Maternity Care System Research Articles

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

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

The meaning of obstetric violence experiences: A qualitative content analysis of the Break the Silence Campaign

BackgroundObstetric violence involves the mistreatment, disrespect, and abuse of birthing people and the problem has been recognized in healthcare systems worldwide. Obstetric violence is a gendered, sex-specific form of violence against women that is a public health problem and a violation of human rights. There are an unknowable number of online posts and social media messages that describe obstetric violence experiences. There are no known studies about self-published experiences of obstetric violence in the US maternity care system. ObjectiveTo understand the meaning of obstetric violence experiences in the US maternity care system from a naturally occurring, purposive sample. DesignA secondary analysis of the textual data from the original Break the Silence social media campaign using qualitative content analysis. The theory of social justice in nursing provided a theoretical framework. A healthcare systems approach was used for a wide-angle view of the multidirectional structure, processes, and outcome of obstetric violence. SettingThe study setting is the public Facebook page where the Break the Silence social media campaign can be seen. Break the Silence was an online activism response to the problem of obstetric violence in the US maternity care system with signboard messages posted from 31 known US states. The setting is bounded by the digital page where the campaign is published. ParticipantsThere were 139 participants, and 11 of them posted more than one signboard message. Most participants were birthing people (n = 125) followed by doulas (n = 10). MethodsKrippendorff's methodology for qualitative content analysis was applied to 156 signboard messages posted on Break the Silence from 2014 to 2016. Qualitative content analysis was supported by Atlas.ti 23. ResultsFour themes illustrated the meaning of obstetric violence in US maternity care: 1) pregnancy and birth as a battle with healthcare providers and the healthcare system, 2) sacrifice of the maternal body normalized and assumed as a gender stereotype, 3) disrupted rites of passage from childbirth, and 4) abuse of fiduciary power by healthcare providers. ConclusionsThis study demonstrated thematic meanings for the experience of obstetric violence in US maternity care with a healthcare systems approach that included structural and organizational considerations to increase understanding. Categories and forms of obstetric violence from the existing literature were expanded and strengthened by findings from this study. Themes were validated in principle with consistency in findings across the international evidence base on obstetric violence.Tweetable abstract: The meaning of #obstetricviolence experiences is interpersonal and structural with thematic consistency across international studies.

South Asian women’s views on and experiences of maternity care services in Hong Kong: A qualitative study

BackgroundHealth disparities among ethnic minority and migrant women can lead to adverse maternal and neonatal outcomes. This study explores the maternity care experiences of South Asian women in Hong Kong, providing insights for woman-centred and culturally responsive care in the East Asia. ObjectiveTo understand South Asian women’s views and experiences regarding maternity care services in Hong Kong. MethodsA qualitative descriptive study was conducted with 20 English-speaking South Asian women who had used maternity care services in Hong Kong within the past 5 years. Data were analysed by thematic analysis. FindingsFour themes were identified: 1) Comparing maternity care services in their home country versus Hong Kong; birth location, mode of birth and care. 2) Navigating Hong Kong maternal medical care system; including private public dual care and learning information from other South Asians. 3) The discrepancy in perception of optimum care; including a preferring for assistance with daily tasks, epidural anaesthesia, doctor-led care, and priority to infants’ health. 4) The impact of the COVID-19 pandemic on maternity care experiences, including the cancellation of translation services and limited visiting hours. DiscussionSouth Asian appreciate Hong Kong’s public maternity services due to its perceived greater cost-effectiveness. The major incongruence between expectations and services provided being women-staff communication. ConclusionThe quality of healthcare in Hong Kong is appreciated. Individualized care should be offered to cater to diverse needs. Improvements in staff attitude and provision of detailed information should help alleviate feelings of differential treatment.

