Maternal Health Professionals Research Articles

The Lived Experience of Family Support Among Women During and After Childbirth in Jordan: A Phenomenological Study.

Many studies highlight the importance of family support in enhancing the experience of childbirth among women. This qualitative study aimed to describe the lived experience of family support from the perspective of women during and after childbirth in the Jordanian context. A qualitative descriptive phenomenological approach was used to explore the experiences of women's family support in the context of their childbirth experiences. A total of 11 Jordanian women participated in the study. Face-to-face semi-structured interviews were conducted to collect data. Four major themes emerged from the data describing family support provided to women during and after childbirth. These themes were family support during childbirth, family support in the postpartum period, importance of family support during and after childbirth, and challenges related to receiving family support. Supportive family members primarily included the husband, the woman's family, and the family-in-law, according to the traditions inherited in the Jordanian context and culture. The study findings could help maternal health professionals screen pregnant women who are at risk of receiving low family support, contribute to developing effective interventions regarding family-centered care, and enhance the overall childbirth experience for women in Jordanian cultural contexts.

Preventing Job Burnout: Could Workplace Support Protect Maternal and Child Health Professionals Who Are Doing Public Health Equity Work?

To assess the potential of workplace support to protect public health equity workers against job burnout and to identify key workplace support components. This mixed-methods, explanatory sequential study analyzed survey and interview data collected between August 2020 and June 2021. Participants included governmental and non-governmental public health employees whose programs largely focus on Maternal and Child Health populations and who reported that their jobs involved working to reduce health inequities ("equity work"). Regression analysis tested the effect of emotional labor on job burnout, and whether workplace support modified that effect. Qualitative analysis of interview transcripts explored possible components of needed workplace support. Emotional labor was positively associated with job burnout (p < .001), and there was a significant negative interaction between emotional labor and workplace support, meaning workplace support appeared to reduce the effect of emotional labor on burnout (p = .036). Qualitative analysis identified four support components: peer-to-peer mentoring connections, workplace accommodations, engaged and empathetic supervision, and mental health resources. Workplace support is associated with reduced job burnout for public health equity workers, especially those whose jobs involve high levels of emotional labor. Few public health employers are providing needed emotional supports for their equity workers, but certain supports appear to be helpful in reducing job burnout.

The relationship between perceived stress and pregnancy distress with self-care of pregnant women: The mediating role of social support-A cross-sectional study.

Pregnancy is a stressful experience, which can affect different aspects of a woman's life. Yet, women with a supportive network of friends and family may experience lower stress and improved self-care behavior. The study aimed to investigate the relationship between perceived stress and pregnancy distress with the self-care of pregnant women, as well as the mediating role of social support. This cross-sectional study was conducted from February to May 2022 in Babol, Iran. A total of 157 pregnant women participated in the study. The participants completed five questionnaires, including a demographic and obstetric questionnaire, a Self-care questionnaire, Perceived Social support (PSS), Perceived Stress Inventory (PSI), and Pregnancy Specific Distress. Structural equation modeling was used to test the hypothesis relationships among the variables. We found that Perceived stress (β = -0.221, p = 0.012β) and pregnancy distress (β = -0.203, p = 0.002β) had a negative and significant effect on the self-care of pregnant women. Also, perceived stress (β = -0.429, p < 0.001β) and pregnancy distress (β = -0.381, p < 0.001β) had a negative and significant effect on the social support of pregnant women. The results exhibited a significant specific indirect effect between pregnancy distress, perceived stress, and pregnancy self-care, with social support as the mediator: standardized indirect effect = -0.068, -0.076, respectively. According to the findings, social support plays a direct and mediating role in improving self-care behaviors among pregnant women. Therefore, providing strategies and measures to improve perceived social support by maternal health professionals may be expected to reduce the impact of stress on pregnant women's self-care. The implementation of policies and social interventions to improve the social support of pregnant women can be one of the applications of the findings.

Attitudes of Chinese maternal and child health professionals toward termination of pregnancy for fetal anomaly: a cross-sectional survey.

