Care Midwives Research Articles

Midwives’ and women’s views on digital midwifery care in Germany: Results from an online survey

BackgroundDigital midwifery services were enabled for the first time in Germany from March 2020 to ensure outpatient midwifery care in times of COVID-19. MethodsIn February and March 2021, a cross-sectional study with an online survey of midwives and mothers was conducted to find out to what extent digital services were offered by the midwives and used by the women, and to obtain information about the level of satisfaction and potential of digital midwifery care in pregnancy and post partum. Results1821 mothers of 18,784 women, who had given birth between May and November 2020 and were asked to participate in the survey, provided feedback (response rate: 9,7%). 1551 midwives responded to the call to participate in the survey and completed the questionnaire. Around one third of the responding mothers had used digital midwifery services in pregnancy and/or the postpartum period and rated these services positively by over 80%. Half of the responding midwives offered digital services and wished to continue this care option. However, not all services were considered equally suitable for digital implementation. From the respondents' point of view, classes and counselling are very well suited whereas postpartum care often requires the midwife's presence. Mothers and midwives alike saw the advantages in COVID-19 infection control and in saving time and travel. The main challenges were seen in handling IT equipment and providing high quality care despite the lack of physical examination and direct assessment of clinical findings. The mothers wished for more interactivity and networking with each other. ConclusionThe COVID-19 pandemic has become a catalyst for digitalisation in midwifery care in Germany. The digital services were, mostly, well accepted and seen to usefully complement the in-person care of midwives. IT-support, guidelines and quality standards could help to optimise the digital services.

The effectiveness of the self-care management model in midwife care through android application as an effort to increase the ability of pregnant mothers in early detection of pregnancy at risk during the COVID-19 pandemic

Introduction: The ability of pregnant women to detect early-risk pregnancies is still low, which is one of the causes of complications that can endanger the welfare of the mother and fetus. This research analyzed the effectiveness of the Self Care Model in Midwifery Care through an Android Application on the Ability of Pregnant Women to Early Detection of Risky Pregnancy During the Covid-19 pandemic. Methods: The data of this study of pregnant women who conducted examinations at PMB Ika Mardiyanti in Maret-May 2021 involved a sample of 100 obtained by simple random sampling. This study uses an analytic design with a cross-sectional design. Data analysis using the Wilcoxon Signed Rank Test. Results: The results show that Asym. Sig. (2-tailed) obtained < (0.0001 < 0.05), this means that the Self Care Model in Midwifery Care through the Android Application is effective for increasing the ability of pregnant women in early detect risky pregnancies during the COVID-19 pandemic. Conclusion: The research conducted to analyze the self-care model in midwifery care through the android application contributes to increasing the efforts of pregnant women to care for their care during pregnancy to prevent the dangers of pregnancy.

P22 - Negotiating the system: Women’s experiences of antenatal exclusion from publicly-funded homebirth

Strict eligibility criteria for publicly-funded homebirth models mean that many women planning a homebirth are later excluded. At present, little is known about women’s experience of antenatal exclusion from these models. Fifteen publicly-funded homebirth programs are operating in Australia, offering eligible women the opportunity to give birth at home at no cost, with the care of a hospital-employed midwife. The model has previously been positively evaluated by childbearing women and the midwives who work in them. This presentation will share findings from research exploring the experiences of women who planned a publicly-funded homebirth and were later excluded due to pregnancy complications or risk factors. This study employed a qualitative descriptive approach. Recruitment was via social media sites specifically related to homebirth in Australia. Data collection involved semi-structured telephone interviews with transcripts being thematically analysed by the research team. Thirteen women participated. Antenatal exclusion from a publicly-funded homebirth program can be distressing and women may wish to continue their plans to give birth at home. Some women feel coerced and bullied into following hospital protocols that are not tailored to their individual circumstances. Maintaining the midwife-mother relationship acts as a protective factor, ameliorating some of the negative effects caused by changing a woman’s planned place of birth. Women plan a homebirth to avoid the medicalised hospital environment and to gain access to continuity of midwifery care. To provide maternity care that is acceptable to women, hospital institutions need to design services that enable continuity of the midwife-mother relationship and assess risk on an individual basis. Exclusion from publicly-funded homebirth has the potential to negatively impact women who may feel a sense of loss, uncertainty or emotional distress related to their planned place of birth.

