Maternal obesity and healthcare experiences: perceptions and challenges in prenatal and postpartum care

Access to prenatal healthcare for East African Somali Speaking Women (EASSW) who are immigrants to the U.S. has been dependent on the availability of a systematic healthcare treatment model. The purpose of this study was to explore EASSW's lived experiences in accessing prenatal healthcare services in the U.S. A descriptive, qualitative phenomenological approach informed by the work of Husserl was used to explore EASSW's experiences, views, and problems encountered while attempting to access prenatal healthcare services in the U.S. Fifteen EASSW of childbearing age (ages 18–45) were recruited for this study. All participants interviewed privately, beginning with a semi-structured, open-ended question regarding access to prenatal health care services, followed by three more focused questions. Due to cultural restraints, no digital recorder was used in this study, instead the researcher took pencil, and paper notes during the interviews. The specific aims of this study were: 1) to describe EASSW's experiences while seeking prenatal healthcare services; 2) to understand EASSW's views towards the American prenatal healthcare services available to them; and 3) to identify any problems participants encountered while obtaining prenatal care, including, if applicable, the reasons for not seeking early prenatal care services. Examination of participants' narratives revealed four major themes, including cultural barriers, favorable and unfavorable prenatal healthcare experiences, systematic obstacles, and the target population's lack of knowledge of the U.S. healthcare system. The study provided additional sub-theme categories regarding prenatal healthcare services for the EASSW of childbearing age. Further analysis of themes and subthemes identified three major categories of factors limiting access to prenatal health care in this population, including internal, external, and systematic factors. These factors include health care providers' lack of cultural sensitivity, a lack of quality interpretation services, EASSW's lack of access to resources such as transportation and childcare, and the complexity of the U.S. healthcare system. This study indicates the need for future research to understand more regarding factors currently limiting access to prenatal care.

Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap?

To investigate factors influencing maternal health care utilisation in western rural China and its relation to income before (2002) and after (2007) introducing a new rural health insurance system (NCMS). Data from cross-sectional household-based health surveys carried out in ten western rural provinces of China in 2003 and 2008 were used in the study. The study population comprised women giving birth in 2002 or 2007, with 917 and 809 births, respectively. Correlations between outcomes and explanatory variables were studied by logistic regression models and a log-linear model. Between 2002 and 2007, having no any pre-natal visit decreased from 25% to 12% (difference 13%, 95% CI 10-17%); facility-based delivery increased from 45% to 80% (difference 35%, 95% CI 29-37%); and differences in using pre-natal and delivery care between the income groups narrowed. In a logistic regression analysis, women with lower education, from minority groups, or high parity were less likely to use pre-natal and delivery care in 2007. The expenditure for facility-based delivery increased over the period, but the out-of-pocket expenditure for delivery as a percentage of the annual household income decreased. In 2007, it was 14% in the low-income group. NCMS participation was found positively correlated with lower out-of-pocket expenditure for facility-based delivery (coefficient -1.14 P < 0.05) in 2007. Facility-based delivery greatly increased between 2002 and 2007, coinciding with the introduction of the NCMS. The rural poor were still facing substantial payment for facility-based delivery, although NCMS participation reduced the out-of-pocket expenditure on average.

Pregnancy and childbirth complications are leading causes of death and disability among women of reproductive age, especially in developing countries, with Nigeria experiencing 576 deaths in every 100,000 births. This is particularly worrisome when most of these deaths could be prevented if pregnant women seek prenatal health care services. It is in the light of the foregoing that this research investigates the level of access and factors that influence use of prenatal health care services in Isiekenesi. Secondary and primary data were used for this study. The study adopted questionnaire, IDI, and FGD as data collection instruments. The data was analyzed at univariate and bivariate levels. The high cost of prenatal health care services was identified as a major factor that influences a woman's decision not to use prenatal health care services. Finally, while all stakeholders should intensify awareness of the importance of using prenatal health care services, concerted effort should be channeled toward reduction of cost or outright free services at least in government-owned health centers in rural areas.

Preconception Women’s Health and Pediatrics: An Opportunity to Address Infant Mortality and Family Health

