Midwifery Research Articles

Men’s perception and participation in maternal and child health care in the field practice area of a teaching hospital: A cross-sectional study from rural Bengal

ABSTRACT Introduction: Participation of men in maternal and child health (MCH) is crucial for the reduction of infant and maternal mortality. MCH care services have been focused on providing information and services to women, but males’ behaviour and decisions affect the health of the child and mother. Objectives: The objectives of the study were to assess the perception and participation of males in MCH care as well as, to identify the association of their perception and participation with socio-demographic characteristics and to find out the correlation between perception and participation regarding MCH care. Materials and Methods: A descriptive type of observational study with a cross-sectional design was conducted among 125 male residents from selected subcentres in Budge Budge II block of South 24 Parganas. Data were collected by face-to-face interviews using a predesigned, pretested, structured schedule. Multivariable binary logistic regression was done to identify the association between dependent and independent variables (P < 0.05). The correlation between perception and participation was assessed by Spearman’s rho. Results: The mean age of the participants was 34.3 (±5.6) years with most (59.2%) between the ages of 31–40 years of age. About 24% were unaware of pregnancy registration time, and 30.4% did not know the number of minimum antenatal check-ups. In total, 20% of study participants did not accompany their partner to the Antenatal Care (ANC) clinic, 6.4% did not accompany them during delivery, and almost 33.6% did not accompany their child to the immunization session. No variables were found to be significantly associated with the dependent variables. A statistically significant positive correlation was found between perception and participation (ρ = 0.3). Conclusion: Men’s perception and participation in MCH care services were found to be reasonably good though they can be improved. Awareness raises about the importance of men’s role in supporting their partner’s health during pregnancy and postpartum, as well as the overall well-being of their children through public health campaigns, community events, and targeted educational programs.

Relationship of Serum Nesfatin-1 and Insulin-Like Growth Factor-1 Levels with Adverse Pregnancy Outcomes in Patients with Polycystic Ovary Syndrome.

To investigate the relationship between serum nesfatin-1 and insulin-like growth factor-1 (IGF-1) levels and adverse pregnancy outcomes (APOs) in patients with polycystic ovary syndrome (PCOS). Observational study. Place and Duration of the Study: The study was performed from June 2021 to 2023 in the General Gynaecology section at the Maternity & Child Care Center of Qinhuangdao, Hebei, China. A total of 120 pregnant women with PCOS were divided into the control and study groups. The control group consisted of 70 pregnant women who successfully delivered healthy newborns, whereas the study group included 50 pregnant women who experienced APOs. The serum nesfatin-1 and IGF-1 levels in both groups were measured upon admission. The potential influencing factors of APOs in pregnant women with PCOS and the predictive value of serum nesfatin-1 and IGF-1 for APOs were analysed. Serum nesfatin-1 and IGF-1 levels were significantly higher in the study group than in the control group (p <0.05). Multivariate analysis revealed that testosterone ≥45μg/L, body mass index ≥25kg/m², waist-hip ratio ≥0.80, gestational diabetes mellitus, nesfatin-1, and IGF-1 were independent risk factors of APOs in patients with PCOS. The AUC for IGF-1 plus nesfatin-1 in predicting APOs in pregnant women with PCOS was 0.900 (95% CI: 0.845, 0.955). Elevated serum nesfatin-1 and IGF-1 levels are associated with pregnancy outcomes of patients with PCOS. Polycystic ovary syndrome, Nesfatin-1, Insulin-like growth factor-1, Adverse pregnancy outcome.

Ambient air pollution and low birth weight in Brazil: A nationwide study of more than 10 million births between 2001 and 2018

