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1.
Reprod Health ; 18(1): 50, 2021 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-33639966

RESUMO

BACKGROUND: We aim to assess competencies (knowledge, skills and attitudes) of midwifery care providers as well as their experiences and perceptions of in-service training in the four study countries; Benin, Malawi, Tanzania and Uganda as part of the Action Leveraging Evidence to Reduce perinatal mortality and morbidity in sub-Saharan Africa project (ALERT). While today more women in low- and middle-income countries give birth in health care facilities, reductions in maternal and neonatal mortality have been less than expected. This paradox may be explained by the standard and quality of intrapartum care provision which depends on several factors such as health workforce capacity and the readiness of the health system as well as access to care. METHODS: Using an explanatory sequential mixed method design we will employ three methods (i) a survey will be conducted using self-administered questionnaires assessing knowledge, (ii) skills drills assessing basic intrapartum skills and attitudes, using an observation checklist and (iii) Focus Group Discussions (FGDs) to explore midwifery care providers' experiences and perceptions of in-service training. All midwifery care providers in the study facilities are eligible to participate in the study. For the skills drills a stratified sample of midwifery care providers will be selected in each hospital according to the number of providers and, professional titles and purposive sampling will be used for the FGDs. Descriptive summary statistics from the survey and skills drills will be presented by country. Conventional content analysis will be employed for data analysis of the FGDs. DISCUSSION: We envision comparative insight across hospitals and countries. The findings will be used to inform a targeted quality in-service training and quality improvement intervention related to provision of basic intrapartum care as part of the ALERT project. TRIAL REGISTRATION: PACTR202006793783148-June 17th, 2020.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Tocologia , Obstetrícia/normas , Qualidade da Assistência à Saúde , Adulto , Benin/epidemiologia , Lista de Checagem , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Parto Obstétrico/enfermagem , Parto Obstétrico/normas , Parto Obstétrico/estatística & dados numéricos , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/normas , Humanos , Cuidado do Lactente/normas , Cuidado do Lactente/estatística & dados numéricos , Recém-Nascido , Malaui/epidemiologia , Tocologia/educação , Tocologia/normas , Tocologia/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Gravidez , Inquéritos e Questionários , Tanzânia/epidemiologia , Uganda/epidemiologia , Adulto Jovem
2.
PLoS One ; 15(12): e0244221, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33332406

RESUMO

BACKGROUND: Midwives and obstetricians are key maternity care providers; they are the most trusted source of information regarding nutrition and gestational weight gain. However, their views, practices and perceived barriers to managing pregnancy related weight gain have not been studied in Ethiopia. The aim of this study was to explore midwives' and obstetricians' observations and perspectives about gestational weight gain and postpartum weight management in Ethiopia. METHODS: We conducted face-to-face interviews with 11 midwives and 10 obstetricians, from January 2019 to March 2019. All interview data were transcribed verbatim. We analysed the data using thematic analysis with an inductive approach. RESULTS: We identified three themes and associated subthemes. Midwives and obstetricians had limited knowledge of the optimal gestational weight gain. Almost all participants were unaware of the presence of the Institute of Medicine recommendations for optimal weight gain in pregnancy. According to the study participants, women in Ethiopia do not want to gain weight during pregnancy, but do want to gain weight after the birth. Counselling about gestational weight gain and postpartum weight management was not routinely provided for pregnant women. This is mostly because gestational weight gain counselling was not considered to be a priority by maternity care providers in Ethiopia. CONCLUSIONS: The limited knowledge of and low attention to pregnancy related weight management by midwives and obstetricians in this setting needs appropriate intervention. Adapting a guideline for pregnancy weight management and integrating it into antenatal care is essential.


Assuntos
Ganho de Peso na Gestação , Conhecimentos, Atitudes e Prática em Saúde , Tocologia/estatística & dados numéricos , Médicos/estatística & dados numéricos , Adulto , Etiópia , Feminino , Humanos , Masculino , Inquéritos e Questionários/estatística & dados numéricos
3.
Curationis ; 43(1): e1-e8, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32633991

RESUMO

BACKGROUND: Lesotho has been experiencing health challenges as indicated by its high maternal mortality ratio of 620 per 100 000 live births for the year 2010, which has been linked to its limited human resources. OBJECTIVES: The knowledge and skills of final-year student nurse-midwives related to the active management of the third stage of labour were determined. METHOD: A quantitative, descriptive survey design was used to conduct this study with 99 final-year midwifery students at four nursing schools in Lesotho using stratified sampling. The structured questionnaire collected data on the knowledge and self-reported competency. Subsequently, the controlled cord traction marks, extracted from the objective structured clinical examination (OSCE), were compared to the self-reported competency of these midwifery students using R software version 3.4.0. RESULTS: The mean score for knowledge and the OSCE was 73.8% (n = 99) and 77.2% (n = 99), respectively. The majority of respondents (95.2%, n = 99) rated themselves highly in terms of the active management of the third stage of labour competency. There was no correlation between the self-reported competency and knowledge (r = 0.08, p = 0.4402), and self-reported competency and OSCE scores (r = -0.004, p = 0.01). CONCLUSION: The high mean scores for the knowledge and the OSCE indicate that the theoretical component of the curriculum on the active management of the third stage of labour was effective in equipping final-year midwifery students with knowledge and skills to carry out this competency.


