Maternity Healthcare Professionals Research Articles

Raspberry leaf (Rubus idaeus) use in pregnancy: a prospective observational study

BackgroundRaspberry leaf use during pregnancy in Australia is widespread. There has been little research exploring the potential beneficial or harmful effects of raspberry leaf on pregnancy, labour, and birth. More research is needed to appropriately inform childbearing women and maternity healthcare professionals on the effects of raspberry leaf so that women can make informed choices.MethodsThis study aimed to determine associations between raspberry leaf use in pregnancy and augmentation of labour and other secondary outcomes. Data was derived from questionnaires which captured demographic information and herbal use in pregnancy. Clinical outcomes were accessed from the maternity services’ clinical database. Data analysis was conducted in R via package ‘brms’ an implementation for Bayesian regression models.ResultsA total of 91 completed records were obtained, 44 exposed to raspberry leaf and 47, not exposed. A smaller proportion of women in the raspberry leaf cohort had augmentation of labour, epidural anaesthesia, instrumental births, caesarean section, and postpartum haemorrhage. A larger proportion had vaginal birth and length of all phases of labour were shorter. Under these conditions the use of raspberry leaf was strongly predictive of women not having their labours medically augmented.ConclusionsWhile our study demonstrated that raspberry leaf was strongly predictive of women not having their labours medically augmented, the results cannot be relied on or generalised to the wider population of pregnant women. While there were no safety concerns observed in our study, this should not be taken as evidence that raspberry leaf is safe. A randomised controlled trial is urgently needed to provide women and healthcare providers with robust evidence on which to base practice.

Maternity healthcare professionals’ experiences of supporting women in decision-making for labour and birth: a qualitative study

ObjectivesTo explore and characterise maternity healthcare professionals’ (MHCPs) experience and practice of shared decision-making (SDM), to inform policy, research and practice development.DesignQualitative focus group study.SettingLarge Maternity Unit in the Southwest...

Information Seeking Behavior and Strategies to Increase Milk Supply Among Breastfeeding Mothers in the United States.

Background: Some breastfeeding mothers try to increase their milk supply through pharmaceutical, dietary, and behavioral strategies that vary in effectiveness. Information seeking behaviors may influence which strategies mothers use. Objective: To describe where mothers obtain information about increasing milk supply, describe the perceived influence of each information source on decision-making about strategies for increasing milk supply, and explore associations between information sources and mothers' use of galactagogues (i.e., pharmaceutical and dietary strategies) and behavioral strategies. Methods: Women who were currently breastfeeding and living in the United States were recruited through Facebook advertisements to complete an online survey between December 2020 and February 2021. Descriptive statistics were calculated, and chi-square tests compared participants' use of galactagogues and behavioral strategies by information sources. Results: Participants were 1,351 breastfeeding mothers (81% non-Hispanic white; 47% first-time breastfeeding; 21% Special Supplemental Nutrition Program for Women, Infants, and Children participants). Nearly all participants (97%) obtained information about increasing milk supply from at least one source, most commonly lactation consultants (68%), Facebook (61%), search engines (50%), websites (47%), and nurses (41%). There was high variability in the perceived influence of each source on decision-making. Galactagogue use was higher among participants who obtained information from the internet (Yes: 68% vs. No: 43%, p < 0.000), social media (Yes: 65% vs. No: 40%, p < 0.000), family and friends (Yes: 65% vs. No: 53%, p < 0.000), and lactation consultants (Yes: 63% vs. No: 54%, p < 0.002). Behavioral strategies were more commonly reported among participants who accessed these same sources, maternal health care professionals (Yes: 98% vs. No: 91%, p < 0.000), and pediatricians (Yes: 98% vs. No: 94%, p = 0.001). Conclusion: Breastfeeding mothers commonly obtained information about increasing milk supply from a variety of sources. Information sources accessed were associated with mothers' use of galactagogues and behavioral strategies for increasing milk supply.

"Are all referrals necessary?" Experiences and perceptions of maternity healthcare providers on emergency intrapartum referrals in Dar es Salaam, Tanzania.