Working in smaller teams in community midwifery practices to foster continuity of carer: Midwives’ experiences – A qualitative study in the Netherlands

BackgroundMidwife-led continuity of carer (MLCC) improves health outcomes and increases pregnant women’s satisfaction. Working in smaller teams in community midwifery practices is one of the ways to promote continuity of carer. AimTo gain insight into the experiences of Dutch community midwives regarding working in smaller teams, by identifying motivators and barriers. MethodsA qualitative study was conducted using individual, semi-structured interviews (n=9). The sample was purposively selected. The interviews were analysed using the Abbreviated Grounded Theory. FindingsFour themes were identified: 1) Ideal implementation of working in smaller teams, 2) Best care for pregnant women, 3) Conflicts with the current maternity care system, 4) Personal interests of the midwife. The core concept connecting all themes was midwives’ experiences of an 'inner conflict' regarding working in smaller teams. ConclusionA strong motivation for working in smaller teams is the wish to provide the best care for pregnant women through offering more continuity of carer. The structure of maternity care, financially and organisationally, acts as a barrier in the transition to working in smaller teams. How community midwives manage these motivators and barriers depends on their personal interests, vision, and personal life. The balance between the motivators and barriers can create an inner conflict among the midwives. This inner conflict encompasses an ethical issue: what is the best care and what is it worth? A discussion within the professional group concerning the practical and ethical aspects of working in smaller teams is needed to find ways to reduce the inner conflict of community midwives who wish to work in smaller teams, thereby promoting the implementation of MLCC.

Burden of multiple high-risk factors in pregnancy before and after the universal two-child policy in Chinese women: An observational study.

The prevalence of high-risk pregnancy increased after the implementation of two-child policy in China, but the impact of this policy change on the burden and profile of multiple high-risk factors in pregnancy (MHFP) has been insufficiently explored. We hypothesised that the profile of MHFP might have changed after the two-child policy was implemented and aimed to estimate the prevalence, intercorrelation, and outcomes of MHFP before and after its introduction. We obtained data on the population of pregnant women before (2015) and after (2020/2021) the implementation of universal two-child policy in Huai'an. We then included 33 risk factors in our analysis based on the Five-Colour Management framework and defined MHFP as an individual having two or more of these factors. We also estimated the changes of the prevalence of each single factor and their coexistence. Lastly, we performed a network analysis to assess the intercorrelations across these factors and used logistic regression models to evaluate MHFP-related pregnancy outcomes. We observed an increase in the prevalence of MHFP after the implementation of the universal two-child policy (25.8% in 2015 vs 38.4% in 2020/2021, P < 0.01). Chronic conditions (e.g. gestational diabetes mellitus, abnormal body mass index) had the largest increase among the included factors, while cardiovascular disease and hypertensive disorders were central factors of the network structures. The correlations of advanced maternal age with abnormal pregnancy histories and scarred uteri increased significantly from 2015 to 2020/2021. MHFP was associated with multiple pregnancy outcomes, including preterm birth (adjusted odds ratio (aOR) = 2.57; 95% confidence interval (CI) = 2.39-2.75), low birthweight (aOR = 2.77; 95% CI = 2.54-3.02), low Apgar score (aOR = 1.41; 95% CI = 1.19-1.67), perinatal death (aOR = 1.75; 95% CI = 1.44-2.12), and neonatal death (aOR = 1.76; 95% CI = 1.42-2.18). Moreover, an increasing number and certain combinations of MHFP were associated with higher odds of pregnancy outcomes. For example, the aOR of preterm birth increased from 1.67 (95% CI = 1.52-1.87) for one risk factor to 8.03 (95% CI = 6.99-9.22) for ≥4 risk factors. Chinese women experienced a higher burden of multiple high-risk factors after the introduction of the two-child policy, particularly those with advanced maternal age, obesity, and chronic conditions. Strategies targeting chronic conditions for women with MHFP should be prioritised and a shift to a multiple-factor-oriented framework is needed in the expanding Chinese maternal health care system.

African Immigrant Women's Experiences of Maternity Care in the United States.

