Childbirth Events Research Articles

Burnout among Nurses, Midwives, and Physicians in Maternity Care Exposed to Traumatic Childbirth Events

Abstract Purpose: To describe the relationship between experiencing traumatic childbirth events and burnout. Study Designs and Methods: This descriptive cross-sectional study used an anonymous online survey to assess traumatic childbirth event exposure and the three independent constructs of burnout: emotional exhaustion, depersonalization, and personal accomplishment. Participants were a convenience sample of registered nurses, obstetric residents, family medicine residents, and attending obstetricians across five hospitals from December 2020 through June 2021. The traumatic childbirth event questionnaire measured the frequency of traumatic childbirth event exposure, perception of severity, and perceived influence on the participant's professional practice and personal life. Results: Data were analyzed from 150 participants. Registered nurses represented the largest percentage of participants (66%). Components of burnout varied according to race and occupation. Asian/Pacific Islanders had significantly higher mean depersonalization scores at 10.1 (SD = 6.0). Resident physicians had the highest emotional exhaustion scores (M = 34.6, SD = 8.8). Traumatic childbirth events perceived influence on practice correlates with personal accomplishments. Yet, no relationship was observed between traumatic childbirth events, emotional exhaustion, and depersonalization. Linear mixed analysis revealed that hospitals account for 7.5% of the variance in emotional exhaustion scores, 11.1% in depersonalization scores, and 1.3% in personal accomplishments scores. Clinical Implications: Maternity clinicians experience burnout at similar rates to those in other specialties. Although traumatic childbirth events are infrequent and not strongly correlated with emotional exhaustion and depersonalization, hospitals should implement effective strategies to support clinicians after such events. Educational interventions can enhance knowledge and resilience, whereas specialized training effectively alleviates burnout. Development of evidence-based strategies that prioritize the wellbeing of clinicians and patients is crucial.

Posttraumatic growth and its associations with perceived stress and core beliefs in women after traumatic childbirth during the COVID-19 pandemic.

The COVID-19 pandemic added new challenges and stressors to the childbirth period, potentially increasing the risk of traumatic childbirth experiences. There is little known about posttraumatic growth (PTG) in a childbearing population. This study describes PTG in women after traumatic childbirth during the COVID-19 pandemic and its association with sociodemographic, birth-related characteristics, traumatic childbirth events, perceived stress, and core beliefs, as well as explores what factors predict PTG. A cross-sectional study was conducted with 202 women who self-identified as having experienced traumatic childbirth. Measures included sociodemographic and birth-related characteristics, traumatic childbirth events, self-reported stress during childbirth, the PTG Inventory, and the Core Beliefs Inventory (CBI). Perceived stress at the time of birth was very high in 70% of the respondents. CBI showed moderate disruption of core beliefs. 41.6% of mothers indicated substantial PTG. Education and type of birth were related to perceived stress levels; higher disruption of core beliefs was observed in individuals who experienced perineal trauma and lack of partners' presence during childbirth, and higher disruption of core beliefs was positively associated with PTG. Predictive models showed that perceived stress had a minimal effect, while the disruption of core beliefs showed a significant positive association with PTG. Traumatic childbirth experiences during the COVID-19 pandemic were positively related to PTG. Health professionals should create an environment where women can explore their feelings and emotions. Changes in current practices are also necessary as cesareans have been shown to be highly associated with high levels of perceived stress.

Posttraumatic growth in women after a childbirth experience: The influence of individual characteristics and intrusive and deliberate rumination.