Intrapartum continuity of care to reduce maternal morbidity and mortality relies heavily on a functional and effective referral system between tiers of care. Capacity building of providers in managing intrapartum referrals is expected to improve the efficiency of the referral system, but this does not always work in practice. This study explored the experiences and perceptions of maternity healthcare providers on emergency intrapartum referrals in Dar es Salaam, Tanzania. An exploratory qualitative study was conducted at Amana Regional Referral Hospital and Muhimbili National Hospital in Dar es Salaam. Maternity healthcare providers were purposively recruited based on cadre, working experience of more than three years in the maternity wards. An in-depth interview guide which involved questions and probes was used to conduct eleven interviews. Data was thematically analyzed. Three major themes emerged, namely: 1) causes of referrals are beyond medical indications; 2) limited maternity healthcare provider capability at referring facilities; and 3) limited communication between referring and receiving facilities. According to maternity healthcare professionals, referrals were seen as a way to minimize blame and a clinical management tool to prevent difficulties. They advocated for more understanding of the skill set among maternity healthcare providers, but some had negative perceptions towards performing their responsibilities. Skills gaps among maternity healthcare providers at referring hospitals influenced referral decision-making and service provision. There was hostility between referring and receiving hospitals. Capacity-strengthening strategies such as ongoing skills training and changes in attitudes toward referrals require improvements. The referring hospital should only consider referrals as a last resort after other case management has been completed.

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

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

Informational support and information-seeking during transition to parenthood: Baby Buddy Forward's focus groups with pregnant women and new mothers in Cyprus.

Relevant and accurate information during the transition to parenthood is vital for active participation in decision-making. The aim of the study was to gain an in-depth understanding of informational support and information-seeking practices among women in Cyprus during the transition to parenthood with a focus on the use of the internet and informed decision making. Qualitative descriptive exploratory design of 12 focus groups with 64 participants representing different language-cultural groups served by the Baby Buddy Cyprus app. A topic guide covering expectations, experiences and practices guided the discussions. Data were analyzed using inductive content analysis. Seven themes and several subthemes emerged. In an 'unsupportive system', 'void' of informational support, pregnant women strive to have a 'confident voice'. They find themselves 'self-navigating in parallel worlds' of formal and informal information, where the internet holds a prominent place. 'Supplementing and filtering', instinctively and selectively, results in a state of 'doubt and faith' towards the trustworthiness of the information but also healthcare providers. Effective communication with providers is needed to break the cycle, but seems dependent on the self-efficacy of the women themselves ('art of communication'). Women 'deconstruct and reimagine' their experiences, often assigning responsibility on themselves for not having been better prepared. Women want control over decisions affecting their pregnancy. While the internet is a prevalent source of information, they value communication with healthcare providers and want direction. A shift is needed from current practices of unguided information-searching. Maternity healthcare professionals need to recognize this phenomenon, offer appropriate guidance, and support active participation in informed decision-making.

‘What do I do?’ A study to inform development of an e-resource for maternity healthcare professionals and students caring for people with lived experience of childhood sexual abuse

BackgroundThe impact of childhood sexual abuse can last a lifetime. It is more prevalent than many common complexities that require additional care during the childbirth cycle but is rarely part of the education of healthcare professionals and students. This study informed the development of an e-resource to support maternity healthcare professionals and students caring for people with lived experience of childhood sexual abuse. ObjectivesTo identify any previous learning of pre-registration students and healthcare professionals in relation to care of survivors of childhood sexual abuse, explore their clinical experience in caring for survivors, identify related learning needs, explore what survivors of childhood sexual abuse would like healthcare professionals to know about their maternity care needs. DesignA qualitative descriptive study using focus groups and interviews. Data derived qualitative content analysis was employed to address the objectives. SettingThe study was designed in consultation with The Survivors Trust and took place in South London, UK ParticipantsThirty seven health care professionals and students participated, comprising 25 students of midwifery, health visiting and medicine; 9 midwives, health visitors and doctors with specialist obstetric training. Eight women with lived experience took part in focus groups. FindingsCare of women and birthing people who have experienced childhood sexual abuse had not been part of the undergraduate/pre-registration curricula, nor in specialist training for obstetricians. Many practitioners felt unprepared to care for those with lived experience of abuse and their learning needs were wide-ranging. The need for a learning resource was acknowledged and the outline plan that had been produced following the focus groups was endorsed by participants with lived experience. ConclusionCare for women and birthing people with lived experience of childhood sexual abuse can be challenging for both personal and professional reasons. This study confirmed the need for a resource that could facilitate the classroom teaching of students and be used for the Continuous Professional Development of qualified practitioners.