This study explores the attitudes of Chinese maternal and child health professionals toward the termination of pregnancy for fetal anomaly (TOPFA) based on four case scenarios and further identifies the factors that influence their attitudes. This cross-sectional study, conducted from February 14-21, 2022, aimed to explore the attitudes of maternal and child health professionals toward TOPFA in Hunan Province. We targeted health service institutions across 14 prefecture-level cities and the autonomous prefecture. A questionnaire was made available online and shared via the instant communication platform, WeChat. Participants were recruited through the same platform and completed the survey online. Descriptive statistics were used to analyze the data, and binary logistic regression was performed to determine factors affecting the health professionals' attitudes toward TOPFA, expressed as the odds ratio (OR) and 95% confidence intervals (CI). The study found that 63.5% of health professionals approved of the birth of a fetus with cleft lip and palate, while 36.5% opposed it. Similarly, 39.7% approved of the birth of a fetus with phenylketonuria, while 60.3% opposed it. The percentages of those in favor of and against the birth of a fetus with precocious heart disease were 45.5 and 54.5%, respectively, and those for and against the birth of a fetus with missing fingers were 50.8 and 49.2%, respectively. The top three factors considered by health professionals when agreeing on TOPFA were "the impact of fetal disease on fetal function and growth," "the severity of fetal disease," and "the assessment of indications for fetal disease by professionals and related professional advice." The majority of health professionals (75-78%) preferred joint decision-making by parents regarding the right to decide TOPFA. Our study indicates that the attitudes of health professionals toward TOPFA can differ significantly depending on the specific birth defect under consideration. Notably, the majority of health professionals prioritized "the impact of fetal abnormalities on fetal function and development" when deciding their support for TOPFA, advocating for the decision to be a joint one between the parents. Additionally, factors such as religious beliefs, professional training, age, and job title appeared to influence these attitudes toward TOPFA. Our findings could serve as a reference point in the development of guidelines for the prevention and management of birth defects.

A survey on Iranian midwives' knowledge about COVID-19 during pregnancy, delivery, postpartum, and neonatal feeding.

The COVID-19 pandemic has impacted the care that maternal and newborn health professionals, especially midwives, provide. If they know how to care for COVID-19 patients during pregnancy, delivery, and postpartum, they can manage these cases better. The study aimed to identify the knowledge of Iranian midwives about COVID-19 during pregnancy, delivery, postpartum, and neonatal feeding. The study aimed to identify the knowledge of Iranian midwives about COVID-19 during pregnancy, delivery, postpartum, and neonatal feeding. This cross‑sectional study was conducted on 438 Iranian midwives from March to April 2021. Personal data and knowledge of them were gathered using an electronic web-based questionnaire. The statistical analysis was performed using the SPSS software version 18. The mean age of participants was 31.8 ± 2.3. The mean knowledge score of midwives was 11.2 ± 2.8, which was moderate. 91.55% of Midwives were more knowledgeable about COVID-19 infection symptoms in pregnant women. 34.93% and 31.05% of midwives had correct knowledge about vaccination against COVID-19 during pregnancy and breastfeeding, respectively. Results showed no statistically significant relationship between personal characteristics and knowledge of them (p > 0.05). Midwives' knowledge about COVID-19 during pregnancy, delivery, postpartum, and neonatal feeding was moderate. Continuing educational programs are needed by the Ministry of Health and Medical Education to design and implement for improving healthcare professionals' knowledge about COVID-19 during pregnancy, delivery, postpartum, and neonatal feeding.

Cultural and linguistic appropriateness of a web-based breastfeeding educational resource for Saudi women: Consensus development conference approach

AimThe purpose of this study was to investigate the cultural and linguistic appropriateness of the content, images and layout of the web-based breastfeeding educational resource for Saudi women using a consensus development approach. BackgroundAlthough the World Health Organization highly recommends exclusive breastfeeding, there is a decline in breastfeeding rates in Saudi Arabia, especially during hospital stay. The combining of health professional support with e-technology tools has been proposed as a method to increase exclusive breastfeeding. However, the cultural and linguistic appropriateness of an e-technology-based approach has not been explored in Saudi women. MethodsAfter developing a content draft of the web-based breastfeeding educational resource specific to Saudi culture, an online consensus development conference was organised with ten participants including two university researchers and eight health care providers to investigate the cultural and linguistic appropriateness of the educational content. The participants from Saudi Arabia were Saudi mothers who had breastfeeding experiences and were key maternity health professionals employed at the Maternity and Children Hospital of Dammam, Saudi Arabia. The SQUIRE checklist was used in the reporting of this study. ResultsFeedback received prior to the meeting showed that 81% of the content was acceptable and minor changes were required. Changes were made to the content based on the suggestions and feedback received. The consensus group accepted all the changes and the content was finalised. ConclusionsThe online consensus development conference was found to be a very convenient way to decide on the cultural and linguistic appropriateness of the content of the web-based breastfeeding educational resource allowing the participation of experts from different countries; this was considered a critical step in ensuring the successful implementation of the intervention.

