Navigating geographical disparities: access to obstetric hospitals in maternity care deserts and across the United States.

BACKGROUND: Access to maternity care in the U.S. remains inequitable, impacting over two million women in maternity care "deserts." Living in these areas, exacerbated by hospital closures and workforce shortages, heightens the risks of pregnancy-related complications, particularly in rural regions. This study investigates travel distances and time to obstetric hospitals, emphasizing disparities faced by those in maternity care deserts and rural areas, while also exploring variances across races and ethnicities. METHODS: The research adopted a retrospective secondary data analysis, utilizing the American Hospital Association and Centers for Medicaid and Medicare Provider of Services Files to classify obstetric hospitals. The study population included census tract estimates of birthing individuals sourced from the U.S. Census Bureau's 2017-2021 American Community Survey. Using ArcGIS Pro Network Analyst, drive time and distance calculations to the nearest obstetric hospital were conducted. Furthermore, Hot Spot Analysis was employed to identify areas displaying significant spatial clusters of high and low travel distances. RESULTS: The mean travel distance and time to the nearest obstetric facility was 8.3 miles and 14.1 minutes. The mean travel distance for maternity care deserts and rural counties was 28.1 and 17.3 miles, respectively. While birthing people living in rural maternity care deserts had the highest average travel distance overall (33.4 miles), those living in urban maternity care deserts also experienced inequities in travel distance (25.0 miles). States with hotspots indicating significantly higher travel distances included: Montana, North Dakota, South Dakota, and Nebraska. Census tracts where the predominant race is American Indian/Alaska Native (AIAN) had the highest travel distance and time compared to those of all other predominant races/ethnicities. CONCLUSIONS: Our study revealed significant disparities in obstetric hospital access, especially affecting birthing individuals in maternity care deserts, rural counties, and communities predominantly composed of AIAN individuals, resulting in extended travel distances and times. To rectify these inequities, sustained investment in the obstetric workforce and implementation of innovative programs are imperative, specifically targeting improved access in maternity care deserts as a priority area within healthcare policy and practice.

Status of the midwifery workforce and childbirth services and the impact of midwife staffing on birth outcomes in China: a multicentre cross-sectional study.

OBJECTIVE: To investigate the status of the midwifery workforce and childbirth services in China and to identify the association between midwife staffing and childbirth outcomes. DESIGN: A descriptive, multicentre cross-sectional survey. SETTING: Maternity hospitals from the eastern, central and western regions of China. PARTICIPANTS: Stratified sampling of maternity hospitals between 1 July and 31 December 2021.The sample hospitals received a package of questionnaires, and the head midwives from the participating hospitals were invited to fill in the questionnaires. RESULTS: A total of 180 hospitals were selected and investigated, staffed with 4159 midwives, 412 obstetric nurses and 1007 obstetricians at the labour and delivery units. The average efficiency index of annual midwifery services was 272 deliveries per midwife. In the sample hospitals, 44.9% of women had a caesarean delivery and 21.4% had an episiotomy. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery (adjusted ß -0.032, 95% CI -0.115 to -0.012, p<0.05) and episiotomy (adjusted ß -0.171, 95% CI -0.190 to -0.056, p<0.001). CONCLUSION: The rates of childbirth interventions including the overall caesarean section in China and the episiotomy rate, especially in the central region, remain relatively high. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery and episiotomy, indicating that further investments in the midwifery workforce could produce better childbirth outcomes.

[Factors associated with breastfeeding at birth in maternity hospitals linked to the Rede Cegonha, Brazil, 2016-2017]. / Fatores associados ao aleitamento materno ao nascer em maternidades vinculadas à Rede Cegonha, Brasil, 2016-2017.

