Background Maternal mortality in Ghana remains high at 263 deaths per 100,000 live births, with the Volta Region showing particularly concerning figures; 37.2% of women give birth without a skilled provider. Many rely on Traditional Birth Attendants (TBAs), whose role remains unofficial and unregulated. Causes of maternal death include hemorrhage, sepsis, hypertensive disorders, and unsafe abortions, compounded by limited access to emergency care and mistrust in clinical settings. To create a dialogue between the stakeholders to reduce maternal mortality, we want to screen the documentary Among Us Women. The documentary is set in rural Ethiopia, explores the choice between home and hospital birth. A first screening in Ghana revealed similar challenges—highlighting women's trust in TBAs and dissatisfaction with clinical care. The film successfully opened dialogue between midwives and TBAs, showing potential for collaboration. Hypothesis We propose that film screenings followed by inclusive dialogue will improve mutual respect and cooperation between TBAs and clinical staff in rural areas, leading to earlier interventions and reduced maternal deaths within one year. Method A shortened, Ewe-dubbed version of the film will be shown in 60 randomly selected communities in the Volta Region, reaching 500+ stakeholders. Roundtables will follow each screening, supported by trained facilitators. Discussions and follow-up evaluations will inform a “community needs catalog” and provide data for potential national scale-up. Discussion The main question is if setting up an efficient dialogue as a result of a film screening in other communities is replicable. To set up a reliable study, test screenings of the film upfront will refine the approach, addressing language, group size, and ethical concerns. Using relatable storytelling and dialogue, the project fosters empathy, shared responsibility, and cultural sensitivity; laying the groundwork for long-term improvements in maternal health.

Objective This retrospective cohort study investigated relationships between antidepressant use in pregnancy and hypertensive disorders of pregnancy. Design/setting/sample Observational cohort study examining births in an outer-metropolitan maternity hospital in Australia between 2008-2022. 75,308 births were examined. Methods Logistic regression analysis considering covariates including maternal age, smoking, BMI, depression, anxiety, schizophrenia or bipolar disorder, gestational diabetes, pre-pregnancy diabetes. The antidepressant treatment cohort was compared with two groups: all births at this hospital within this time period, and a more closely matched depressed/anxious cohort not treated with antidepressants in pregnancy. The overall group of women taking antidepressants in pregnancy was also compared with women taking antihypertensive medications in pregnancy. Main outcome measures Clinical diagnoses of hypertension, pre-eclampsia or eclampsia recorded in pregnancy, at birth or the immediate postpartum, as well as treatment with antihypertensive medication. Results A statistically significant relationship ( p = 0.001) between antidepressant use in pregnancy and clinically diagnosed hypertension, OR 2.65, CI 1.45-4.81, when compared with the overall birthing cohort. When covariates were added, including BMI, age and gestational diabetes, this relationship lost statistical significance. The relationship was also non-significant when a depressed/anxious cohort was used as the comparator group: OR 1.49 ( p = 0.24, CI 0.77 – 2.88). A highly statistically significant relationship was found between antenatal antidepressant use and pre-eclampsia, OR 2.90, ( p < 0.0005, CI 2.1 – 4.0), which retained significance when covariates were added to the regression analysis (OR 2.07, CI 1.45-2.97, p < 0.0005). BMI and gestational diabetes were also significant risk factors for pre-eclampsia in this sample. As in other research, depression was also found to be related to pre-eclampsia at a borderline significant level ( p = 0.086). Considering the co-administration of antidepressants and antihypertensive medications, a strong relationship was found: OR 2.90, p < 0.000, CI 2.13-3.94, aOR 2.02 p < 0.000, CI 1.39-2.93. When women taking antidepressants were compared with depressed/anxious peers a similarly significant relationship between antidepressant use and hypertension of pregnancy was found: OR 2.56, ( p < 0.0005, CI 1.7 – 3.7). We found a highly significant relationship between antidepressant use and eclampsia, OR 2.84 ( p < 0.0005, CI 2.06 – 3.92), unchanged when compared with the depressed/anxious cohort: OR 2.84 ( p < 0.0005, CI 2.06 – 3.92). Conclusions This study supports existing research suggesting a strong relationship between antidepressant use in pregnancy and hypertensive disorders. Comparison with a depressed/anxious cohort reduces the risk that these underlying conditions could contribute to this finding.