Exploring mothers’ experiences of perinatal care in Cyprus: Babies Born Better survey

IntroductionA positive perinatal experience facilitates a smooth transition to motherhood and enhances the development of a strong bond between mother and newborn, contributing to maternal and societal wellbeing. Given the medicalization of childbirth in Cyprus, the examination of mothers’ experiences of perinatal care becomes imperative.AimTo investigate mothers’ experiences of care during the perinatal period and to identify factors related to the provision of maternal care that contribute to the interpretation of these experiences.MethodsThe study draws on data from the European survey “Babies Born Better”, an online survey utilizing a mixed-methods approach to explore women’s experiences of maternity care across Europe. The study population were women who had given birth in Cyprus over a 5-year period (2013–2018). Quantitative data were analyzed using SPSS v22, while qualitative data were analyzed through inductive content analysis.FindingsA total of 360 mothers participated in the study. In rating their overall experience, 24.2% stated that they had a “bad experience”, 11.1% a “good experience”,13.9% a “very good experience”, and 13,3% a “very bad experience”. The top three sub-factors of the overall experience which received positive evaluation were “Relationship with health care professionals” (33.6%), “Birth environment and care” (11.4%), and “Breastfeeding guidance” (10.8%). The qualitative analysis yielded five themes: “Relationship with health care professionals”, “Breastfeeding establishment”, “Childbirth rights”, “Birth environment and services” and “Choice of mode of birth”.ConclusionMothers in Cyprus wish to have respectful maternity care. They need maternity health care professionals to respect their dignity and ask for evidence-based information with shared decision making. Mothers in Cyprus expect to have their childbirth rights safeguarded, to have better support from HCP, and to receive humanized care. The perinatal care provided in Cyprus needs significant improvements based on mothers’ needs and expectations.

Maternal Health Services in Pakistan

Background: Women must be provided with necessary health services for a child's good health and future during pregnancy. Women's health has experienced a considerable epidemiological change during the past several decades. Maternal well-being and health affect not only the developed world but predominantly the developing nations. Differences in resource allocation between industrialized and developing countries ultimately led to notable differences in pregnancy complications and deaths. Aim: To investigate these barriers. A literature review was carried out to address this research topic. Methodology: Six online databases AMED, CINAHL PLUS, PUBMED, MEDLINE, COCHRANE LIBRARY and SCIENCE DIRECT were used for a preliminary search that yielded 6353 articles. No grey literature was discovered due to time restrictions. Seven publications were discovered to be eligible for inclusion in the literature review after carefully reading, analysing, and evaluating them with the help of critical appraisal techniques. After the initially searched articles were filtered using robust inclusion and exclusion criteria. Findings: Data were taken from different sources like the Pakistan Demographic and Health Surveys (PDHSs), WHO, and a comparison was made with the findings from different factors. The analysis concentrates on women of Pakistan having maternal health issues and maternal health services. The Critical Appraisal Skills Program (CASP) is used for the assessment and qualitative analysisof this study. Practical implications: By addressing the issues highlighted in this paper there appears to be substantial room for improvements in Pakistan’s pregnancy outcomes. This review provides a better understanding of the risk factors determining maternal mortality in Pakistan.Public awareness is important as this paper almost covered the different platforms which are working on maternal health servicesto aware the society. To promote maternal health messages and encourage pregnant women to receive maternal healthcare services, policymakers, healthcare professionals, and health organizations can adopt a variety of campaigns. Results: This study discussed the impact of different factorswhich effect on maternal health. Different factors are associated with utilizing maternal healthcare services at antenatal care and delivery stages of pregnancy in Pakistan. This review concentrated on the economic and social vulnerability of pregnant women and emphasized the importance of parallel, more all-encompassing initiatives, like poverty reduction and women's empowerment. Poor maternal health in Pakistan has many root causes, including undernourishment of young girls, early marriage, high fertility rates, and unmet contraceptive needs. Conclusion: The key factors influencing women's hesitation and refusal to use the health facilities in Pakistan include structural hurdles, maternal knowledge and education levels, and men's dominance in decision-making, according to the themes drawn from the literature. Keywords: Pregnant women, Maternal health, Ante-natal care, Pakistan,Demographic and health surveys,