Low birth weight (LBW) is a global health concern. While it is commonly associated with maternal health and behavior, exposure to ambient air pollution, can also play a role in contributing to LBW. In Brazil, where diverse environmental conditions and regional disparities exist, assessing the impact of ambient air pollution on LBW becomes particularly pertinent. To our knowledge, there is a gap in the existing literature, as no previous study has specifically investigated the relationship between ambient air pollution and LBW nationwide in Brazil. This study aims to fill this gap by examining the association between ambient air pollution and LBW in each trimester of pregnancy across the Brazilian states. In this work, birth data from January 1, 2001, to December 31, 2018 has been used. We utilized logistic regression models to estimate the odds ratio (OR) for low birth weight (LBW) associated with ambient air pollution (PM2.5, NO2, and O3) during each trimester of pregnancy (1st to 3rd trimester) across all 27 Brazilian states in our nationwide case-control study. We adjusted our model for several variables, including ambient temperature, relative humidity, and socioeconomic status (SES) variables at the individual level. We also conducted effect modification analyses by infant sex, mother's age, and the number of prenatal visits. Our study comprises over 10,213,144 birth records nationwide. Of these, 479,204 (4.92%) infants were included as cases of LBW. Our results indicate positive associations between PM2.5 and LBW, mainly in the Southern region. For example, in the state of Santa Catarina (South region), ORs were 1.003 (95% CI: 1.002, 1.004), 1.003 (95% CI: 1.002, 1.004), and 1.005 (95% CI: 1.003, 1.007) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. NO2 had a robust association with LBW in the Northern and Northeastern states, including the state of Amapá (North region, where the Amazon Forest is located) with ORs of 1.377 (95% CI: 1.010, 1.878), 1.390 (95% CI: 1.020, 1.894), and 1.747 (95% CI: 1.297, 2.352) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. Similarly, O3 had a robust association in the North and Midwest states, as observed in the state of Amapá with ORs of 1.033 (95% CI: 1.012, 1.054), and 1.033 (95% CI: 1.013, 1.053) for the 2nd, and 3rd trimesters, respectively. In the stratified analysis, boys were more vulnerable than girls, and the lower number of prenatal visits was associated with higher OR. Our findings are essential to the development of guidelines to prevent maternal exposure and protection of newborns in Brazil. This study provides valuable insights for region-specific strategies to improve maternal and neonatal health.

According to the Record

Abstract In this piece Lisa E. Wright analyzes the penmanship on her grandmother’s birth certificate to question whether her great-grandmother gave birth to her Grandma Rickey in 1938 with a white doctor or with a midwife who may not have had a license. She explores if her grandmother’s birth reflected changing attitudes toward Black midwives, her great-grandmother’s choice, or a luxury afforded to her great-grandmother by her great-grandfather’s status as a Black coal miner. To analyze the decisions of the next generation of women who gave birth in her family, in this piece Wright struggles with the reasons her grandmother looked outside their community of midwives for maternal care and gave birth in a Jim Crow hospital in Lynchburg, Virginia.

Practice variation in induction of labor: A critical document analysis on the contribution of regional protocols.

Despite national guidelines with recommendations on induction of labor (IOL), large variation in the use of this intervention exists between regions in the Netherlands. Guidelines are translated into protocols, which give a contextual description of medical practice provided in a given region. Possibly, protocols developed by regional multidisciplinary maternity care networks (MCNs) contribute to the regional variation in IOL. The aim of this study was to assess the variation between regional protocols and national guidelines regarding recommendations on IOL and the extent to which this contributes to practice variation. We performed a systematic document analysis using the Ready materials, Extract data, Analyze, Distil (READ) approach. National guidelines (n = 4) and regional protocols (n = 18) from six MCNs on topics linked to IOL were assessed between October 2021 and April 2022. An analytical framework was used to extract data for the comparison of regional protocols. Some MCNs followed all the recommendations of national guidelines in their regional protocols, others developed their own recommendations, and for some this varied per topic. When developing their own recommendations, MCNs with a high percentage of IOL added additional risk factors and stricter cut-off values. In contrast, MCNs with a low percentage of IOL added more care options for continuing midwife-led care. No clear relationship was observed between the Appraisal of Guidelines for Research & Evaluation (AGREE) scores of the national guidelines and the extent to which regional protocols complied with the recommendations. The translation of national guidelines to regional protocols seemed arbitrary and not very systematic. To reduce unwarranted practice variation in the use of IOL, guidance is needed to better align regional protocols with national guidelines, while including appropriate contextual factors and allowing women's preferences. Additionally, healthcare providers should be trained in practicing evidence-based medicine instead of using evidence.

