believed that these results may contribute to the development of policies that promote a culture of safety in institutions.

Patient safety culture in the maternal-child area of a university hospital.

OBJECTIVE: To describe the safety culture of the patient from the perspective of nurses and physicians working in the maternal-child area. METHOD: A cross-sectional study conducted from January to September 2018 with 41 professionals of the Obstetrics Center and obstetric hospitalization of a university hospital in the south of the country. The Hospital Survey on Patient Safety Culture was used, with 12 dimensions of the safety culture, measured by means of a general score (0 to 10) and of positive answer percentages to assess strengths and weaknesses. RESULTS: The action of supervisors/bosses can be considered a strength of patient safety, with 78.2% of positive answers; already regarding communication, it was considered a fragility, punctuating 13.24%. The general safety grade of the patient assigned to the work's unit was very good, in a confidence interval of 95%. CONCLUSION: With the identification of the strengths and weaknesses of patient safety, it is possible to plan improvement actions. We emphasize that the non-punitive approach is essential.

Midwives' experiences as preceptors and the development of good preceptorships in obstetric units.

OBJECTIVE: To study midwives' experience in their role as a preceptor and their perception on how to best support midwifery students in obstetrics units. Obstetric units are an important learning area for student midwives but knowledge on how to become a good midwife preceptor is limited. DESIGN: This qualitative study explores midwife preceptors' experience of supervising midwifery students in three obstetric units in Sweden. Following ethical approval seventeen midwife preceptors were interviewed and data were analysed thematically. FINDINGS: Thematic analysis of the interviews resulted in the identification of two themes and five subthemes: (1) self-efficacy in the preceptor role which involves (a) being confident in the professional position and (b) having the support of management and colleagues and (2) supporting the student to attain self-confidence and independence which entails (a) helping the student to grow, (b) facilitating reflection in learning situations, and (c) "taking a step back". KEY CONCLUSION: Good preceptorship occurs when midwives achieve full self-efficacy, when they master the preceptor role, and when they have enhanced their abilities to help, the student reach confidence and independence. IMPLICATIONS FOR PRACTICE: Health care organisations needs to develop and support midwifery preceptorships.

Patients experiences after hospitalization at Gynecologic Obstetrics Department: Identifying parts for improvement.

OBJECTIVE: Evaluation of the quality of the hospital care at individual departments of the clinic from the patient's perspective using a standard questionnaire. DESIGN: Retrospective observational studies. SETTING: 2nd Department of Obstetrics and Gynecology, University hospital Bratislava, Faculty of Medicine, Comenius University Bratislava, Slovakia. MATERIAL AND METHODS: In the study we included all patients who were hospitalized in II. GPK from 1. 1. 2019 to 1. 3. 2019. When the patient was released, they received a HCAHPS questionnaire. Obtained results were statistically processed and compared with publicly available data from all USA hospitals. RESULTS: We received 481 questionnaires suitable for processing. 53.2% of patients evaluated the clinic as the best possible. 57.4% of patients would definitely recommend the clinic to their family and friends. The biggest difference between patients who rated the clinic as the best and those who rated it low were in nurse communication (OR: 6.19, CI: 4.46-8.63). At maternity ward we haven't found any statistical effect in impact of age, but in nurses communication, pain management, communiation about medicines we found significant statistical differences in impact of different education between women. CONCLUSION: The quality of nurses and doctors communication and instructing patients about medication has a significant impact on the clinic's evaluation. Women with university education at maternity ward evaluate quality of hospital care stricter, regardles of age.

Recomendaciones de la Sociedad Española de Reumatología sobre síndrome antifosfolípido primario. Parte II: síndrome antifosfolípido obstétrico y situaciones especiales / Recommendations of the Spanish Rheumatology Society for Primary Antiphospholipid Syndrome. Part II: Obstetric Antiphospholipid Syndrome and Special Situations