The direct and mediating effect of social support on health-related quality of life during pregnancy among Australian women

BackgroundPrenatal stress can have a negative effect on the quality of life (QoL) of pregnant women. Social support plays a vital role in improving the psychological well-being of pregnant women by enhancing their stress-coping ability. The current study assessed the association between social support and health-related quality of life (HRQoL) as well as the mediating role of social support in the linkage between perceived stress and HRQoL among pregnant Australian women.MethodsSecondary data was obtained from 493 women who reported being pregnant in survey six of the 1973–78 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH). Social support and perceived stress were assessed using the Medical Outcomes Study Social Support Index (MOS-SSS-19) and the Perceived Stress Scale, respectively. The Mental Component Scale (MCS) and Physical Component Scale (PCS) of the SF-36 were used to examine the mental and physical HRQoL. A mediation model was used to examine the mediating effect of social support in the relationship between perceived stress and HRQoL. A multivariate quantile regression (QR) model was used to assess the association between social support and HRQoL after adjusting for potential confounders.ResultThe mean age of the pregnant women was 35.8 years. The mediational analysis revealed that emotional/informational support (β= -1.53; 95% CI: -2.36, -0.78), tangible support (β= -0.64; 95% CI: -1.29, -0.09), and affectionate support/positive social interaction (β= -1.33; 95% CI: -2.25, -0.48), played a significant mediating role in the relationship between perceived stress and mental health-related QoL. In addition, perceived stress had a significant indirect effect on mental health-related QoL through overall social support (β = -1.38; 95% CI: -2.28, -0.56), and the mediator accounted for approximately 14.3% of the total effect. The multivariate QR analysis indicated that all the domains of social support and overall social support scores were positively associated with higher MCS scores (p < 0.05). However, social support was found to have no significant association with PCS (p > 0.05).ConclusionSocial support plays a direct and mediating role in improving the HRQoL of pregnant Australian women. Maternal health professionals need to consider social support as an essential tool to improve the HRQoL of pregnant women. Further, as part of routine antenatal care activity, assessing pregnant women’s level of social support is beneficial.

Stories for Change:The impact of Public Narrative on the co-production process.

Involving service users in health service design and delivery is considered important to improve the quality of healthcare because it ensures that the delivery of healthcare is adapted to the needs of the users. Co-production is a process used to involve service users, but multiple papers have highlighted the need for the mechanisms and values guiding co-production to be more clearly stated. The aim of this paper was to evaluate the mechanisms and values that guided the co-production approach of the Stories for Change project, which used Public Narrative as part of the co-design process to create change in National Health Service maternity services. This study was conducted using a rapid feedback evaluation approach. Semistructured interviews (n = 16) were the main source of data, six of which were maternity service users, with observations (5 h) and documentary analysis also carried out in parallel. RREAL sheets were used for data analysis to organize data based on key topics of interest. This study identified three broad mechanisms and values underpinning the co-production approach: creating an open and safe space to share ideas, learning how to tell stories using Public Narrativeand having service providers who play a key role in strengthening the health system listen to stories compelling them to action. This study identified the main areas for improvement of the Stories for Change project related to recruitment, the inclusion of participants, the co-design process, the Skills Sessionand the Learning Event. Our study provided a deeper understanding of the co-production approach that addresses the need to uncover the mechanism and values underlying co-production and co-design approaches. This study expands on the literature pertaining to the influence of storytelling in creating meaningful change in health care. We propose a co-design methodology that uses Public Narrative as a model for service user engagement to help inform future healthcare development processes. The experiences and perceptions of maternity service users and health professionals informed this evaluation. The project organizers were involved in the manuscript preparation stage by providing feedback, and service users wrote a commentary on the project from the lived experience perspective.