Effect of continuity of team midwifery care on maternal and neonatal outcomes: a quasi-experimental study in Iran

Midwife-led continuity of care models have been linked to better clinical outcomes in certain developed countries. However, there is a paucity of research on these models in developing nations. This quasi-experimental study was conducted on primiparous women who referred to one private midwifery center and two public hospitals in Ahvaz, Iran to evaluate the effect of team midwifery care on maternal and neonatal outcomes of pregnant women in Iran. Two hundred women were allocated either into the experimental (n = 100) or control (n = 100) groups. Women in the experimental group, received team midwifery care, while women in the control group, received routine care. Data were collected using a demographic questionnaire, Mackey questionnaire, and a checklist. Women in the team midwifery care group experienced significantly higher rates of normal vaginal birth and exclusive breastfeeding compared to women in the control group. No statistically significant difference was observed between the two groups in terms of the rate of induction of labor and postpartum hemorrhage. The duration of labor was longer in the team midwifery care compared to the control group. Women in the team midwifery care group had a significantly higher rate of exclusive breastfeeding at six weeks postpartum compared to the control group (80 vs. 61%, p = 0.001). After excluding women with ruptured membranes and prolonged pregnancies, neonates in the intervention group had significantly higher first- and fifth-minute Apgar scores (p < 0.0001), and a lower rate of admission to intensive care unit in the intervention group compared to the control group (1 vs. 9%, p = 0.04). Also, women in the team midwifery group had skin-to-skin contact significantly earlier than those in the control group (33.87 ± 66.26 min vs. 111.98 ± 247.31 min, p = 0.578). Given the positive impact of continuous team midwifery care on maternal and neonatal outcomes, its implementation in maternity care systems, particularly in countries like Iran with high cesarean section rates, is strongly recommended.

Vaginal Uncomplicated Delivery Rate as a Quality Indicator Compared to Cesarean Delivery Rate: A Quantitative Analysis of a Population Database

ObjectivesThe objective of this study is to compare the vaginal uncomplicated delivery (VUD) rate, defined as all vaginal deliveries (including forceps and vacuum) without an adverse maternal or neonatal labour outcome, to the cesarean delivery (CD) rate, as a performance indicator. MethodsThis is a retrospective cohort analysis from a provincial database of all term deliveries by an obstetrician in a single year, excluding diagnoses preventing active labour. Most obstetricians in this jurisdiction practice consultative obstetrics, focused on supporting primary maternity care. We investigated the association of adverse delivery (AD), measured by the adverse outcome index, with CD and VUD rates. ResultsWe report 16 620 deliveries by 210 obstetricians, with a vaginal delivery rate of 39.6%, of which 36.6% were operative vaginal delivery. The overall AD rate was 9.9%, and the overall VUD rate was 34%. While the CD and VUD both correlated with the mode of delivery, only the VUD rate was correlated to the AD rate. ConclusionsQuality assurance in obstetrics must balance the needs of 2 patients based on limited data. Our data shows the shortcomings of the prevailing performance indicator, CD rate, which does not correlate with birth outcomes for the pregnant patient or infant. The VUD rate provides an alternative that assesses both mode of delivery and labour outcomes. Shifting the quality lens to focus on the VUD rate will provide a better metric that measures optimal outcomes for pregnant people and their babies.

A National Study of the Associations between Hormonal Modulators in Hydraulic Fracturing Fluid Chemicals and Birth Outcomes in the United States of America: A County-Level Analysis.

