Maternity Ward Research Articles

Appraisal of Nursing Care Received and it’s Satisfaction: A Case Study of Admitted Patients in Afe Babalola Multisystem Hospital, Ado Ekiti, Ekiti State

Background Patients are the best recruiter of patients if given prompt treatment and comprehensive care. Patient satisfaction with nursing care has been strongly advocated to be an important indicator of the quality of nursing care delivery which raises concerns in many areas, including information communication, privacy, physical and psychological care, availability and accessibility of nurses, and emotional care. The aim of this study centred on identifying the domain of nursing care received by in-patients of Afe Babalola Multisystem Hospital (AMSH) and determining the level of patient satisfaction towards nursing care in AMSH.  Methods A hospital-based cross-sectional, descriptive design was employed. A convenience sampling technique was used to select 102 patients admitted to surgical wards (male and female), Medical wards (male and female), renal wards, accident and emergencies and maternity wards. The Qualipak nursing quality questionnaire (QUALPAC) was used to collect the required data. Data were analysed using SPSS software version 27. Pearson chi-square test and logistic regression analysis was used.  Results Patients received overall moderate nursing care (64.7%) in the framework of physical, communication and psychosocial care. Overall satisfaction with nursing care received was found to be 76.5%. Among the domains of nursing satisfaction, satisfaction towards communication care (89.2%) and physical care (80.4%) showed a high level and satisfaction towards psychosocial care (58.8%) care was lower compared to other dimensions. Respondents’ between the ages of 18-25 years (P< 0.05, Odd ratio- 14.569, CI: 679.461– 0.312), male patients (P< 0.05, Odd ratio- 8.850, CI: 7.477– 0.097), single patients (P< 0.05, Odd ratio- 5.130, CI: 7.569- 0.035), primary education (P< 0.05, Odd ratio- 40.123, CI: 2021.829– 0.076), patients admitted to male renal ward (P< 0.05, Odd ratio- 2.328, CI: 196.160– 0.028) and patients who chose expert doctors as a reason (P< 0.05, Odd ratio- 4.900, CI: 25.509– 0.009) were associated with patient satisfaction. Nursing care received was high among admitted patients in male medical wards, female medical ward and male renal ward.  Conclusion Patientsin this study received moderate nursing care in the three domains of nursing care. A high nursing satisfaction was received. To increase satisfaction with nursing care, greater emphasis should be given to the psychosocial care of patients.

Bring in the Social, Bring in the Noise

ABSTRACT Taking Stephen Hartman’s vignette about his visit to a maternity ward as an example of the operation of digital media/technologies central to what I am referring to as an information infrastructure, I follow him in questioning the priority that psychoanalytic theory gives the (m)other-infant relationship and the resulting influence the relationship has had in shaping the techniques of psychoanalytic practice. I turn to information theory to address the changes brought about by the digital media/technologies of the current information infrastructure urging us to recognize that the (m)other infant-relationship is not sufficient as a starting point for understanding the social; it is not robust enough to bring the noise of the social into our sessions and our treatments.

P-772 Assisted reproductive technology and the risk of minor congenital heart defects in the newborn