With hospital-based obstetric care declining in rural areas, risk-appropriate care, which aligns patient clinical conditions with hospital capabilities using level of care, may be limited for pregnant rural residents, especially those with higher-risk conditions that necessitate specialty or subspecialty obstetric care. To assess the proportion of higher-risk pregnant rural residents who receive risk-appropriate care during childbirth and identify factors associated with not receiving risk-appropriate care. This cross-sectional study used linked vital statistics and hospital discharge data for pregnant rural residents with higher-risk clinical conditions who had hospital-based births in Michigan (2010-2020), Oregon (2010-2020), Pennsylvania (2010-2018), and South Carolina (2010-2020). Data analyses were performed between December 2023 and July 2025. Birth hospital maternal level of care (I, basic; II, specialty; III, subspeciality; IV, regional perinatal). The main outcome was birth in a hospital with risk-appropriate care, defined as having the necessary level of care for the patient's clinical condition. Covariates included age, race and ethnicity, insurance, education, prenatal care utilization, medical and obstetric comorbidities, distance to the closest risk-appropriate hospital (quartile 1: 0.50-5.57 miles, quartile 2: 5.58-18.90 miles, quartile 3: 18.91-33.93 miles, quartile 4: 33.94-209.80 miles), year, and state. A total of 199 225 higher-risk pregnant rural residents (mean [SD] maternal age, 27.9 [5.6] years) were included, of whom 11 651 (5.9%) identified as Hispanic, 3054 (1.5%) as non-Hispanic American Indian or Alaska Native, 1370 (0.7%) as non-Hispanic Asian or Pacific Islander, 18 296 (9.2%) as non-Hispanic Black, 5320 (2.7%) as non-Hispanic other race, and 159 253 (79.9%) as non-Hispanic White. Birth at a risk-appropriate hospital occurred for 38 441 of 70 647 individuals (54.4%) with conditions requiring level II care, 4611 of 9270 (49.7%) with conditions requiring level III care, and 1793 of 6527 (27.5%) with conditions requiring level IV care. Those with significantly higher rates of not receiving risk-appropriate care included American Indian or Alaska Native (adjusted incidence rate ratio [aIRR], 1.13; 95% CI, 1.10-1.17), or Hispanic (aIRR, 1.06; 95% CI, 1.03-1.08) individuals (compared with White individuals), those without private insurance (public: aIRR, 1.03; 95% CI, 1.01-1.04; uninsured: aIRR, 1.07; 95% CI, 1.01-1.14), those who were younger and had less education (age <20 years: aIRR, 1.05; 95% CI, 1.03-1.08, compared with 30-34 years; some high school: aIRR, 1.04; 95% CI, 1.03-1.06, compared with high school degree), and those who lived further from a risk-appropriate hospital (furthest quartile: aIRR, 23.86; 95% CI, 20.48-27.79, compared with closest quartile). In this study, lack of risk-appropriate care was common for pregnant rural residents with clinical complexity. Associated factors, including race, ethnicity, insurance, age, education, and distance, highlight the barriers and need for increasing access to subspecialty care for pregnant rural residents.

BackgroundFacilitating placental transfusion—the transfer of blood from the placenta to the newborn—via delayed cord clamping (DCC) or umbilical cord milking (UCM) at birth has been shown to improve iron stores in healthy term infants and may positively impact long-term neurodevelopmental outcomes. Infants who are non-vigorous at birth and at risk of developing hypoxic-ischemic encephalopathy (HIE) are particularly likely to benefit from placental transfusion. This process may offer neuroprotection by enhancing cardiopulmonary transition, supporting cardiac preload, improving systemic and cerebral perfusion, delivering stem cells and neurotrophic factors, and preventing iron deficiency. While DCC is not currently recommended for non-vigorous term infants requiring immediate resuscitation, UCM offers a viable alternative, as it can be performed quickly.MethodsThis study is a multicenter, cluster-randomized, crossover-controlled trial comparing UCM with early cord clamping (ECC) in term and late preterm infants who are non-vigorous at birth. The trial will be conducted across seven centers in India. Before the trial begins, each site will be assigned to an initial study arm using a computer-generated randomization scheme. Once 50% of the enrollment is complete, sites will switch to the alternate study arm after a 2-month washout period. The study is designed with sufficient power to assess the composite outcome of death or moderate-to-severe HIE during birth hospitalization and survival without moderate-to-severe neurodevelopmental impairment at 2 years of age. Secondary outcomes include survival without moderate-to-severe neurodevelopmental impairment at 1 year of age and survival without evidence of brain injury on MRI during the birth hospitalization.DiscussionThe CORDMILK trial aims to generate critical evidence on whether UCM can improve survival without moderate-to-severe HIE during birth hospitalization and survival without significant neurodevelopmental impairment at 2 years of age in late preterm and term neonates who are non-vigorous at birth.Trial registrationClinical Trial Registry–India CTRI/2021/09/036759. Registered on 22/09/2021. ClinicalTrials.Gov number NCT03657394 and NCT03682042.