O82 - Mandarin Caseload Midwifery Program-Using Non-English Language Concordance and continuity of midwifery care

This presentation will focus on the experiences of bilingual midwives providing care to Chinese born women. It will also discuss the results of a retrospective cohort study that evaluates birth outcomes of the Mandarin Caseload Midwifery Program (MCMP). Cultural variances become more pronounced during the perinatal period, and language difficulties can be more impactful for women from non-English speaking backgrounds affected by the heterogeneity of health determinants, needs, and vulnerabilities. Discordant language communication, when a woman and care provider don't share proficiency in the same language, creates an added disadvantage. Chinese-born women are the third-largest group of women giving birth in Australia, and more than 20% of them require an interpreter when receiving maternity care. However, migrants are not just recipients of care but are also increasingly represented amongst clinicians providing care. At Westmead Hospital, we used an opportunity to utilise bilingual midwives to provide caseload midwifery services for women who share their ethnic background and first language. MCMP was established within an existing low-risk entry, no exit model of caseload midwifery care. It started in August 2019 with two full-time Mandarin-speaking midwives, each caring for 36 women a year. By September 2021 MCMP looked after 142 Chinese born women and their babies. The Midwives providing the care develop strong relationships with women. They feel more confident delivering education in their first language and understand and support the cultural differences encountered when accessing the Australian healthcare system . Routine audits evaluated the outcomes of care, and the data in this retrospective cohort review demonstrates high levels of vaginal birth (87%), lower reliance on epidural analgesia (30%), and shorter hospital stays. Westmead hospital MCMP demonstrates the benefits of language concordant care for midwives using bilingual skills and maternity care outcomes.

P27 - MGP - the answer to sustainable rural maternity services in Victoria. The Journey from a service perspective

For anyone with a knowledge and passion for Midwifery Group Practice (MGP) the answer to a sustainable rural maternity service seems simple. We know that continuity of care improves outcomes for birthing families but for smaller services it can also be the key to sustainability. Existing models of rural maternity care with the dual expectations of nurse/midwives are problematic, by changing the way midwives work to a caseload model of care through the implementation of MGP, rural maternity services are better able to recruit and retain midwives as well as respond to increased consumer demand for continuity of midwifery care. This presentation reflects on the experience of several health services in regional Victoria at different stages of their journey towards sustainable maternity care. These rural units are reinvigorating their maternity services by introducing MGP. This discussion looks at the journey towards MGP from the perspective of multiple services with the hope that sharing learnings will lay a better foundation for others to build on. As part of this discussion we will focus on the journey to change. The importance of collaborative partnerships with higher level services will be highlighted, not only for women with identified risk, but for improved quality, safety and governance. The value of midwives maintaining continued exposure to complex care for midwives working in low volume birthing units will also be discussed along with the industrial challenges that change brings. With the understanding that MGP offers greater sustainability for rural maternity services and the knowledge that continuity of carer is highly desired by women and has better outcomes for all women but particularly for some of the very vulnerable women and families in these disadvantaged rural communities is it time to look at the framework that surrounds the introduction of these models and for greater departmental and industrial support and reform?

Knowledge and skills used for clinical decision-making on childbirth interventions: A qualitative study among midwives in the Netherlands.

INTRODUCTIONAppropriate use of interventions in maternity care is a worldwide issue. Midwifery-led models of care are associated with more efficient use of resources, fewer medical interventions, and improved outcomes. However, the use of interventions varies considerably between midwives. The aim of this study was to explore how knowledge and skills influence clinical decision-making of midwives on the appropriate use of childbirth interventions.METHODSA qualitative study using in-depth interviews with 20 primary care midwives was performed in June 2019. Participants’ clinical experience varied in the use of interventions. The interviews combined a narrative approach with a semi-structured question route. Data were analyzed using deductive content analysis.RESULTS‘Knowledge’, ‘Critical thinking skills’, and ‘Communication skills’ influenced midwives’ clinical decision-making towards childbirth interventions. Midwives obtained their knowledge through the formal education program and extended their knowledge by reflecting on experiences and evidence. Midwives with a low use of interventions seem to have a higher level of reflective skills, including reflection-in-action. These midwives used a more balanced communication style with instrumental and affective communication skills in interaction with women, and have more skills to engage in discussions during collaboration with other professionals, and thus personalizing their care.CONCLUSIONSMidwives with a low use of interventions seemed to have the knowledge and skills of a reflective practitioner, leading to more personalized care compared to standardized care as defined in protocols. Learning through reflectivity, critical thinking skills, and instrumental and affective communication skills, need to be stimulated and trained to pursue appropriate, personalized use of interventions.