Abstract Study question Are children conceived through assisted reproductive technology (ART) at higher risk of minor congenital heart defects (CHD) compared with naturally conceived (NC) children? Summary answer Contrary to previous studies children conceived through ART had similar risk of minor CHDs compared with children conceived naturally. What is known already Congenital heart defects (CHD) may precipitate cardiac arrhythmias, lead to thromboembolic events, culminate in heart failure or even sudden cardiac demise. A systematic review and meta-analysis showed an elevated odds ratio (OR) for diagnosis of any CHD among children conceived through in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) compared with NC children. Other studies indicate that ART is associated with an increased arterial blood pressure and vascular dysfunction in the pulmonary and systemic arterial vasculature. This association persists throughout childhood, adolescence, and early adulthood in individuals conceived through ART; this indicates a lasting impact on the cardiovascular circulatory system. Study design, size, duration The present study is a sub-study to the Copenhagen Baby Heart Study (CBHS), a prospective population-based cohort study of > 25 000 children born in the three main maternity wards in Copenhagen, Denmark, in 2016–2018. Transthoracic echocardiography (TTE) was performed on all children within 60 days of delivery and diagnosis of CHD was reviewed by a specialist in paediatric cardiology. Information regarding parental health, pregnancy, delivery, and the newborn was collected through Danish patient registries. Participants/materials, setting, methods This study includes all children conceived by ART in the CBHS (n = 1 784), and a matched group (1:4 by maternal age at birth) of NC children (n = 7 141). Exclusion criteria were genetic or chromosomal syndromes and heart surgery. Minor CHD was defined as an atrial (ASD) or ventricular septum defects (VSD), bicuspid aortic valve, coarctation of the aorta, pulmonary stenosis, or patent ductus arteriosus. We calculated ORs using logistic regression analyses. Main results and the role of chance The mean maternal age at birth was 34.9 (standard deviation [SD] ±4.4) and 35.1 years (SD ± 4.6) and the newborn mean age at TTE was 12.1 (SD ± 9.3) and 12.2 days (SD ± 9.4) in the ART and NC population, respectively. Parental CHD was registered in 40 (2.2 %) children in the ART group and 121 (1.7 %) in the NC group. Overall, 165 (9.2%) children conceived by ART and 611 (8.6%) NC children were diagnosed with a minor CHD. The most prevalent CHDs were VSD and ASD which accounted for 38.8 % and 35.2 % in children with CHD in the ART group, respectively, and 36.8 % and 33.9 % in children with CHD in the NC group. The unadjusted OR for minor CHD was 1.09 (95% CI 0.91–1.30). Adjustments for maternal age and parental CHD did not change the OR. There were no differences in ORs when stratifying by minor CHD type. We stratified by the method of ART: ICSI and IVF and frozen embryo transfer and fresh embryo transfer, and calculated risk of minor CHD comparing the methods and with NC children. We found no difference in any ORs, crude or adjusted. Limitations, reasons for caution Children born preterm, and children with severe minor and major CHDs, were underrepresented in the cohort indicating parents of such children chose not to participate in a research project that would include another hospital visit. Residual confounding is plausible because parental CHD diagnoses were retrieved from patient registries. Wider implications of the findings The number of children conceived through ART is increasing each year and previous research have found an increased risk of CHD in children conceived through ART. Our findings indicate no increased risk of minor CHD, providing comforting and significant information for advising individuals considering or undergoing ART treatment. Trial registration number NCT02753348

The Stork

ABSTRACT Taking my trip to a maternity ward to visit my newborn niece as a “clinical case,” I visit the phenomenon of digitally surveilling neonates with the self-same devices that were designed to enforce the house-arrest of would-be felons whose noisy place in the cultural imaginary has rendered the neonate’s ankle a transgenerational “risk object” in the unconscious collective. In conversation with the ever-emergent genre known as autotheory, I invite the reader to be an accomplice as I “dramatize my unsettlement” contrasting autotheory with Laplanchean “self-theorization” via interludes about temporality, expertise, birth, gender, race, and place that come to life in the tale of The Stork.

Risk Factors Associated With Low-Birth-Weight Babies in Tertiary Health Care Facilities in Lahore, Pakistan: A Case-Control Study.