Community births in the UnitedStates-including planned home and freestanding birth center deliveries-have increased in recent years. Understanding how these patterns have evolved across racial and ethnic groups, particularly in the post-pandemic period, is essential for clinical practice and health policy. Objective: To analyze national trends in community births from 2016 through 2024 by race and ethnicity, and to discuss clinical, ethical, and policy implications. Birth certificate data from the CDC natality database were examined for 2016-2024. Community births were defined as intended home or freestanding birth center births. Trends were assessed overall and stratified by race/ethnicity, with relative changes indexed to2016. From 2016 to 2024, community births increased overall but diverged by group. Non-Hispanic White and Hispanic women demonstrated sustained increases relative to 2016, while non-Hispanic Black women showed an increase during the pandemic followed by decline, and non-Hispanic Asian women displayed a modest upward trend. These shifts occurred against the backdrop of declining total births in some groups, affecting proportional comparisons. International comparisons are limited by the distinctive U.S. context, where midwifery is less integrated and credentialing standards are variable. Community birth patterns since the pandemic reveal both growth and divergence across racial and ethnic groups. These findings highlight the need for policy interventions to address maternity care deserts and harmonize midwifery credentialing. Clinically, professional responsibility requires fully informed consent leading to directive counseling, which should not be misinterpreted as paternalism but as an ethical duty to recommend hospital birth as the safest option while respecting patient autonomy.

Late preterm infants represent nearly a quarter of a million infants born in the United States annually. There is a known variation in admission location for these infants. The objective of this study was to identify the timing and reasons for transfer for late preterm infants requiring an escalation in care during the birth hospitalization. This single-center retrospective cohort study examined the birth hospitalization for late preterm infants (34 + 0 to 36 + 6weeks) born between 2019 and 2021, specifically focusing on infants requiring an escalation to a higher level of care. Infants with congenital anomalies expecting neonatal intensive care unit (NICU) admission were excluded. The analysis included descriptive and inferential statistics. Of 1022 infants, 150 symptomatic infants were admitted to the level III/IV NICU at birth. Of the remaining 872 infants, 14% (n = 124) received escalation of care (n = 77 from level I to II, 25 from level I to III/IV, 22 from level II to III/IV). The most common reasons for escalation were need for respiratory support (n = 32, 26%), cardiorespiratory monitoring (n = 31, 25%), thermoregulation (n = 29, 23%), and dextrose-containing intravenous fluids (n = 27, 22%). Infants required escalation of care at a median of 12.5hours after birth (IQR 4-40hours, range 0-133), with 50% (n = 62) occurring within the first 12hours and 67% (n = 83) within 24hours. Escalation of care for late preterm infants most frequently occurs in the first 24hours after birth. The most frequent reasons for escalation were the need for respiratory support, followed by cardiorespiratory monitoring and thermoregulation.

Nurse workforce diversity and use of neuraxial labor analgesia in the United States.

BackgroundCesarean section (CS) delivery rates have risen dramatically worldwide, with most countries exceeding the World Health Organization’s (WHO) recommended rate of 10–15%. However, disparities exist, with evidence suggesting that socioeconomic disadvantage and geographic location significantly influence CS rates. Despite this, comprehensive estimates, particularly in Bangladesh, remain limited. This study aims to examine trends, district-level variations, and socioeconomic disparities in CS rates in Bangladesh.MethodsData from seven rounds of the Bangladesh Demographic and Health Surveys, conducted between 1999/2000 and 2022, were analyzed. The outcome variable was CS delivery, categorized by mode of delivery and place of delivery. Explanatory variables included districts, wealth quintiles, and socio-demographic characteristics. Descriptive statistics were used to illustrate trends and variations in CS delivery over time in Bangladesh. Multilevel mixed-effects binary logistic regressions were employed to identify the factors associated with CS delivery.ResultsBetween 1999/2000 and 2022, hospital births in Bangladesh increased by 55%, largely driven by a significant rise in CS deliveries, from 32% to 69%. Around 85% of the total CS deliveries occurred in the private healthcare facilities in 2022, a marked increase from 41.5% in 1999/2000. In contrast, CS delivery rates in government healthcare facilities fell from 53% to 13.6% during the same period. Mothers in border and hilly districts, as well as those in the poorest wealth quintile, reported lower rates of CS delivery compared to their counterparts.ConclusionThe uneven distribution of CS delivery across districts and socioeconomic groups highlights the need for a more tailored approach to childbirth. While government efforts to reduce unnecessary CS use have been insufficient, this study suggests that a one-size-fits-all strategy may exacerbate disparities. Instead, the focus should shift from increasing access to ensuring justified and appropriate use of CS, with public healthcare facilities playing a crucial role in providing safe alternatives.