Development of an instrument to measure awareness and mitigation of bias in maternal healthcare.

Implicit bias among maternal healthcare professionals contributes to disrespectful care and racial and ethnic disparities in patient outcomes, and there is growing consensus that implicit bias training is a key component of birth equity initiatives. A requirement for implicit bias training for healthcare professionals has become more widespread, but the impact training has is largely unknown, in part, because of a lack of validated instruments. Therefore, there is an urgent need for a psychometrically valid instrument for use in the evaluation of implicit bias training. This study aimed to develop a valid and reliable instrument to assess implicit bias awareness and mitigation practices among maternal care professionals and that can be used to evaluate interventions aimed at mitigating such bias in clinical practice. We conducted an instrument development and validation study in 3 phases. In phase 1, item development, we generated a 43-item bank from literature and consultation and established content validity with subject matter experts. In phase 2, instrument development, we administered a revised set of 33 items to 307 nurses and midwives and conducted exploratory factor analysis to demonstrate construct validity and reliability. In phase 3, instrument evaluation, we confirmed the factor structure and compared the means of implicit bias training-exposed and -unexposed participants to further demonstrate construct validity with a representative state sample of 2096 maternal healthcare professionals (physicians, midwives, and nurses). Based on phase 2 results, we retained 23 items for the Bias in Maternal Health Care scale, which showed high internal consistency (Cronbach's alpha, 0.86). We identified 3 subscales, namely a 9-item Bias Awareness subscale (Cronbach's alpha, 0.86), a 7-item Bias Mitigation Practice subscale (Cronbach's alpha, 0.82), and a 7-item Bias Mitigation Self-Efficacy subscale (Cronbach's alpha, 0.81). Validation of the Bias Awareness and Bias Mitigation Practice subscales in phase 3 demonstrated the instrument's high reliability (Cronbach's alpha 0.86 and 0.83, respectively) and discriminating performance among maternal healthcare professionals. We developed a reliable and valid instrument for measuring awareness and mitigation of bias among maternal healthcare professionals. It can be used to evaluate implicit bias training and other bias mitigation interventions in maternal healthcare settings.

Adaptation and validation of the Portuguese version of the provider attitudes towards planned home birth (PAPHB) Scale

Maternity health care professionals' attitudes on the option of home birth can influence the choices and decisions women and their partners make about place of birth. Midwives are particularly influential in this space. The study outlined in this paper aimed to translate and validate the Provider Attitudes towards Planned Home Birth (PAPHB) scale questionnaire for use in the Portuguese maternity context. Methods: A total of 118 Portuguese midwives were selected through intentional sampling. The procedure was divided into two phases. In the first phase, a triple translation from the original language into Portuguese and a cross-cultural adaptation of the Provider Attitudes towards Planned Home Birth (PAPHB) scale were carried out, obtaining three versions of the same questionnaire. The second phase consisted of the validation of the questionnaire, for which the Provider Attitudes towards Planned Home Birth (PAPHB) scale was submitted to a panel of 20 experts and to a pilot test. Subsequently, the reliability and statistical validity of the scale were evaluated. Results: After content analysis, the results confirmed a four-dimensional structure with a Cronbach's α value of 0.933 for the Provider Attitudes towards Planned Home Birth (PAPHB) scale as a whole, showing good internal consistency. Finally, a bivariate analysis was carried out identifying associations between variables and midwives' attitudes towards home birth. Positive attitudes towards homebirth were strongly influenced by previous clinical experience and exposure to home birth during midwives' academic education. Conclusion: The 18-item scale is a reliable and valid tool to quantify attitudes towards planned home births in Portugal as the results obtained in the study showed very good internal consistency.