Breastfeeding (BF) is a human right, and it must start from birth. The adequacy of Rede Cegonha (RC) strategies can contribute to the promotion of BF. The objective was to identify factors associated with BF in the first and 24 hours of live births at full-term maternity hospitals linked to CR. Cross-sectional study with data from the second evaluation cycle 2016-2017 of the RC that covered all of Brazil. Odds ratios were obtained through binary logistic regression according to a hierarchical model, with 95% confidence intervals and p-value < 0.01. The prevalence of BF in the first hour was 31% and in the 24 hours 96.6%. The chances of BF in the first hour increased: presence of a companion during hospitalization, skin-to-skin contact, vaginal delivery, delivery assistance by a nurse and accreditation of the unit in the Baby-Friendly Hospital Initiative. Similar results at 24 hours, and association with maternal age below 20 years. BF in the first hour was less satisfactory than in the 24 hours, probably due to the high prevalence of cesarean sections, a factor associated with a lower chance of early BF. Continuous training of professionals about BF and the presence of an obstetric nurse during childbirth are recommended to expand BF in the first hour.

O aleitamento materno (AM) é um direito humano e deve ser iniciado desde o nascimento. A adequação das estratégias da Rede Cegonha (RC) pode contribuir na promoção do AM. O objetivo foi identificar os fatores associados ao AM na primeira e nas 24 horas de nascidos vivos a termo em maternidades vinculadas à RC. Estudo transversal com dados do segundo ciclo avaliativo 2016-2017 da RC, que abrangeu todo o Brasil. Foram obtidas razões de chance por meio de regressão logística binária segundo modelo hierarquizado, com intervalos de confiança a 95% e p-valor < 0,01. A prevalência de AM na primeira hora foi de 31%, e nas 24 horas, de 96,6%. Aumentaram as chances de AM na primeira hora: presença de acompanhante na internação, contato pele a pele, parto vaginal, assistência ao parto por enfermeira e acreditação da unidade na Iniciativa Hospital Amigo da Criança. Resultados semelhantes nas 24 horas, e associação com idade materna inferior a 20 anos. O AM na primeira hora foi menos satisfatório do que nas 24h, provavelmente pela elevada prevalência de cesariana, fator associado à menor chance de AM precoce. A capacitação dos profissionais sobre AM de forma contínua e a presença de enfermeiro obstetra no parto são recomendadas para ampliar o AM na primeira hora.

Factors associated with antepartum pilgrimage at a reference maternity hospital in Ceará.

OBJECTIVE: To identify factors associated with antepartum pilgrimage in pregnant women in Fortaleza, Ceará, Brazil. METHOD: A cross-sectional study with 300 postpartum women from a state reference maternity hospital, carried out from March 2020 to January 2021. The frequency of pilgrimage was estimated according to socioeconomic characteristics and prenatal care. Analysis with Pearson's chi-square test selected variables for adjusted Poisson regression. RESULTS: The frequency of antepartum pilgrimage to more than one health service was 34.3%. Not knowing the reference maternity hospital (1.16; 95%CI: 1.04-1.30) and not living close to the reference maternity hospital (1.16; 95%CI: 1.03-1.31) were associated with the occurrence of pilgrimage among women. Personal characteristics and prenatal care were not associated. CONCLUSION: There was an association between antepartum pilgrimage and lack of knowledge of the reference maternity hospital and residence far from that maternity hospital, which requires better team communication and the guarantee of easier access to obstetric care services, through effective implementation of regionalization of maternal care.

Contribution of proactive management of healthcare risks to the reduction of adverse events in a maternity hospital.

BACKGROUND: The risks of the childbirth assistance process are still very high, both for mothers and babies. According to the WHO, birth-related asphyxia accounts for 23% of all 3.3 million annual neonatal deaths and an even larger number of survivors with disabilities. On the other hand, maternal mortality is still a global challenge, affecting 17 mothers per 100 000 births in the USA. This is associated with the use of outdated technologies and a lack of well-defined processes in monitoring labour and early recognition of maternal clinical deterioration. METHOD: This study used Lean methodology to map the care flow for pregnant women in a Brazilian maternity hospital (Hospital Israelita Albert Einstein) in order to identify the risks within this process and a set of actions to minimise them. The work team consisted of 29 individuals, including local medical and nursing leaders, as well as healthcare professionals. The What-if tool was used to categorise the levels of risks, and the proportion of severe and catastrophic adverse events was evaluated before and after the implementation of changes. RESULTS: After the implementation of the actions, 100% of the extreme risks (28 risks) and 8% of the high risks (4 risks) were eliminated. This led to a reduction in the interval between severe/catastrophic events from 126 to 284 days, even with an increase in the average monthly number of visits from 367 to 449. Consequently, the weighted value of events decreased from 7.91 to 3.29 per 1000 patients treated, resulting in an annual cost savings of R$693 646.80 (US$139 000.00). DISCUSSION: The construction of a process based on Lean methodology was essential for mapping the involved risks and implementing a set of actions to minimise them. The participation of the healthcare team and leadership seemed to be important in choosing the measures to be adopted and their applicability. The results found can be attributed to both the established changes and the safety culture brought about by this constructive process.