OBJETIVO: La dificultad para el diagnóstico y la variedad de manifestaciones clínicas que pueden determinar la elección del tratamiento del síndrome antifosfolípido (SAF) primario ha impulsado a la Sociedad Española de Reumatología (SER) en la elaboración de recomendaciones basadas en la mejor evidencia posible. Estas recomendaciones pueden servir de referencia para reumatólogos y otros profesionales implicados en el manejo de pacientes con SAF. MÉTODOS: Se creó un panel formado por 4 reumatólogos, una ginecóloga y una hematóloga, expertos en SAF, previamente seleccionados mediante una convocatoria abierta o por méritos profesionales. Las fases del trabajo fueron: identificación de las áreas claves para la elaboración del documento, análisis y síntesis de la evidencia científica (utilizando los niveles de evidencia de SIGN, Scottish Intercollegiate Guidelines Network) y formulación de recomendaciones a partir de esta evidencia y de técnicas de «evaluación formal» o «juicio razonado». RESULTADOS: Se han elaborado 46 recomendaciones que abordan 5áreas principales: diagnóstico y evaluación, medidas de tromboprofilaxis primaria, tratamiento del SAF o tromboprofilaxis secundaria, tratamiento del síndrome antifosfolípido obstétrico y situaciones especiales. Está incluido también el papel de los nuevos anticoagulantes orales, el problema de las recurrencias o los principales factores de riesgo identificados en estos individuos. En este documento se reflejan las últimas 25, referidas a las áreas de: SAF obstétrico y situaciones especiales. El documento contiene una tabla de recomendaciones y algoritmos de tratamiento. CONCLUSIONES: Se presentan las recomendaciones de la SER sobre SAF. Este documento corresponde a la parte 2.ª relacionada con el SAF obstétrico y las situaciones especiales. Estas recomendaciones se consideran herramientas en la toma de decisiones para los clínicos, teniendo en consideración tanto la decisión del médico experto en SAF como la opinión compartida con el paciente. Se ha elaborado también una parte I que aborda aspectos relacionados con el diagnóstico, evaluación y tratamiento

OBJECTIVE: The difficulty in diagnosis and the spectrum of clinical manifestations that can determine the choice of treatment for antiphospholipid syndrome (APS) has fostered the development of recommendations by the Spanish Society of Rheumatology (SER), based on the best possible evidence. These recommendations can serve as a reference for rheumatologists and other specialists involved in the management of APS. METHODS: A panel of 4rheumatologists, a gynaecologist and a haematologist with expertise in APS was created, previously selected by the SER through an open call or based on professional merits. The stages of the work were: identification of the key areas for the document elaboration, analysis and synthesis of the scientific evidence (using the Scottish Intercollegiate Guidelines Network, SIGN levels of evidence) and formulation of recommendations based on this evidence and formal assessment or reasoned judgement techniques (consensus techniques). RESULTS: Forty-six recommendations were drawn up, addressing 5 main areas: diagnosis and evaluation, measurement of primary thromboprophylaxis, treatment for APS or secondary thromboprophylaxis, treatment for obstetric APS and special situations. These recommendations also include the role of novel oral anticoagulants, the problem of recurrences or the key risk factors identified in these subjects. This document reflects the last 25, referring to the areas of: obstetric APS and special situations. The document provides a table of recommendations and treatment algorithms. CONCLUSIONS: Update of SER recommendations on APS is presented. This document corresponds to part II, related to obstetric SAF and special situations. These recommendations are considered tools for decision-making for clinicians, taking into consideration both the decision of the physician experienced in APS and the patient. A part I has also been prepared, which addresses aspects related to diagnosis, evaluation and treatment

Recomendaciones para la prevención de la infección y el control de la enfermedad por coronavirus 2019 (COVID-19) en la paciente obstétrica / No disponible

No disponible

Knowledge management infrastructure to support quality improvement: A qualitative study of maternity services in four European hospitals.

The influence of multilevel healthcare system interactions on clinical quality improvement (QI) is still largely unexplored. Through the lens of knowledge management (KM) theory, this study explores how hospital managers can enhance the conditions for clinical QI given the specific multilevel and professional interactions in various healthcare systems. The research used an in-depth multilevel analysis in maternity departments in four purposively sampled European hospitals (Portugal, England, Norway and Sweden). The study combines analysis of macro-level policy documents and regulations with semi-structured interviews (96) and non-participant observations (193 hours) of hospital and clinical managers and clinical staff in maternity departments. There are four main conclusions: First, the unique multilevel configuration of national healthcare policy, hospital management and clinical professionals influence the development of clinical QI efforts. Second, these different configurations provide various and often insufficient support and guidance which affect professionals' action strategies in QI efforts. Third, hospital managers' opportunities and capabilities for developing a consistent KM infrastructure with reinforcing enabling conditions which merge national policies and guidelines with clinical reality is crucial for clinical QI. Fourth, understanding these interrelationships provides an opportunity for improvement of the KM infrastructure for hospital managers through tailored interventions.

Facility preparedness for an obstetric unit during the Covid-19 pandemic.