Risk of preterm birth (PTB) and low birth weight (LBW) due to hydraulic fracturing (HF) exposure is a growing concern. Regional studies have demonstrated links, but results are often contradictory among studies. This is the first US national study to our knowledge linking fracturing fluid ingredients to the human hormone pathways targeted-estrogen, testosterone, or other hormones (e.g., thyroid hormone)-to assess the effect of HF ingredients on rates of PTB and LBW. We constructed generalized linear regression models of the impact of HF well density and hormone targeting chemicals in HF fluids (2001-2018) on the county-level average period prevalence rates of PTB and LBW (2015-2018) with each outcome measured in separate models. Our data sources consisted of publicly available datasets, including the WellExplorer database, which uses data from FracFocus, the March of Dimes Peristats, the US Census Bureau, the US Department of Agriculture, and the Centers for Disease Control and Prevention. We conducted additional stratified analyses to address issues of confounding. We used stratification to address issues regarding outcomes in rural vs. urban communities by assessing whether our models achieved similar results in nonmetro counties, as well as farming and mining counties. We also stratified by the year of the HF data to include HF data that was closer to the time of the birth outcomes. We also added covariate adjustment to address other important factors linked to adverse birth outcomes, including the proportion of the population belonging to various racial and ethnic minority populations (each modeled as a separate variable); education (bachelor's degree and high school); use of fertilizers, herbicides, and insecticides, acres of agricultural land per square mile; poverty; insurance status; marital status; population per square mile; maternal care deserts; and drug deaths per 100,000 people. We found that the density of HF wells in a county was significantly associated with both PTB and LBW rates (percentage of live births) in our fully adjusted models. We report the results from our more restrictive stratified analysis with a subset including only the 2014-2018 data, because this resulted in the most meaningful time frame for comparison. Across all models, the magnitude of effect was highest for wells with ingredients that include estrogen targeting chemicals (ETCs), testosterone targeting chemicals (TTCs) and other hormone targeting chemicals (OHTCs), and, finally, all wells grouped regardless of chemical type. For every unit increase in well density per square mile of wells that use chemicals that include an ETC, we observed a 3.789-higher PTB rate (95% CI: 1.83, 5.74) compared with counties with no ETC wells from 2014 to 2018 and likewise, we observed a 1.964-higher LBW rate (95% CI: 0.41, 3.52). Similarly, for every unit increase in well density per square mile of wells that use TTC, we observed a 3.192-higher PTB rate (95% CI: 1.62, 4.77) compared with counties with no TTC wells. Likewise, for LBW, we found a 1.619-higher LBW rate (95% CI: 0.37, 2.87). We also found that an increase in well density per square mile among wells that use chemicals that include an OHTC resulting in a 2.276-higher PTB rate (95% CI: 1.25, 3.30) compared with counties with no OHTC wells, and for LBW, we found a 1.244-higher LBW rate (95% CI: 0.43, 2.06). We also explored the role of HF well exposure in general (regardless of the chemicals used) and found that an increase in total well density (grouped regardless of hormonal targeting status of the chemicals used) resulted in a 1.228-higher PTB rate (95% CI: 0.66, 1.80) compared with counties with no wells, and for LBW, we found a 0.602-higher LBW rate (95% CI: 0.15, 1.05) compared with counties with no wells. We found similar results in our primary analysis that used all data without any exclusions and the statistical significance did not change. Our findings reinforce previously identified regional associations between HF and PTB and LBW, but on a national scale. Our findings point to dysregulation of hormonal pathways underpinning HF exposure risk on birth outcomes, which warrants further exploration. Future research must consider the specific ingredients used in HF fluids to properly understand the differential effects of exposure. https://doi.org/10.1289/EHP12628.

Racial Disparities in Parturient Urine Drug Screening at a Texas Level IV Maternal Care Centre: A Single-Centre Retrospective Study

ObjectivesWe hypothesized that Black or African American (hereby referred to as Black) and Hispanic patients would have higher rates of urine drug screening (UDS) during pregnancy compared with White or Caucasian (herby referred to as White) patients at our hospital. MethodsPatients who delivered at our hospital between 1 December 2020 and 31 May 2021 and between 1 December 2022 and 31 May 2023 and who were Black, Hispanic, or White were included in the final analysis. We performed separate bivariate analyses comparing White patients to either Black patients or Hispanic patients. We performed a multivariate logistic regression, including variables of interest designed to predict risk factors for UDS during pregnancy. ResultsA total of 457 Black, 813 Hispanic, and 1252 White patients were identified. During pregnancy, 187 (40.9%) Black patients had UDS compared with 265 (21.2%) White patients (P < 0.001). In addition, 258 (31.7%) Hispanic patients had UDS during pregnancy, which was statistically different compared with White patients (P < 0.001). A multivariate logistic regression found that identification as Black was independently associated with UDS during pregnancy (adjusted OR [aOR] 1.871; 95% CI 1.382–2.534, P < 0.001), identification as Hispanic was not independently associated (aOR 1.177; 95% CI 0.900–1.538, P = 0.234), and patients who delivered after the COVID-19 pandemic were less likely to receive UDS (aOR 0.783; 95% CI 0.621–0.987, P = 0.039). ConclusionIdentification as Black and delivery during the COVID-19 pandemic were independently associated with increased adjusted odds of UDS during pregnancy at our hospital.