O57 - eLearning significantly improves midwives’ knowledge of the congenital cytomegalovirus prevention guidelines

Congenital cytomegalovirus (CMV) infection is a preventable cause of neurodevelopmental disability. Australian guidelines recommend pregnant women are informed about CMV hygiene precautions to reduce their risk of infection however less than 10% of maternity health professionals routinely provide such prevention advice. We developed and evaluated the effectiveness of an eLearning course for midwives to improve knowledge and confidence about CMV. Participants undertaking the online course through the Australian College of Midwives Learning Management System between March and November 2020 were invited to complete a course evaluation questionnaire; prior to commencing the course (T1), immediately following completion (T2) and three months after completion (T3). A linear mixed model with random intercept was used to evaluate change in participant scores over time, while accounting for within-subject correlation. A p-value of <0.05 was considered statistically significant. 363 midwives (87%), midwifery students (8%) and other nurses (5%) participated. At T1 80% indicated they had not received education about CMV. Total adjusted mean scores for questionnaires completed between T1 (n=363) and T2 (n=238) increased significantly (from 17.2 to 22.8, p<0.001). Limited data at T3 (n=27) indicated that whilst scores were lower than at T2 (-1.7, p<0.001), they remained significantly higher than at T1 (+3.6, p <0.001). Participant’s awareness of CMV information resources improved from 10% at T1 to 97% by T2 and 100% at T3. Confidence in providing CMV advice increased from 6% at T1 to 95% at T2 (p<0.001). 99% of participants indicated they would recommend the course to their colleagues. Participants who completed the eLearning course had significantly improved knowledge and confidence in providing advice about CMV. Programs targeting other maternity health professional groups should be considered, to further support the implementation of the congenital CMV prevention guidelines.

O43 - Together we can co-design perinatal interprofessional psychosocial education for maternity clinicians

This project addresses a significant problem. Each year in Australia, 300,000 women give birth and 20% will experience mental health morbidity with suicide reported as a leading cause of maternal death. Maternity care health professionals have a pivotal role in identifying and responding to women experiencing mental health concerns. Many clinicians however, lack skills to assess and respond appropriately and there are limited opportunities for training and skills practice in an interprofessional simulated environment recommended in national guidelines The aim of this research is to co-design, implement and evaluate a comprehensive ongoing education program for maternity health professionals related to psychosocial issues in the perinatal period. This presentation will discuss the co-design development phases of the project. Phases 1 & 2 used mixed methods gathering both qualitative and quantitative data. Including two workshops key stakeholders, maternity clinician needs assessment and focus groups. A scoping review identified gaps in lack of current perinatal psychosocial education and experiential learning opportunities in this space. A co-design team was formed with lived experience consumers, experts and clinicians with experience in psychosocial concerns to develop the program The two initial workshops key stakeholders (n=40), maternity clinician a survey (n=133) and focus groups (n=52) were conducted to identify the key learning priorities across a local health district in NSW. This data was used by a co-design team to develop the overall program content, modes and learning objectives for face-to face and online workshops. The principles of co-design Equal Partnership; Openness; Respect; Empathy; Design Together were displayed in this process working to create a safe interprofessional learning program. Together co-design with lived experience consumers and interprofessional experts by experience in the development phase can positively impact the co-design team and create better program outcomes for all.

Being connected: Exploring the needs of mothers during the postnatal period in Queensland, Australia.

This project explored the needs of mothers beyond the immediate postnatal period in Queensland, Australia, for the development of improved models of care. Data were collected through group and individual interviews. A qualitative methodology using thematic analysis captured the experience of 58 participants. Four key themes were generated: Caring for self, Being connected, Getting direction and Having options. Being connected with care providers and peers was highly valued by participants as was having a sense of direction. Having a relationship with a carer who knew them personally throughout pregnancy and postnatal care avoided retelling stories and facilitated information sharing. Relationship-based care enabled mothers to better meet their personal needs necessary to fulfil the parenting role. Yet, many points of disconnect were identified including inconsistencies in information and gaps in care. These findings demonstrate a range of unmet needs, situated within a lack of relational continuity. Maternity and child health professionals, service managers and policy makers must reorient systems by listening, acknowledging and keeping the voice of mothers at the centre of care.