This study targets women who had a self-defined traumatic childbirth experience to (a) explore the differences between sociodemographic-, obstetric-, and trauma-related variables in relation to the rumination style; (b) determine differences between intrusive and deliberate rumination in relation to posttraumatic growth (PTG) dimensions, and (c) test whether intrusive rumination is associated with deliberate rumination, which in turn is associated with PTG dimensions. A cross-sectional study design was employed using a web-based survey method for data collection. In total, 202 women who identified their childbirth experience as traumatic participated in this study. Intrusive rumination and deliberate rumination were positively associated with all dimensions of PTG in women following the traumatic childbirth event. Deliberate rumination fully explained the relationship between intrusive rumination and PTG aspects of relating to others, new opportunities, and personal strength, and partially explained the relationship between intrusive rumination and PTG aspects of spiritual changes and appreciation of life. The results suggest that deliberate rumination can contribute to explain the occurrence of PTG. These findings could help develop psychosocial interventions to maximize opportunities for deliberate rumination for women with traumatic childbirth experiences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Anthropometric Indicators of the Proportionality of the Physique of Girls and Boys Living in the Moscow Region

Anthropometric data provide a qualitative and quantitative assessment of the health status of the population. Typically, they are used in clinical practice to assess general health, nutritional adequacy, growth and development of the body. The aim is to conduct a comparative analysis of anthropometric indicators and proportionality of the physique of boys and girls living in Moscow and the Moscow region. Material and methods. The study involved 198 third-year students of the Faculty of Medicine of the State University of Education, over the age of 18, living in Moscow and the Moscow region. The surveyed population did not have either acute or chronic diseases in the stage of decompensation, congenital malformations, ultra-low or excess body weight. An anthropometric study was carried out with measurements of the longitudinal and transverse dimensions of the torso and limbs, calculation of the body mass index, determination of the somatotype and subsequent statistical processing of the data obtained. Conclusion. Anthropometric indicators of girls and boys living in the Moscow region have a number of features. Persons with a mesomorphic somatotype predominate, which indicates the harmonious physical development of boys and girls. Most girls have a transversely narrowed shape of the pelvis, which indicates a possible risk of obstetric complications in the event of pregnancy and childbirth. Otherwise, both boys and girls develop proportionally in accordance with the parameters of the biological and physiological norm.

Screening for post-traumatic stress disorder following childbirth using the Peritraumatic Distress Inventory

BackgroundPost-traumatic stress disorder (PTSD) following traumatic childbirth may undermine maternal and infant health, but screening for maternal childbirth-related PTSD (CB-PTSD) remains lacking. Acute emotional distress in response to a traumatic experience strongly associates with PTSD. The Peritraumatic Distress Inventory (PDI) assesses acute distress in non-postpartum individuals, but its use to classify women likely to endorse CB-PTSD is unknown. Methods3039 women provided information about their mental health and childbirth experience. They completed the PDI regarding their recent childbirth event, and a PTSD symptom screen to determine CB-PTSD. We employed Exploratory Graph Analysis and bootstrapping to reveal the PDI's factorial structure and optimal cutoff value for CB-PTSD classification. ResultsFactor analysis revealed two strongly correlated stable factors based on a modified version of the PDI: (1) negative emotions and (2) bodily arousal and threat appraisal. A score of 15+ on the modified PDI produced high sensitivity and specificity: 88 % with a positive CB-PTSD screen in the first postpartum months and 93 % with a negative screen. LimitationsIn this cross-sectional study, the PDI was administered at different timepoints postpartum. Future work should examine the PDI's predictive utility for screening women as closely as possible to the time of childbirth, and establish clinical cutoffs in populations after complicated deliveries. ConclusionsBrief self-report screening concerning a woman's emotional reactions to childbirth using our modified PDI tool can detect those likely to endorse CB-PTSD in the early postpartum. This may serve as the initial step of managing symptoms to ultimately prevent chronic manifestations.

Informing about childbirth without increasing anxiety: a qualitative study of first-time pregnant women and partners’ perceptions and needs