Prenatal care associated with neonatal outcomes in maternity hospitals: a hospital-based cross-sectional study.

OBJECTIVE: To verify the association between prenatal care quality indicators and neonatal outcomes in maternity hospitals. METHOD: Hospital-based cross-sectional study in four high-risk referral maternity hospitals in the five health macro-regions enabled by the Stork Network in Ceará-Brazil. Between April 2017 and July 2018, 440 puerperal women were interviewed using simple probabilistic sampling and a formula with finite populations and stratification of each maternity hospital. The analysis involved Pearson's Chi-Square, Adjusted Residuals Analysis and Fisher's Exact. RESULTS: There was an association between fewer consultations with prematurity and low birth weight. Delivery in the maternity hospital where the woman lived was associated with low birth weight and the need for ventilatory support. CONCLUSION: Prenatal care quality indicators influenced neonatal outcomes, which underlines the importance of ensuring access and quality of care as ways of reducing infant morbidity and mortality.

Current hospital policies on breastfeeding: a survey from Italy.

BACKGROUND: The availability of an appropriate newborn feeding policy is an essential component of the promotion of breastfeeding in health facilities. The Italian Society of Neonatology (SIN) and the Italian Society of Paediatrics (SIP) have run an online survey among Maternity Hospitals to explore the existing breastfeeding policies and their characteristics. METHODS: Between February and April 2023, an online survey was carried out among 110 Italian maternity hospitals with a Neonatal Intensive Care Unit (NICU). RESULTS: Forty-nine Maternity Hospitals completed the online questionnaire. Twenty out of 49 (40.8%) reported to have a breastfeeding policy. When a policy is available, its quality appears to be suboptimal because of lack of inclusion of a family representative in the policy working group, limited options for translating breastfeeding policy into minority languages, lack of periodic assessment of their implementation. CONCLUSION: Currently, only a limited number of Italian Maternity Hospitals have developed a breastfeeding policy. Additional efforts are needed for their improvement as well as implementation.

How well do we truly understand clitoral anatomy? An Irish maternity hospital's perspective.

BACKGROUND: The clitoris has long been ignored in medical literature and teaching, with the first paper describing its anatomy only published in 1993. It is essential that those working in women's health understand the anatomy of this important female sexual organ. AIMS: The aim of this study was to assess the level of knowledge of the anatomy of the clitoris across five cohorts in a busy teaching maternity hospital in Ireland. MATERIALS AND METHODS: A questionnaire was devised, asking ten consultants, ten non-consultant hospital doctors (NCHDs), ten midwives, ten midwifery students and ten medical students to name the anatomical parts of a 3D model of the clitoris. RESULTS: None of the 50 respondents could name all five labelled parts of the clitoris, and 38 of respondents could not correctly name one anatomical part. CONCLUSIONS: It is evident that there is a lack of knowledge of the anatomical parts of the clitoris among the medical staff included in this study. This reflects a lack of adequate teaching in this area in both past and recent years. Despite this, we acknowledge that women's health and sexual health awareness is improving all of the time, and we hope that this study can highlight the need for reformed teaching in this area.

Potential effectiveness of integrating human milk banking and lactation support on neonatal outcomes at Pumwani Maternity Hospital, Kenya.