Determinants of non-exclusive breastfeeding practice during the first 6 months after an elective caesarean birth: a prospective cohort study

BackgroundCaesarean birth is associated with higher rate of non-exclusive breastfeeding (non-EBF) than vaginal birth. Non-EBF refers to providing food or fluid besides breast milk, excluding drugs and vitamins, to infants before six months of age. This study determined the prevalence and factors associated with non-EBF during the first six months after an elective Caesarean birth.MethodsThis prospective cohort study recruited 171 mothers who underwent an elective caesarean birth at two tertiary hospitals in Kelantan, Malaysia. Face-to-face interviews were conducted two days after the birth to obtain information on the variables of interest. Follow-up phone calls were made at one, three and six months after birth to determine the prevalence of non-EBF. Simple and multiple logistic regressions were used for data analysis.ResultsThe prevalence of non-EBF was 19.9%, 40.4% and 57.9% at one, three and six months, respectively. Women who perceived that they had no breast milk, or their breast milk was inadequate were more likely to practise non-EBF at one month [Adjusted Odds Ratio (AOR) 4.83; 95% CI 1.06, 21.96], three months (AOR 4.97; 95% CI 1.67, 14.85) and six months (very often / often AOR 10.06; 95% CI 2.41, 41.99; sometimes / seldom AOR 3.27; 95% CI 1.46, 7.32). Women with at least one child were less likely to practise non-EBF at one month (age of last child ≤ 2 years old AOR 0.10; 95% CI 0.02, 0.66; 3–5 years old AOR 0.10; 95% CI 0.02, 0.53; and > 5 years AOR 0.15; 95% CI 0.02, 0.92).ConclusionPerceived breast milk insufficiency was the only factor associated with non-EBF at all time points. The issue of perceived breast milk insufficiency therefore needs to be explored further and addressed by lactation consultants and other maternal and child health professionals. Strategies may include breastfeeding education prior to the surgery and provision of a helpline to provide information and emotional support to the mothers following delivery. The important roles of lactation support groups in early detection and intervention of the problem cannot be emphasised enough.

ELearning significantly improves maternity professionals' knowledge of the congenital cytomegalovirus prevention guidelines.

AimsCytomegalovirus (CMV) is a preventable cause of neurodevelopmental disability. Australian guidelines recommend that pregnant women are informed about CMV to reduce their risk of infection; however, less than 10% of maternity health professionals routinely provide prevention advice. The aim was to develop and evaluate the effectiveness of an eLearning course for midwives to improve knowledge and confidence about CMV.Materials and MethodsParticipants undertaking the course between March and November 2020 were invited to complete an evaluation questionnaire: before the course (T1), immediately after (T2) and three months post completion (T3). A linear mixed model was used to evaluate change in participant scores; P < 0.05 was considered statistically significant.ResultsMidwives (316/363, 87%), midwifery students (29/363, 8%) and nurses (18/363, 5%) participated. At T1 80% indicated they had not received education about CMV. Total adjusted mean scores for questionnaires completed between T1 (n = 363) and T2 (n = 238) increased significantly (from 17.2 to 22.8, P < 0.001). Limited available T3 scores (n = 27) (−1.7, P < 0.001), while lower than T2, remained higher than at T1 (+3.6, P < 0.001). Participants’ awareness of CMV information resources improved from 10 to 97% from T1 to T2. Confidence in providing CMV advice increased from 6 to 95% between T1 and T2 (P < 0.001) and was maintained at T3. Almost all (99%) participants indicated they would recommend the course to colleagues.ConclusionParticipants who completed the eLearning course had significantly improved knowledge and confidence in providing advice about CMV. Programs targeting other maternity health professionals should be considered, to further support the implementation of the congenital CMV prevention guidelines.

Cultural Adaptation of the Mothers and Babies Intervention for Use in Tribal Communities.