The objective: to study the features of pregnancy in women under martial law.Materials and methods. 97 pregnant women with a gestation period of more than 22 weeks of pregnancy from the combat zone were under observation were involved into the main group (MG). They were admitted for treatment and gave birth in maternity hospitals in Lviv from 2022 to 2024. The control group (CG) included 33 pregnant women – residents of Lviv and the Lviv region. The pregnant women were examined in accordance with Order No. 417 of the Ministry of Health of Ukraine dated July 15, 2011. Examination of pregnant women included collection of life anamnesis, allergic, obstetric and gynecological anamnesis. Pregnant women filled out questionnaires prepared in advance, which included questions from C. D. Spielberger State-Trait Anxiety Inventory in the modification of Y. L. Khanin. Statistical analysis of the results was performed using the Student’s test and Fisher’s method. Differences were considered statistically significant at p &lt; 0.05.Results. The average age of pregnant women was 32.74 ± 0.58 years in the MG, while in the CG it was 31.68 ± 0.58 years. 49 (50.5%) pregnant women in the MG and 13 (39.4%) pregnant women in the CG had permanent jobs. The number of housewives in the MG was 48 (49.5%) and in the CG – 20 (60.6%). 77 (79.4%) pregnant women in the MG and 29 (87.9%) pregnant women in the CG were married; not married were 20 (20.6%) pregnant women in the MG and 4 (12.1%) – in the CG. 84 (86.6%) patients in the MG and 30 (90.8%) patients in the CG had a burdened somatic history (p &lt; 0.05). 76 pregnant women (78.4%) of the MG and 27 (81.8%) – of the CG had a history of gynecological diseases. The course of pregnancy was significantly more often complicated by:– the threat of early abortion – in 39 (40.2%) of pregnant women of the MG and 5 (15.2%) – CG (p &lt; 0.05);– the threat of late spontaneous abortion – in 50 (51.5%) of pregnant women in the MG and 11 (33.3%) – CG (p &lt; 0.05);– the threat of premature birth – in 56 (57.7%) women in the MG and 8 (24.2%) – in CG (p &lt; 0.05);– placental dysfunction – in 33 (34.1%) pregnant women in MG and 4 (12.1%) – in CG (p &lt; 0.05).Placental dysfunction was diagnosed in 62 (63.9%) pregnant women in the MG vs 6 (18.2%) – in CG (p &lt; 0.05). Gestosis was found in 52 (53.6%) pregnant women in the MG and 8 (24.2%) – CG (p &lt; 0.05). 35 (36.1%) women in the MG were deli-vered operatively, while in the CG only 6 (18.2%) women. Considering the test results of C. D. Spielberger State-Trait Anxiety Inventory, moderate and high level of state anxiety (SA) and trait anxiety (TA) prevailed in the pregnant women in the MG.Conclusions. A feature of the course of pregnancy in women in martial law is the threat of early and late abortion, the threat of premature birth, placental dysfunction, and gestosis, which were 1.5 times more common in pregnant women from combat zones. These women had moderate and high levels of SA and TA, and the average level of SA was 1.5 times higher. Pregnant women from combat zones twice more used epidural anesthesia during childbirth, which can be explained by the desire to relieve emotional components with a high level of anxiety. It was found that pregnant women from combat zones had an operative delivery twice more often.

Abstract Background Home births have a mortality risk 2.6 times higher in domiciliary delivery compared to hospital births, but they allow for the adoption of alternative delivery methods like Lotus Birth (LB). This practice entails preserving the connection between the newborn and placenta by leaving the umbilical cord intact, minimizing the trauma and promoting a gentler separation process for both the mother and the infant. Although research has not established neonatal benefits of LB, documented cases have identified associated risks such us sepsis and physiological jundice, precluding its adoption in hospital settings. The potential link between LB and pathological jaundice remains unclear. Known risk factors for severe hyperbilirubinemia and bilirubin encephalopathy include sepsis, blood-group incompatibility, and dehydration; conditions typically preventable through standard hospital protocols. Case report A male infant born at 40 + 0 weeks of gestational age through a eutocic birth at home by LB was brought to the emergency department on the fourth day of life due to exacerbating jaundice, hyporeactivity, and feeding difficulties persisting for about two days. Laboratory analysis revealed a serum bilirubin level of 51 mg/dL. After admission to NICU infant received intensive phototherapy, IV fluids, exchange transfusion, albumin infusion, IVIG and antibiotic prophylaxis.. The newborn also showed neurological symptoms including muscle stiffness and apparently erratic eye movements, requiring neurological assessment and, during hospitalization, tested positive for COVID-19. Magnetic resonance imaging (MRI) revealed hippocampal changes, and hearing tests yielded pathological results. At one month, the infant was discharged in stable condition but with ongoing neurological and developmental concerns. Conclusion This case highlights the dangers associated with non-evidence-based birth practices (home birth, lotus birth) and the need for vigilant postnatal monitoring. In conclusion, this clinical case delineates a rare yet extremely serious complication of neonatal AB0 incompatibility jaundice, exacerbated by concurrent sepsis and dehydration compounded by inadequate nutrition following lotus birth at home. Upon admission, the neurological examination suggested a diagnosis of severe hyperbilirubinemic encephalopathy. However, confirmation of neurological damage and the subsequent diagnosis of kernicterus were only possible following the performance of MRI.