We assessed the potential effectiveness of human milk banking and lactation support on provision of human milk to neonates admitted in the newborn unit (NBU) at Pumwani Maternity Hospital, Kenya. This pre-post intervention study collected data from mothers/caregivers and their vulnerable neonates or term babies who lacked sufficient mother's milk for several reasons admitted in the NBU. The intervention included establishing a human milk bank and strengthening lactation support. Preintervention data were collected between 5 October 2018 and 11 November 2018, whereas postintervention data were collected between 4 September 2019 and 6 October 2019. Propensity score-matched analysis was performed to assess the effect of the intervention on exclusive use of human milk, use of human milk as the first feed, feeding intolerance and duration of NBU stay. The surveys included 123 and 116 newborns at preintervention and postintervention, respectively, with 160 newborns (80 in each group) being included in propensity score matched analysis. The proportion of neonates who exclusively used human milk during NBU stay increased from 41.3% preintervention to 63.8% postintervention (adjusted odds ratio [OR]: 2.68; 95% confidence interval [CI]: 1.31, 5.53) and those whose first feed was human milk increased from 55.0% preintervention to 83.3% postintervention (adjusted OR: 5.09; 95% CI: 2.18, 11.88). The mean duration of NBU stay was 27% (95% CI: 5.8%, 44.0%) lower in the postintervention group than in the preintervention group. The intervention did not affect feeding intolerance. Integrating human milk banking and lactation support may improve exclusive use of human milk among vulnerable neonates in a resource limited setting.

Safety culture in maternity hospital: Perception of nurse-midwives.

AIM: To explore nurse-midwives' perceptions of safety culture in maternity hospitals. DESIGN: A descriptive phenomenological study was conducted using focus groups and reported following the Consolidated Criteria for Reporting Qualitative Research. METHODS: Data were obtained through two online focus group sessions in June 2022 with 13 nurse-midwives from two maternity hospitals in the central region of Portugal. The first focus group comprised 6 nurse-midwives, and the second comprised 7 nurse-midwives. Qualitative data were analysed using content analysis. FINDINGS: Two main themes emerged from the data: (i) barriers to promoting a safety culture; (ii) safety culture promotion strategies. The first theme is supported by four categories: ineffective communication, unproductive management, instability in teams and the problem of errors in care delivery. The second theme is supported by two categories: managers' commitment to safety and the promotion of effective communication. CONCLUSION: The study results show that the safety culture in maternity hospitals is compromised by ineffective communication, team instability, insufficient allocation of nurse-midwives, a prevailing punitive culture and underreporting of adverse events. These highlight the need for managers to commit to providing better working conditions, encourage training with the development of a fairer safety culture and encourage reporting and learning from mistakes. There is also a need to invest in team leaders who allow better conflict management and optimization of communication skills is essential. IMPACT: Disseminating these results will provide relevance to the safety culture problem, allowing greater awareness of nurse-midwives and managers about vulnerable areas, and lead to the implementation of effective changes for safe maternal and neonatal care. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution as the study only concerned service providers, that is, nurse-midwives themselves.

The association between blood groups, Rhesus factors, body mass index and obesity among pregnant women at Gadarif Maternity Hospital, Eastern Sudan.

BACKGROUND: The existing evidence regarding the link between blood groups and obesity remains inconclusive, and there is a noticeable lack of data on the potential association between blood groups and obesity during pregnancy. Consequently, this study aimed to investigate the association between blood groups, body mass index (BMI), and obesity among pregnant women receiving care at Gadarif Maternity Hospital in eastern Sudan. METHODS: This cross-sectional study was conducted in eastern Sudan during the period from April to September 2022. A questionnaire was employed to gather sociodemographic information from pregnant women. BMI was computed based on weight and height. Blood groups determinations were made using the agglutination method which is commonly used in the study's region. Multinominal and multiple linear regression analyses were performed, and adjusted for covariates in the regression models. RESULTS: Eight hundred and thirty-three pregnant women were enrolled with a median (interquartile range, IQR) gestational age of 10.0 (9.3‒11.0) weeks. The median (IQR) BMI of the women was 26.3(24.2‒29.4) kg/m2. Of these women, 11(1.3%) were underweight, 268(32.2%) were of normal weight, 371(44.5%) were overweight, and 183(22.0%) were obese. One hundred eighty-three (22.0%) women had blood group A, 107 (12.8%) had blood group B, 56 (6.7%) had blood group AB, and 487(58.5%) had blood group O. While 798 (95.8%) of the women were Rhesus factor positive, only 35 (4.2%) were Rhesus factor negative. Multinominal regression showed that only urban residency (adjusted odds ratio, AOR = 2.46, 95% confidence interval, CI = 1.47‒4.13) was associated with overweight. Blood groups and Rhesus factors were not associated with overweight. Age (AOR = 1.06, 95% CI = 1.01‒1.11), urban residence (AOR = 2.46, 95%, CI = 1.47‒4.13), and blood group O (AOR = 1.60, 95%, CI = 1.06‒2.40), were associated with obesity. Rhesus factors were not associated with obesity. In the multiple linear regression, age (coefficient = 0.07, P = 0.028), gravidity (coefficient = 0.25, P = 0.014), urban residence (coefficient = 1.33, P = 0.001), and blood group O (coefficient = 0.68, P = 0.035) were associated with BMI. CONCLUSIONS: Blood group O was associated with obesity and high BMI among pregnant women in eastern Sudan. Rhesus factors were not associated with obesity.