Midwife Care on 3 Months Injected Kb Accepters With Spotting At The Angel Paropo Maternity Clinic

Based on the Indonesian Health Profile, the number and percentage of Indonesia's population for adolescents aged 10-19 years (WHO definition for adolescent) is 44 million or 21%, where the problems faced by many adolescents are reproductive health issues, premarital sex, unprotected pregnancy. It is hoped that the number of drug users, the number of people with STDs, HIV/AIDS and cases of abortion show quite worrying symptoms. Research has been carried out which aims to describe the knowledge of mothers who have teenage girls about sexual behavior and teenage pregnancy in the VIII Ward of Menistrim Village, Kec. East Binjai. This research is descriptive using primary data obtained through questionnaires submitted to respondents with a sample of 54 people. The study was conducted in August 2006. From the results of the study, it is known that the majority of 54 respondents are knowledgeable enough as much as 50%, where based on age, the majority are 40-60 years old and 73.91% have good knowledge, based on education the majority are secondary education and 66.6 % knowledgeable enough, and based on the majority of information sources from the mass media and 62.96% knowledgeable enough. In order to obtain better knowledge, it is hoped that mothers who have teenage girls seek correct information, namely from health workers about sexual behavior and teenage pregnancy. based on education the majority of secondary education and 66.6% have sufficient knowledge, and based on information sources the majority are from the mass media and 62.96% are moderately knowledgeable. In order to obtain better knowledge, it is hoped that mothers who have teenage girls seek correct information, namely from health workers about sexual behavior and teenage pregnancy. based on education the majority of secondary education and 66.6% have sufficient knowledge, and based on information sources the majority are from the mass media and 62.96% are moderately knowledgeable. In order to obtain better knowledge, it is hoped that mothers who have teenage girls seek correct information, namely from health workers about sexual behavior and teenage pregnancy.

Sexual abstinence as a reproductive health-promoting behavior for women: A perspective.

This article is intended to provide an appropriate context for adopting sexual abstinence from a health-promoting behavioral perspective that can be applied to women of reproductive age worldwide to improve reproductive health, maintain well-being, and prevent health problems in women. The topics related to women's health status, sexual abstinence definitions, benefits, and application, as well as sexual autonomy and efficacy, including family collaboration, are discussed. This article will provide health care providers, especially nurses and midwives, with new ideas for integrating sexual abstinence into nursing and midwifery practice.

Better maternity care pathways in pregnancies after stillbirth or neonatal death: a feasibility study

BackgroundAround 1 in 150 babies are stillborn or die in the first month of life in the UK. Most women conceive again, and subsequent pregnancies are often characterised by feelings of stress and anxiety, persisting beyond the birth. Psychological distress increases the risk of poor pregnancy outcomes and longer-term parenting difficulties. Appropriate emotional support in subsequent pregnancies is key to ensure the wellbeing of women and families. Substantial variability in existing care has been reported, including fragmentation and poor communication. A new care package improving midwifery continuity and access to emotional support during subsequent pregnancy could improve outcomes. However, no study has assessed the feasibility of a full-scale trial to test effectiveness in improving outcomes and cost-effectiveness for the National Health Service (NHS).MethodsA prospective, mixed-methods pre-and post-cohort study, in two Northwest England Maternity Units. Thirty-eight women, (≤ 20 weeks’ gestation, with a previous stillbirth, or neonatal death) were offered the study intervention (allocation of a named midwife care coordinator and access to group and online support). Sixteen women receiving usual care were recruited in the 6 months preceding implementation of the intervention. Outcome data were collected at 2 antenatal and 1 postnatal visit(s). Qualitative interviews captured experiences of care and research processes with women (n = 20), partners (n = 5), and midwives (n = 8).ResultsOverall recruitment was 90% of target, and 77% of women completed the study. A diverse sample reflected the local population, but non-English speaking was a barrier to participation. Study processes and data collection methods were acceptable. Those who received increased midwifery continuity valued the relationship with the care coordinator and perceived positive impacts on pregnancy experiences. However, the anticipated increase in antenatal continuity for direct midwife contacts was not observed for the intervention group. Take-up of in-person support groups was also limited.ConclusionsWomen and partners welcomed the opportunity to participate in research. Continuity of midwifery care was supported as a beneficial strategy to improve care and support in pregnancy after the death of a baby by both parents and professionals. Important barriers to implementation included changes in leadership, service pressures and competing priorities.Trial registrationISRCTN17447733 first registration 13/02/2018.