Assuntos
Competência Clínica/normas , Terceira Fase do Trabalho de Parto/fisiologia , Tocologia/educação , Estudantes de Enfermagem/estatística & dados numéricos , Adulto , Competência Clínica/estatística & dados numéricos , Currículo/tendências , Feminino , Humanos , Tocologia/estatística & dados numéricos , Gravidez , África do Sul , Inquéritos e Questionários
4.
BMC Public Health ; 20(1): 1033, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600380

RESUMO

BACKGROUND: Owing to migration, female genital mutilation or cutting (FGM/C) has become a growing concern in host countries in which FGM/C is not familiar. There is a need for reliable estimates of FGM/C prevalence to inform medical and public health policy. We aimed to advance methodology for estimating the prevalence of FGM/C in diaspora by determining the prevalence of FGM/C among women giving birth in the Netherlands. METHODS: Two methods were applied to estimate the prevalence of FGM/C in women giving birth: (I) direct estimation of FGM/C was performed through a nationwide survey of all midwifery practices in the Netherlands and (II) the extrapolation model was adopted for indirect estimation of FGM/C, by applying population-based-survey data on FGM/C in country of origin to migrant women who gave birth in 2018 in the Netherlands. RESULTS: A nationwide survey among primary care midwifery practices that provided care for 57.5% of all deliveries in 2018 in the Netherlands, reported 523 cases of FGM/C, constituting FGM/C prevalence of 0.54%. The indirect estimation of FGM/C in an extrapolation-model resulted in an estimated prevalence of 1.55%. Possible reasons for the difference in FGM/C prevalence between direct- and indirect estimation include that the midwives were not being able to recognize, record or classify FGM/C, referral to an obstetrician before assessing FGM/C status of women and selective responding to the survey. Also, migrants might differ from people in their country of origin in terms of acculturation toward discontinuation of the practice. This may have contributed to the higher indirect-estimation of FGM/C compared to direct estimation of FGM/C. CONCLUSIONS: The current study has provided insight into direct estimation of FGM/C through a survey of midwifery practices in the Netherlands. Evidence based on midwifery practices data can be regarded as a minimum benchmark for actual prevalence among the subpopulation of women who gave birth in a given year.


Assuntos
Circuncisão Feminina/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Estatística como Assunto , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Gravidez , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Inquéritos e Questionários , Migrantes/estatística & dados numéricos , Adulto Jovem
5.
PLoS One ; 15(6): e0234318, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32530944

RESUMO

BACKGROUND: Efforts to expand access to institutional delivery alone without quality of care do not guarantee better survival. However, little evidence documents the quality of childbirth care in Ethiopia, which limits our ability to improve quality. Therefore, this study assessed the quality of and barriers to routine childbirth care signal functions during intra-partum and immediate postpartum period. METHODS: A sequential explanatory mixed method study was conducted among 225 skilled birth attendants who attended 876 recently delivered women in primary level facilities. A multi stage sampling procedure was used for the quantitative phase whilst purposive sampling was used for the qualitative phase. The quantitative survey recruitment occurred in July to August 2018 and in April 2019 for the qualitative key informant interview and Focus Group Discussions (FGD). A validated quantitative tool from a previous validated measurement study was used to collect quantitative data, whereas an interview guide, informed by the literature and quantitative findings, was used to collect the qualitative data. Principal component analysis and a series of univariate and multivariate linear regression analysis were used to analyze the quantitative data. For the qualitative data, verbatim review of the data was iteratively followed by content analysis and triangulation with the quantitative results. RESULTS: This study showed that one out of five (20.7%, n = 181) mothers received high quality of care in primary level facilities. Primary hospitals (ß = 1.27, 95% CI:0.80,1.84, p = 0.001), facilities which had staff rotation policies (ß = 2.19, 95% CI:0.01,4.31, p = 0.019), maternal involvement in care decisions (ß = 0.92, 95% CI:0.38,1.47, p = 0.001), facilities with maternal and newborn health quality improvement initiatives (ß = 1.58, 95% CI:0.26, 3.43, p = 0.001), compassionate respectful maternity care training (ß = 0.08, 95% CI: 0.07,0.88, p = 0.021), client flow for delivery (ß = 0.19, 95% CI:-0.34, -0.04, p = 0.012), mentorship (ß = 0.02, 95% CI:0.01, 0.78, p = 0.049), and providers' satisfaction (ß = 0.16, 95% CI:0.03, 0.29, p = 0.013) were predictors of quality of care. This is complemented by qualitative research findings that poor quality of care during delivery and immediate postpartum related to: work related burnout, gap between providers' skill and knowledge, lack of enabling working environment, poor motivation scheme and issues related to retention, poor providers caring behavior, unable translate training into practice, mismatch between number of provider and facility client flow for delivery, and in availability of essential medicine and supplies. CONCLUSIONS: There is poor quality of childbirth care in primary level facilities of Tigray. Primary hospitals, facilities with staff rotation, maternal and newborn health quality improvement initiatives, maternal involvement in care decisions, training on compassionate respectful maternity care, mentorship, and high provider satisfaction were found to have significantly increased quality of care. However, client flow for delivery service is negatively associated with quality of care. Efforts must be made to improve the quality of care through catchment-based mentorship to increase providers' level of adherence to good practices and standards. More attention and thoughtful strategies are required to minimize providers' work-related burnout.