BackgroundComplications requiring medical interventions during childbirth are far from rare, even after uncomplicated pregnancies. It is often a challenge for maternity healthcare professionals to know how to prepare future parents for these eventualities without causing unnecessary anxiety. Studies on traumatic birth experiences have shown that feelings of loss of control, insufficient information, and lack of participation in medical decisions during childbirth are factors of difficult experiences. However, little is known about the information and communication needs of expectant parents about childbirth during the prenatal period. To gain a deeper understanding of the information and communication needs of first-time pregnant women and partners, we explored their perceptions and expectations for their upcoming childbirth, and the actions they initiated to prepare for it.MethodsSemi-structured interviews were conducted individually with first-time pregnant women and partners of pregnant women aged 18 years or older, with an uncomplicated pregnancy. Thematic analysis was used to identify themes and sub-themes.ResultsTwenty expectant parents (15 pregnant women and five partners of pregnant women) were interviewed. Six themes were identified: Childbirth event; Childbirth experience; Childbirth environment; Organisation of care; Participation in decision making; Roles within the couple and transition to parenthood.ConclusionsThis study contributes to a better understanding of the information needs of future parents expecting their first child. Results highlighted that the notion of “childbirth risks” went beyond the prospect of complications during birth, but also encompassed concerns related to a feeling of loss of control over the event. Expectant parents showed an ambivalent attitude towards consulting risk information, believing it important to prepare for the unpredictability of childbirth, while avoiding information they considered too worrying. They expressed a desire to receive concrete, practical information, and needed to familiarise themselves in advance with the birth environment. Establishing a respectful relationship with the healthcare teams was also considered important. The findings suggest that information on childbirth should not be limited to the transmission of knowledge, but should primarily be based on the establishment of a relationship of trust with healthcare professionals, taking into account each person’s individual values and expectations.

Midwifery Students' Traumatic Childbirth Experiences, Traumatic Childbirth Perceptions, and Levels of Fear of Childbirth.

Although childbirth is generally seen as a positive phenomenon, negative childbirth events can be experienced as well. Midwifery students are at risk of encountering traumatic events throughout their education. The primary aim of this research was to reveal midwifery students' experiences of witnessing traumatic events at childbirth. The secondary aim was to determine the effects of traumatic childbirth experiences witnessed by midwifery students on their traumatic childbirth perceptions and levels of fear of childbirth. This cross-sectional study was conducted between January 1 and June 30, 2021. The study sample consisted of 517 midwifery students in Turkey. Data were collected using a descriptive information form, the Traumatic Childbirth Perception Scale (TCPS), and the Visual Analog Scale (VAS) for measuring fear of childbirth. The majority (88%) of students witnessed a traumatic event at childbirth. The mean (SD) TCPS score was 59.7 (26.1), and the level of fear of childbirth measured with VAS was 5.1 (2.7). A moderate positive correlation was found between the VAS score and TCPS scores (r = .63; P<.001). Although the mean TCPS scores of students who witnessed a traumatic event were not signficiantly different from those who did not, their mean VAS score was higher than those who did not (P = .001). Among students who experiences traumatic events at childbirth, 35.8% stated that the traumatic events negatively affected their education, and 65.6% reported that they thought it would negatively affect their future professional life. Witnessing traumatic events at childbirth is associated with increased perception of childbirth as traumatic and fear of childbirth in midwifery students. Traumatic experiences can affect midwifery students' educational and professional lives. Educators in the field of midwifery should support students in coping with traumas.

Mistreatment of Women during Childbirth and Associated Factors in Northern West Bank, Palestine.

Mistreatment of women during childbirth is a clear breach of women’s rights during childbirth. This study aimed to determine the prevalence and associated factors of mistreatment of women during childbirth in the north of West Bank, Palestine. A cross-sectional study was conducted among 269 women within the first 16 weeks of their last vaginal childbirth to understand the childbirth events by using proportionate stratified random sampling. An Arabic valid questionnaire was used as a study instrument. Simple and multiple logistic regression analyses were conducted to determine the factors associated with each type of mistreatment. The mean age of the women was 26.5 (SD 4.77) years. The overall prevalence of mistreatment was 97.8%. There were six types of mistreatment. Nine factors were significantly associated with the occurrence of one or more types of mistreatment. Delivery at a public childbirth facility was associated with all of the six types (aAdjOR: 2.17–16.77; p-values < 0.001–0.013). Women who lived in villages (aAdjOR 2.33; p-value = 0.047), had low education (aAdjOR 5.09; p-value = 0.004), underwent induction of labour (aAdjOR 3.03; p-value = 0.001), had a long duration of labour (aAdjOR 1.10; p-value = 0.011), did not receive pain killers (aAdjOR: 2.18–3.63; p-values = 0.010–0.020), or had an episiotomy or tear (aAdjOR 5.98; p-value < 0.001) were more likely to experience one or more types of mistreatment. With every one-hour increase in the duration of labor, women were 1.099 times more likely to experience a failure to meet the professional standard of care. Women were less likely to experience mistreatment with increasing age. Women with increasing age (aAdjOR: 0.91–0.92; p-values = 0.003–0.014) and parity (aAdjOR 0.72; p-value = 0.010) were less likely to experience mistreatment. Awareness of women’s fundamental rights during childbirth, making the childbirth process as normal as possible, and improving the childbirth facilities’ conditions, policies, practices and working environment may decrease mistreatment occurrence.