Community-based birth supported by midwives and nurses is increasing in the United States amid stark racial disparities in maternal outcomes and worsening access to pregnancy care. Although studies examining prenatal confidence have shown that persons with higher confidence are more likely to give birth vaginally, reporting less pain, anxiety, and dissatisfaction, existing measurement tools have focused on hospital births. Accordingly, we adapted the previously validated Preparation for Labor and Birth (P-LAB) instrument, which measures third-trimester confidence for physiologic birth, for community-based births, centering the perspectives of Black populations. Expert stakeholders (N = 5) including practicing midwives and maternal health researchers assessed the relevance and completeness of the P-LAB. Following individual reviews, stakeholders adapted the tool during a group review session. Virtual cognitive interviews were then conducted with community stakeholders (N = 10), prenatal and newly postpartum persons, to test comprehensibility, informing further adaptation of P-LAB items. Findings were summarized and analyzed using an abbreviated framework method. A subset of community stakeholders (N = 5) pretested the final instrument for redundancy and appropriateness. The iterative adaptation process informed removal of irrelevant items (N = 6), further clarification of existing items (N = 12), and the generation of additional items (N = 7). The final instrument, the Preparation for Community-Based Labor and Birth (P-CLAB), is a 23-item, Likert-response survey. Expert stakeholder engagement resulted in replacing medication-focused measures with items related to safety, dignity, and racial concordance while incorporating language aligning with the midwifery model of care. Community stakeholder engagement highlighted unclear items and opportunities to improve relevance. In addition to promising utility for research, measuring prenatal confidence may equip midwives and nurses to further engage in person-centered care by addressing maternal fears and empowering patients according to their specific needs. The participatory P-CLAB adaptation enhances the instrument's utility and applicability to community-based care settings.

To examine maternal risk factors for congenital syphilis (CS). We used a retrospective, population-based cohort of births in California (2011-2021) with linked birth certificates and hospital records. Modified Poisson regression models with robust standard errors were used to assess characteristics associated with CS. Among dyads with CS, maternal syphilis documentation was also examined. Of 4,481,096 births, 4659 (0.1%) had maternal syphilis without CS, and 2608 (0.06%) had both maternal syphilis and CS. CS was associated with having public insurance, tobacco use, drug use disorders, and residence in fringe-metro or medium/small-metro counties. Among CS dyads, 62.0% had no maternal syphilis documentation. There was a lower risk of no maternal syphilis documentation among those with <12th grade education; non-Hispanic Black identity; tobacco, cannabis, or drug use disorders; mental health conditions; and inadequate prenatal care. Universal prenatal syphilis screening, treatment, and documentation are essential to preventing CS.