Introduction Low birth weight (LBW) is a well-known contributing factor to neonatal health, emphasizing the importance of maternal health and socio-economic conditions. The birth weight of a newborn is a major public health problem, which is more common in low-middle-income countries (LMICs). Objective The objective of this study is to assess the association of different socio-economic and maternal factors with LBW babies in Lahore. Methods This case-control study was carried out at the Obstetrics and Gynecological Department in Mayo Hospital, Lahore, Pakistan from September 25, 2023 to December 31, 2023. A total of 186 mothers who delivered in the maternity ward, categorized into two groups (93 cases and 93 controls), were included and data was collected with the help of a self-administered structured tool. A chi-square test was used to identify maternal risk factors significant for LBW babies. The strength of association between maternal risk factors and LBW babies was presented using the odds ratio (OR) with the respective 95% confidence interval (CI). Results The study revealed that maternal anemia [OR: 3.378, 95% CI: 1.568, 7.275] and inadequate nutritional status [OR: 1.031, 95% CI: 0.014, 0.071] were more likely to cause delivery of LBW babies. Regarding socio-demographic factors, household income < 25000 [OR: 5.185, 95% CI: 2.770, 9.707] and illiterate mothers [OR: 3.325, 95% CI: 1.820, 6.074] were associated with increased likelihood of LBW babies. Maternal age < 20 had a strong association [OR: 10.920, 95% CI: 2.455,48.575]with delivery of LBW children. Conclusion The study concludes that multiple risk factors including anemia, inadequate nutritional status, household income < 25000, illiterate mother, and maternal age < 20 are strongly associated with LBW babies. It is apparent that a multimodal strategy is necessary to reduce the risk of LBW babies.

Analysis of the appropriateness of using the Robson Classification in a high-risk maternity ward in Brasília, Brazil

The Robson Classification is a tool designed to monitor cesarean section rates in diverse populations and assess the impact of management changes. This study aimed to evaluate the application of the Robson Classification in a high-risk maternity ward in Brasília, Brazil. A cross-sectional observational study was conducted, analyzing 1813 deliveries between January and June 2019 at the Materno Infantil Hospital in Brasília. The overall cesarean section rate was 55.7%, and Robson Group 5 significantly contributed to the global rate at 33.3%. It was concluded that there is an association with the type of delivery, newborn weight, and fetal disease, irrespective of the type. Regarding maternal conditions, an association was observed in Robson Group 10, which exhibited a 51.4% cesarean section rate. The use of the Robson Classification within the maternity context, despite being a local reference for high-risk pregnancies, indicated the potential for reducing cesarean rates in specific cases. A protocol based on the Robson Classification is proposed as an instrument for adjusting cesarean birth rates in all public maternity hospitals in the Federal District, Brasília, Brazil.

Home birth in Croatia - a medico-legal perspective today.

In Croatia, the model of obstetrics-midwifery management of childbirth in maternity hospitals is still in effect, and this is how > 99% of Croatian women give birth. However, in my view, midwives are still not sufficiently educated for completely independent work notwithstanding their university education. The Law on Midwifery defined the role of the midwife in home birth without, however, setting out other organisational-communication and professional provisions. Then it began with sporadic midwifery home births of a few per year, which grew quite rapidly, especially with the impact of the Covid-19 virus pandemic, to about 100 out of a total of about 38,000 births that are performed annually in the Republic of Croatia in maternity hospitals. Since the start of planned home births many bad perinatal outcomes have been recorded in hospital maternity wards who have admitted women after such deliveries. These include puerperal sepsis, protracted labour of several days, neglected protracted labour with perinatal asphyxia and aspiration of meconium amniotic fluid and resuscitation of the newborn (who later developed cerebral palsy), severe postpartum haemorrhage with obstetric shock and postpartum hysterectomy, episiotomy infection, and stillbirth at term pregnancy. Therefore, planned home birth in Croatia should now be regarded as an unsafe birth in extraordinary circumstances and the person who takes charge of it must be professionally prepared, educated and have numerous social skills. Most Croatian gynaecologists and obstetricians give support to midwives in their efforts to be professional and independent when at work, including the controlled and legal implementation of the planned home birth. We unreservedly support self-aware midwives to maintain their profession as highly ethical and professional as possible above the wishes of non-professionals who call for autonomy, so that we do not have to discuss such problems of malpractice of Croatian midwifery in the 21st century.

Informed consent to midwifery practices and interventions during the second stage of labor-An observational study within the Oneplus trial.