Cross-Sectional Study of the Frequency and Severity of Traumatic Childbirth Events and How They Affect Maternity Care Clinicians

ObjectiveTo describe the frequency and severity of traumatic childbirth events (TCEs) and how they affected the professional practice and personal lives of maternity care clinicians, including registered nurses (RNs), certified nurse-midwives, attending physicians, and resident physicians. DesignDescriptive cross-sectional study. SettingMaternity units across five hospitals in the Baltimore metropolitan area. ParticipantsMaternity care clinicians (N = 160) including RNs (n = 104), certified nurse-midwives (n = 17), attending physicians (n = 28), and resident physicians (n = 11). MethodsParticipants completed an online survey to measure the frequency and severity of TCEs and how they affect participants’ professional practice and personal lives. We used descriptive statistics to characterize maternity care clinicians and bivariate analysis and linear regression to examine relationships. ResultsMost participants were women (92.5%), White (62.5%), between the ages of 21 and 54 years (89.4%), RNs (65.0%), and employed full-time (79.2%). Shoulder dystocia was the most frequently observed TCE (90.6%), and maternal death was the most severe TCE (M = 4.82, SD = 0.54). Attending physicians (50.0%) reported a significantly greater frequency of exposure to TCEs than the other participants, χ2(6) = 23.8 (n = 159), p <. 001. The frequency of TCEs had a significant medium correlation with perceived effect on professional practice, r(154) = 0.415, p < .001, and personal life, r(155) = 0.386, p < .001. Perception of severity was strongly associated with professional practice, β = 0.52, p < .001, and personal life, β = 0.46, p < .001. ConclusionIf severe, TCE exposure can affect the professional practice and personal life of maternity care clinicians.

What Makes You Hold on to That Old Car? Joint Insights From Machine Learning and Multinomial Logit on Vehicle-Level Transaction Decisions

What makes you hold on to that old car? While the vast majority of household vehicles are still powered by conventional internal combustion engines, the progress of adopting emerging vehicle technologies will critically depend on how soon the existing vehicles are transacted out of the household fleet. Leveraging a nationally representative longitudinal data set, the Panel Study of Income Dynamics, this study examines how household decisions to dispose of or replace a given vehicle are: 1) influenced by the vehicle’s attributes, 2) mediated by households’ concurrent socio-demographic and economic attributes, and 3) triggered by key life cycle events. Coupled with a newly developed machine learning interpretation tool, TreeExplainer, we demonstrate an innovative use of machine learning models to augment traditional logit modeling to both generate behavioral insights and improve model performance. We find the two gradient-boosting-based methods, CatBoost and LightGBM, are the best performing machine learning models for this problem. The multinomial logistic model can achieve similar performance levels after its model specification is informed by TreeExplainer. Both machine learning and multinomial logit models suggest that while older vehicles are more likely to be disposed of or replaced than newer ones, such probability decreases as the vehicles serve the family longer. Pickup trucks and sport utility vehicles are less likely to be disposed of or replaced than cars, and leased vehicles are more likely to be transacted than owned vehicles. We find that married families, families with higher education levels, homeowners, and older families tend to keep their vehicles longer. Life events such as childbirth, residential relocation, and change of household composition and income are found to increase vehicle disposal and/or replacement. We provide additional insights on the timing of vehicle replacement or disposal, in particular, the presence of children and childbirth events are more strongly associated with vehicle replacement among younger parents.