Assuntos
Acesso aos Serviços de Saúde , Assistência Perinatal/normas , Qualidade da Assistência à Saúde , Adolescente , Adulto , Estudos Transversais , Etiópia , Feminino , Grupos Focais , Instalações de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Tocologia/normas , Tocologia/estatística & dados numéricos , Enfermagem Obstétrica/normas , Enfermagem Obstétrica/estatística & dados numéricos , Obstetrícia/normas , Obstetrícia/estatística & dados numéricos , Parto , Assistência Perinatal/estatística & dados numéricos , Período Pós-Parto , Gravidez , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
6.
J Psychosoc Nurs Ment Health Serv ; 58(7): 42-51, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32396208

RESUMO

The current cross-sectional study was conducted to investigate nurses' and midwives' opinions about their roles in caring for women with postpartum depression (PPD) in Saudi Arabia. Convenience sampling was used to recruit 181 nurses and 141 midwives. A self-administered questionnaire was used to collect data. Participants lacked experience assessing and managing PPD and providing health education and counseling to mothers about PPD. Moreover, participants underestimated the importance of their roles in preventing PPD risk factors, and detecting, assessing, and managing PPD. Findings show significant differences between nurses' and midwives' opinions, with more frequency of agreement among nurses than midwives regarding their roles in caring for women with PPD. Continuing health education programs for nurses and midwives are recommended to improve knowledge, skills, and awareness of their roles in assessing and managing PPD. [Journal of Psychosocial Nursing and Mental Health Services, 58(7), 42-51.].


Assuntos
Atitude do Pessoal de Saúde , Depressão Pós-Parto/terapia , Conhecimentos, Atitudes e Prática em Saúde , Tocologia/estatística & dados numéricos , Mães/psicologia , Papel do Profissional de Enfermagem/psicologia , Adulto , Aconselhamento , Estudos Transversais , Feminino , Humanos , Serviços de Saúde Mental , Tocologia/educação , Gravidez , Arábia Saudita , Inquéritos e Questionários
8.
Obstet Gynecol ; 135(6): 1353-1361, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459427

RESUMO

OBJECTIVE: To evaluate the difference in odds of cesarean delivery in term, singleton, vertex pregnancies between the midwife and obstetrician-led services at the same rural tertiary care center. METHODS: A retrospective cohort study of term, singleton, and vertex deliveries in patients without a history of cesarean delivery was performed. Patients self-selected a delivery service. The primary outcome was the odds of cesarean delivery between midwife and obstetrician-led services. After propensity score matching, logistic regression was performed on the matched sample to assess the adjusted odds of cesarean delivery. RESULTS: From January 2015 to December 2017, 1,787 (80.2% of total) deliveries were analyzed with management of 956 (53.5%) by the midwife service and 831 (46.5%) by the obstetrician-led service. The rate of cesarean delivery was 20.7% (n=172) in the obstetrician-led service and 13.1% (n=125) in the midwife service. In the matched sample, the odds of cesarean delivery were lower in the midwife service compared with the obstetrician-led service in unadjusted and adjusted analyses (odds ratio [OR] 0.62, 95% CI 0.47-0.81; adjusted odds ratio [aOR] 0.58, 95% CI 0.44-0.80). Older maternal age (OR 1.02, 95% CI 1.00-1.06; aOR 1.07, 95% CI 1.04-1.10) and higher delivery body mass index (OR 1.06, 95% CI 1.04-1.08; aOR 1.07, 95% CI 1.04-1.09) were associated with higher odds of cesarean delivery. Increased parity was associated with decreased odds of cesarean delivery (OR 0.41, 95% CI 0.31-0.55; aOR 0.35, 95% CI 0.26-0.48). There were no differences in neonatal outcomes. CONCLUSION: At a single rural tertiary care center, patients on the midwife service have significantly lower adjusted odds of cesarean delivery than patients on the obstetrician-led service.