Knowledge, Utilization, and Associated Factors of Nonpneumatic Antishock Garments for Management of Postpartum Hemorrhage among Maternity Ward Health Care Professionals in South Wollo Zone Health Facilities, Ethiopia, 2021: A Cross-Sectional Study Design.

In 2017, approximately, 810 women died every day from preventable causes related to pregnancy and childbirth around the world. Obstetric hemorrhage, specifically postpartum hemorrhage, is the leading cause of preventable maternal mortality in the world. New strategies and technologies are needed to reduce the global public health epidemic of maternal mortality. However, nonpneumatic antishock garments were recently introduced and incorporated into teaching curriculums as a management modality for postpartum hemorrhage in Ethiopia. Therefore, this study assessed the knowledge, utilization and associated factors of nonpneumatic antishock garment among maternity ward healthcare professionals in the selected South Wollo zone health facilities, North West Ethiopia. An institutional-based cross-sectional study design was conducted from February 1 to April 30, 2021. A consecutive sampling technique was employed to collect the data. A self-administered semistructured English version questionnaire was used to collect the data. EPI-Info and SPSS were used for data entry and analysis, respectively. Bivariable and multivariable logistic regression analyses were used to analyze the association of nonpneumatic antishock garment utilization with independent variables. A total of 244 maternity ward health care professionals participated. One hundred forty-six (59.8%) had a good knowledge of nonpneumatic antishock garments. About 110 (45.1%) of the participants have ever used it for the management of postpartum hemorrhage. Those having one nonpneumatic antishock garment (AOR = 2.7, 95% CI: 1.3, 5.5), two or more nonpneumatic antishock garments (AOR = 14.1, 5.7, 35.0), good knowledge (AOR = 5.2, 2.5, 10.7), and positive attitude (AOR = 2.5, 1.1, 5.7) and those who were receiving training (AOR = 2.2, 1.1, 4.4) at 95% CI were significantly associated with utilization of nonpneumatic antishock garments. The knowledge and utilization of nonpneumatic antishock garments for the management of postpartum hemorrhage were low. Those having more nonpneumatic antishock garments, good knowledge, and a positive attitude and those who received training were found to be significantly associated with nonpneumatic antishock garment utilization. The provision of training and availability of nonpneumatic antishock garments are the key actions to be taken to increase the utilization of nonpneumatic antishock garments.

Predictorsassociated withlow-riskwomen's pre-labour intention for intrapartum pain relief: a cross-sectional study.

Pregnant women have preferences about how they intend to manage labour pain. Unmet intentions can result in negative emotions and/or birth experiences. To examine the antenatal level of intention for intrapartum pain relief and the factors that might predict this intention. A cross-sectional online survey-based study. 414 healthy pregnant women in the Netherlands, predominantly receiving antenatal care from the community-based midwife who were recruited via maternity healthcare professionals and social media platforms. The attitude towards intrapartum pain relief was measured with the Labour Pain Relief Attitude Questionnaire for pregnant women. Personality traits with the HEXACO-60 questionnaire, general psychological health with the Mental Health Inventory-5 and labour and birth anxiety with the Tilburg Pregnancy Distress Scale. Multiple linear regression was performed with the intention for pain relief as the dependant variable. The obstetrician as birth companion (p<.001), the perception that because of the impact of pregnancy on the woman's body, using pain relief during labour is self-evident (p<.001), feeling convinced that pain relief contributes to self-confidence during labour (p=.023), and fear of the forthcoming birth (p=.003) predicted women were more likely to use pain relief. The midwife as birth companion (p=.047) and considering the partner in requesting pain relief (p=.045) predicted women were less likely to use pain relief. Understanding the reasons predicting women's intention of pain management during labour, provides insight in low-risk women's supportive needs prior to labour and are worth paying attention to during the antenatal period.