Experiences, Beliefs, and Values Influencing Midwives' Attitudes Toward the Use of Childbirth Interventions.

Intervention rates in perinatal care vary between and within countries, without populations' characteristics as a full explanation. Research suggests that one factor in this variation might be the attitudes of perinatal health care providers. Systematic knowledge on the background of midwives' attitudes and how this influences the use of interventions is limited. The study aim was to to explore experiences, beliefs, and values that influence midwives' attitudes toward interventions in perinatal care. A qualitative study using in-depth interviews with primary care midwives (n = 20) in the Netherlands. The interviews were performed in June 2019 and combined a narrative approach with a semistructured interview guide. Inductive content analysis was applied. We identified 2 main themes: attitudes toward interventions and influences on midwives' attitudes. The midwives in our study described their attitudes toward interventions as oriented to either wait and see or check and control. Care based on wait and see displayed a more supportive style of behavior, and care based on check and control appeared to display a more directive style of behavior. In the theme of influences on midwives' attitudes, 3 subthemes emerged: experiences in collaboration, trust and fear, and woman-centeredness. Midwives with a wait and see attitude seem to have a more restricted approach toward interventions compared with midwives with a check and control attitude. Midwives need to be aware how their experiences, beliefs, and values shape their attitudes toward use of interventions. This awareness could be a first step toward the reduction of unwarranted interventions.

The evolution of the midwife in the obstetric high dependency unit.

This study involves two stand-alone tertiary level maternity hospitals with a combined average of 17,000 births per year, and with approximately 300 obstetric high dependency unit (OHDU) admissions annually. Many midwives feel that working in an OHDU does not constitute normal midwifery work and they have voiced concerns regarding their training in this setting. Midwives and nurses from different departments throughout the two hospitals are often asked to care for the OHDU patients. Co-location and expansion of a new OHDU, as well as a discussion around staffing, prompted this questionnaire. The aim of this study was to formally assess midwives' and nurses' attitudes and confidence working in an OHDU. After obtaining ethics committee approval, we conducted a survey and collected information on previous training in critical care, level of competence with HDU-related equipment and management of common HDU conditions. In total, 188 staff participated in the survey (38% response rate). The majority (n = 142, 76%) did not feel competent caring for critically ill patients despite almost 40% (n = 69) saying they had experience doing so. Nurses or dual trained midwives were more likely to state they felt competent caring for critically ill patients, with only 2 midwives feeling competent (2.2%) compared to 32 nurses or dual trained staff (34.4%), p < 0.01. One hundred forty-seven (78%) and 136 (72%) respondents felt confident managing major haemorrhage and sepsis respectively. One hundred sixty-nine (89%) respondents would be interested in further training. A greater proportion of nurses and dual trained midwives feel confident caring for ODHU patients. This survey suggests that a mixture of specialty-trained critical care nurses and midwives is required in order to provide a full complement of HDU care to both the antenatal and postnatal women.

"We All Believe in Breastfeeding": Australian Midwives' Experience of Implementing the Baby Friendly Hospital Initiative.