To study informed consent to midwifery practices and interventions during the second stage of labor and to investigate the association between informed consent and experiences of these practices and interventions and women's experiences of the second stage of labor. This study uses an observational design with data from a follow-up questionnaire sent to women one month after giving birth spontaneously in the Oneplus trial, a study aimed at evaluating collegial midwifery assistance to reduce severe perineal trauma. The trial was conducted between 2018-2020 at five Swedish maternity wards and trial registered at clinicaltrials.gov, no NCT03770962. The follow-up questionnaire contained questions about experiences of the second stage of labor, practices and interventions used and whether the women had provided informed consent. Evaluated practices and interventions were the use of warm compresses held at the perineum, manual perineal protection, vaginal examinations, perineal massage, levator pressure, intermittent catheterization of the bladder, fundal pressure, and episiotomy. Associations between informed consent and women's experiences were assessed by univariate and multivariable logistic regression. Of the 3049 women participating in the trial, 2849 consented to receive the questionnaire. Informed consent was reported by less than one in five women and was associated with feelings of being safe, strong, and in control. Informed consent was further associated with more positive experiences of clinical practices and interventions, and with less discomfort and pain from interventions involving physical penetration of the genital area. The findings indicate that informed consent during the second stage is associated with feelings of safety and of being in control. With less than one in five women reporting informed consent to all practices and interventions performed by midwives, the results emphasize the need for further action to enhance midwives' knowledge and motivation in obtaining informed consent prior to performance of interventions.

Postpartum acute stress disorder symptoms, social support, and quality of couple's relationship associations with childbirth PTSD.

We aimed to examine the hypothesized negative associations between childbirth post-traumatic stress disorder (PTSD) symptoms (using the two-factor model of birth-related and general symptoms), social support, and a couple's relationship quality at 8-12 weeks postpartum. This analysis considered the longitudinal positive shared variance with acute stress disorder (ASD) symptoms measured shortly after birth, while accounting for obstetric and demographic variables. Participants included 246 mothers who gave birth at the maternity ward of a tertiary healthcare center. Self-report questionnaires were used 1-4 days postpartum (T1): Demographic information, the Birth Satisfaction Scale-Revised (BSS-R), and the National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS). At T2 (8-12 weeks postpartum), the Multidimensional Scale of Perceived Social Support (MSPSS), the Dyadic Adjustment Scale (DAS-7), and the City Birth Trauma Scale (BiTS). In partial support of our hypotheses, three hierarchical regression analyses revealed a significant positive contribution of ASD symptoms to childbirth PTSD general symptoms (β = .33, p <.001) and the total score (β=.29, p <.001), but not to birth-related symptoms. Social support (β = -.21, p = .003) and the quality of the couple's relationship (β=-.20, p = .003) showed negative associations with the BiTS general symptoms. Our study enhances understanding of the shared variance between childbirth ASD and PTSD, supporting the factor structure of general and birth-related symptoms as different aspects of childbirth PTSD and highlighting the negative association of social support and the quality of a couple's relationship with PTSD general symptoms, suggesting potential avenues for targeted interventions.

A roller coaster of emotions. A content analysis of experiences and evaluations of hospitalization after birth

BackgroundMost new parents spend the first few days with their newborns in the hospital. Problem: Although negative hospital care experiences can have short- and long-term negative consequences (e.g., risk of postnatal depression), only a handful of studies have investigated experiences of maternity care after birth. Aim of the studyThe aim was to gather more detailed information on the experiences during the immediate postpartum period at the maternity ward, in order to confirm and complement previous findings with additional data sources. MethodsA content analysis was conducted on 524 textual units comprising ratings of maternity care units in Germany provided by mothers or accompanying individuals. These units were sourced from a publicly accessible website. FindingsThe analysis identified three overarching themes that influenced positive or negative experiences: Hospital and Maternity Ward Infrastructure; Midwifery, Medical, and Nursing Care; and Breastfeeding and Establishing a Breastfeeding Relationship. DiscussionThe findings indicate systemic challenges within the medical system, including persistent issues such as staff shortages and overworked personnel. Additionally, critical primary support structures related to early parental mental health care and breastfeeding initiation were found to be lacking in certain hospitals. ConclusionThese results underscore the necessity for structural reforms within hospitals to establish a comprehensive prevention network capable of early problem detection and intervention.