Among Black birthing people, high-quality, respectful care throughout pregnancy and postpartum is hindered by distrust, racial discrimination, and unsatisfactory care. The purpose of this integrative review was to examine prenatal and postpartum care experiences among Black birthing people in the United States. A literature search, spanning from inception through October 6, 2022, across 4 research databases, used a combination of keywords to capture reports on care experiences among Black birthing people. We included quantitative and qualitative studies in the United States with people who self-identified as Black or African American and reported prenatal or postpartum health care experiences. Intrapartum experiences were excluded. All studies were evaluated with the Mixed-Methods Appraisal Tool, National Institutes of Health Study Quality Assessment tool, or Joanna Briggs Institute critical appraisal checklist. Data were analyzed and synthesized using the Joanna Briggs Institute convergent integrated approach to incorporate quantitative and qualitative research. A total of 16 studies published over 27 years met the inclusion criteria. All studies examined the health care experiences of Black birthing people during prenatal or postpartum care. None of the studies focused solely on postpartum care experiences. The 2 most prominent themes were models of care and patient-provider interactions, encompassing both positive and negative experiences. Positive care experiences included collaborative patient-provider interactions, continuity of care, and culturally centered care. Adverse experiences were more frequently noted and involved discriminatory treatment during patient-provider interactions, fragmented care models, and a lack of cultural awareness. Black birthing people in the United States report some positive but more negative health care experiences during pregnancy and postpartum care, which may play an important role in health inequities. Promoting prenatal and postpartum care models that provide continuity and are high-quality, collaborative, and culturally centered were identified as high-priority targets to foster patient safety and improve clinical outcomes.

This research examines individual and area level factors associated with maternal health care utilization in Pakistan. The 2012-2013 Pakistan Demographic and Health Surveys data was used to model five outcomes: prenatal care within the first trimester, four plus prenatal visits, birth attendance by a skilled attendant, birth in a medical facility, and receipt of postnatal care. Less than half of births were to mothers receiving prenatal care in the first trimester, and approximately 57% had trained personnel at delivery. Over half were born to mothers who received postnatal care. Evidence was found to support the positive effect of individual level variables, education and wealth, on the utilization of maternal health care across all five measures. Although, this study did not find unilateral differences between women residing in rural and urban settings, rural women were found to have lower odds of utilizing prenatal services as compared to mothers in urban environments. Additionally, women who cited distance as a barrier, had lower odds of receiving postnatal health care, but still engaged in prenatal services and often had a skilled attendant present at delivery. The odds of utilizing prenatal care increased when women resided in an area where prenatal utilization was high, and this variability was found across measures across provinces. The results found in this paper highlight the uneven progress made around improving prenatal, delivery, and postnatal care in Pakistan; disparities persist which may be attributed to factors both at the individual and community level, but may be addressed through a consorted effort to change national policy around women's health which should include the promotion of evidence based interventions such as incentivizing health care workers, promoting girls' education, and improving transportation options for pregnant women and recent mothers with the intent of ultimately lowering the Maternal Mortality Rate as recommended in the U.N.'s Millennium Development Goal 5.

INTRODUCTION: Approximately 25% of women in the United States are obese (body mass index greater than 30 kg/m2). Obese women are at risk for poor perinatal outcomes, and studies imply that inadequate, late onset, or both of prenatal care are contributing factors in this population. We previously demonstrated that maternal obesity is actually associated with improved adequacy of prenatal care as measured by the Kotelchuck index and now further examine the use of specific prenatal services by otherwise uncomplicated obese women. METHODS: Retrospective cohort study of medically uncomplicated women who initiated prenatal care and delivered at our institution from January 2009 to December 2011. Maternal history and delivery information were obtained through chart abstraction. Use of specific prenatal care services including diabetic screening, ultrasound examinations, and hospitalization was compared between nonobese and obese women. RESULTS: A total of 320 women were evaluated, of whom 38% were obese. Mean (±standard error) length of hospital stay for combined intrapartum and postpartum care was 3.0±0.1 days in obese women compared with 2.9±0.1 days in nonobese women (P=.4). Both populations had similar diabetic screening compliance of 86.4% for nonobese and 86.8% for obese women (P=.9). However, obesity was significantly associated with more obstetrical ultrasonographic examinations with 48% obese women having five or more ultrasound scans compared with only 25% of nonobese women (P<.05). CONCLUSION: In our population, obesity in otherwise uncomplicated pregnant women is associated with increased use of obstetric ultrasound services, but there were no differences in use of other prenatal services.

The subject of the study is the anxiety-depressive symptoms of women in the postpartum period. The aim of the study is to identify the interrelationships of anxiety-depressive symptoms of women in the postpartum period and the type of their attitude to pregnancy. The author identified differences in anxiety-depressive symptoms of women with different types of residence and the use of maternity care. The results on the relationship of anxiety and depression with the type of attitude to pregnancy of women in the postpartum period were obtained. Research methodology: typology of the psychological component of the gestational dominant I.V. Dobryakova. Empirical basis of the study: the study was conducted on the basis of the Altai Regional Clinical Center for Maternal and Child Health with women in the early postpartum period.The existence of interrelations between the appearance of anxiety-depressive symptoms of women in the postpartum period and the type of attitude to pregnancy is theoretically substantiated and empirically proven. Qualitative characteristics of differences in the type of attitude to pregnancy of women with different types of residence and the use of maternity care are determined. The main conclusions of the study are : Anxious symptoms in the postpartum period are more typical for women from rural areas; Women who have undergone natural childbirth are more likely to experience depression and anxiety in the postpartum period; Rural women are more characterized by a hypogestognosic type of attitude to pregnancy, urban women - a depressive type of attitude to pregnancy; Anxious and depressive types of attitude to pregnancy associated with fears, expressed fears, tearfulness are risk factors for the development of anxiety-depressive symptoms in women in the postpartum period.