Assuntos
Cesárea/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Adulto , Índice de Apgar , Feminino , Parto Domiciliar/estatística & dados numéricos , Humanos , Recém-Nascido , Modelos Logísticos , New Hampshire , Paridade , Gravidez , Resultado da Gravidez , Pontuação de Propensão , Estudos Retrospectivos , Adulto Jovem
9.
PLoS One ; 15(4): e0231489, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32315328

RESUMO

OBJECTIVE: The objective of Sustainable Development Goal 3.1 is to reduce the global maternal mortality ratio (MMR) below 70 per 100,000 live births by 2030. One of the indicators for this objective is the proportion of births attended by skilled health attendants (SBA). This study assessed the progress of low- and middle-income countries from South and Southeast Asian (SSEA) region in SBA coverage and evaluated the contribution of women's education in this progression. METHODS: The Demographic and Health Surveys were assessed, which included 38 nationally representative surveys on women aged between 15-49 years from 10 selected SSEA region countries in past 30 years. Binary Logistic regression models were fitted adjusting the survey clusters, strata and sampling weights. Meta-analyses were conducted by collapsing effect sizes and confidence intervals of education modeled on SBA coverage. RESULTS: Results indicated that Cambodia, Indonesia and Philippines had over 80% SBA coverage after 2010, whereas Bangladesh and Afghanistan had around 50% coverage. Women with primary, secondary and higher level of education were 1.65, 2.21 and 3.14 times significantly more likely to access SBA care during childbirth respectively as compared to women with no education, suggesting that education is a key factor to address skilled delivery cares in the SSEA region. CONCLUSION: Evaluation of the existing skilled birth attendance policies at the national level could provide useful insight for the decision makers to improve access to skilled care at birth by investing on women's education in remote and rural areas.


Assuntos
Parto Obstétrico/educação , Parto Obstétrico/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Ásia Sudeste , Feminino , Objetivos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Mortalidade Materna , Tocologia/educação , Tocologia/estatística & dados numéricos , Parto , Cuidado Pré-Natal/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , Desenvolvimento Sustentável
11.
PLoS One ; 15(3): e0230341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32163492

RESUMO

BACKGROUND: Maternal mortality remains a major challenge to health systems in low and middle-incoming countries. Some pregnant women develop potentially life-threatening complications during childbirth. Therefore, home delivery is a precursor for maternal mortality. In this study, we aimed at not only estimating the percentage of deliveries occurring at home and examining the factors associated with home delivery, but we also explored the reasons for home delivery among women in rural Ghana. METHODS: The study was conducted among mothers with delivery experience in selected communities in the Builsa South district located in the Upper East Region of Ghana. Both quantitative and qualitative data were collected using semi-structured questionnaires and Focus Group Discussion (FGD) guide respectively. A total of 456 mothers participated in this study. Regression models were used in the quantitative analysis whereas a thematic analysis approach was used to analyze the qualitative data. RESULTS: Of the 423 mothers in the quantitative research, 38.1% (95% CI: 33.5-42.8) delivered their index child at home. In adjusted analysis, women who were not exposed to information (AOR = 13.64, p<0.001) and women with 2 (AOR = 4.64, p = 0.014), 3 (AOR = 4.96, p = 0.025) or at least 4 living children (AOR = 9.59, p = 0.001) had higher odds of delivering at home. From the qualitative analysis, the poor attitude of nurses (midwives), lack of, and cost of transportation, cost of delivery kits, and traditional beliefs and practices were cited as reasons for home delivery. CONCLUSION: Despite the government's efforts to provide free maternal care services to women in Ghana, a significant proportion of rural women still deliver at home due to other 'hidden costs'. Addressing poor staff attitude, transportation challenges, and negative traditional beliefs and practices through awareness creation may contribute to improving health facility delivery by rural pregnant women in Ghana.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Parto Domiciliar/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Estudos Transversais , Feminino , Grupos Focais , Gana , Instalações de Saúde/estatística & dados numéricos , Humanos , Tocologia/estatística & dados numéricos , Mães , Gravidez , Gestantes , Cuidado Pré-Natal/estatística & dados numéricos , População Rural/estatística & dados numéricos , Inquéritos e Questionários
12.
PLoS One ; 15(3): e0229488, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32134957

RESUMO

BACKGROUND: Variations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics. METHODS: In this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks' gestation in 2010-2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife- and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman's rank correlations. FINDINGS: Intrapartum referral rates varied between 55-68% (nulliparous) and 20-32% (multiparous women), with a negative correlation with receiving midwife-led care at the onset of labour in two-thirds of the regions. Regions with higher referral rates had higher rates of severe postpartum haemorrhages. Rates of home birth varied between 6-16% (nulliparous) and 16-31% (multiparous), and was negatively correlated with episiotomy and postpartum oxytocin rates. Among midwife-led births, episiotomy rates varied between 14-42% (nulliparous) and 3-13% (multiparous) and in obstetrician-led births from 46-67% and 14-28% respectively. Rates of postpartum oxytocin varied between 59-88% (nulliparous) and 50-85% (multiparous) and artificial rupture of membranes between 43-52% and 54-61% respectively. A north-south gradient was visible with regard to birthplace, episiotomy, and oxytocin. CONCLUSIONS: Our study suggests that attitudes towards interventions vary, independent of maternal characteristics. Care providers and policy makers need to be aware of reducing unwarranted variation in birthplace, episiotomy and the postpartum use of oxytocin. Further research is needed to identify explanations and explore ways to reduce unwarranted intervention rates.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Parto Domiciliar/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Parto , Complicações na Gravidez , Feminino , Geografia , Humanos , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
13.
JAMA Netw Open ; 3(2): e1921363, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32074288