Knowledge of Therapeutic Communication among Nurses in Maternal Wards at Hospital

Knowledge of Therapeutic Communication among Nurses in Maternal Wards at Hospital

Determinants of maternal near-miss among women admitted to public hospitals in the Hadiya zone, central Ethiopia: a case-control study

One of the Sustainable Development Goals of the United Nations is to bring the global maternal mortality ratio down to less than 70 per 100,000 live births by 2030. Therefore, pinpointing the factors that influence maternal near-misses would help expedite the accomplishment of this goal. Studies on these topics are, nevertheless, scarce in the Hadiya zone and throughout Ethiopia as a whole. Therefore, the purpose of this study was to determine the factors that contribute to maternal near-misses among women who are admitted to public hospital maternity wards in the Hadiya zone in central Ethiopia. A facility-based, unmatched case-control study was conducted from February 17 to August 16, 2019. The study covered all secondary and tertiary public healthcare facilities in the Hadiya zone, which includes three district hospitals and one referral hospital offering comprehensive emergency obstetric care services. The study included 279 women in total (70 cases and 209 controls). Mothers who had had a near-miss were the cases, and mothers who had not had one were the controls. The Statistical Package for Social Sciences version 24 was used to analyze the data, and the multivariable binary logistic regression model was used to control confounders. The odds ratios (OR) and 95% confidence intervals (CI) were used to determine statistical significance at a p-value of less than 0.05. Living in a rural area [adjusted OR (AOR)=3.16; 95% CI: 1.62, 6.16], no birth preparedness (AOR=3.50; 95% CI: 1.66, 7.41), ever gave birth by cesarean section (AOR=3.68; 95% CI: 1.63, 8.31), previous history of hypertension (AOR=3.69; 95% CI:1.52, 8.96), and poor knowledge of pregnancy danger signs (AOR=3.15; 95% CI: 1.32, 7.52) were all determinants of maternal near-miss. Thus, strengthened public health and clinical interventions in these arenas need to prioritize rural women and women with a previous history of hypertension.

Autonomy and Respect among Postnatal Mothers during Maternity Care in a Tertiary Level Hospital

Background: Lack of respectful maternity care act as more powerful deterrents to skilled birth care utilization than other more commonly recognized deterrents such as geographic and financial obstacles. Ensuring high level of respectful maternity care encourage the women to utilize facility-based care, which is essential for improving maternal and neonatal health. Thus, the objective of the study is to find out autonomy and respect during maternity care among the postnatal mothers in a tertiary level hospital. Methods: A descriptive cross-sectional study was conducted among 214 postnatal mothers receiving child birth services from the facility were selected by using non-probability purposive sampling technique. Analysis of data was done by using descriptive statistics (number, percentage, mean, standard deviation) and chi- square test was used for association between autonomy and respect and selected socio-demographic variables. Results: The study result indicated that (74.8%) of the respondents had high level of autonomy. Similarly, (71%) of the respondents reported that they experience high level of respect. A significant association was present between autonomy of postnatal mothers with caste (p=.027) and parity (p=.005) and a significant association was present between respect of postnatal mothers with type of delivery is with p value (.001). Conclusions: Hence, level of autonomy and respect tends to be high among postnatal mothers during maternity care and is associated with caste, parity and type of delivery. Continuous professional development programme for all cadres of health personnel should be conducted in respectful maternity care of maternity ward.