How well do we support whanau with postpartum contraception? Comparison of two Auckland maternity hospitals.

AIM: To compare the rates of recall of contraceptive discussion and provision of chosen contraceptive method before discharge among patients who recently birthed in two tertiary maternity units in Auckland, New Zealand. METHOD: A cross-sectional survey of recently postpartum patients at tertiary and associated primary birthing units aligned with Auckland and Counties Manukau maternity services was undertaken in 2019 and 2020. RESULTS: Five hundred and seventy-one patients took part in the survey. Overall recall around contraceptive discussions was low, as was the number of patients leaving hospital with their preferred method of contraception. Compared to Counties Manukau, almost twice as many patients at Auckland were unable to recall either an antenatal or postpartum discussion with a health professional about contraception (77% vs 39%, p<0.001). Those birthing at Counties Manukau were also more likely to recall seeing a hospital contraceptive brochure than those at Auckland (42% vs 20%, p<0.001). Twice as many patients at Counties Manukau left hospital with their chosen method compared to those at Auckland (31% vs 14%, p<0.001). In addition, long-acting reversible contraceptives (LARCs) were more often chosen for contraception at Counties Manukau (31% vs 22%, p=0.01) and more patients left hospital with their LARC compared to Auckland (13% vs 7%, p=0.03). CONCLUSION: These differences between two large tertiary maternity services suggests an opportunity for quality improvement around contraception provision.

Stillbirth rates and their determinants in a national maternity hospital in Phnom Penh, Cambodia in 2017-2020: a cross-sectional assessment with a nested case-control study.

BACKGROUND: In Cambodia, stillbirths and their underlying factors have not been systematically studied. This study aimed to assess the proportion and trends in stillbirths between 2017 and 2020 in a large maternity referral hospital in the country and identify their key determinants to inform future prevention efforts. METHODS: This was a retrospective cross-sectional analysis with a nested case-control study of women giving birth at the National Maternal and Child Health Centre (NMCHC) in Phnom Penh, 2017-2020. We calculated percentages of singleton births at ≥ 22 weeks' gestation resulting in stillbirth and annual stillbirth rates by timing: intrapartum (fresh) or antepartum (macerated). Multivariable logistic regression was used to explore factors associated with stillbirth, where cases were all women who gave birth to a singleton stillborn baby in the 4-year period. One singleton live birth immediately following each case served as an unmatched control. Multiple imputation was used to handle missing data for gestational age. RESULTS: Between 2017 and 2020, 3.2% of singleton births ended in stillbirth (938/29,742). The stillbirth rate increased from 24.8 per 1000 births in 2017 to 38.1 per 1000 births in 2020, largely due to an increase in intrapartum stillbirth rates which rose from 18.8 to 27.4 per 1000 births in the same period. The case-control study included 938 cases (stillbirth) and 938 controls (livebirths). Factors independently associated with stillbirth were maternal age ≥ 35 years compared to < 20 years (aOR: 1.82, 95%CI: 1.39, 2.38), extreme (aOR: 3.29, 95%CI: 2.37, 4.55) or moderate (aOR: 2.45, 95%CI: 1.74, 3.46) prematurity compared with full term, and small-for-gestational age (SGA) (aOR: 2.32, 1.71, 3.14) compared to average size-for-age. Breech/transverse births had nearly four times greater odds of stillbirth (aOR: 3.84, 95%CI: 2.78, 5.29), while caesarean section reduced the odds by half compared with vaginal birth (aOR: 0.50, 95%CI: 0.39, 0.64). A history of abnormal vaginal discharge increased odds of stillbirth (aOR: 1.42, 95%CI: 1.11, 1.81) as did a history of stillbirth (aOR: 3.08, 95%CI: 1.5, 6.5). CONCLUSIONS: Stillbirth prevention in this maternity referral hospital in Cambodia requires strengthening preterm birth detection and management of SGA, intrapartum care, monitoring women with stillbirth history, management of breech births, and further investigation of high-risk referral cases.