Covid-19 infection has placed health systems under unprecedented strain and foresight for preparedness is the key factor to avert disaster. Every facility that provides obstetric service needs a certain level of preparedness to be able to handle at least Covid-suspect pregnant women awaiting test reports, who need to be managed as Covid-positive patients till reports are available. Thus, these facilities need to have triage areas and Covid-suspect labour rooms. Healthcare facilities can have designated areas for Covid-positive patients or have referral linkages with designated Covid-positive hospitals. Preparation includes structural reorganization with setting up a Covid-suspect and Covid-positive facility in adequate space, as well as extensive training of staff about infection control practices and rational use of personal protective equipment (PPE). A systematic approach involving five essential steps of making standard operating procedures, infrastructural reorganization for a triage area and a Covid-suspect labour ward, procurement of PPE, managing the personnel and instituting appropriate infection control practices can ensure uninterrupted services to patients without compromising the safety of healthcare providers.

Incidence of maternal near miss among women in labour admitted to hospitals in Ethiopia.

OBJECTIVES: To assess the incidence of maternal near miss and contributing factors among hospitals in Ethiopia. The study also assessed the ability of hospitals to provide signal functions of emergency obstetric care and its regional distribution. DESIGN: A national dataset accessed from the Ethiopian Public Health Institute were analysed to assess the incidence of maternal near miss and mortality index among women admitted to hospitals with obstetric complications. SETTING: Maternal health indicators including obstetric complications, maternal deaths and births conducted at all hospitals available in Ethiopia were included. MEASUREMENTS: The maternal near miss incidence ratio, which is the number of near miss cases per 1,000 live births, and the mortality index were presented descriptively. Chi-squared test at p value ≤ 0.05 was used to assess the presence of significant regional differences of the provision of signal functions of emergency obstetric care. RESULTS: In 2015, 78,195 women were admitted to hospitals with both the direct (68,002) and indirect (10,193) causes of maternal mortality. Of women who experienced the direct causes, 435 died which means there were 67,567 maternal near miss cases. In the same year, 323,824 live births were reported in hospitals, making the crude maternal near miss incidence ratio of 20.8% (9.1-38.8%) and mortality index of 0.64% (435/68,002) for the direct causes of maternal mortality. A significant regional variation was observed with regard to incidence of maternal near miss, mortality index and the provision of signal functions of emergency obstetric care. Administration of parenteral antibiotics was the most frequently practiced signal function of emergency obstetric care while blood transfusion was the least provided signal function. CONCLUSIONS: In Ethiopian hospitals, the incidence of maternal near miss was unacceptably high. A significant regional variation was detected with regard to maternal near miss incidence ratio, mortality index and the provision of signal functions of emergency obstetric care. The Ethiopian government needs to work on equitable resource distribution and quality improvement initiatives in order to close the detected regional variations. IMPLICATIONS FOR PRACTICE: The Ethiopian government needs to practice evidence-based maternal health strategies, including capacity building of the regional hospitals in order to improve the distribution of resources and quality of maternal health.

Culture of patient safety in hospital units of gynecology and obstetrics: a cross-sectional study / Cultura de seguridad del paciente en unidades hospitalarias de ginecología y obstetricia: estudio transversal / Cultura de segurança do paciente em unidades hospitalares de ginecologia e obstetrícia: estudo transversal

ABSTRACT Objectives: to assess the patient safety culture of the health team working in three maternity hospitals. Methods: observational, cross-sectional, comparative study. 301 professionals participated in the study. The Hospital Survey on Patient Safety Culture questionnaire validated in Brazil was used. For data analysis, it was considered a strong area in the patient safety culture when positive responses reached over 75%; and areas that need improvement when positive responses have reached less than 50%. To compare the results, standard deviation and thumb rule were used. Results: of the 12 dimensions of patient safety culture, none obtained a score above 75%, with nine dimensions scoring between 19% and 43% and three dimensions between 55% and 57%. Conclusions: no strong dimensions for safety culture were identified in the three maternity hospitals. It is believed that these results may contribute to the development of policies that promote a culture of safety in institutions.

RESUMEN Objetivos: evaluar la cultura de seguridad del paciente de la equipe de salud que actúa en tres maternidades. Métodos: estudio observacional, transversal, comparativo. Participaron del estudio 301 profesionales. Se ha utilizado el cuestionario Hospital Survey on Patient Safety Culture validado en Brasil. Para el análisis de los datos, ha sido considerado área fuerte en la cultura de seguridad del paciente cuando las respuestas positivas atingieron arriba de 75%; y áreas que precisan de mejorías cuando las respuestas positivas atingieron menos de 50%. Para la comparación de los resultados, se empleó desviación típica y regla del pulgar. Resultados: de las 12 dimensiones de la cultura de seguridad del paciente, ninguna obtuvo puntuación arriba de 75%, siendo nueve dimensiones con puntuación entre 19% y 43% y tres dimensiones entre 55% y 57%. Conclusiones: No han sido identificadas dimensiones fuertes para cultura de seguridad en las tres maternidades. Se cree que esos resultados puedan contribuir en la elaboración de políticas que promuevan la cultura de seguridad en las instituciones.