Introduction Maternal and child health are crucial for the well-being of a society. Armed conflicts negatively affect health systems including maternal and child health services. We explored access and utilization of prenatal and postnatal care services in Nagorno-Karabakh: a frozen conflict zone. Methods We applied cluster sampling to draw a sample of 1023 households in Nagorno-Karabakh in 2022. Interviewer-administered surveys were conducted among women of reproductive age (18-49) from the selected households. The instrument captured key reproductive health, and maternal and child health indicators, for the youngest 0-5 y.o. child. Results Out of 1023 women, 299 (29.5%) had at least one 0-5 y.o. child: 54.5% males and 45.5% females. Almost all the respondents received prenatal care (97.7%), the majority of them (95%) starting in the first trimester with frequency of more than 4 visits (90.7%). The visits included blood pressure measurement (99.3%), urine test (99.7%), blood test (99.7%), checking baby's heartbeat (99.3%), ultrasound (98.3%), nutrition education (82.9%) and breastfeeding counseling (79.8%), and asking about vaginal bleeding episodes (58.2%). Less than half of the respondents reported folic acid (49.5%) and iron (46.5%) supplementation during the pregnancy. While in the healthcare facility, mostly doctors checked mothers’ and babies’ health, 78.6% and 90.3%, respectively. Once discharged, less than 50% of the mothers and more than 80% of the babies received follow-up health checks. Conclusions Despite operating in a frozen-conflict zone, the health system of Nagorno-Karabakh was able to provide prenatal care in line with global evidence-based recommendations. Our findings indicate some gaps in breastfeeding counseling, folic-acid supplementation, and utilization of postnatal services. Capacity-building and community-based educational programs have the potential to improve overall prenatal and postnatal care and build sustainable health systems. Key messages • This unique study showed that despite operating in a frozen-conflict zone, the health system of Nagorno-Karabakh was able to provide prenatal care in line with global evidence-based recommendations. • Capacity building, as well as patient-provider and community-based educational programs have the potential to improve overall prenatal and postnatal care in Nagorno-Karabakh.

Prenatal Care Visits and Associated Costs for Treatment-Seeking Women With Depressive Disorders

This study aimed to determine whether a history of depressive disorders is associated with use and costs of prenatal care among pregnant women in Taiwan. Participants were mothers with singleton births between 2004 and 2006 (N=23,290), some of whom (N=614) had received care for depression in the year before conception but not during pregnancy. The mean number of prenatal care visits was 8.50 and associated costs were $NT 51,187 for pregnant women with a history of depressive disorders and 9.17 visits and $NT 27,998, respectively, for those without such a history. After adjustment for age, monthly income, medical conditions, and obstetric complications, mothers with a history of depression were significantly less likely to receive prenatal care (relative risk=.94, 95% confidence interval=.92-.97, p<.001). However, women with a history of depression had $NT 22,494 higher prenatal care costs than mothers without a history of depression. Pregnant women with a history of depressive disorders had fewer prenatal care visits but higher prenatal care costs. Physicians should consider screening to identify pregnant women with a history of depressive disorders.

Since the transition from a centrally planned to a market economy, Tajikistan has witnessed a high rate of child and maternal mortality, a decline in the birth rate and a significant drop in public expenditures on health care. Against this backdrop, this paper analyses the determinants of prenatal health care utilization using Andersen's behavioural model, which has been modified to the context of Tajikistan. We applied a two-stage sequential model to data drawn from a nationally representative survey. Binary logit regression is used to predict and explain the probability of using prenatal health care services, while negative binomial regression is used to predict and explain the frequency of using these services. Findings suggest that higher educational attainment increases the utilization of prenatal care. Conversely, poverty, limited knowledge about matters related to sex, low quality of health care service, lack of public infrastructure, as well as absence of or long distance of travel to the nearest health facility, all reduce the utilization of prenatal health care. Health policy and research implications are presented and discussed.