The purpose of this study was to explore maternity care experiences of African immigrant women during the perinatal period including factors affecting access to and use of care. We used Sandelowski's (2010) qualitative descriptive approach to examine how African immigrant women from various countries of origin and with diverse ethnic backgrounds experienced and navigated the maternity care system in the United States during pregnancy and childbirth. We conducted semi-structured interviews with 15 African immigrant women living in the Columbus, Ohio area. Participants were recruited using purposive and snowball sampling between February 2021 and May 2021. Interviews were recorded, transcribed, and analyzed using a reflexive thematic analysis approach. Four major themes defined the experiences of our study participants: access to information, patient-clinician relationships, experiences of discrimination, and costs of maternity care. Findings highlight key barriers to providing quality and acceptable maternity care to African immigrant women at multiple levels. This group's unique barriers underlie the importance of incorporating their diverse experiences into maternity care models and clinical practice. Further research is needed to evaluate and improve maternity care for African immigrant women.

TYPES AND STRUCTURE OF SURGICAL DISEASES IN NEWBORNS ACCORDING TO DATA FROM A REGIONAL CENTER

Reducing perinatal morbidity and mortality is one of the main tasks of the maternal and child health care system. Congenital anomalies contribute significantly to these indicators and occupy leading positions in terms of prevalence. According to the World Health Organization, 25% of newborns are born with developmental defects. In light of this data, increasing the efficiency of early medical care and reducing growth and development-related disorders in newborns is crucial. Congenital anomalies of the digestive tract occupy a primary place, corresponding to 21.7%-25%. Currently, perinatal studies of the problem of mother and child with congenital digestive tract anomalies are considered separately, which is significant for perinatal diagnostics, the ability to predict congenital digestive tract anomalies, and determining tactics. This is of great importance for both pediatricians and surgeons. As a first step in creating a system for assessing and improving medical services provided to the younger generation, it is important to optimize medical care for newborns with surgical diseases.

Pregnancy experiences of transgender and gender-expansive individuals: A systematic scoping review from a critical midwifery perspective.

Evidence suggests that transgender and gender-expansive people are more likely to have suboptimal pregnancy outcomes compared with cisgender people. The aim of this study was to gain a deeper understanding of the role of midwifery in these inequities by analyzing the pregnancy experiences of transgender and gender-expansive people from a critical midwifery perspective. We conducted a systematic scoping review. We included 15 papers published since 2010 that reported on pregnancy experiences of people who had experienced gestational pregnancy at least once, and were transgender, nonbinary, or had other gender-expansive identities. Three themes emerged from our analysis: "Navigating identity during pregnancy," "Experiences with mental health and wellbeing," and "Encounters in the maternal and newborn care system." Although across studies respondents reported positive experiences, both within healthcare and social settings, access to gender-affirmative (midwifery) care and daily social realities were often shaped by trans-negativity and transphobia. To improve care outcomes of transgender and gender-expansive people, it is necessary to counter anti-trans ideologies by "fixing the knowledge" of midwifery curricula. This requires challenging dominant cultural norms and images around pregnancy, reconsidering the way in which the relationship among "sex," "gender," and "pregnancy" is understood and given meaning to in midwifery, and applying an intersectional lens to investigate the relationship between gender inequality and reproductive inequity of people with multiple, intersecting marginalized identities who may experience the accumulated impacts of racism, ageism, and classism. Future research should identify pedagogical frameworks that are suitable for guiding implementation efforts.

Women’s experiences of remote video calls with a labour ward midwife during early labour

BackgroundIn an increasingly strained maternity care system with a shortage of midwives and great demands for service, pregnant women in their early labour are at risk of receiving insufficient support. Women make calls and visit the labour ward on multiple occasions before being admitted. A video call with a labour ward midwife during early labour is an unknown practice but could support pregnant women and their partners during this uncertain period. AimThe study aimed to describe women’s experiences of remote video calls with a labour ward midwife during early labour. MethodsA qualitative study comprising nine semi-structured interviews followed by an inductive thematic analysis was conducted. ResultsThe results revealed that video calls prepared women and their partners by means of practical support. They received an assessment of early labour and the interaction with labour ward midwives prepared them for the impending birth. The participants reported feeling secure and strengthened by being met at their current stage of labour. Furthermore, they found the service accessible, easy to use and emphasised the need for increased availability and continuity. ConclusionThis study highlights the positive impact of video calls in early labour when conducted by competent labour ward midwives. The perceived accessibility and ease of use e-health system underscore a demand for extended availability. These findings indicate the potential benefits of integrating video calls in labour care to enhance support, security, accessibility and overall satisfaction for pregnant women and their partners.