The education and support of new mothers during the in-hospital stay for childbirth is a critical time to establish breastfeeding. The Baby-Friendly Hospital Initiative was launched in 1991 to encourage maternity services to support and educate mothers to breastfeed by implementing Ten Steps to Successful Breastfeeding. To explore midwives' experiences of implementing the Baby-Friendly Hospital Initiative in a Baby-Friendly accredited public hospital in Australia. In this prospective, cross-sectional qualitative study we used focus groups to explore midwives' experiences. Midwives (N = 26) participated in two focus groups conducted between October and November 2019. Data were analyzed using thematic analysis. Time as a critical resource, and continuity of care, were crosscutting themes that framed midwives' experiences in supporting mothers to breastfeed their babies. Time constraints were experienced both through the health system structure and the BFHI accreditation process. Despite the challenges, the overarching theme-that we all believe in breastfeeding-fueled midwives' motivation. Health services policy and practice need to consider ways to enable continuity of midwifery care and adequate time for midwives to support women to breastfeed their babies.

Effectiveness of Kegel Education for The Elderly as A Form of The Authority of The Midwife in Community Midwife Care

Background: The ageing process is usually characterized by physical, biological, mental, or psychosocial changes. Kegel exercises are beneficial for strengthening the double muscles of the pelvic floor, thereby strengthening the function of the external sphincter of the bladder. The research purposes were to prove the Effectiveness of Kegel Education for The Elderly as A Form of The Authority of The Midwife in Community Midwife Care Methods: The method used in the pra experiment in this community service activity is divided into three stages and is supported through a pretest and posttest to evaluate activities. An evaluation is carried out after one month of providing education. The population was all older adults, and This activity was attended by 27 older adults in the Tabanan I Health Center. Results: The result of the research show that the average score of the frequency of urination before being given Kegel exercises was 0.19 after being given Kegel exercises of 0.85. It also obtained an at-count value of -6.245 and a p-value of 0.000 &lt; (0.05) so that it can be concluded that Kegel exercise education influences the elderly in the Tabanan Health Center area. Conclusion: Education Kegel exercises affect urinary incontinence. Kegel exercise can stimulate and increase the activation of chemical, neuromuscular, and muscular in the pelvic muscles so that it can reduce the frequency of urination in the elderly. Providing education related to Kegel exercise will greatly assist midwives in carrying out the midwife's authority in community care.

Getting kicked off the program: Women’s experiences of antenatal exclusion from publicly-funded homebirth in Australia

ProblemEligibility criteria for publicly-funded homebirth models are strict and, as such, many women who initially plan a homebirth later become excluded. BackgroundFifteen publicly-funded homebirth programs are operating in Australia, offering eligible women the opportunity to give birth at home at no cost, with the care of a hospital-employed midwife. AimTo explore the experiences of women who planned a publicly-funded homebirth and were later excluded due to pregnancy complications or risk factors. MethodsA qualitative descriptive approach was taken. Recruitment was via social media sites specifically related to homebirth in Australia. Data collection involved semi-structured telephone interviews. Transcripts were thematically analysed. FindingsThirteen women participated. They were anxious about ‘Jumping through hoops’ to maintain their low-risk status. After being ‘Kicked off the program’, women carefully 'negotiated the system’ in order to get the birth they wanted in hospital. Some women felt bullied and coerced into complying with hospital protocols that did not account for their individual needs. Maintaining the midwife-woman relationship was a protective factor, decreasing negative experiences. DiscussionWomen plan a homebirth to avoid the medicalised hospital environment and to gain access to continuity of midwifery care. To provide maternity care that is acceptable to women, hospital institutions need to design services that enable continuity of the midwife-woman relationship and assess risk on an individual basis. ConclusionExclusion from publicly-funded homebirth has the potential to negatively impact women who may feel a sense of loss, uncertainty or emotional distress related to their planned place of birth.

Women who smoke during pregnancy are more likely to be referred to an obstetrician during pregnancy and birth: results from a cohort study