RESUMO

Importance: Despite improvements in antenatal care and increasing cesarean delivery rates, birth asphyxia leading to neonatal encephalopathy (NE) continues to contribute to neonatal death and long-term neurodevelopmental disability. Cardiotocography (CTG) has been used in labor for several decades to detect a stressed fetus so that delivery can be expedited and NE avoided. Objective: To investigate whether experienced clinicians can detect and respond to abnormal readings from CTGs during the penultimate hour before birth in infants with moderate to severe NE but no acute peripartum event. Design, Setting, and Participants: This case-control study included 10 practicing obstetricians and midwives at maternity hospitals in New Zealand. Participants, who were masked to the perinatal outcome, were asked to assess CTG tracings from 35 neonates with NE and evidence of birth hypoxia (ie, cases) and 105 neonates without NE or birth hypoxia (ie, controls), all of whom were born in 2010 to 2011. Data analysis was conducted from May to December 2017. Exposures: Brief clinical details and 1 hour of CTG tracings from the penultimate hour before birth were provided for each baby. Clinicians assessed the CTG tracings and recommended a plan. Main Outcomes and Measures: Intra-assessor and interassessor agreement on CTG findings and action plans as well as sensitivity (ie, detection of NE) and specificity (ie, ruling out those without NE) for the assessment of abnormal CTG readings leading to immediate action (ie, fetal blood sample or immediate delivery) were reported. Results: A total of 35 infants (mean [SD] gestational age, 40 [1.4] weeks; 16 [45.7%] cesarean deliveries) were designated cases, and 105 infants (mean [SD] gestational age, 39.4 [1.2] weeks; 22 [21.0%] cesarean deliveries) were designated controls. No infants had congenital anomalies. The mean (range) sensitivity for detection of abnormal CTG results and for recommending immediate action for all assessors was 75% (63%-91%) and 41% (23%-57%), respectively, with a mean (range) specificity of 67% (53%-77%) and 87% (65%-99%), respectively. A sensitivity analysis including only assessors with 80% or more interassessor agreement only differed from the main analysis by 6% or less (mean [range] sensitivity for detection, 76% [63%-91%]; sensitivity for action plan, 36% [25%-49%]; specificity for detection, 71% [53%-77%]; and specificity for action plan, 93% [88%-99%]). Conclusions and Relevance: Experienced clinicians detected 3 of 4 infants who were subsequently diagnosed with NE. Action to expedite delivery was recommended for more than 40% of infants with NE. These results indicate that CTG does not identify all infants at risk of NE, and that there is a need for further investment in new approaches to fetal surveillance in labor.


Assuntos
Asfixia Neonatal/complicações , Asfixia Neonatal/diagnóstico , Encefalopatias/complicações , Cardiotocografia , Competência Clínica/estatística & dados numéricos , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Tocologia/estatística & dados numéricos , Nova Zelândia , Médicos/estatística & dados numéricos , Gravidez
14.
Am J Obstet Gynecol ; 223(2): 254.e1-254.e8, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32044310