Elective induction of labor versus expectant management at 39 weeks among low-risk nulliparous pregnant women: A randomized controlled trial in India (ELITE-39 trial).

The aim of the present open label randomized controlled trial was to compare the rate of cesarean section (CS) after elective induction with that of expectant management in low-risk nulliparous women at 39 weeks. This randomized controlled trial from a tertiary maternity care center enrolled low risk nulliparous pregnant women at 38-38+4 weeks between April 1, 2019 and December 31, 2021. Participants were randomized into either the elective induction group (e-IOL) or the expectant management (EM) group though computer generated block randomization. The primary outcome was cesarean rate and the secondary outcome include adverse maternal and perinatal outcome between e-IOL and EM groups. We performed intention to treat analysis. A total of 360 women were enrolled into the present study. Analysis was performed for 179 women in the e-IOL group and 180 women in the EM group. The baseline demographic characteristics including Bishop score were comparable between the groups. The CS rate in both groups was 17.3% (31/179) and 25% (45/180), which is comparable (P = 0.08). There was one intrapartum stillbirth in the e-IOL group, and two babies succumbed in the neonatal period in the EM group. The maternal and perinatal outcomes between the groups were not found to be significantly different. Elective induction of low-risk nulliparous women at 39 weeks was not associated with increased cesarean section rate. The maternal and perinatal outcomes were comparable. Large, multicentric real time randomized controlled trials are needed to understand the benefit of elective induction in low-risk nulliparous women. This should include centers with large volume of deliveries especially from emerging countries also.

Effectiveness of a package of community-based mental healthcare services to address perinatal mental disorders in Bangladesh: A cluster-randomized controlled trial

BackgroundPerinatal mental disorders of women have an impact on their pregnancy and their child’s brain development across low and middle-income countries. However, to address this issue, there are no specific guidelines for community-level service providers in Bangladesh. Therefore, we aimed to develop a community-based mental healthcare (CBMHC) service package and test its effectiveness in reducing depression, anxiety, and stress among mothers during the perinatal period. MethodsA cluster-randomized controlled trial (cRCT) was applied to test the CBMHC package in 2017 and 2018. It was provided to one group of mothers along with routine maternal care while another group received only routine maternal care. Paired sample t-test was applied to assess mean changes at baseline and endline in the Depression, Anxiety, and Stress Scales-21 (DASS-21) and EuroQol-5 Dimension and 3 Level (EQ5D3L) scales. A linear mixed-effects model was used to assess the relationship between the DASS-21 score and EQ5D3L. Results1,215 participants were enrolled, including 605 in the intervention group and 610 in the control group. Measures of depression, anxiety, and stress were significantly decreased in both groups. Reduction in the levels of stress, as measured by changes in the stress score, were significantly greater in the intervention than in the control group (diff: 1.2, 95% CI: 0.1, 2.2). The EQ5D3L index improved significantly, 0.02 units more at endline in the intervention group than in the control group (diff: 0.02, 95% CI: 0.007, 0.03). The levels of mobility, usual activities, pain or discomfort, depression, and anxiety improved by 1.4%, 7.6%, 4.4%, 2.6%, and 0.4% more, respectively, in the intervention group compared to the control groups. These improvements were statistically significant. The DASS-21 score was negatively and significantly correlated with both the EQ-5D3L index and the Visual Analogue Scale (VAS) score for the intervention group as well as for the usual care group, indicating that EQ5D3L improved when common mental disorders decreased. ConclusionAlthough the improvements were modest, a CBMHC service package was effective in reducing perinatal levels of stress among Bangladeshi rural women. Trial registrationClinicalTrials.gov ID: NCT03678415

Iranian midwives’ experiences of using the World Health Organization’s Safe Childbirth Checklist: A qualitative research