To evaluate the association of vaginal versus caesarean birth with neonatal and maternal outcomes for breech, singleton deliveries at 22 0/7 to 25 6/7 weeks of gestation. Retrospective cohort study. Hospital births in the United States. This study analysed non-anomalous, singleton, breech live births at 22 0/7 to 25 6/7 weeks of gestation identified in the linked birth-infant death records data from 2016 to 2021. A propensity score analysis was conducted to establish pseudo-randomization based on the mode of delivery, matching vaginal to caesarean deliveries at a ratio of 1:2 using greedy nearest-neighbour matching. The propensity score estimation included year of delivery, maternal age, race/ethnicity, pre-pregnancy body mass index, parity, marital status, maternal education, insurance status, attendant at delivery, smoking status, hypertensive disorders, diabetes mellitus, gestational age, induction of labour and whether a trial of labour was attempted. We estimated the risk differences (RD) and odds ratios (OR) and associated 95% CIs, taking the matching into consideration. Multiple imputation was used to account for missing data. Composite adverse neonatal and maternal outcomes. Of 21,461 periviable breech singleton births, 34.0% (n = 7289) were delivered vaginally. The median gestational age was 24 (IQR: 23-25) and 23 (IQR: 22-24) weeks in the vaginal and caesarean delivery groups, respectively. Earlier gestational age was associated with vaginal birth, while later gestational age was associated with caesarean births. After propensity score matching, the distributions of baseline factors, except for gestational age, were balanced between the vaginal and caesarean delivery groups. A composite of adverse neonatal outcomes occurred among 99.0% (n = 7213) of vaginal and 96.8% (n = 13,716) of caesarean breech births (aRD 1.8%, 95% CI 1.3 to 2.4; aOR 2.25, 95% CI 1.59 to 3.17). Neonatal mortality rates were higher among vaginal compared to caesarean breech births (72.6% versus 36.2%; aRD 26.8%, 95% CI 25.0 to 28.6; aOR 3.15, 95% CI 2.85 to 3.48). A composite of adverse maternal outcomes occurred in 1.6% of vaginal breech and 3.1% of caesarean births (aRD -1.7%, 95% CI -2.2 to -1.1; aOR 0.47, 95% CI 0.35 to 0.63). Vaginal breech birth between 22 0/7 and 25 6/7 weeks of gestation is associated with a lower risk of adverse maternal outcomes but a higher risk of neonatal adverse outcomes and mortality.

Background and Aim: Opioid use disorder (OUD) during pregnancy has become a major public health issue, with its prevalence rising significantly in recent years. The incidence of neonatal abstinence syndrome (NAS) has also surged, from 1.5 cases per 1000 hospital births in 1999 to 6.0 cases per 1000 in 2013. This study aims to identify and analyze the concerns faced by pregnant people in accessing OUD treatment on time, specifically focusing on New York. Methods: The pooled sample of 225,275 individuals represents pregnant patients with OUD who received treatment at substance use disorder (SUD) facilities across New York State between 2016 and 2020, using data from the TEDS-D database. This dataset includes all pregnant individuals diagnosed with OUD, with consistent criteria for treatment eligibility applied. Results: The adjusted odds ratio (AOR) for medication-assisted treatment (MAT) for OUD was 1.41 (95% CI 1.15, 1.72; p = 0.0008) for full-time employees and 1.11 (95% CI 0.91, 1.34; p = 0.32) for part-time employees, compared to unemployed individuals. Regarding marital status, the AOR for treatment access was 1.51 (95% CI 1.34, 1.70; p < 0.0001) for currently married individuals and 1.85 (95% CI 1.67, 2.06; p < 0.0001) for those who are divorced or widowed, compared to individuals who have never married. Discussion: Our study highlights key sociodemographic barriers that affect early access to care for pregnant individuals in New York. OUD continues to be a critical public health issue, particularly among pregnant people, who are exposed to heightened health risks for both themselves and their babies, due to societal perceived stigma related to use during pregnancy.

IntroductionCesarean sections are commonly performed in the United States, including among patients for whom vaginal delivery may be clinically feasible. This study aimed to evaluate rates and factors associated with cesarean section use and inpatient cost among low-risk deliveries in selected U.S. states.MethodsThis was a retrospective, cross-sectional analysis using Healthcare Cost and Utilization Project (HCUP) State Inpatient database for Maryland, Florida, and Wisconsin between January 1, 2017, and December 31, 2020. American Hospital Association (AHA) data and median household income quartiles based on the Agency for Healthcare Research and Quality’s (AHRQ) 2018 estimates were included in this study to assess hospital and patient neighborhood characteristics. AHA data was linked to HCUP data using the hospital identifier number. Median household income quartiles were linked to HCUP using ZIP codes. A multivariable generalized estimating equations regression model including a random intercept for hospitals was used to identify patient- and hospital-level characteristics associated with the use of cesarean section.Results245,383 women who underwent a delivery between 2017 and 2020 were included in the analysis. Of these women, 8.1% had cesarean section and 91.9% had vaginal delivery. Mean age was 26.9 (SD ± 4.41) years for cesarean section and 26.9 (SD± 4.37) years for vaginal delivery. An increasing rate of cesarean section was detected during the study period. Higher rates of cesarean section were found among Black and Hispanic women compared to White and Asian, and among women with lower income. Hospitals in Florida had the highest cesarean section rate of 9.4% among low-risk women while Maryland and Wisconsin had rates of 6.3% and 5.3%, respectively. Being Hispanic or Black, having private insurance, and giving birth in a for-profit hospital were associated with higher cesarean section utilization after controlling patient- and hospital-level factors. DiscussionA range of clinical and policy interventions have been implemented over the past decade to reduce cesarean sections among low-risk deliveries; however, we still identified an increasing rate of cesarean section among low-risk women between 2017 and 2020 in select U.S. states. There is an emergent need to revisit policies and interventions that impact cesarean section in these states. Women with low socioeconomic status were more vulnerable to have cesarean sections. Identifying variation in cesarean delivery rates among low-risk populations may inform future efforts to improve maternal care quality.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12884-025-08148-0.