Consequences of Housing Conditions on Maternal Health of Forced Migrant Women

Abstract Background Housing is a major social determinant and contextual factor of health. Forced migrants are restricted in their freedom of choosing and shaping their housing conditions. This qualitative study highlights the impact of housing restrictions on reproductive and maternal health from the lived experience of forced migrant women who recently gave birth to a child. Methods Qualitative problem-centered interviews were conducted with 33 refugee mothers (Mage = 31 years) 1-9 month postpartum. Interviewees came from 19 countries of origins, spoke 22 languages, and had lived in Germany for an average of three years. The mothers’ perspectives were complemented by 75 qualitative interviews with maternal health care professionals, (HCPs: midwives, gynecologists, social workers). Interview transcripts were analyzed via framework method regarding (1) type of housing: shared accommodation vs. private apartment, (2) region: rural vs. urban, (3) exhausting and supporting conditions as well as (4) consequences on maternal health. Results Interviewees living in shared accommodations reported exhausting conditions hindering self-determined upbringing of their newborn, e.g., confined living spaces, racism of staff, shared kitchen and bathrooms, lack of privacy, mobility, access to medical care, hygiene. Reported consequences on maternal health ranged from physical stress to social stress and mental stress (e.g., sleeping problems, depression, fear, worrying about health of the newborn). Interviewees living in private apartments showed higher autonomy and contentment. HCPs reported missing time and staff to provide adequate support. Conclusions Both refugee women and HCPs reported housing as main stressor during pregnancy and childbed, resulting in higher physical, social, and mental stress. Strategic social support for finding suitable private apartments for new families is needed as well as comprehensive visiting midwifery care in accommodations. Key messages • Living conditions in shared accommodations are unacceptable from a public health and human rights perspective, especially for women during pregnancy and childbed. • Negative effects on maternal health and self-determination of families were shown.

Importance of communication between health care professionals and forced migrant women during birth

Abstract Background Communication and information are part of the Sexual and Reproductive Health and Rights (SRHR). Various studies show that successful communication between birthing person and health care professionals (HCP) has a positive impact on birth and lowers risk of traumatic birth experience for women. Since information and communication is a major challenge for both forced migrant women (FMW) and health workers during birth, we investigated experiences of both sides in qualitative study. Methods Qualitative interviews were conducted with 7 maternal HCPs (midwifes, physicians, social workers) and with 7 FMW 1-9 months after the birth of their child in 3 regions in Germany. The refugee sample included new mothers from 6 countries of origins, 14 languages, and an average of three years living in Germany. The interviews were analyzed via framework analysis. Results The majority of the interviewed FMW had no or little knowledge about SRHR. Good communication is one of the main factors allowing a safe and trustful environment with the birthing women. If verbal communication is not possible nonverbal communication helps to create and maintain a care relationship with the women is given. However, due to lack of staff, time and interpreters FMW with little German language proficiencies receive hardly any relevant information and had a poorer accompaniment during birth. Conclusions To provide for equity and SRHRs in maternal health and care there is an urgent need for reliable professional interpretation and easily accessible information in relevant languages material about giving birth, medical possibilities, procedures and interventions. Additionally, further training on heterogeneous needs and life contexts is necessary, to improve professional care during birth in maternity wards. HCPs 1:1 support is strongly recommended. Key messages • Information on SRHR and communication are a fundamental part of birth work and should be made possible for all women including FMW to prevent discrimination and traumatic birth experiences. • If given, 1:1 support by HCPs during birth can comensate missing communication.

Development of a co-designed behaviour change intervention aimed at healthcare professionals recruiting to clinical trials in maternity care