Perspectives of stakeholders of the free maternity services for mothers in western Kenya: lessons for universal health coverage

BackgroundThe strategic aim of universal health coverage (UHC) is to ensure that everyone can use health services they need without risk of financial hardship. Linda Mama (Taking care of the mother) initiative focuses on the most vulnerable women, newborns and infants in offering free health services. Financial risk protection is one element in the package of measures that provides overall social protection, as well as protection against severe financial difficulties in the event of pregnancy, childbirth, neonatal and perinatal health care for mothers and their children.PurposeThe aim of this study was to find out the extent of awareness, and involvement among managers, service providers and consumers of Linda mama supported services and benefits of the initiative from the perspectives of consumers, providers and managers.MethodsWe carried out cross sectional study in four sub counties in western Kenya: Rachuonyo East, Nyando, Nyakach, and Alego Usonga. We used qualitative techniques to collect data from purposively selected Linda Mama project implementors, managers, service providers and service consumers. We used key informant interview guides to collect data from a total of thirty six managers, nine from each Sub -County and focus group discussion tools to collect data from sixteen groups of service consumers attending either antenatal or post-natal clinics, four from each sub county, selecting two groups from antenatal and two from postnatal clinics in each sub county. Data analysis was based on thematic content analysis.FindingsManagers and service providers were well aware of the initiative and were involved in it. Participation in Linda Mama, either in providing or using, seemed to be more prominent among managers and service providers. Routine household visits by community health volunteers to sensitize mothers and community engagement was core to the initiative. The managers and providers of services displayed profound awareness of how requiring identification cards and telephone numbers had the potential to undermine equity by excluding those in greater need of care such as under-age pregnant adolescents. Maternity and mother child health services improved as a result of the funds received by health facilities. Linda Mama reimbursements helped to purchase drug and reduced workload in the facility by hiring extra hands.ConclusionThe initiative seems to have influenced attitudes on health facility delivery through: Partnership among key stakeholders and highlighting the need for enhanced partnership with the communities. It enhanced the capacity of health facilities to deliver high quality comprehensive, essential care package and easing economic burden.

The Impact of International Migration and the Third Childbirth Event in Egypt using the Simultaneous Hazard Model

The Impact of International Migration and the Third Childbirth Event in Egypt using the Simultaneous Hazard Model

Effectiveness of the World Health Organization Safe Childbirth Checklist (WHO-SCC) in preventing poor childbirth outcomes: a study protocol for a matched-pair cluster randomized control trial

BackgroundWomen delivering in health facilities in sub-Saharan Africa and their newborns do not always receive proven interventions needed to prevent and/or adequately manage severe complications. The gaps in quality of care are increasingly pointed out as major contributing factor to the high and slow declining perinatal mortality rates. The World Health Organization Safe Childbirth Checklist (WHO-SCC), as a quality improvement strategy, targets low cost and easy to perform interventions and suits well with the context of limited resource settings. In this matched-pair cluster randomized controlled trial, we assess the effectiveness of the WHO-SCC in improving healthcare providers’ adherence to best practices and ultimately improving childbirth outcomes.MethodsThis is a multi-country study. In each country we will carry out a matched-pair cluster randomized controlled trial whereby four pairs of regional hospitals will be randomized on a 1:1 basis to either the intervention or control group. A context specific WHO-SCC will be implemented in the intervention facilities along with trainings of healthcare providers on best childbirth practices and ongoing supportive supervisions. The standard of care will prevail in the control group. The primary outcome is a summary composite metric that combine the following poor childbirth outcomes: stillbirths, maternal deaths, early neonatal deaths, severe postpartum hemorrhage, maternal infections, early neonatal infections, prolonged obstructed labor, severe pre-eclampsia, uterine rupture in the health facility, eclampsia and maternal near miss. The occurrence of these outcomes will be ascertained in a sample of 2530 childbirth events in each country using data extraction. A secondary outcome of interest is the adherence of healthcare providers to evidence best practices. This will be measured through direct observations of a sample of 620 childbirth events in each country.DiscussionOur study has the potential to provide strong evidence on the effectiveness of the WHO-SCC, a low cost and easy to implement intervention that can be easily scaled up if found effective.Trial registrationThe trial was registered in the Pan-African Clinical Trials Registry on 21st January 2020 under the following number: PACTR202001484669907. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9662