BackgroundAcross the United States, newborns are being transferred from their birth hospital to a tertiary hospital for more care. This action separates the mother from her newborn, breaking a bond, or emotional tie, between the two. This narrative review explores the available literature on technology being used in the neonatal intensive care unit (NICU) to help support bonding when the mother is separated from her newborn.MethodsUtilizing the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) approach for this review, four databases (CINAHL, MEDLINE, Web of Science, and PUBMED) were searched. Terms searched were bonding, technology, neonatal intensive care OR NICU, and web camera. The search included the years 2016-2023 and the English language.ResultsEleven studies were included in this review, which resulted in the identification of three positive and two negative emotions that described how parents felt about using technology to see their newborn. The positive emotions include a decrease in stress and anxiety, and improved family relationships. The negative emotions included guilt and experiencing psychological distress. Additionally, the review showed that staff in the NICU need to be consulted before implementing this type of technology to ensure success.ConclusionUnderstanding the different types of technology in the NICU, how it affects parents, and nurse workflow is necessary to identify ways to promote bonding when separated at birth.

Objective: Surgical correction of ankyloglossia through frenotomy has increased over 10-fold in the past decade, despite not seeing any significant improvement in breastfeeding rates. Due to heightened attention to this diagnosis and lack of consensus on treatment, we sought to evaluate our regional practice and standardize the screening for ankyloglossia. Materials and Methods: A retrospective cohort study of frenotomy practice within the birth hospital stay was conducted from June 1, 2019, to June 30, 2021. Patients were identified through billing data and grouped according to race, ethnicity, and health insurance status. The Tongue-tie and Breastfed Babies pictorial tool was then implemented regionally to test for differences. Post-intervention data was analyzed from June 1, 2023, to December 31, 2024. Chi-squared analysis was performed to test for differences. Results: Pre-intervention, there were significant disparities in frenotomy rates, with privately insured patients 2.75 times more likely than those with public insurance to receive a frenotomy during their birth hospitalization (OR 2.75, 95% CI: 2.43-3.12, p < 0.0001). Non-Hispanic White infants were 2.3 times more likely than non-Hispanic Black patients (OR 2.31, 95% CI: 1.94-2.74, p < 0.0001) and 3.9 times more likely than Hispanic infants to undergo the procedure (OR 3.87, 95% CI: 2.19-6.86, p < 0.0001). After the standardization, there were no longer any statistically significant disparities in frenotomy rates by insurance payor status as well as those between non-Hispanic White and non-Hispanic Black patients. Non-Hispanic White infants were still slightly more likely than Hispanic patients to undergo the procedure, but the odds ratio decreased significantly to just 1.37 (OR 1.37, 95% CI: 1.04-1.80, p = 0.0265). Conclusion: These findings suggest that standardizing the assessment of ankyloglossia can improve disparities among those who receive a frenotomy.

The primary objective was to determine whether a behaviour change intervention delivered to hospital staff would (1) improve the proportion of Aboriginal and/or Torres Strait Islander (Aboriginal) babies being registered and (2) reduce hospital admissions and emergency presentations for babies <6 months old. The secondary objective was an observational analysis to determine factors that might influence the proportion of registered Aboriginal births in Western Australia (WA). Quasi-experimental design and cohort study. Five tertiary birthing hospitals in WA. The intervention was delivered to health service providers who were in the five tertiary birthing hospitals. Outcome data were collected on Aboriginal babies born between 1 January 2016 and 30 June 2018 who were delivered within these hospitals. Babies in the control group (n=226) were born 6 months before the intervention and intervention babies (n=232) were born 6 months following the intervention. For the secondary objective, there were 4573 babies included in the analysis. A behaviour change intervention delivered to hospital staff in five hospitals. The primary outcomes were the proportion of babies who were registered and whether a baby had been admitted to hospital or an emergency department by 3 and 6 months old. The secondary outcome was to determine factors that might influence the proportion of registered Aboriginal births in WA (cohort study). There was evidence of a 38% reduction in emergency presentations within 6 months for babies born to hospitals 6 months following the staff training (OR 0.62, 95% CI 0.42 to 0.91), and little evidence of improvements in birth registrations, hospital admissions within 3 or 6 months of birth or emergency department presentations within 3 months of birth. Of the 4573 babies included in the cohort study, 3769 (82.4%) babies had their births registered and 804 (17.6%) babies did not. Factors that were associated with not having a birth registered included low birth weight babies with a 34% decrease in odds of having a registered birth compared with those with a normal birth weight (adjusted OR (aOR) 0.66, 95% CI 0.51 to 0.86). Timing of first antenatal visit was associated with reduced odds of having a birth registered if this occurred in the second (aOR 0.77, 95% CI 0.64 to 0.93) or third trimester (aOR 0.59, 95% CI 0.45 to 0.77) compared with the first trimester. Our study identifies the complexities surrounding birth registrations and improved hospital utilisation for Aboriginal babies, the importance of targeted interventions and ongoing efforts needed to address this issue comprehensively. ACTRN12615000976583.