BackgroundThe evidence on what strategies can improve recruitment to clinical trials in maternity care is lacking. As trial recruiters, maternity healthcare professionals (MHCPs) perform behaviours (e.g. talking about trials with potential participants, distributing trial information) they may not ordinarily do outside of the trial. Most trial recruitment interventions do not provide any theoretical basis for the potential effect (on behaviour) or describe if stakeholders were involved during development. The study aim was to use behavioural theory in a co-design process to develop an intervention for MHCPs tasked with approaching all eligible potential participants and inviting them to join a maternity trial and to assess the acceptability and feasibility of such an intervention.MethodsThis study applied a step-wise sequential mixed-methods approach. Key stages were informed by the Theoretical Domains Framework and Behaviour Change Techniques (BCT) Taxonomy to map the accounts of MHCPs, with regard to challenges to trial recruitment, to theoretically informed behaviour change strategies. Our recruitment intervention was co-designed during workshops with MHCPs and maternity service users. Acceptability and feasibility of our intervention was assessed using an online questionnaire based on the Theoretical Framework of Acceptability (TFA) and involved a range of trial stakeholders.ResultsTwo co-design workshops, with a total of nine participants (n = 7 MHCP, n = 2 maternity service users), discussed thirteen BCTs as potential solutions. Ten BCTs, broadly covering Consequences and Reframing, progressed to intervention development. Forty-five trial stakeholders (clinical midwives, research midwives/nurses, doctors, allied health professionals and trial team members) participated in the online TFA questionnaire. The intervention was perceived effective, coherent, and not burdensome to engage with. Core areas for future refinement included Anticipated opportunity and Self-efficacy.ConclusionWe developed a behaviour change recruitment intervention which is based on the accounts of MHCP trial recruiters and developed in a co-design process. Overall, the intervention was deemed acceptable. Future evaluation of the intervention will establish its effectiveness in enabling MHCPs to invite all eligible people to participate in a maternity care trial, and determine whether this translates into an increase in maternity trial recruitment rates.

Barriers to effective management of primary postpartum haemorrhage following in-hospital births in northwest Ethiopia: healthcare providers’ views using a qualitative approach

BackgroundData showed that postpartum haemorrhage contributed to over 40% of in-hospital deaths of Ethiopian women. However, little is known about the barriers to effective management of primary postpartum haemorrhage. This study aims to explore the views and experiences of maternity healthcare professionals about the barriers to managing primary postpartum haemorrhage following in-hospital births in northwest Ethiopia using the ‘Three Delays’ model as a conceptual framework.MethodsA qualitative descriptive study was employed at two tertiary referral hospitals between December 2018 and May 2019. Forty-one maternal healthcare providers, including midwives, midwifery unit managers, and obstetricians, participated in this study. Individual face-to-face interviews, focus group discussions, and self-administered open-ended questionnaires were used to collect data. A framework analysis approach was used for the qualitative data analysis. Themes were identified based on the Three Delays model of ‘delay the decision to seek care’, ‘delay arrival at a health facility’, and ‘delay the provision of appropriate and quality care’.ResultsParticipants reported several modifiable issues when managing primary postpartum haemorrhage, and all were linked to a delay in receiving appropriate and quality care due to limited resources. Five sub-themes were identified: ‘workforce’, ‘communication issues between healthcare providers’, ‘systemic issues’, ‘education, training, and resourcing issues’, and ‘lack of identification and referral’.ConclusionMaternal healthcare providers in these hospitals require training in managing a birthing emergency. In addition, the birth units need adequate supplies and continuous essential services.

Support and services for perinatal low mood and depression: A qualitative study exploring women's and healthcare professionals' experiences.

This study aimed to explore women's experiences of support and care received from maternity healthcare professionals for perinatal low mood or depression, and healthcare professionals' experiences of providing support and care for women experiencing perinatal low mood or depression. In this qualitative study, face-to-face individual semistructured interviews and focus groups were conducted with 15 women and 19 healthcare professionals living or working in Yorkshire and the Humber, England in 2019. Thematic analysis was used to analyze the qualitative data. The following themes were identified: (1) lack of standardization in identification and support for perinatal low mood and depression; (2) unclear and nonstandardized pathways for perinatal low mood and depression; and (3) enablers and barriers of receiving support and care for perinatal low mood and depression. Providing training opportunities for healthcare professionals, especially midwives, may be helpful for filling the gray area for women who do not need a referral to mental health services but require support from healthcare professionals. Improving the variety of psychological therapies for the treatment of perinatal depression may also be helpful to meet women's expectations of treatments.