In Cambodia, there is very little information published on stillbirths to know precisely how many there are and to understand the underlying reasons they occur so they can be prevented in the future. Our study aimed to quantify the number of stillborn babies and identify some underlying risk factors from one of the largest maternity referral hospitals in Phnom Penh, Cambodia. We examined data from almost 30,000 health facility medical files of women who gave birth between 2017 and 2020 which included 938 stillbirths. We found that about 3.2% of births ended in a stillbirth and that this percentage increased between 2017 and 2020. Women who had preterm babies, or whose babies were small in weight for their gestational age, and babies that were born breech had a higher chance of being stillborn. Women who had abnormal vaginal discharge, which can indicate a possible infection, also had a higher odds of having a stillbirth. We also found that women who had a stillbirth previously had almost three times higher chance of having another stillborn baby. Having a caesarean section reduced the likelihood of having a stillborn baby by about half. These findings suggest that efforts are needed to better identify and manage women with preterm births and monitor fetal growth as well as ensure breech births are managed adequately.

Association of the presence of a COVID-19 infection at the time of birth and the rates of exclusive breastfeeding upon discharge in BFHI hospitals: a multicenter, prospective cohort study.

BACKGROUND: Very few studies have assessed the association between COVID-19 infection and the rates of exclusive breastfeeding (EBF) upon discharge following the first waves of the pandemic and after initiation of vaccination. The primary objective of this study is to compare the rates of EBF since birth upon discharge in mothers diagnosed with COVID-19 infection at the time of the delivery versus a group of non-infected mothers in maternity hospitals with Baby Friendly Hospital Initiative (BFHI) accreditation. The secondary objectives include determining the rates of any breastfeeding at three and six months of life in both groups, as well as determining the possible factors associated with EBF rates observed upon discharge. METHODS: An observational, Spanish multi-center hospital, prospective cohort study conducted from 1 to 2021 to 31 March 2022 and with follow-up during the first six months of life. Follow-up was performed via telephone contact with calls performed at three and six months. A multivariate logistic regression analysis model was used to identify the factors related to a lower probability of EBF upon discharge. RESULTS: 308 mother-infant pairs participated in the study, 111 in the cohort of women with COVID infection and 197 in the comparison group. EBF upon discharge was 62.7% in the COVID group vs. 81.2% in the comparison group (p = 0.002); at three months; 52.4% vs. 57.0% (p = 0.33) were performing EBF, with the rates of EBF at six months being 43.0% vs. 39.3% (p = 0.45), respectively. Exposure to COVID-19 at delivery (AOR 5.28; 95% CI 2.01, 13.86), not practicing BF previously (AOR 36.3; 95% CI 7.02, 187.74), birth via Cesarean section (AOR 5.06; 95% CI 1.62, 15.79) and low birth weight of the newborn (AOR 1.01; 95% CI 1.01, 1.01) were associated with a greater risk of not performing EBF upon discharge. CONCLUSIONS: Mothers with a mild or asymptomatic COVID-19 infection at the time of the delivery were less likely to have exclusively breastfed during their hospital stay than other mothers in these BFHI-accredited hospitals. However, there were no differences in breastfeeding rates between the groups at three and six months postpartum.

Surveillance of severe maternal morbidity and maternal mortality in maternity hospitals of the Latin American and Caribbean network - Red CLAP: study protocol.