ObjectiveWhile one in five women may experience mood and anxiety disorders during pregnancy and postpartum, Indigenous identity increases that risk by 62%, especially among younger Indigenous women. The need for evidence-based perinatal mental health interventions that provide culturally relevant well-being perspectives and practices is critical to improving maternal, child, and community outcomes for Indigenous peoples, and reducing health inequities.MethodsThrough a collaboration between community maternal and child health professionals, intervention researchers, and a cultural consultant, our workgroup developed cultural adaptations to Mothers and Babies, an evidence-based perinatal depression prevention intervention. Applying a cultural interface model, the workgroup identified existing intervention content for surface adaptations, as well as deep, conceptual adaptations to incorporate traditional teachings into this evidence-based intervention.ResultsThis collaboration developed a culturally adapted facilitator manual for intervention providers, including guidance for implementation and further adaptation to represent local tribal culture, and a culturally adapted participant workbook for Indigenous perinatal women that reflects cultural teachings and traditional practices to promote well-being for mother and baby.ImplicationsCommitting to a culturally respectful process to adapt Mothers and Babies is likely to increase the reach of the intervention into Indigenous communities, reengage communities with cultural practice, improve health outcomes among parents, children, and the next generation's elders, and reduce disparities among Indigenous groups. Replication of this community-engaged process can further the science and understanding of cultural adaptations to evidence-based interventions, while also further reducing health inequities. Future steps include evaluating implementation of the culturally adapted intervention among tribal home visiting organizations.

The impact of panel composition and topic on stakeholder perspectives: Generating hypotheses from online maternal and child health modified‐Delphi panels

IntroductionMultistakeholder engagement is crucial for conducting health services research. Delphi‐based methodologies combining iterative rounds of questions with feedback on and discussion of group results are a well‐documented approach to multistakeholder engagement. This study develops hypotheses about the impact of panel composition and topic on the propensity and meaningfulness of response changes in multistakeholder modified‐Delphi panels.MethodsWe conducted three online modified‐Delphi (OMD) multistakeholder panels using the same protocol. We assigned 60 maternal and child health professionals to a homogeneous (professionals only) panel, 60 pregnant or postpartum women (patients) to a homogeneous panel, and 30 professionals and 30 patients to a mixed panel. In Round 1, participants rated the seriousness of 11 maternal and child health outcomes using a 0–100 scale and explained their ratings. In Round 2, participants saw their own and their panel's Round 1 results and discussed them using asynchronous, anonymous discussion boards moderated by the study investigators. In Round 3, participants revised their original ratings. Our outcome measures included binary indicators of response changes to ratings of the low, medium and high severity maternal and child health outcomes and their meaningfulness, measured by a change of 10 or more points.ResultsParticipants changed 818 of 1491 (55%) of responses; the majority of response changes were meaningful. Patterns of response changes were different for patients and professionals and for different levels of outcome seriousness. Using study results and the literature, we developed three hypotheses. First, OMD participants, regardless of their stakeholder group, are more likely to change their responses on preference‐sensitive topics where there is a range of viable alternatives or perspectives. Second, patients are more likely to change their responses and to do so meaningfully in mixed panels, whereas professionals are more likely to do so in homogeneous panels. Third, the association between panel composition and response change varies according to the topic (e.g., the level of outcome seriousness).ConclusionsResults of our work not only helped generate empirically derived hypotheses to be tested in future research but also offer practical recommendations for designing multistakeholder OMD panels.Patient or Public ContributionPregnant or postpartum women were involved in this study.

The mediational role of social support in the relationship between stress and antenatal anxiety and depressive symptoms among Australian women: a mediational analysis

BackgroundPregnancy can be a stressful period for most women and their family members, and the mental wellbeing of pregnant women can face serious challenges. Social support can play a role in improving the psychological well-being of pregnant women by enhancing the stress coping ability and alleviating stressful conditions. The current study aimed to assess the mediating effects of social support in the relationship between perceived stress and depressive symptoms as well as anxiety symptoms during pregnancy among Australian women.MethodsOf the 8,010 women who completed Survey 6 of the 1973–78 Australian Longitudinal Study on Women’s Health (ALSWH) cohort in 2012, those who reported being pregnant (n = 493) were included in the current analyses. Antenatal depressive and anxiety symptoms were assessed using the 10 item Center for Epidemiological Studies Depression (CES-D-10) scale, and the 9-item Goldberg Anxiety and Depression scale (GADS) respectively. The 19 item-Medical Outcomes Study Social Support index (MOSS) was used to examine social support. A parallel mediation model was used to explore the mediational role of each domain of social support between perceived stress and antenatal depressive and anxiety symptoms.ResultThe study found that emotional/informational support has a partial mediating effect on the relationship between perceived stress and antenatal depressive symptoms (β = 0.371, 95% CI: 0.067, 0.799) and on the relationship between perceived stress and antenatal anxiety symptoms (β = 0.217, 95% CI: 0.029, 0.462). Affectionate support/positive social interaction and tangible support was found to play no significant mediation role between stress and antenatal depressive and anxiety symptoms.ConclusionsEmotional/informational support appears to play a mediating role in the relationship between stress and antenatal depressive as well as between stress and antenatal anxiety symptoms. In order to further protect pregnant women from the effects of stress, policy makers and maternal health professionals are advised to develop community-based social support programs to enhance prenatal psychosocial support and ensure pregnant women have adequate emotional/information support.