BACKGROUND: The goal of natural childbirth care is to have a healthy mother and baby with minimal interventions that are contrary to health. Worldwide, there is concern that non-evidence-based interventions and care in labor and childbirth will remain standard practice. Therefore, access to care related to pregnancy and childbirth is considered a priority. To address safety concerns during organized births, the Safe Childbirth Checklist (SCC) was created by the World Health Organization (WHO). This checklist is a tool that combines evidence-based practices that should be provided before, during, and after childbirth. As midwives have a vital role in using this up-to-date evidence, this study was conducted to explore Iranian midwives’ perception of using SCC. MATERIALS AND METHOD: This qualitative study was conducted from January 2022 to April 2023 in two public (teaching and nonteaching) hospitals in Ahvaz, Iran. Seventeen semi-structured interviews were conducted with midwives who had more than one year of work experience in maternity wards. Participants were selected purposefully. A content analysis approach was used to analyze the data and extract themes. RESULTS: All midwives had a positive attitude toward using SCC. The midwives’ reasons for being in favor of using the checklist during the clinical procedures of childbirth are summarized in four main themes, namely “standardized maternity care practices,” “SCC as a guide for performing essential childbirth practices,” “self-efficacy of midwifery care,” and “improved maternal and neonatal outcomes.” CONCLUSION: Midwives have endorsed this checklist as a guide to standard childbirth management. It seems that the use of this checklist will help to improve the health outcomes of mothers and babies by strengthening the self-efficacy of midwives.

The Correlation of Maternal Behavior in Toddlers Breastfeeding with Wasting Prevention in Pidie

Besides children, teenagers also suffer from malnutrition due to certain factors. The development of wasting is considered related to mothers’ behavior during breastfeeding times. However, it has big impact towards the quality of breastfeeding. According to data from World Health Organization, 45.4 million children under the age of five were underweight in 2020, while the highest infant wasting rate nationally was 11.9% in several districts and cities from 33 provinces in Indonesia. Globally, 149.2 million children under the age five suffer from stunting, while its distribution of region in Indonesia is in Maluku and Aceh. Aceh is in fourth place of stunting with a percentage of 11.3% nationally. Based on the data related to wasting using the ratio of children’s weight to height, Pidie regency ranks third in Aceh as a whole with ratio of 15.3%. This study used a cross-sectional research with sample of 332 toddlers selected as the research object using Slovin formula. The sample data of this study was determined randomly and was taken from Pidie Regency Health Center which had a population of 1979 toddlers listed. SPSS 23 statistical software with Chisquare was used as a tool for data analysis. The findings of this study came from a bivariate statistical analysis test using the chisquare test at a confidence level of 95%, resulting in a p-value of 0.042 (p&lt;; 0.05). This shows that the variable of maternal knowledge has an influence in keeping toddlers from experiencing wasting. The results of the chisquare test at the 95% confidence level in the bivariate statistical analysis test with p= 0.021 (p&lt;; 0.05) showed that the maternal attitude variable had an influence on the ability of toddlers to avoid wasting. The results of the chisquare test for bivariate statistical analysis are at a confidence level of 95%: p = 0.024 (p&lt;; 0.05). Characteristics of maternal behavior and prevention of wasting have a close correlation. Mothers' attitudes, knowledge, and behaviors towards wasting prevention are influenced by their breastfeeding practices. The best way to prevent wasting is to encourage mothers to breastfeed. The researchers stated that the increasing knowledge and attitudes of mothers in breastfeeding also improved their behavior, especially in terms of preventing wasting while breastfeeding. Supervision of health workers is expected to increase the knowledge and attitude of mothers and improve the prevention of wasting

Maternal Behavioral Qualities in Mother-infant Interaction in the Context of Postnatal Depression: A Scoping Review

Maternal behaviors displayed in mother-infant interaction set the grounds for relationship formation in early childhood. Meanwhile, maternal postnatal depression represents an atypical context for infant development. The present review aims to systematically analyze previous research on specific maternal behaviors reflecting maternal depression in the first postnatal year, focusing on the definitions and findings regarding these behaviors. The review includes observational studies with mothers of infants up to 12 months. Results show variability in definitions, particularly for sensitivity and responsiveness, and mixed findings on the relationship between depression and maternal behaviors. Positive behaviors and negative behaviors were inconsistently associated with depression across studies, suggesting moderating factors such as maternal age, personality, socioeconomic status, and cultural context. We emphasize the need for standardized definitions and measures of maternal behaviors and call for further research into moderating variables. This review underscores the complexity of the relationship between maternal depression and maternal behaviors, advocating for more comprehensive and consistent future research.