RESUMO

BACKGROUND: Planned home births have leveled off in the United States in recent years after a significant rise starting in the mid-2000s. Planned home births in the United States are associated with increased patient-risk profiles. Multiple studies concluded that, compared with hospital births, absolute and relative risks of perinatal mortality and morbidity in US planned home births are significantly increased. OBJECTIVE: To explore the safety of birth in the United States by comparing the neonatal mortality outcomes of 2 locations, hospital birth and home birth, by 4 types of attendants: hospital midwife; certified nurse-midwife at home; direct-entry ("other") midwife at home; and attendant at home not identified, using the most recent US Centers for Disease Control and Prevention natality data on neonatal mortality for planned home births in the United States. Outcomes are presented as absolute risks (neonatal mortality per 10,000 live births) and as relative risks of neonatal mortality (hospital-certified nurse-midwife odds ratio, 1) overall, and for recognized risk factors. STUDY DESIGN: We used the most current US Centers for Disease and Prevention Control Linked Birth and Infant Death Records for 2010-2017 to assess neonatal mortality (neonatal death days 0-27 after birth) for single, term (37+ weeks), normal-weight ( >2499 g) infants for planned home births and hospital births by birth attendants: hospital-certified nurse-midwives, home-certified nurse-midwives, home other midwives (eg, lay or direct-entry midwives), and other home birth attendant not identified. RESULTS: The neonatal mortality for US hospital midwife-attended births was 3.27 per 10,000 live births, 13.66 per 10,000 live births for all planned home births, and 27.98 per 10,000 live births for unintended/unplanned home births. Planned home births attended by direct-entry midwives and by certified nurse-midwives had a significantly elevated absolute and relative neonatal mortality risk compared with certified nurse-midwife-attended hospital births (hospital-certified nurse-midwife: 3.27/10,000 live births odds ratio, 1; home birth direct-entry midwives: neonatal mortality 12.44/10,000 live births, odds ratio, 3.81, 95% confidence interval, 3.12-4.65, P<.0001; home birth-certified nurse-midwife: neonatal mortality 9.48/10,000 live births, odds ratio, 2.90, 95% confidence interval, 2.90; P<.0001). These differences increased further when patients were stratified for recognized risk factors. CONCLUSION: The safety of birth in the United States varies by location and attendant. Compared with US hospital births attended by a certified nurse-midwife, planned US home births for all types of attendants are a less safe setting of birth, especially when recognized risk factors are taken into account. The type of midwife attending US planned home birth appears to have no differential effect on decreasing the absolute and relative risk of neonatal mortality of planned home birth, because the difference in outcomes of US planned home births attended by direct-entry midwives or by certified nurse-midwives is not statistically significant.


Assuntos
Parto Domiciliar/estatística & dados numéricos , Mortalidade Infantil , Tocologia/estatística & dados numéricos , Enfermeiras Obstétricas/estatística & dados numéricos , Adulto , Entorno do Parto/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Intenção , Gravidez , Estados Unidos
15.
Midwifery ; 83: 102657, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32035341

RESUMO

OBJECTIVE: Rates of maternal and neonatal death remain high in the Global South, especially in Sub-Saharan Africa. In addition, indicators vary significantly by geography. This study aimed to understand what communities in northern Ghana with frequent maternal and newborn deaths or near deaths (near-misses) perceive to be the causes. As part of a larger study, four communities in Ghana's Northern Region were identified as areas with high concentrations of deaths and near-misses of mothers and babies. DESIGN: Stakeholders were interviewed using in-depth interviews (IDIs) and focus-group discussions (FGDs). Field workers conducted 12 FGDs and 12 IDIs across a total of 126 participants. SETTING: This exploratory descriptive study was conducted in the East Mamprusi District in the Northern Region of Ghana, in the communities of Jawani, Nagboo, Gbangu and Wundua. PARTICIPANTS: FGDs were led by trained field workers and attended by traditional chiefs and their elders, members of women's groups, and traditional birth attendants in each of the four study communities. IDIs, or one-on-one interviews, were conducted with traditional healers who manage maternal and neonatal cases, community health nurses, and midwives. MEASUREMENTS AND FINDINGS: Qualitative data were audio-recorded, transcribed, and thematically analyzed using the Attride-Sterling analytical framework. Discussions focused on where blame should be attributed for the negative outcomes of mothers and babies - with blame either being directed at the actions or inactions of the mothers (behavioral), or at the larger factors associated with poverty (situational) that necessitate mothers' behavior. For example, some respondents blamed women for their poor diets, while others blamed the lack of money or household support to buy nutritious foods. Blame was rarely attributed to the fathers despite local gender norms of males being the household decision-makers with regard to spending and care-seeking. KEY CONCLUSIONS: These findings contribute to a small but growing body of literature on the blaming of mothers for their own deaths and those of their newborns - a phenomenon also described in high-income countries - and is supported by blame attribution theories that explain the self-protective nature of victim-blaming. IMPLICATIONS FOR PRACTICE: These results carry important implications for education and intervention design related to maternal and neonatal mortality, including more focused efforts at incorporating men and the larger community. More research is warranted on blame attribution for these adverse outcomes and its effects on the victims.


Assuntos
Mortalidade Fetal/tendências , Mortalidade Materna/tendências , Opinião Pública , Adulto , Idoso , Feminino , Grupos Focais/métodos , Gana , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Tocologia/normas , Tocologia/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa , População Rural/estatística & dados numéricos
16.
BMC Womens Health ; 20(1): 37, 2020 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-32103753