Coexistence and prevalence of obstetric interventions: an analysis based on the grade of membership

BackgroundObstetric interventions performed during delivery do not reflect improvements in obstetric care. Several practices routinely performed during childbirth, without any scientific evidence or basis - such as Kristeller maneuver, routine episiotomy, and movement or feeding restriction - reflect a disrespectful assistance reality that, unfortunately, remains in place in Brazil. The aims of the current study are to assess the coexistence and prevalence of obstetric interventions in maternity hospitals in Belo Horizonte City, based on the Grade of Membership (GoM) method, as well as to investigate sociodemographic and obstetric factors associated with coexistence profiles generated by it.MethodsObservational study, based on a cross-sectional design, carried out with data deriving from the study “Nascer em Belo Horizonte: Inquérito sobre o Parto e Nascimento” (Born in Belo Horizonte: Survey on Childbirth and Birth). The herein investigated interventions comprised practices that are clearly useful and should be encouraged; practices that are clearly harmful or ineffective and should be eliminated; and practices that are inappropriately used, in contrast to the ones recommended by the World Health Organization. The analyzed interventions comprised: providing food to parturient women, allowing them to have freedom to move, use of partogram, adopting non-pharmacological methods for pain relief, enema, perineal shaving, lying patients down for delivery, Kristeller maneuver, amniotomy, oxytocin infusion, analgesia and episiotomy. The current study has used GoM to identify the coexistence of the adopted obstetric interventions. Variables such as age, schooling, skin color, primigravida, place-of–delivery financing, number of prenatal consultations, gestational age at delivery, presence of obstetric nurse at delivery time, paid work and presence of companion during delivery were taken into consideration at the time to build patients’ profile.ResultsResults have highlighted two antagonistic obstetric profiles, namely: profile 1 comprised parturient women who were offered diet, freedom to move, use of partogram, using non-pharmacological methods for pain relief, giving birth in lying position, patients who were not subjected to Kristeller maneuver, episiotomy or amniotomy, women did not receive oxytocin infusion, and analgesia using. Profile 2, in its turn, comprised parturient women who were not offered diet, who were not allowed to have freedom to move, as well as who did not use the partograph or who were subjected to non-pharmacological methods for pain relief. They were subjected to enema, perineal shaving, Kristeller maneuver, amniotomy and oxytocin infusion. In addition, they underwent analgesia and episiotomy. This outcome emphasizes the persistence of an obstetric care model that is not based on scientific evidence. Based on the analysis of factors that influenced the coexistence of obstetric interventions, the presence of obstetric nurses in the healthcare practice has reduced the likelihood of parturient women to belong to profile 2. In addition, childbirth events that took place in public institutions have reduced the likelihood of parturient women to belong to profile 2.Conclusion(s)Based on the analysis of factors that influenced the coexistence of obstetric interventions, financing the hospital for childbirth has increased the likelihood of parturient women to belong to profile 2. However, the likelihood of parturient women to belong to profile 2 has decreased when hospitals had an active obstetric nurse at the delivery room. The current study has contributed to discussions about obstetric interventions, as well as to improve childbirth assistance models. In addition, it has emphasized the need of developing strategies focused on adherence to, and implementation of, assistance models based on scientific evidence.

Factors contributing to a positive childbirth experience for women in a hospital setting: an umbrella review protocol.