The sustained reduction in maternal mortality in America underlines the need to analyse women who survived a complication that could have been fatal if appropriate and timely care had not been taken. Analysis of maternal near-miss (MNM) cases, as well as potentially life-threatening conditions (PLTC), are considered indicators for monitoring the quality of maternal care. The specific objective of this study protocol is to develop a surveillance system for PLTC, MNM and maternal mortality, as primary outcomes, in Latin American and Caribbean maternal healthcare institutions. Secondarily, the study was designed to identify factors associated with these conditions and estimate how often key evidence-based interventions were used for managing severe maternal morbidity. This is a multicenter cross-sectional study with prospective data collection. The target population consists of all women admitted to health centres participating in the network during pregnancy, childbirth, or the postpartum period. Variables describing the sequence of events that may result in a PLTC, MNM or maternal death are recorded. Relevant quality control is carried out to ensure the quality of the database and confidentiality. Centres with approximately 2,500 annual deliveries will be included to achieve a sufficient number of cases for calculation of indicators. The frequency of outcome measures for PLTC, MNM and maternal mortality and their confidence intervals and differences between groups will be calculated using the most appropriate statistical tests. Similar procedures will be performed with variables describing the use of evidence-based practices. Networking creates additional possibilities for global information management and interaction between different research groups. Lessons can be learned and shared, generating scientific knowledge to address relevant health problems throughout the region with provision of efficient data management.

Maternal and child predictors associated with loss to follow-up in the newborn hearing screening program: a cohort study in maternity hospitals in northeastern Brazil.

PURPOSE: Analyze maternal and child predictors associated with loss to follow-up in the newborn hearing screening program at maternity hospitals in northeastern Brazil. METHODS: Retrospective cohort study, including secondary data from infants (n=604) referred to the newborn hearing screening program in two maternity hospitals for monitoring and/or diagnosis. The predictors evaluated included socioeconomic factors, such as maternal age, marital status, income, schooling, place of residence, number of children and number of prenatal visits. In addition, maternal and child health factors, such as smoking and drug intake during pregnancy, consanguinity, congenital infections, craniofacial malformations, use of ototoxic drugs, syndromes and a history of hearing loss in the family. Statistical analysis was performed based on binary logistic regression models, using the stepwise method. RESULTS: The logistic regression model containing the number of prenatal visits and the history of hearing loss in the family was significant [χ2(2) =34.271; p<0.001]. The number of prenatal visits (OR = 2.343; 95% CI = 1.626 - 3.376) and family history of hearing loss (OR = 2.167; 95% CI = 1.507 - 3.115) were significant predictors. The other predictors were not significant. CONCLUSION: The results reveal that newborns whose mothers had ≤ 5 prenatal visits and those with a family history of hearing loss increased their likelihood of loss to follow-up by 2.3 and 2.1 times, respectively. It is important to provide subsidies for public health improvements in order to help advise, guide and educate mothers, especially during prenatal care.

Fear of childbirth: prevalence and associated factors in pregnant women of a maternity hospital in southern Brazil.

BACKGROUND: The fear of childbirth (FOC) harms maternal and fetal health, however it has been little studied in Brazil. This research aimed to determine the prevalence of FOC in a maternity hospital in southern Brazil and identify its associated factors. METHODS: The Wijma Delivery Expectancy Questionnaire - W-DEQ(A) was used to assess the prevalence of FOC, and its relationship with sociodemographic variables, gestational history, aspects of the current pregnancy, knowledge about childbirth, anxiety symptoms (Beck Anxiety Inventory), depressive symptoms (Edinburgh Postnatal Depression Scale), and perception of social support (Multidimensional Scale of Perceived Social Support) was investigated. Questionnaires about the content of FOC and information sources regarding childbirth were also applied. RESULTS: We interviewed 125 pregnant women between 28 and 36 weeks of pregnancy between July and September of 2021, and 12% of them scored ≥ 85 on the W-DEQ(A), indicating severe FOC. There was a significant correlation between FOC and anxiety symptoms (r = 0.50, p < 0.001), depressive symptoms (r = 0.34, p < 0.001), and poor social support (r = -0.23, p = 0.008). FOC was lower in pregnant women with complete elementary education when compared to those with higher education (p = 0.003), however, those with negative experiences in previous deliveries had more FOC than those who had had positive experiences (p = 0.001). More than 85% of them fear fetal distress. CONCLUSIONS: FOC is a prevalent condition that impacts the mental health of pregnant women. Therefore, health professionals should recognize and address it during prenatal care to provide integral maternal-fetal care and improve the childbirth experience.