RESUMO Objetivos: avaliar a cultura de segurança do paciente da equipe de saúde que atua em três maternidades. Métodos: estudo observacional, transversal, comparativo. Participaram do estudo 301 profissionais. Utilizou-se o questionário Hospital Survey on Patient Safety Culture validado no Brasil. Para a análise dos dados, considerou-se área forte na cultura de segurança do paciente quando as respostas positivas atingiram acima de 75%; e áreas que precisam de melhorias quando as respostas positivas atingiram menos de 50%. Para a comparação dos resultados, empregou-se desvio-padrão e regra do polegar. Resultados: das 12 dimensões da cultura de segurança do paciente, nenhuma obteve escore acima de 75%, sendo nove dimensões com escore entre 19% e 43% e três dimensões entre 55% e 57%. Conclusões: não foram identificadas dimensões fortes para cultura de segurança nas três maternidades. Acredita-se que esses resultados possam contribuir na elaboração de políticas que promovam a cultura de segurança nas instituições.

Patient safety culture in the maternal-child area of a university hospital / Cultura de seguridad del paciente en el área materno-infantil de un hospital universitario / Cultura de segurança do paciente na área materno-infantil de hospital universitário

ABSTRACT Objective: To describe the safety culture of the patient from the perspective of nurses and physicians working in the maternal-child area. Method: A cross-sectional study conducted from January to September 2018 with 41 professionals of the Obstetrics Center and obstetric hospitalization of a university hospital in the south of the country. The Hospital Survey on Patient Safety Culture was used, with 12 dimensions of the safety culture, measured by means of a general score (0 to 10) and of positive answer percentages to assess strengths and weaknesses. Results: The action of supervisors/bosses can be considered a strength of patient safety, with 78.2% of positive answers; already regarding communication, it was considered a fragility, punctuating 13.24%. The general safety grade of the patient assigned to the work's unit was very good, in a confidence interval of 95%. Conclusion: With the identification of the strengths and weaknesses of patient safety, it is possible to plan improvement actions. We emphasize that the non-punitive approach is essential.

RESUMEN Objetivo: Describir la cultura de seguridad del paciente en la perspectiva de enfermeros y médicos actuantes en el área materno-infantil. Método: Estudio transversal realizado de enero a septiembre de 2018 con 41 profesionales del Centro de Obstetricia y del área de internación obstétrica de un hospital universitario del sur del país. Se utilizó la Hospital Survey on Patient Safety Culture (Encuesta hospitalaria sobre la cultura de la seguridad), con 12 dimensiones de la cultura de seguridad, medidas por medio de un puntaje general (0 a 10) y de porcentajes de respuestas positivas para evaluar fortalezas y debilidades. Resultados: La acción de supervisores/jefes puede ser considerada una fortaleza de la seguridad del paciente, con el 78,2% de respuestas positivas; en lo referente a la comunicación, se la consideró una debilidad, con el 13,24%. La nota general de seguridad del paciente asignada a la unidad de trabajo fue muy buena, en un intervalo de confianza del 95%. Conclusión: Al identificar las fortalezas y debilidades en la seguridad del paciente es posible planificar acciones de mejora. Destacamos que el enfoque no punitivo es esencial.

RESUMO Objetivo: Avaliar a cultura de segurança do paciente na perspectiva de enfermeiros e médicos atuantes na área materno-infantil. Método: Estudo transversal, realizado de janeiro a setembro de 2018, com 41 profissionais do Centro Obstétrico e internação obstétrica de hospital universitário do sul do país, utilizando o Hospital Survey on Patient Safety Culture, com 12 dimensões da cultura de segurança, mensuradas por meio de um escore geral (0 a 10) e percentuais de respostas positivas para aferir fortalezas e fragilidades. Resultados: A ação de supervisores/chefes foi considerada uma fortaleza, tendo 78,2% de respostas positivas; já no que diz respeito à comunicação, considerou-se uma fragilidade, pontuando 13,2%. A nota geral de segurança do paciente foi de muito boa, nota 4, num intervalo de confiança de 95%. Conclusão: Com a identificação das fortalezas e fragilidades da segurança do paciente é possível planejar ações de melhoria. Destacamos que a abordagem não punitiva é essencial.