Predictors of depression, anxiety and stress symptoms among maternity nurses and midwives in a Middle Eastern country.

This study assessed anxiety, depression, and stress levels among midwives and maternity nurses in Oman using the DASS-21 questionnaire in a cross-sectional survey of 200 participants from three public hospitals. Results indicated that 27.0% experienced mild to moderate depression, while 33.5% and 32% reported mild to moderate anxiety and stress, respectively. No severe cases were observed, but the findings highlight significant predictors such as sleep quality, job satisfaction, caseload per shift, age, and working area. These factors were significantly associated with the mental health outcomes measured. The study underscores the importance of addressing the psychological and emotional well-being of midwives and maternity nurses through targeted support and interventions, given the substantial percentage experiencing mild to moderate symptoms. Continuous efforts are essential to mitigate these issues and promote a healthier work environment for these healthcare professionals.

Sensitive infant care tunes a frontotemporal interbrain network in adolescence

Caregiving plays a critical role in children’s cognitive, emotional, and psychological well-being. In the current longitudinal study, we investigated the enduring effects of early maternal behavior on processes of interbrain synchrony in adolescence. Mother-infant naturalistic interactions were filmed when infants were 3–4 months old and interactions were coded for maternal sensitivity and intrusiveness with the Coding Interactive Behavior Manual. In early adolescence (Mean = 12.30, SD = 1.25), mother-adolescent interbrain synchrony was measured using hyperscanning EEG during a naturalistic interaction of positive valence. Guided by previous hyperscanning studies, we focused on interbrain connections within the right frontotemporal interbrain network. Results indicate that maternal sensitivity in early infancy was longitudinally associated with neural synchrony in the right interbrain frontotemporal network. Post-hoc comparisons highlighted enhancement of mother-adolescent frontal-frontal connectivity, a connection that has been implicated in parent-child social communication. In contrast, maternal intrusiveness in infancy was linked with attenuation of interbrain synchrony in the right interbrain frontotemporal network. Sensitivity and intrusiveness are key maternal social orientations that have shown to be individually stable in the mother-child relationship from infancy to adulthood and foreshadow children’s positive and negative social-emotional outcomes, respectively. Our findings are the first to demonstrate that these two maternal orientations play a role in enhancing or attenuating the child’s interbrain frontotemporal network, which sustains social communication and affiliation. Results suggest that the reported long-term impact of maternal sensitivity and intrusiveness may relate, in part, to its effects on tuning the child’s brain to sociality.

Behavioral responses during and after a postpartum human-animal interaction in rangeland breeding ewes

