Exploring midwives' coping and functioning in the labour wards during the Covid-19 pandemic from the Labour Ward Head Nurses' perspective: A qualitative study.

AIM: The aim of this study is to explore midwives' coping and functioning in the labour wards during the Covid-19 pandemic from the Labour Ward Head Nurses' perspective. BACKGROUND: The World Health Organization announced the Covid-19 outbreak to be a pandemic in March 2020. Midwives worldwide were affected by this outbreak, working in risky environments, confronting the anxiety and fear of childbearing women. METHODS: A qualitative study using thematic analysis was conducted using semi-structured interviews done over the telephone. Thirteen Labour Ward Head Nurses were interviewed, and the texts were analysed. The study took place in April 2020 during the first Covid-19 lockdown in Israel. RESULTS: Three main themes were generated in the coding process: (a) stress, fear and anxiety, (b) joint efforts and (c) frustration. CONCLUSION: Our study illustrates the difficulties that arose at the beginning of the pandemic, a new and unfamiliar chaotic period. Midwives' managers can use the current research to learn about actions that may assist in improving staff resilience and cohesion during times of crisis. IMPLICATIONS FOR NURSING MANAGEMENT: Understanding the psychological impact of the Covid-19 pandemic among health care professionals is crucial for guiding policies and interventions to maintain staff's psychological well-being.

A Correlational Study Of Midwives' Self-Compassion, Psychosocial Health, and Well-Being During the First Wave of COVID-19: What Have We Learned?

INTRODUCTION: During the first wave of the COVID-19 pandemic, midwives worked in a threatening environment and worried about themselves and their families becoming infected. Self-compassion is defined as an attitude of self-kindness that is supported by a balanced attitude toward negative thoughts or feelings and may contribute to the psychosocial health and well-being. The purpose of this study was to describe midwives' self-compassion, psychosocial health, and well-being and the correlation between them. METHODS: This was a descriptive correlational study using a survey administered online during May, 2020. Participants included midwives who worked in labor and delivery units across Israel during the beginning of the COVID-19 pandemic. Measures included a demographic questionnaire; the Self-Compassion Scale Short Form (SCS-SF), which has 12 items in 6 subscales; and the psychosocial health and well-being questionnaire, a short version of the Copenhagen Psychosocial Questionnaire, which has 24 items in 6 subscales. RESULTS: Participants (N = 144) reported a moderate-high level of self-compassion with a mean (SD) SCS-SF score of 3.57 (0.69). The mean (SD) psychosocial well-being score was 30.72 (13.57). The burnout subscale score had the highest mean (46.27), representing a high level of burnout. A minority (11.3%) of midwives considered resigning their midwifery positions. A higher level of self-compassion correlated with better psychosocial well-being (r = -0.466; P < .001). The highest correlation was found between the SCS-SF and the psychosocial health and well-being subscale for depressive symptoms (r = -0.574; P < .001). DISCUSSION: During the first wave of the COVID-19 pandemic, midwives had a moderate-high grade of self-compassion and good psychosocial well-being. Midwives with higher self-compassion had better psychosocial well-being. The findings could inform the development of programs to increase midwives' self-compassion, and psychosocial well-being and the quality of midwifery care, in times of stability and during future pandemics or disasters.

Perineal massage during pregnancy: a prospective controlled trial.

BACKGROUND: Women frequently suffer perineal trauma while giving birth. Interventions to increase the possibility for an intact perineum are needed. OBJECTIVES: To evaluate the effectiveness of antenatal perineal massage in increasing the likelihood of delivering with an intact perineum. METHODS: This single blinded prospective controlled trial included 234 nulliparous women with a singleton fetus. Women allocated to the study group were instructed to practice a 10 minute perineal massage daily from the 34th week of gestation until delivery. Primary outcome measures included the episiotomy rate; first, second, third and fourth-degree perineal tear rates; and intact perineum. Secondary outcomes were related to specific tear locations and the amount of suture material required for repair. RESULTS: Episiotomy rates, overall spontaneous tears and intact perineum rates were similar in the study and control groups. Women in the massage group had slightly lower rates of first-degree tears (73.3% vs. 78.9%, P = 0.39) and slightly higher rates of second-degree tears (26.7% vs. 19.3%, P= 0.39), although both of these outcomes did not reach statistical significance. The rates of anterior perineal tears were significantly higher in the massage group (9.5% vs. 3%, P = 0.05), whereas internal lateral tears rates were slightly lower but without statistical significance (11.5% vs.13.1%, P=0.44). CONCLUSIONS: The practice of antenatal perineal massage showed neither a protective nor a detrimental significant effect on the occurrence of perineal trauma.

Effects of changes in copayment for obstetric emergency room visits on the utilization of obstetric emergency rooms.