Breastfeeding with and without the WHO/UNICEF baby-friendly hospital initiative: A cross-sectional survey.

The World Health Organization and United Nations Children's Fund's Baby-Friendly Hospital Initiative is aimed at the global promotion, protection and support of breastfeeding. In this study, we compared breastfeeding-related information received, knowledge and behaviours among postpartum women in Baby-Friendly Hospital Initiative accredited and non-accredited hospitals. We selected 10 hospitals: 9 non-accredited hospitals in the Campania region in southern Italy and one accredited hospital in the Piedmont region in northern Italy. In total, 786 women (580 (73.8%) in Campania and 206 (26.2%) in Piedmont) in the hospitals' maternity wards completed a questionnaire comprising 5 sections within 24 to 72hours after giving birth. The questionnaire investigated breastfeeding activities in the days immediately following childbirth, as well as the information provided by health personnel, knowledge about breastfeeding before and during hospitalisation, and participation in antenatal classes. To evaluate the comparison between the 2 regions, we performed at first a bivariate analysis and then a multinomial and a multivariate logistic regression. Compared with Piedmont, in Campania hospitals there was a rate of breastfeeding of 44.3% vs 89.3%, a skin-to-skin contact between mother and child of 74.5% vs 90.7% and first milk feed within 2hours of 15.0% vs 87.2%. The Campania group had fewer problems with child latching. The Campania group reported receiving less information about breastfeeding in general compared with the Piedmont group. In general, both groups showed good basic knowledge about different aspects of breastfeeding. In both regions, about 90% reported that the information received during the antenatal classes simplified the breastfeeding experience. Our study confirms the importance of systematic promotion of breastfeeding and subsequent delivery of adequate support to maternity departments, in accordance with international guidelines.

Using the repertory grid technique to explore the experience of compassion by mothers in a mother and baby unit.

Despite differences between Mother and Baby Units (MBUs) and other inpatient psychiatric settings, research has not yet explored the nature and value of compassionate care offered by MBU staff despite the increasing importance of compassion in healthcare. This novel study investigated the experience of compassionate care by fifteen mothers admitted to a MBU in England using the Repertory Grid Technique. Our findings indicated that these women perceived their MBU care as compassionate. Compassion was central to nursing care and clearly implicated in women's recovery from mental illness. Additionally, other staff characteristics were important to mothers, including how effectively MBU staff coped with stressful situations, staff flexibility in their care approach and how they adhered to professional boundaries. It is important to facilitate the expression of compassion which partially depends on the personalities and training of staff and the cooperation of service managers in fostering compassionate care.

Optimal continuous support accompanying labor - the midwives' and laboring women's point of view.

BACKGROUND: Women who have continuous intrapartum support are more likely to have a shorter labor and spontaneous vaginal birth, and are less likely to need intrapartum analgesia than women who receive usual care without support. We aimed to determine what women in labor and midwives regard as the optimal number of labor supporters and whether they should be present during medical interventions. METHODS: A questionnaire was distributed to midwives participating in a national midwifery conference in June 2015. In addition, an anonymized questionnaire concerning the preferred number and type of supporters was distributed to laboring women at the beginning of labor and repeated post-partum in the maternity unit of a single tertiary medical center between March 2017 and January 2018. RESULTS: Of 124 midwives from 18 hospitals throughout Israel attending the conference, 92 (74%) completed the questionnaire. Eighty-three percent of the midwives who responded felt that more than two supporters interferes with their work. Eighty percent of the midwives work in obstetrical units that allow up to two labor supporters, and 82% of them felt that one or two supporters is optimal. Similarly, of the 140 laboring women surveyed, 84% preferred one or two supporters. There was no difference in the preferred number of supporters between the maternal pre- and post-partum questionnaires. The laboring women and midwives had differing opinions regarding supporter presence during vacuum extraction and perineal suture. Sixty-four percent of the midwives preferred that the supporter not be present during vacuum extraction, and 45% of them preferred that the supporter not be present during perineal suture. In contrast, among the laboring women, 78% preferred supporter presence during vacuum extraction, 76% during perineal suture and 74% during vaginal examination. Interestingly, even among the midwives, 82% preferred that the supporter remain during vaginal examination and 84% preferred the supporter remain during medical rounds. CONCLUSIONS: Serious consideration should be given to restricting the number of labor supporters to two, as both laboring woman and midwives consider that to be the optimal number. In light of the difference of opinion regarding presence of supporters during certain medical procedures, additional surveys concerning the points of view of obstetricians and laboring women in additional hospitals should be considered before establishing a national policy.