Lamb welfare, performance and survival on rangeland is partially determined by the quality of maternal care received (i.e., high durations of sniffing/grooming, allowing udder access, and staying close to the lamb). Previous studies have explored maternal behavior scores (MBSs), as a tool to select ewes based on their proximity to the lamb and the shepherd, finding variable evidence towards sensitivity and robustness in scores in ability to gauge lamb outcome (birth weight and weaning weight), survival, and maternal care throughout the lambing season. Though this scoring system is convenient, there may be another behavioral attribute related to fear of human or relationship to the human handler may be elicited during lamb collection and processing. This longitudinal study investigated the presence of a trait in response to the human handler employing a Lamb Handling (during processing) and a Lamb Tie Down (after processing) test with N= 42 total ewes and n=26 ewes consistently present across both years of the study. The current study also set out to investigate the relationship between proximity to the shepherd and lamb outcome. Attempts to perform principal component analysis revealed that variables from the Lamb Handling and Lamb Tie down test were not suitable for factor analysis. In the Lamb Handling test, proportion of ‘pacing’ was a nearly significant, negative predictor (P=0.07) term in the binary ‘investigating human’ model, improved model fit and explained more variance compared to the null model [(cumulative weight: 90 vs 10 %); (R2adjusted: 30.8 vs 15.2 %; deviance= 31 vs 18.5 %)]. A random term for individual also improved fit in this model, indicating a potential behavioral trait driven by the ewe related to fear or perception of the human. The occurrence of grazing (0 or 1) was a nearly significant, positive predictor (P=0.06), improved model fit and explained more variance in the ‘investigating human’ model compared to the null model [(cumulative weight: 76 vs 24 %); (R2adjusted: 21 vs 15.2 %; deviance= 26.8 vs 18.5 %)]. Individual did not improve model fit in the relationship between ‘investigation human’ and ‘grazing’. Weaning weights were a nearly significant positive predictor in the model for ‘close proximity’ at lamb collection (P=0.07) and a significant positive predictor for ‘close proximity’ during processing (P<0.001), however, did not improve model fit over the null. Birth weights improved model fit for behaviours including ‘sniffing/grooming’ and ‘pawing’ in the Lamb Tie Down test and these behaviours may have been moderated by maternal investment in heavier lambs. Behavioural responses, expanding beyond proximity measures, can be useful for gauging maternal attachment and investment in the lamb during and after processing. Fear or perception of humans should also be considered as contributors to the response to the shepherd during human-animal interactions in the lambing season.

Assessment of Women's Knowledge about the Risks of Medication Use During Pregnancy in Al - Najaf Provence

Objective: The current study aims to assess women's knowledge about the Risks of Medication Use during Pregnancy and determine the relationship between Women's Knowledge about the Risks of Medication Use during Pregnancy and demographic characteristics. Methodology: A descriptive design /cross sectional study was conducted using analytical utilities to accomplish the stated objectives. In the time frame of 1st November 2023 to 19th July 2024. A non-probability sampling (Purposive sample) approach was used, based on the following criteria: pregnant women in any stage of the pregnancy, including the first, second, and third trimesters (primi gravida and multigravida). A sample of 250 pregnant women was chosen from those admitted to Al-Zahraa Maternity Teaching Hospital/ Al-Furat Teaching Hospital/ AL-Hakim Teaching hospital / primary Health care centers (Maternal, child, and infant care units). Results: the results show the level of knowledge differs significantly (P&lt;0.05) according to level of education in which women who have institute and above exhibited the highest level of knowledge (MS=2.05). On the other hand, women whose husbands work in free jobs showed the highest level of knowledge (MS=1.97) while those whose husbands are retired exhibited the lowest level of knowledge (MS=1.50). Regarding gestational age, pregnant women within the (18-22) weeks exhibited the highest knowledge (MS=2.03). Conclusion: The study found that Women knew very little about the possible effects of some medications on fetal development, on the other hand the participants had little awareness of the safety of anticonvulsants and medications for the common cold and flu. Women had moderate levels of knowledge regarding the safety of using paracetamol (acetaminophen) for pain and fever during pregnancy.

Nutritional Status of Children in Bangladesh: Changes and Challenges for Development

Despite suffering from widespread poverty, Bangladesh has made remarkable improvements in the nutritional status of children over the past three decades. This paper describes the trends in the nutritional status of children in Bangladesh by age groups, explores factors associated with these trends, and concludes with a description of future challenges for development in Bangladesh. The national-level survey (BDHS), national plan and policy paper, and literature were used for the study. It is remarkable for Bangladesh that stunting, underweight, and wasting among children under five years old has improved gradually. Children 12- 23 months of age are the most vulnerable. Living in a rural vs urban area, wealth status and maternal education are the main determinants linked to the nutritional status of children. Poverty reduction, improved water and sanitation, strengthened maternal and child health care, education and other policies linked to food and dietary practices and many other policies and programs could continue to improve nutritional levels in children in Bangladesh. Attention is also needed to under five mortality and the double burden of malnutrition. Addressing gaps in policies and programs to achieve the goals of national plans and SDG targets will pay health dividends for the entire population.

Access to Maternal and Child Health Care Services in Primary Health Care Centers in Nigeria: Perspectives from Primary Health Care Nurses

Access to Maternal and Child Health Care Services in Primary Health Care Centers in Nigeria: Perspectives from Primary Health Care Nurses