RESUMO

BACKGROUND: Physiotherapists and midwives in primary healthcare often encounter women with an increased separation between the two rectus abdominis muscle bellies after pregnancy, a so-called increased inter recti distance (IRD). There are few studies on the contribution of increased IRD to the explanation of post-partum health complaints, and very little guidance in the literature for health professionals on the management of increased IRD. The aim of this study was to describe how physiotherapists and midwives in primary healthcare perceive the phenomenon of increased IRD and its management in women after childbirth. METHODS: A purposeful sampling approach was used to select physiotherapists and midwives working in primary healthcare in three large county council healthcare organisations in Sweden having experience of encountering women with increased IRD after pregnancy. Sixteen physiotherapists and midwives participated in focus group discussions. Four focus groups with four participants in each were undertaken. A semi-structured topic guide was used to explore responses to the research questions and the discussions were analysed using qualitative content analysis. RESULTS: We identified an overarching theme: Ambivalence towards the phenomenon increased IRD and frustration over insufficient professional knowledge. The theme included three categories: Uncertainty concerning the significance of increased IRD as a causal factor for functional problems; perceived insufficient professional knowledge base for the management of increased IRD; and lack of inter-professional collaboration and teamwork in the management of patients with increased IRD. Due to sparse and somewhat contradictory research findings and absence of clinical guidelines, the health professionals lacked basic preconditions for applying an evidence-based practice concerning increased IRD. They obtained their information about increased IRD from the media and fitness coaches, and hence were somewhat unsure about what to believe regarding the phenomenon. CONCLUSIONS: There was no consensus among the health professionals on how to best approach increased IRD in the clinical setting. Our findings stress the importance of more research to increase the professional knowledge base among physiotherapists and midwives. The findings highlight the urgent need for policies and clinical guidelines advising health professionals in the management of increased IRD and for facilitating inter-professional collaboration and teamwork.


Assuntos
Atitude do Pessoal de Saúde , Parto Obstétrico/efeitos adversos , Enfermeiras Obstétricas/psicologia , Fisioterapeutas/psicologia , Transtornos Puerperais/terapia , Adulto , Feminino , Grupos Focais , Humanos , Tocologia/estatística & dados numéricos , Parto/fisiologia , Período Pós-Parto , Gravidez , Atenção Primária à Saúde , Transtornos Puerperais/fisiopatologia , Pesquisa Qualitativa , Reto do Abdome/fisiopatologia , Suécia
17.
Midwifery ; 83: 102646, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32004734

RESUMO

OBJECTIVE: Before January 2019, no established solutions regarding the screening, assessment, and treatment of patients suffering from perinatal depression existed in Poland. From 2019, a new standard of perinatal care has imposed the obligation to monitor the mental state of women during pregnancy and in the postpartum period on the healthcare providers (mainly on midwives). Thus, our study aimed to evaluate midwives' knowledge about prenatal and postnatal mental health disorders in the first six months of implementing the new standard of perinatal care in Poland. DESIGN: Polish midwives completed a survey consisting of the Test of Antenatal and Postpartum Depression Knowledge by Jones, Creedy, and Gamble (2001) and questions related to a hypothetical case study of a depressed woman named "Mary", developed by Buist and colleagues (2006). The midwives also rated their perceived knowledge and skills in assessing women' mental health condition. SETTING: The study was conducted in four Polish cities: Gdansk, Olsztyn, Szczecin, Wroclaw, and the surrounding rural areas. PARTICIPANTS: 111 Polish midwives with varied professional experience and socio-demographic characteristics participated in the study. MEASUREMENTS AND FINDINGS: Among all of their professional responsibilities, the midwives self-rated their knowledge and skills in assessing the mental state of patients as the lowest ones. A subsequent objective assessment revealed their insufficient knowledge about antenatal and postnatal depression and the ways of treatment of these disorders. KEY CONCLUSIONS: Midwives are not properly prepared for the new tasks resulting from the Polish standard of perinatal care: specifically, for the assessment of a woman's mental state. IMPLICATIONS FOR PRACTICE: Further trainings are required to ensure midwives' competency and knowledge about the assessment and dealing with mental disorders of patients who experience prenatal and postpartum depression.


Assuntos
Competência Clínica/normas , Depressão Pós-Parto/enfermagem , Depressão/enfermagem , Tocologia/normas , Adulto , Competência Clínica/estatística & dados numéricos , Depressão/psicologia , Depressão Pós-Parto/psicologia , Feminino , Humanos , Recém-Nascido , Programas de Rastreamento/métodos , Tocologia/estatística & dados numéricos , Polônia , Gravidez , Inquéritos e Questionários
18.
Artigo em Inglês | MEDLINE | ID: mdl-31963831

RESUMO

The prevalence of burnout in midwives has been briefly studied. Given the negative effects of burnout syndrome in the physical and mental health, and also related to the quality of care provided, rates of absenteeism and sick leave; identifying related factors for the syndrome are needed. The aim was to determine the prevalence, levels, and factors related to the burnout syndrome, measured with the Copenhagen Burnout Inventory in midwives. A systematic review and meta-analysis were selected from CINAHL, LILACS, ProQuest, PsycINFO, PubMed, SciELO, and Scopus databases, with the search equation "burnout AND (midwife OR midwives OR nurses midwives)". Fourteen articles were found with a total of 8959 midwives. Most of the studies showed moderate levels of personal burnout. The prevalence obtained was 50% (95% CI = 38-63) for personal burnout; 40% (95% CI = 32-49) for work-related burnout; and 10% (95% CI = 7-13) for client-related burnout. Midwives' age, less experience, and living alone constitute the main related factors, as well as, the scarcity of resources, work environment, and the care model used. Most midwives present personal and work-related burnout, which indicates a high risk of developing burnout. Personal factors and working conditions should be taken into account when assessing burnout risk profiles of midwives.