The objective of this umbrella review is to identify and evaluate the factors that contribute to a positive childbirth experience in laboring women in the hospital setting. Childbirth is a milestone for women. Overall, the experience can positively or negatively affect self-esteem, bonding, future childbirth decisions, and overall health and well-being. Understanding of the mother's perception and expectation of the childbirth event is needed to promote positive experiences and outcomes. This review will consider qualitative systematic reviews that include pregnant women, women in active labor, or women who have recently given birth. This review will consider systematic reviews conducted in a hospital setting in any geographical location reporting on women's positive childbirth experiences, and the factors that led to positive experiences. The search strategy will aim to locate qualitative systematic reviews. Databases to be searched include MEDLINE, CINAHL, Embase, Scopus, JBI Evidence Synthesis, and Cochrane Database of Systematic Reviews. Sources of unpublished reviews and gray literature to be searched include ProQuest Dissertations and Theses Sciences and Engineering Collection and OpenGrey. Systematic reviews published since 2001 in the English language will be included. Data will be extracted from systematic reviews by two independent reviewers and findings from the included reviews, as they relate to the umbrella review question, will be presented in tabular format with a supplemental narrative to ensure interpretability. PROSPERO CRD42021251796.

A longitudinal study of women's representations and experiences of pregnancy and childbirth

ObjectiveTo explore women's representations of pregnancy and childbirth and how these representations are constructed and have changed. BackgroundIn the 1980s, many women in Quebec demanded that the birthing process be both demedicalised and humanised, resulting in the legalisation of the midwife profession while expanding their choices over birthing locations within the public health system (e.g., birthing centres, the home, or hospitals). Birth-related technologies were also improving at that time. Nearly 40 years later, we wanted to learn about their perceptions. MethodThis qualitative and contextualised phenomenological study surveyed 25 first-time mothers who had received care from midwives, general practitioners, or obstetricians. Each participant met with the researcher twice during her pregnancy and once after giving birth to engage in narrative conversations, which were analysed from an interdisciplinary viewpoint (socio-anthropology). FindingsParticipant perceptions of pregnancy varied. Some saw it as a state that distorted the body, while others saw it as a long period of struggle with a compulsory step that was also fascinating and/or even happy. Women undergo an incremental process of change before contemplating childbirth, and typically undergo a transitional period when nearing the event itself. They may think of childbirth as joyful and/or painful. Representations are built intersubjectively through influences involving family, the media, and care providers. Stories from their mothers, therefore, created undeniable impressions. ConclusionIn a context heavily influenced by technology, easy pregnancies and/or childbirth events are typically deemed “lucky.” This negatively reinforces both the cultural and intergenerational values transmitted regarding these events.

The Prevalence and Associated Factors of Postpartum Post-Traumatic Stress Disorder in a Population of Moroccan Women

Postpartum post-traumatic stress disorder prevalence varies from 0.8 to 5.6%, and its development is linked to several obstetrical, social, psychiatric and subjective distress factors. The objective of the study was to measure its prevalence in the Moroccan population and identify the related factors. We conducted a descriptive study of 302 women. We found a prevalence of 28.57% of postpartum post-traumatic stress disorder. The related factors were being single, history of psychiatric treatment or depression or anxiety disorder, prenatal depression or anxiety, previous fear of childbirth or previous traumatic event. No correlation was found between obstetrical and subjective distress factors and postpartum post-traumatic stress disorder. The results contrasted with those found in western countries. It showed the importance of cultural factors and social aspects in the appearance of such a disorder. It also showed the importance of detecting this disorder in post natal visits.

Information Resource Network Analysis of Factors Influencing Breastfeeding Planning and Duration

This study aimed to identify the modifiable factors affecting breastfeeding planning and duration among healthy mothers and their use of breastfeeding information resources. A cross-sectional survey was conducted in a community setting. Four hundreds participants were recruited at five pediatric clinics and three community health centers located in Paju-si and Goyang-si, Gyeonggi-do, between January and May 2019. Based on the breastfeeding decision-making model, driven by Martens and Young's work, the survey items consisted of demographics, childbirth and breastfeeding characteristics, and breastfeeding information resources. In the analysis, 389 responses were used in the t-test, ANOVA, and logistic regression. Information resource networks were compared before and after childbirth including a subgroup analysis depending on the breastfeeding duration. The modifiable factors affecting breastfeeding planning and duration were antenatal and postpartum breastfeeding education and the provision of information in the hospital. The frequency of Internet use and websites visited were notable and potentially modifiable factors, which were also observed in the networks showing different relationship patterns according to participant subgroups and times. The childbirth event increased the centralization of the network in the planned group, while the network of the non-planned group was more diffused after childbirth. The network of the short-term breastfeeding group was characterized by a more centralized pattern and the resources of high betweenness centrality than the long-term group. Breastfeeding education is a consistent factor that affects breastfeeding behavior. A well-designed internet-based approach would be an effective nursing intervention to meet the needs of women seeking breastfeeding information and changing their behaviors.