Awareness and practice regarding puerperal danger signs among postnatal mothers attending at rural tertiary care center of Nepal

Background: Global evidences show that all pregnancies are at risk and complications during pregnancy, childbirth, and the postnatal period are difficult to predict. Awareness regarding puerperal danger signs is essential for appropriate and timely health management so that maternal mortality and morbidity can be reduced. An objective of the study is to assess the awareness and practice regarding puerperal danger signs among postnatal mothers. Method: Descriptive cross-sectional study design was conducted among 139 postnatal mothers, who were attending at maternal and child health (MCH) clinic and postnatal ward of Karnali Academy of Health Sciences (KAHS), Jumla. Probability simple random sampling method was used. Data were collected by using semi-structured interview questionnaire. After collection of the data, coding was done. Coded data was entered into EXCEL and transformed in SPSS for analysis. Result: Out of 139 postnatal mothers, 60.4% had poor level of awareness regarding puerperal danger signs. Only 39.6% had good level of awareness regarding puerperal danger signs. Similarly, 85.6% of the respondents had poor practice on puerperal danger signs. Only 14.4% had good practice on puerperal danger signs. Conclusion: Health education &amp; awareness program is needed to improve the mother’s knowledge and practice on puerperal danger signs.

Growth charts for use at birth and in the neonatal period: Recommendations of the French Neonatal Society.

The use of different growth charts can lead to confusion in discussions between professionals. There are obstetric charts (of fetal growth) and neonatal charts (of measurements at birth and of postnatal growth). These charts can be descriptive (derived from an unselected population) or prescriptive (derived from of a population at low risk and with optimal conditions for growth). (1) To describe available charts for infants at birth and in the neonatal period and compare them, and (2) to recommend one or more charts for use in neonatology in France. Bibliographic research was conducted on MEDLINE and completed by the guidelines of professional societies. Antenatal information about fetal growth restriction or fetuses identified as small-for-gestational-age using Intrauterine charts must be integrated into the identification of newborns at risk, but the use of Intrauterine charts to evaluate birthweight is not recommended to allow consistency with postnatal charts used in neonatal practice. Z-score variations using the updated Fenton postnatal charts are the most appropriate for the assessment of birthweight and postnatal growth for infants born preterm. These charts are sex-specific, include the three measurements (length, weight, and head circumference) and enable longitudinal follow-up of growth up to 50 weeks of corrected age and are linked to the World Health Organization charts at term. The French Audipog charts, although are individualized, accessible online and can be used in maternity units to evaluate birthweight for term infants, but do not allow the follow-up of postnatal growth, while Fenton charts may be used to evaluate birthweight and postnatal growth in the first month for hospitalized term infants. The updated Fenton charts are the neonatal charts that best suit the objectives of pediatricians in France for monitoring the growth of preterm newborns. The use of the Audipog charts at term remains an alternative in maternity wards, while Fenton charts can be used for hospitalized term newborns.

COVID-19 related barriers to institutional childbirth during the early phase of the pandemic in rural Arsi zone, Ethiopia, 2022: A qualitative study

IntroductionGlobal, national, and local studies revealed that the COVID-19 pandemic has significantly reduced institutional childbirth. However, it is not well understood how the COVID-19 epidemic affected institutional childbirth service utilization. Therefore, this study aimed to evaluate COVID-19 related impediments to institutional childbirth service uptake during the early phase of the COVID-19 pandemic (March 20/2020–June 20/2020) in the rural Arsi zone of Ethiopia. MethodsA community-based Phenomenological study was conducted from January 10–25/2022, among mothers who gave birth in the Arsi zone during the early phase of the COVID-19 epidemic (March 20/2020–June 20/2020) in Ethiopia. Data was collected by the primary author and a university graduated Midwives with experience in qualitative data collection. Eight focus group discussions and six in-depth interviews were conducted among mothers who gave birth in selected rural areas of the Arsi zone during the early phase of the COVID-19 pandemic. Nine key informant interviews were also conducted among Midwives, Maternity Ward Heads, and Community Health Extension Workers. Data was transcribed, translated, and analyzed thematically using Atlas Ti.7 version. ResultsFour major themes and eleven sub-themes emerged regarding the barriers to institutional childbirth during the early phase of COVID-19 pandemic. The COVID-19 related fear was a reason for avoiding institutional childbirth for almost all participants. COVID-19 restrictions such as transportation bans, market bans and public transport price doubling were also critical concerns to seeking institutional childbirth. Perceived Poor quality of institutional childbirth care during the curfew was also an impeding factor. Poor communication, incomplete care components and absenteeism were mentioned under this theme. Unbalanced mass media tragedies and rumors of unknown sources were COVID -19 related infodemics found affecting the practice of institutional childbirth. ConclusionsCOVID-19 related fears, COVID-19 restrictions, Perceived Poor quality of care during the COVID-19 pandemic and the COVID-19 Infodemic were the main reasons for reduced institutional childbirth service utilization during the early phase of the COVID-19 pandemic in Ethiopia. Therefore, strategies must be designed proactively to maintain essential maternal health services, particularly institutional childbirth, during pandemics like COVID-19 and similar future epidemics.