Assuntos
Esgotamento Profissional/epidemiologia , Tocologia/estatística & dados numéricos , Esgotamento Profissional/psicologia , Feminino , Humanos , Prevalência , Fatores de Risco
19.
BMC Pregnancy Childbirth ; 20(1): 31, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931742

RESUMO

BACKGROUND: Evidence suggests that cigarette smoking and alcohol consumption during pregnancy negatively impacts fetal health. Health agencies across countries have developed specific guidelines for health professionals in perinatal care to strengthen their role in smoking and alcohol use prevention. One such example is the "Guideline on Screening and Counselling for prevention of cigarette smoking and alcohol consumption before, during, and after pregnancy" introduced by the Swiss Midwives Association in 2011. The current study assesses the changes in midwives' engagement in smoking and alcohol use prevention before (2008) and after the introduction of the Guideline (2018). Further, the current study examines differences across regions (German vs. French speaking regions), graduation years (before and after the introduction of the Guideline) and different work settings (hospital vs. self-employed). METHODS: Survey data were collected in 2008 (n = 366) and in 2018 (n = 459). Differences in how midwives engaged in smoking and alcohol use prevention between 2008 and 2018 were assessed with chi-square tests, as were differences across German and French speaking regions, graduation years (before and after the introduction of the Guideline) and across different work settings (working in hospitals or as self-employed). RESULTS: An increase in midwives' awareness of the risks of consuming even small quantities of cigarettes and alcohol for the unborn child between 2008 and 2018 is evident. Explaining the risks to pregnant women who smoke or use alcohol remained the most frequently reported prevention strategy. However, engagement with more extensive smoking and alcohol use preventive strategies across the whole course of pregnancy, such as assisting women in the elaboration of a plan to stop smoking/alcohol use, remained limited. CONCLUSIONS: Seven years after its introduction, the effectiveness of the Guideline in increasing midwives' engagement in smoking and alcohol use prevention appears limited despite midwives' increased awareness.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Tocologia/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Prevenção do Hábito de Fumar/estatística & dados numéricos , Participação dos Interessados/psicologia , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Implementação de Plano de Saúde , Humanos , Tocologia/normas , Guias de Prática Clínica como Assunto , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Prevenção do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/normas , Inquéritos e Questionários , Suíça
20.
Reprod Health ; 17(1): 3, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931824

RESUMO

BACKGROUND: Pakistan reports the highest stillbirth rate in the world at 43 per thousand births with more than three-quarters occurring in rural areas. The Global Network for Women's and Children's Health maintains a Maternal and Newborn Health Registry (MNHR) in 14 study clusters of district Thatta, Sindh Pakistan. For the last 10 years, the MNHR has recorded a high stillbirths rate with a slow decline. This exploratory study was designed to understand the perspectives of women and traditional birth attendants regarding the high occurrence of stillbirth in Thatta district. METHODS: We used an exploratory qualitative study design by conducting in-depth interviews (IDIs) and focus group discussions (FGDs) using semi-structured interview guide with rural women (FGDs = 4; n = 29) and traditional birth attendants (FGDs = 4; n = 14) who were permanent residents of Thatta. In addition, in-depth interviews were conducted with women who had experienced a stillbirth (IDIs = 4). This study presents perceptions and experiences of women and TBAs regarding high rate of stillbirth in Thatta district, Karachi. RESULTS: Women showed reluctance to receive skilled/ standard care when in need due to apprehensions towards operative delivery, poor attitude of skilled health care providers, and poor quality of care as service delivery factors. High cost of care, far distance to facility, lack of transport and need of an escort from the family or village to visit a health facility were additional important factors for not seeking care resulting in stillbirth. The easy availability of unskilled provider in the form of traditional birth attendant is then preferred over a skilled health care provider. TBAs shared their husband or family members restrict them to visit or consult a doctor during pregnancy. According to TBAs after delivering a macerated fetus, women are given herbs to remove infection from woman's body and uterus. Further women are advised to conceive soon so that they get rid of infections. CONCLUSION: Women of this rural community carry lots of apprehension against skilled medical care and as a result follow traditional practices. Conscious efforts are required to increase the awareness of women to develop positive health seeking behavior during pregnancy, delivery and the post-partum period. Alongside, provision of respectful maternity care needs to be emphasized especially at public health facilities.


Assuntos
Parto Domiciliar/psicologia , Parto Domiciliar/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Natimorto/epidemiologia , Adulto , Tomada de Decisões , Feminino , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Paquistão/epidemiologia , Gravidez , Pesquisa Qualitativa , População Rural , Natimorto/psicologia , Adulto Jovem
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