Problem-based learning for in-service training on breastfeeding in Friuli Venezia Giulia, Italy

BackgroundProblem-Based Learning (PBL) is extensively used in pre- and post-graduate teaching programmes. However, it has been seldom used for in-service training and continuing medical education. We aimed to develop a PBL curriculum for a short in-service training on breastfeeding for maternal and child health professionals, and to assess the effect of these courses on their knowledge and skills. Also, the project aimed at increasing exclusive breastfeeding rates and duration in an Italian region.MethodsAfter initial training on PBL and an assessment of the learning needs of about 400 health professionals, a small working group developed learning objectives, designed a curriculum, produced manuals, and shaped assessment tools for a new PBL course on breastfeeding. The field test of the new course allowed selection of the tutors for the scaling up of the training to the whole region. During this extension phase, participants were asked to complete an evaluation questionnaire. In addition, the health professionals who attended the PBL courses in 2019 were asked to complete an online survey to assess knowledge, attitudes and practices (KAP) just before, soon after the course, and 4–6 months later.ResultsThe new 29 − hour PBL course, to be delivered in four days over four consecutive weeks, gives priority to tutorial groups and practical activities (71% of the total time). Supervised clinical practices absorb 16% of time. Ethics, communication and woman-centred clinical management content run throughout the four days and all activities. The three manuals, for tutors, participants and practical activities, facilitate the tasks and performance of tutors and participants. After the field test, 32 regional tutors ran courses for 562 health professionals. The analysis of the evaluation showed a high level of satisfaction for perceived effectiveness, relevance to practice, and educational quality. The KAP questionnaires indicated a general improvement after the course and retention after 4–6 months.ConclusionsDespite some predictable shortcomings, this new PBL approach for short in-service training courses on breastfeeding showed encouraging results as far as participants’ satisfaction and KAP are concerned. The possible effects on rates and duration of exclusive breastfeeding need further research.

A Cross-sectional Study of Immune Seroconversion to SARS-CoV-2 in Frontline Maternity Health Professionals

(Anaesthesia. 2020;75:1614–1619) Seroconversion rates for COVID-19 provides data on the pervasiveness and spread of the infection. One challenge is the rate of asymptomatic seroconversion. This has implications for health care providers on the frontline of obstetric care, who may be at increased risk of COVID-19 transmission to and from patients and staff. To date, there are no studies that have provided a baseline rate of seroconversion in frontline, obstetric care providers. The aim of this study was to assess the prevalence of seroconversion in obstetric providers who were not previously diagnosed with SARS-CoV-2 and examine the associations among their characteristics, symptoms, and seroconversion.

Postpartum Depression in Women Refugees/Asylum Seekers- Recognition and Coping Strategies

Immigrant families form a quickly changing multicultural context in many European countries and particularly in Greece. This study is a narrative review regarding postpartum depression within the refugee/immigrant population, in an attempt to increase understanding of immigrant women’s mental health care postnatally. First, we provided a brief review regarding the causes and symptoms of postpartum depression; moreover, we presented the already established bibliography concerning the immigrant/refugee population. Finally, we present several coping strategies that can be applied for dealing with such occurrences. Depression rates are higher among immigrants and refugees than in the general population due to their living conditions. New immigrant mothers may often be particularly vulnerable to less than optimal mental health following childbirth given the cultural and geographic isolation, socioeconomic factors, gender roles, and language difficulties that influence their postpartum experiences. Refugee women’s mental health issues often go unrecognized. Maternity health professionals, especially midwives, should recognize the inequalities and provide culturally sensitive health care services and help to design tailored prevention programs in order to protect women in these population groups from postpartum depression.

COVID-19 and maternity care in South East London: shared working and learning initiative

The SARS-CoV-2 COVID-19 pandemic has had an immediate and profound impact on how healthcare systems organise and deliver services and specifically, there is a disproportionate negative impact on Black, Asian...