In view of the growing proportion of "non-urgent" admissions to obstetric emergency rooms (OERs) and recent changes in copayment policies for OER visits in Israel, we assessed factors contributing to OER overcrowding. The changes investigated were (a) exemption from copayment for women with birth contractions, (b) allowing phone referrals to the OER and (c) exemption from copayment during primary care clinic closing hours. We analyzed data of a large tertiary hospital with 37 deliveries per day. Counts of women discharged to home from the OER were an indicator of "non-urgent" visits. The annual number of non-urgent visits increased at a higher rate (3.4%) than the natural increase in deliveries (2.1%). Exemption from copayment for visits during non-working hours of primary care clinics was associated with increases in OER admissions (IRR=1.22) and in non-urgent OER visits (IRR=1.54). Younger and first-time mothers with medically unjustified complaints were more likely to be discharged to home. We showed that the changes in the policy for OER copayment meant to attract new clients to the HMO had an independent impact on OER utilization, and hence, added to the workload of medical personnel. The change in HMO policy regulating OER availability requires rigorous assessment of possible health system implications.

Stressful childbirth situations: a qualitative study of midwives.

INTRODUCTION: This study aimed to explore clinical life-threatening childbirth situations, which midwives perceive as extremely stressful, and to identify how midwives cope with those experiences. METHODS: Participants were 18 midwives employed in 6 labor and delivery units in Israeli hospitals. Individual semistructured, in-depth interviews were conducted wherein participants were asked to describe an extremely stressful situation that they had experienced, their significant feelings associated with the event, their coping strategies, and their support systems. RESULTS: Thematic content analysis revealed 2 themes, with each consisting of 4 categories. The first theme focused on reactions to stressful childbirth situations and their impact on midwives. Categories were: functioning professionally in an unexpected reality, emotional reactions, physical reactions, and long-term effects. The second theme related to coping with stressful situations, focusing on coping difficulties, and suggestions for change. Categories were: midwives' coping difficulties, their colleagues' reactions, their feelings about supervisory staff support, and their suggestions for meeting expressed needs. DISCUSSION: Stressful childbirth situations can have a long-term impact on midwives' professional and personal identities. Midwives need to feel supported and valued in order to deal with emotional stress. Incorporating clinical supervision by experienced midwives can serve as a supportive framework for other midwives.

Prediction of perineal trauma during childbirth by assessment of striae gravidarum score.

OBJECTIVE: To explore the association between striae gravidarum (SG) and the risk for perineal trauma (PT) in childbirth. DESIGN: A cross-sectional study. SETTING: Maternity ward in 5 university medical centers. PARTICIPANTS: Three hundred and eighty-five women (28.9+/-5.3 years old) who delivered vaginally. METHODS: Striae gravidarum score was assessed using the Atwal numerical scoring system. The association was examined between PT as the outcome measure, defined by tears or laceration, and the total striae scores (TSS) obtained at the abdomen, hips, buttocks, and breast. RESULTS: Significantly higher TSS scores were found in women with PT compared with women without PT (3.60+/-0.39 vs. 2.31+/-0.23, p=.003). Specifically, striae scores at the breast and hips were significantly higher among women who had PT. Logistic regression analysis revealed that TSS (OR=0.079; 95% CI 1.012, 1.151; p=.021), as well as a rise in body mass index (BMI) during pregnancy (OR=1.025; 95% CI 1.001, 1.049; p=.043) are significant predictors of PT. CONCLUSIONS: This study demonstrates a significant relation between SG and PT. The findings suggest that SG assessment may be used in the clinical setting by midwives and nurses as a simple and noninvasive tool to better define women at risk for PT.

Oxidative stress as determined by glutathione (GSH) concentrations in venous cord blood in elective cesarean delivery versus uncomplicated vaginal delivery.

OBJECTIVE: To determine whether neonates are subject to oxidative stress by the labor process and the mode of delivery by measuring glutathione (GSH) concentrations in umbilical cord venous blood. STUDY DESIGN: Forty-eight women with singleton term pregnancies were prospectively recruited and classified as follows: 26 women had a spontaneous uncomplicated vaginal delivery (VD), and 22 women had an elective cesarean delivery (CD). GSH concentration in umbilical venous blood samples was determined by a spectroscopic method. RESULTS: Umbilical cord venous blood GSH levels were significantly lower in the elective CD group than in the VD group (2.2 and 2.7 mM, respectively, P = 0.0003). There was a significantly negative correlation between cord blood pO(2) and GSH levels; however, the negative correlation was significantly higher in the elective CD group (P < 0.05). CONCLUSION: Neonates delivered by CD were exposed to a higher oxidative stress as determined by GSH levels compared to those who had an uncomplicated VD.