Getting midwives back to hospitals: A discrete choice experiment

BackgroundThere is a severe global shortage of midwives, and the situation worsens when qualified professionals leave their jobs because of inadequate working conditions. Hospitals have increasing difficulties in filling vacancies for midwives. In the case of Germany, midwives tend to give up birth assistance after an average of seven years working in delivery rooms, which are usually led by physicians. ObjectiveWe aim to provide concrete recommendations on encouraging qualified professionals to work in maternity wards by examining the job preferences of midwives who currently do not provide such services. These insights shall help policy makers and hospital managers to fill vacancies more quickly and provide adequate care to more women. DesignDiscrete choice experiment. Setting(s)Online survey promoted through email and social media to midwives in Germany. Participants415 midwives participated; we examine the subgroup of 241 midwives who do not offer birth assistance. MethodsWe obtain individual parameter estimates through a multinominal logit analysis with hierarchical Bayes estimation techniques, calculate importance weights, and simulate uptake probabilities of different hypothetical job offers that include birth assistance. ResultsParticipants want to provide birth assistance but fiercely reject doing so under physicians' supervision. With a 15 % increase in income, however, 16 % would accept this least preferred setting. Forty-four percent, however, would choose to offer birth assistance if they could work in a midwife-led unit. An additional increase in income of 5 % (15 %) could even lead to uptake probabilities of 67 % (77 %). ConclusionsThere is a common understanding that midwife-led care is a safe and effective option for healthy women. Policy makers are advised to further extend their initial support for such units to fill vacancies quicker and enable comprehensive healthcare for more childbearing women. Tweetable abstractMidwife-led units help counter shortages: Midwives want to provide birth assistance but reject doing so under physicians' supervision.

"I could not find the strength to resist the pressure of the medical staff, to refuse to give commercial milk formula": a qualitative study on effects of the war on Ukrainian women's infant feeding.

During emergencies, breastfeeding protects infants by providing essential nutrients, food security, comfort, and protection and is a priority lifesaving intervention. On February 24, 2022, the war in Ukraine escalated, creating a humanitarian catastrophe. The war has resulted in death, injuries, and mass internal displacement of over 5 million people. A further 8.2 million people have taken refuge in neighboring countries, including Poland. Among those impacted are infants and young children and their mothers. We conducted a study to explore the infant feeding challenges and needs of Ukrainian women affected by the war. We conducted a qualitative descriptive study involving in-depth interviews (IDIs) with 75 war-affected Ukrainian mothers who had at least one infant aged less than 12 months at the time of the interview. Eligible mothers were either (1) living as Ukrainian refugees in Poland, having crossed the border from Ukraine on or after February 24, 2022, when the war started (n = 30) or (2) living in Ukraine as internally displaced persons or as residents in the community (n = 45). All interviews were audio-recorded (either transcribed or had responses summarized as expanded notes) and analyzed using qualitative thematic analysis using a two-step rapid analysis process. Participants in Ukraine who wanted to initiate breastfeeding right after birth faced opposition from healthcare workers at maternity hospitals. Ukrainian refugees who gave birth in Poland faced language barriers when seeking breastfeeding support. Half of the participants in Ukraine received commercial milk formula (CMF) donations even if they said they did not need them. Most respondents stated that breastfeeding information and support were urgently needed. Our data suggests that healthcare workers in Ukrainian maternity hospitals require additional training and motivation on delivering breastfeeding support. In addition, lactation consultants in maternity ward are needed in Ukraine, and interpretation support is needed for refugees to overcome language barriers. There is a need to control the indiscriminate donations of commercial milk formula and to ensure that complementary foods and commercial milk formula are available to those that need it. This study confirms the need for actions to ensure infant and young child feeding (IYCF) support is provided during emergencies.