Determinants of rural-urban differences in health care provider visits among women of reproductive age in the United States.

BackgroundRural health disparities and access gaps may contribute to higher maternal and infant morbidity and mortality. Understanding and addressing access barriers for specialty women’s health services is important in mitigating risks for adverse childbirth events. The objective of this study was to investigate rural-urban differences in health care access for women of reproductive age by examining differences in past-year provider visit rates by provider type, and quantifying the contributing factors to these findings.Methods and findingsUsing a nationally-representative sample of reproductive age women (n = 37,026) from the Medical Expenditure Panel Survey (2010–2015) linked to the Area Health Resource File, rural-urban differences in past-year office visit rates with health care providers were examined. Blinder-Oaxaca decomposition analysis quantified the portion of disparities explained by individual- and county-level sociodemographic and provider supply characteristics. Overall, there were no rural-urban differences in past-year visits with women’s health providers collectively (65.0% vs 62.4%), however differences were observed by provider type. Rural women had lower past-year obstetrician-gynecologist (OB-GYN) visit rates than urban women (23.3% vs. 26.6%), and higher visit rates with family medicine physicians (24.3% vs. 20.9%) and nurse practitioners/physician assistants (NPs/PAs) (24.6% vs. 16.1%). Lower OB-GYN availability in rural versus urban counties (6.1 vs. 13.7 providers/100,000 population) explained most of the rural disadvantage in OB-GYN visit rates (83.8%), and much of the higher family physician (80.9%) and NP/PA (50.1%) visit rates. Other individual- and county-level characteristics had smaller effects on rural-urban differences.ConclusionAlthough there were no overall rural-urban differences in past-year visit rates, the lower OB-GYN availability in rural areas appears to affect the types of health care providers seen by women. Whether rural women are receiving adequate specialized women’s health care services, while seeing a different cadre of providers, warrants further investigation and has particular relevance for women experiencing high-risk pregnancies and deliveries.

Kultura rojevanja na Goriškem v 20. stoletju

Uvod: Nosečnost in z njo povezan porod sta za žensko in njeno družino zelo pomembna in čustvena dogodka, ki s seboj prinašata veliko sprememb. Namen kvalitativne raziskave je bil skozi primere porodnih zgodb proučiti kulturo rojevanja na Goriškem v 20. stoletju.Metode: V raziskavi je bila uporabljena deskriptivna interpretativna metoda. Uporabljen je bil namenski vzorec šestih žensk. Najmlajša izmed sodelujočih je bila stara 66 let, najstarejša pa 95 let. Raziskava je potekala aprila 2019. Podatki so bili zbrani z delno strukturiranim intervjujem in analizirani s pomočjo metode analize vsebine.Rezultati: Identificirane so bile štiri teme: (1) spomini na porodno izkušnjo, (2) opis porodne izkušnje v resničnosti takratnega časa, (3) podporna vloga ožje in širše skupnosti v obporodni oskrbi in (4) determinacija zdravstvenega statusa skozi družbeni status. Pri porodnem dogodku doma so sodelovale babice in bližnje sorodnice, medtem ko so porodni dogodek v bolnišnici oblikovali zdravstveni delavci. Lajšanje porodne bolečine ni bilo v ospredju. Porod je potekal v hrbtnem položaju. Informacije o rojevanju so se prenašale od ene do druge ženske. Prva porodna izkušnja je prelomna za doživljanje poroda.Diskusija in zaključek: Porod in obporodno dogajanje sta v tistem času in prostoru v večji meri izpolnila pričakovanja žensk kljub nekaterim socialnim dejavnikom in pomanjkanju materialnih dobrin, ki jih v današnjem času prepoznavamo kot neobhodne.