The Department of Defense Birth and Infant Health Research (BIHR) program regularly identifies live births among TRICARE beneficiaries (i.e., United States military-connected families) for epidemiologic surveillance and research purposes. Linkage of infants with their TRICARE sponsor and birth mother (who may also be the sponsor) provides the capability to examine parental and military characteristics of births and associated health outcomes. The current study describes BIHR data methodology and presents population characteristics for a recent, 6-year cohort of live births among military families. The study cohort comprised all infants in BIHR data born January 2016 through December 2021. Same-sex multiples were not captured because of difficulty differentiating their neonatal medical records. Infants were identified and linked with sponsors and birth mothers using data from the Military Health System Data Repository and Defense Manpower Data Center, which were also used to derive demographic, military, and medical characteristics. Birth and infant health outcomes were ascertained using diagnosis and procedure codes from medical encounter files, which encompassed all care covered by TRICARE (i.e., across military and civilian facilities). Population characteristics were reported using descriptive statistics, overall and by birth mother beneficiary type: sponsor, dependent spouse, or other. Trends in selected adverse outcomes were also described (i.e., cesarean delivery, preterm birth [<37 weeks' gestation], low birthweight [<2500 g], and birth defects). There were 632,565 live births identified from 2016 to 2021; birth mother beneficiary type was most frequently dependent spouse (78.0%, n = 493,183), followed by sponsor (17.3%, n = 109,293) and other (4.8%, n = 30,089). Overall, mean maternal age at delivery was 28.4 years; the majority of infants had sponsors who were married (89.3%, n = 564,999), non-Hispanic White (60.7%, n = 384,148), on active duty status (73.1%, n = 462,107), and of any enlisted rank (79.6%, n = 503,848). Most infants' sponsors deployed at least once before their birth (57.0%, n = 360,312), with a smaller proportion deployed during pregnancy (7.5%, n = 47,306). Births were more likely to occur at civilian versus military hospitals, and the proportion of births at civilian hospitals increased over the study period, from 61.6% in 2016 to 69.5% in 2021. Among all infants, 28.2% (n = 178,589) were delivered by cesarean, 7.3% (n = 45,940) were preterm, 5.2% (n = 32,605) were low birthweight, and 3.4% (n = 21,222) were diagnosed with a major structural birth defect in the first year of life; all of these outcomes were more likely to occur among civilian versus military hospital births. Overall, BIHR data comprise a large number of live births with distinct parental demographic and exposure characteristics. Data can be leveraged to examine adverse health outcomes and various aspects of health care delivery among infants born to United States military-connected families.

Background: Low birth weight (LBW, &lt; 2.5 kg) is an important indicator of health and a serious public health concern in low- and middle-income countries. Objectives: The present study aimed to determine the prevalence of LBW and to identify its associated factors in Khash city, Iran. Methods: A cross-sectional study was conducted, using a census method, on 590 mothers who gave birth in the public hospitals in Khash city, Sistan and Baluchestan, Iran from January 01 to December 30, 2023. Sociodemographic characteristics of mothers delivered and characteristics related to newborn was collected by a self-administered questionnaire. The data were analyzed in SPSS software, version 22. Adjusted odds ratio (AOR) with 95% confidence intervals (CI) was used to declare significant factors associated with LBW at birth. Results: Prevalence of LBW was 13.7% (95% CI: 11 - 16.7). Significant associations were observed between LBW and mother’s occupational status, gestational age, type of pregnancy and height of neonate (P &lt; 0.05). Also, gestational age less than 37 weeks and baby's height of less than 50 cm increase the risk of LBW by 4.4 times (95% CI = 2.5 - 7.9) and 41.2 times (95% CI = 3.6 - 469.4), respectively. Conclusions: In the study area, there was a high prevalence of LBW. Effective nutritional counseling and the incorporation of dietary strategies, along with the implementation of proven methods to prevent preterm births, could help reduce instances of LBW and subsequently improve survival rates among infants.