Maternal Bacille Calmette-Guérin Scars and Mortality Risk for Male and Female Newborns: Observational Study From Guinea-Bissau.

Maternal priming with bacille Calmette-Guérin (BCG) has been associated with reduced mortality in male offspring. We investigated this association in a cohort of healthy BCG-vaccinated neonates. This observational study within a randomized controlled trial comparing different BCG strains was conducted in Guinea-Bissau from 2017 to 2020. As part of trial inclusion procedures, on the day of discharge from the maternity ward, maternal BCG scar status was evaluated by visual inspection, followed by offspring BCG and polio vaccination. Through mortality data collected at telephone interviews at 6 weeks and 6 months of age, we assessed all-cause mortality risk in Cox proportional hazards models adjusted for maternal schooling and BCG strain, providing adjusted mortality rate ratios (aMRRs). In total, 64% (11 070/17 275) of mothers had a BCG scar, which was not associated with admission risk, admission severity, or all-cause mortality for females and the overall sample. By 6 months of age, the mortality rate (MR) was 4.1 (200 deaths/4919 person-years) for the maternal BCG scar cohort and 5.2 (139/2661) for no maternal scar (aMRR, 0.86; 95% Confidence Interval [CI], .69-1.06). In males, 6-month MRs were 4.3 (109 deaths/2531 person-years) for maternal BCG scar vs 6.3 (87/1376) for no scar (aMRR, 0.74; 95% CI, .56-.99). In females, 6-month MRs were 3.8 (91 deaths/2388 person-years) vs 4.0 (52/1286), respectively (aMRR, 1.04; 95% CI, .74-1.47; for interaction with sex, P = .16). While we cannot rule out an association in females, being born to a mother with a BCG scar reduced the risk of death during early infancy for BCG-vaccinated males, reproducing findings from previous studies.

Knowledge and attitude of spouses of puerperas towards breastfeeding

ObjectiveTo investigate the extent of knowledge about breastfeeding and attitudes towards infant feeding among spouses of puerperas at the time of discharge from hospital, and explore the factors influencing spousal attitudes toward breastfeeding.MethodsWe conducted a questionnaire survey among 204 spouses of puerperas who were admitted in the maternity wards at a tertiary hospital in Shaanxi Province between October 2021 and December 2021. Respondents who fulfilled the inclusion criteria were identified using convenient sampling.Results(1) The score of breastfeeding knowledge among spouses prior to discharge from the hospital was (10.56 ± 3.78), with an accuracy rate of 59.6%, and the lowest accuracy rate was for Item 1 “Newborns should be fed on time, not on demand” (42.6%) and Item 5 “Breastfeeding can prevent infant rickets” (49.5%). (2) The average score of spouses’ infant feeding attitudes was (58.15 ± 5.55), and the lowest scoring was for Item 17 “Daily urine volume of infants is a reliable indicator to judge whether they get enough breast milk” (1.99 ± 1.14). (3) Generalized linear model analysis showed a more positive attitude (higher score) among spousal attitudes towards infant feeding in those who had received breastfeeding education [OR = 4.588, 95% CI (0.160 ∼ 3.598)] and those with a master’s degree or above [OR = 18.278, 95% CI (3.471 ∼ 9.346)].Conclusion(1) Spouses that received breastfeeding education and those that had a Masters Degree and above had more positive attitude towards infant feeding. (2) Medical staff should focus on puerperas’spouses with degrees below master’s level who had not received breastfeeding education. We recommend using a variety of education methods to enable them to acquire more knowledge on breastfeeding and develop a more positive attitude towards breastfeeding, which will further enhance spousal support for breastfeeding, thus positivizing postpartum co-parenting attitudes and improving the rate of exclusive breastfeeding.