BackgroundWomen who smoke during pregnancy make less use of prenatal care; the relation of smoking behavior with the use of other forms of maternal healthcare is unknown. The objective of this study is to investigate the association between women’s smoking behavior and their use of healthcare during pregnancy, birth and six weeks postpartum.MethodsWe analyzed data from the Dutch Midwifery Case Registration System (VeCaS), period 2012–2019. We included women with a known smoking status, singleton pregnancies, and who had their first appointment before 24 weeks of gestation with the primary care midwife. We compared three groups: non-smokers, early stoppers (stopped smoking in the first trimester), and late- or non-stoppers (stopped smoking after the first trimester or continued smoking). Descriptive statistics were used to report maternal healthcare utilization (during pregnancy, birth and six weeks postpartum), statistical differences between the groups were calculated with Kruskal–Wallis tests. Multivariable logistic regression was conducted to assess the association between smoking behavior and referrals to primary, secondary or tertiary care.ResultsWe included 41 088 pregnant women. The groups differed significantly on maternal healthcare utilization. The late- or non-stoppers initiated prenatal care later and had less face-to-face consultations with primary care midwives during pregnancy. Compared to the non-smokers, the early- and late- or non-stoppers were statistically signficiantly more likely to be referred to the obstetrician during pregnancy and birth. Postpartum, the early- and late- or non-stoppers were statistically signficantly less likely to be referred to the obstetrician compared to the non-smokers.ConclusionsAlthough the early- and late- or non-stoppers initiated prenatal care later than the non-smokers, they did receive adequate prenatal care (according to the recommendations). The results suggest that not smoking during pregnancy may decrease the likelihood of referral to secondary or tertiary care. The large population of smokers being referred during pregnancy underlines the important role of the collaboration between healthcare professionals in primary and secondary or tertiary care. They need to be more aware of the importance of smoking as a medical and as a non-medical risk factor.

A Review Of Effective Interventions To Improve Emotional Risk Factors Of Anxiety, Stress, Depression In Infertile And Infertile Patients Undergoing Treatment With Assisted Reproductive Techniques

IntroductionInfertility is a major problem in life and affects the lives of infertile couples in every wayObjectivesInfertility is associated with several negative reactions and emotional problems. Review of effective interventions for improving emotional risk factors In infertile and infertile patients undergoing treatmentMethodsA comprehensive narrative review of the studies was conducted. Databases such as Web of Science, Science Direct, Cochrane Library, Scopus, PubMed/Medline, Clinical Key, and MAGIRAN were retrieved from May 10 to August 8, 2021, with no time limit. After reviewing the abstract and the full text of the articles, 32 articles were selected for writing. The methodological quality of the article was assessed based on the Cochrane Risk of BiasResultsInterventions were divided into two subgroups of mind-body, and web-based CBT. Mind-body interventions generally show the anxiety, stress and depression reduction and Possible improvement in pregnancy rate, but most of these programs require extensive financial resources.The results of web-based,showed that using online CBT approach can greatly reduce stress and anxiety,due to increased use of the internet, non-collaborative, cheap and private treatment of web-based interventions, this method can be used as a way along with other treatments to reduce these negative reactions.Conclusions According to the present study CBT methods, application and Internet-based interventions can be used as appropriate counseling methods in reducing stress, anxiety and improving pregnancy outcomes in infertile patients. This information can be used as a proper source to select appropriate counseling methods for health care providers, midwives, and treatment staff involved in infertility patients.DisclosureNo significant relationships.

Counselling for prenatal anomaly screening to migrant women in the Netherlands: An interview study of primary care midwives' perceived barriers with client-midwife communication.

INTRODUCTIONLarge ethnic inequalities exist in the prenatal screening offer, counselling, informed decision-making, and uptake of prenatal anomaly tests. More insight into midwives’ experiences with offering prenatal counselling to migrant women may provide better insight into the origins and consequences of these ethnic inequalities.METHODSWe conducted interviews with 12 midwives certified as counsellors for prenatal anomaly screening for women they identified as migrants. Interviews were analyzed using thematic analysis.RESULTSMidwives reported most difficulties in communicating with women of ‘non-western migrant background’, which include first- and second-generation migrants from Africa, Latin-America, Asia, and Turkey. They experienced barriers in communication related to linguistics, health literacy, sociocultural and religious differences, with midwife stereotyping affecting all three aspects of counselling: health education, decision-making support, and the client–midwife relation. Health education was difficult because of language barriers and low health-literacy of clients, decision-making support was hampered by sociocultural and religious midwife–client differences, and client–midwife relations were under pressure due to sociocultural and religious midwife–client differences and midwife stereotyping.CONCLUSIONSBarriers to optimal communication seem to contribute to suboptimal counselling, especially for women of ‘non-western migrant background’. Client–midwife communication thus potentially adds to the ethnic disparities observed in the offer of and informed decision-making about prenatal anomaly screening in the Netherlands. The quality of prenatal counselling for women from all ethnic backgrounds might be improved by addressing linguistic, health literacy, sociocultural and religious barriers in future training and continuing education of prenatal counsellors.