An examination of the association between marital status and prenatal mental disorders using linked health administrative data

BackgroundInternational research shows marital status impacts the mental health of pregnant women, with prenatal depression and anxiety being higher among non-partnered women. However, there have been few studies examining the relationship between marital status and prenatal mental disorders among Australian women.MethodsThis is a population-based retrospective cohort study using linked data from the New South Wales (NSW) Perinatal Data Collection (PDC) and Admitted Patients Data Collection (APDC). The cohort consists of a total of 598,599 pregnant women with 865,349 admissions. Identification of pregnant women for mental disorders was conducted using the 10th version International Classification of Diseases and Related Health Problems, Australian Modification (ICD-10-AM). A binary logistic regression model was used to estimate the relationship between marital status and prenatal mental disorder after adjusting for confounders.ResultsOf the included pregnant women, 241 (0.04%), 107 (0.02%) and 4359 (0.5%) were diagnosed with depressive disorder, anxiety disorder, and self-harm, respectively. Non-partnered pregnant women had a higher likelihood of depressive disorder (Adjusted Odds Ratio (AOR) = 2.75; 95% CI: 2.04, 3.70) and anxiety disorder (AOR = 3.16, 95% CI: 2.03, 4.91), compared with partnered women. Furthermore, the likelihood of experiencing self-harm was two times higher among non-partnered pregnant women (AOR = 2.00; 95% CI: 1.82, 2.20) than partnered pregnant women.ConclusionsNon-partnered marital status has a significant positive association with prenatal depressive disorder, anxiety disorder and self-harm. This suggests it would be highly beneficial for maternal health care professionals to screen non-partnered pregnant women for prenatal mental health problems such as depression, anxiety and self-harm.

Assessing the Validity of the Long-Term Conditions Questionnaire (LTCQ) in Women During Pregnancy and the First Year Following Birth.

BackgroundThe aim of this study was to validate a generic patient-reported outcome measure, the Long-Term Conditions Questionnaire (LTCQ), among pregnant and postpartum women living with a pre-existing long-term condition (LTC).MethodsCognitive interviews were conducted with women who were currently pregnant or had given birth within the past year and living with a pre-existing LTC (n=11) and with healthcare professionals working in maternal care (n=11) to explore the acceptability of LTCQ items. An online survey was subsequently administered among women who were pregnant or had given birth within the past year and living with a pre-existing LTC (n=718). Tests of validity were performed including assessing correlations between the LTCQ and reference measures, the Well-being in Pregnancy (WiP) Questionnaire and the EuroQol EQ-5D-5L. Internal consistency was assessed using the Cronbach’s alpha statistic.ResultsAll LTCQ items were considered relevant and appropriate for use with women who were pregnant or had given birth within the past year. The most commonly reported LTC among the online survey sample (n=718) was a mental health condition (n=350, 48.7%) followed by joint, bone and connective tissues (n= 212, 29.5%) and gastrointestinal (n=143, 19.9%) condition. Data indicated LTCQ scores behaved in a predictable pattern, demonstrating poorer scores for women reporting a greater number of LTCs; mean (SD) scores, one LTC= 61.86 (17.8), two LTCs= 55.29 (16.0), three LTCs= 49.84 (15.52) and four LTCs= 44.94 (12.2). Poorer scores were also reported for women living with at least one mental health condition compared to those reporting no mental health condition, mean score = 66.18 (SD 16.7) v 48.64 (SD 13.3), p<0.001 respectively. As anticipated, LTCQ scores demonstrated significant correlations in the expected direction with both the EQ-5D-5L and WiP scores. For all LTCQ items, the Cronbach’s alpha statistic was 0.93.ConclusionData presented here indicate that the LTCQ, which assesses living well with one or more LTC, is suitable for use among pregnant and postpartum women, from both the woman’s perspective and from the perspectives of maternity healthcare professionals. Use of the LTCQ would facilitate the identification of unmet needs within this high-risk cohort and support the exploration of how LTCs may affect women throughout the pregnancy and post-natal period. Understanding unmet needs within this cohort of women provides an opportunity to link up specialist care within maternity services and enhance personalised care.