The purpose of this study was to examine the effects of feelings about pregnancy and consideration of abortion on late initiation of prenatal care and postpartum appointment. A descriptive study was conducted in a tertiary clinic in Detroit using a convenience sample comprised of 518 low-income pregnant and postpartum women with a large number of unintended pregnancies. A series of chi-square analyses and logistic regression models were conducted to identify variables predictive of these outcomes. Teenagers were 1.8 times more likely to initiate late prenatal care versus early care (p = 0.05), and women who considered an abortion were 3.7 times more likely to initiate late prenatal care (p = 0.01). Having considered abortion but deciding against it due to psychologic/moral reasons was protective against late initiation of prenatal care (OR = 0.23; p = 0.01). Multiparity was the only predictor of a missed postpartum appointment. Multiparous women were three times more likely to miss the appointment (p = 0.05). Success in improving early access to prenatal care will involve addressing the issue of unintended pregnancy. This challenge will require that health care providers assess feelings and values related to a pregnancy. Understanding women's feelings and values about the pregnancy will allow providers to more effectively assist with decision-making and positive pregnancy behaviors. In addition, community-based education related to family planning and the value of prenatal and postpartum care is needed to involve women's partners, family, and friends, because social support systems influence decisions regarding pregnancy behaviors.

ObjectiveThis study investigates the effects of developing and implementing an integrated service model for antepartum, intrapartum, and postpartum care in maternal and child specialty hospitals under the deep integration of Internet technology. The goal is to provide practical references for addressing declining birth rate challenges and promoting the sustainable development of maternal and child specialty hospitals.MethodsUsing a convenience sampling method, 100 pregnant and postpartum women from a tertiary maternal and child health hospital in Chengdu, China, were selected as the participants for this study. A random number table was used to assign the participants into the control group and the intervention group, with 50 participants in each group. The control group received conventional nursing care, while the intervention group was provided with an integrated service model for antepartum, intrapartum, and postpartum care, fully implemented with Internet technology. A comprehensive comparative analysis was conducted between the two groups across several key dimensions, including the number of return visits within 42 days postpartum: The actual number of return visits for checkups, treatments, or consultations due to various health issues during this period was recorded and compared; Postpartum complications within 42 days: The occurrence rates of common complications, such as postpartum infections, hemorrhage, and milk stasis, were meticulously documented and analyzed for both groups. Service satisfaction: A nursing satisfaction questionnaire was used to objectively and comprehensively assess the satisfaction levels of participants in both groups with the care they received. Willingness for postpartum follow-up visits: Differences in participants’ subjective willingness and proactive attitudes toward arranging subsequent postpartum visits were thoroughly examined. Psychological indicators: Using psychological assessment scales, the psychological status of the two groups was evaluated from the establishment of personal health records to postpartum follow-up, analyzing the psychological differences between the two groups.ResultsThrough systematic data collection, organization, and rigorous statistical analysis, the results revealed that the average number of return visits within 42 days postpartum was significantly lower in the intervention group (0.16 ± 0.42) compared to the control group (1.44 ± 1.11) (t = −7.630, P < .001). For service satisfaction, 84.00% (42/50) of participants in the intervention group were very satisfied, significantly higher than 52.00% (26/50) in the control group (χ² = 3.170, P = .001). The incidence of mastitis within 42 days postpartum was 2.00% (1/50) in the intervention group, markedly lower than 28.00% (14/50) in the control group (χ² = 2.670, P < .001). For willingness to seek follow-up visit, 96.00% (48/50) of participants in the intervention group stated they would return to the hospital if they had health issues, compared to 82.00% (41/50) in the control group (χ² = 5.010, P = .025). 92.00% (46/50) of participants in the intervention group were willing to choose our hospital for the newborn's health checkup, significantly higher than 76.00% (38/50) in the control group (χ² = 61.060, P < .001). The 28 weeks GAD-7 scored lower in the intervention group (4.14 ± 0.73) than in the control group (5.27 ± 1.00) (t = −6.430, P < .001) and also lower in the intervention group than in the control group at admission (5.58 ± 1.40 vs. 7.29 ± 1.61; t = −5.630, P < .001). There was no significant difference in 28 weeks EPDS scores between two groups (9.02 ± 0.68 vs. 9.18 ± 0.78; t = −1.110, P = .270). The intervention group showed significantly lower EPDS scores at 42 days postpartum (7.84 ± 0.71 vs. 9.61 ± 1.84; t = −6.310, P < .001).ConclusionThe integrated service model for antepartum, intrapartum, and postpartum care in maternal and child specialty hospitals, based on the “Internet+” concept, effectively integrates Internet technology with critical processes in nursing services. This model precisely and efficiently addresses pregnant and postpartum women's unique maternal and childcare needs at different physiological stages. It demonstrates significant advantages in optimizing medical resource allocation, improving the quality and efficiency of nursing services, and enhancing patients’ healthcare experiences and trust. The findings of this empirical study provide robust evidence for the model's effectiveness in nursing care. The successful implementation of this innovative service model offers new perspectives and directions for transforming and upgrading maternal and child specialty hospitals in the face of declining birth rates and the associated challenges and opportunities. It holds significant value for broader application and promotion, with promising prospects for further development.