Efectividad de la autotoma del exudado vaginorrectal para el cribado prenatal de la infección por Streptococcus agalactiae. Estudio GALL

ObjetiveTo evaluate the effectiveness of vagino-rectal swab autotomy for prenatal screening for GBS infection and to identify the barriers and facilitators encountered by the pregnant woman for this intervention. DesignCross-sectional study of diagnostic tests. Participants and siteA total of 213 pregnant women who attended the primary care midwife's office in 6 health centers of the Basque Health Service/Osakidetza in Bizkaia, who met the inclusion criteria and agreed to participate in the study, participated in the study. Main measurementsThe result of the vagino-rectal culture obtained by the pregnant woman was compared with the result of the vagino-rectal culture taken by the midwife in consultation on the same day, and the barriers and facilitators encountered by the women in the self-test were collected. ResultsSelf-testing as a test for GBS was found to have a sensitivity of 93.3% (95% CI 78.7–98.2), a specificity of 99.4% (95% CI 96.5–99.9), a positive predictive value of 96% (95% CI 82.8–99.4) and a negative predictive value of 98.8% (95% CI 95.6–99.7). 27.3% of respondents encountered some difficulty in the collection, only 4.8% did not feel qualified, 84.2% felt comfortable, 99.5% considered the information provided to be adequate and complete, 94.7% did not find the steps to follow complicated, and 96% were satisfied with the study. ConclusionsSelf-collection of vagino-rectal exudate for GBS detection has proved to be valid and reliable, which would make it possible to offer this option to pregnant women in the systematic screening for GBS infection.

Effectiveness of an Instructional Program on Nurses-Midwifes' Practices about Application of Ethical Rules at the Delivery Room

Background: Nurse midwives are often expected to make ethical decisions in the context of their professional practice, which can lead to ethical confrontations, some of which may lead to ethical dilemmas. The nurses and midwives in the delivery room must keep ethical considerations in mind while caring for a woman in labor so that correct judgments can be made. As a result, the current study emphasized raising ethical efficacy by creating scenarios that simulate the reality of working in the field of reproductive health in order to prepare nurse-midwives who comply with ethical rules during professional practice. Purpose: The main aim of this study is examining how an instructional nursing professional ethics-focused program may affect practice among nurses- midwives in the delivery room. Methods: The quiz experimental design (one-group pretest–posttest design) was used. The purposive non-probability sample consisted of 50 nurse-midwives who worked during the data collection phase in the delivery room. Data collection began in May 2021 - June 2022, using a tool that contains 20 case-scenario that simulate the reality of reproductive care and clinical practice of nurses and midwives regarding professional ethical issues Results: The findings revealed that instructional intervention had a positive impact on nurses - midwife's ethical performance in terms of following professional ethics rules Conclusion: The use of the case-scenario based simulation approach to teach professional nursing ethics contributed to improving compliance with the ethical rules for nurses-midwives working in the delivery room Keywords: Ethical Rules, Instructional Program, Delivery Room, Nurses-midwifes, Practices

Corona Virus Disease 2019 Pandemic Contributed to Pregnancy Devastating Outcomes in Low Income Countries

Corona Virus Disease 2019 (COVID-19) pandemic has been a public health threat of the 21st century. This pandemic has unexpectedly occurred, and countries have faced challenges to implement the preventive strategies against this unexpected killer. Pregnancy is a critical state among women, and special care should be provided to prevent pregnancy related complications as early as possible. COVID-19 pandemic has restricted services provided to pregnant women due to some prevention measures and treatment programs. Previous studies reported the high increase of obstetric complications among women infected or ever infected by COVID-19. Depression, suicidal intention, low quality of life during pregnancy, gestational hypertension and gestational diabetes mellitus, the premature rupture of membranes, miscarriage, preterm delivery, edema, maternal death, and hypoxia and other respiratory conditions were observed among women infected by COVID-19. Strategies for protecting pregnant women during pandemics should be enhanced to prevent pregnancy related complications and maternal death. There should be home health care nurses and midwives working with community health workers to assist pregnant women at home. Governments should develop policies and plans about maintaining maternal and child health during pandemics requiring travel ban and other prevention measures.