Listening to Black Women's Perspectives of Birth Centers and Midwifery Care: Advocacy, Protection, and Empowerment.

Black women in Texas experience high rates of adverse maternal outcomes that have been linked to health inequities and structural racism in the maternal care system. Birth centers and midwifery care are highlighted in the literature as contributing to improved perinatal care experiences and decreased adverse outcomes for Black women. However, compared with White women, Black women underuse birth centers and midwifery care. Black women's perceptions in Texas of birth center and midwifery care are underrepresented in research. Thus, this study aimed to highlight the views of Black women residing in Texas on birth centers and midwifery care to identify their needs and explore ways to increasing access to perinatal care. Semistructured interviews were conducted with 10 pregnant and postpartum Black women residing in Texas. Questions focused on the women's access, knowledge, and use of birth centers and midwifery care in the context of their lived maternal care experiences. Interview transcripts were reviewed and analyzed using inductive, qualitative content analysis. The Black women interviewed all shared experiences of discrimination and bias while receiving obstetric care that affected their interest in and overall perceptions of birth center and midwifery care. Participants also discussed financial and institutional barriers that impacted their ease of access to birth center and midwifery care services. Additionally, participants highlighted the need for culturally sensitive and respectful perinatalhealth care. The Black women interviewed in this study emphasized the prevalence of racism and discrimination in perinatal health care encounters, a reflection consistent with current literature. Black women also expressed a desire to use birth centers and midwifery care but identified the barriers in Texas that impede access. Study findings highlight the need to address barriers to promote equitable perinatal health care access for Black women.

Maintaining A Long-Term Practice of Daily Pelvic Floor Muscle Exercises: What Do Childbearing Women Think?

To be effective, pelvic floor muscle therapy (PFMT) exercises should be intense, be practiced consistently, and include clinical support. Many women do not adhere to a consistent PFMT program, compromising the resolution or prevention of urinary incontinence (UI). This study aimed to answer 2 key questions: What prevents women from performing PFMT long term, and what can health care providers do to support women to perform them? Postpartum women from 4 sites in the United States completed a questionnaire about experiences with PFMT or Kegel exercises during and after pregnancy. This study focused on one of the 7 open-ended questions: What would prevent you from performing Kegels lifelong? Thematic analysis was implemented via an inductive approach using Braun and Clarke's 6-phase process. Three salient themes emerged that help explain factors that prevent women from adhering to a daily PFMT routine: (1) life gets in the way, (2) inadequate PFMT education and instruction, and (3) disconnect exists about long-term consequences. The sample included 368 participants. The themes were congruent with the limited body of qualitative literature on experience with PFMT exercises. This study was able to identify areas of need in the US maternal health care system to help childbearing people adopt daily PFMT, such as (1) inadequate parental leave and childcare support, (2) no formalized education related to UI and PFMT and a lack of pelvic health promotion, (3) lacking prioritization of long-term PFMT, and (4) the need to dispel the acceptance that UI postbirth is normal. Health care providers should prioritize interactive education, emphasizing how to correctly perform PFMT and the importance and effectiveness of integrating clinical support. To adequately encompass pelvic floor health care and education up to one year postbirth, changes are needed to the US perinatal health care system, providing sufficient insurance reimbursement and parental social support programs.

Racializing Motherhood and Maternity Care in News Representations of Breastfeeding.

Racial inequalities in breastfeeding have been a U.S. national concern, prompting health science research and public discourse. Social science research reveals structural causes, including racism in labor conditions, maternity care practices, and lactation support. Yet research shows that popular and health science discourses disproportionately focus on individual and community factors, blaming Black women and communities for unequal breastfeeding rates. This study examines how scientific reports are communicated to the public through a critical analysis of 104 U.S. news articles reporting research on racial disparities in breastfeeding. Findings show that articles acknowledge unequal treatment within maternity care but justify it by presenting Black patients as overburdening the maternity care systems they use due to low socioeconomic status, welfare dependency, poor family support, and poor health. Through these representations, articles co-construct racialized motherhood and maternity care systems in ways that hide manifestations of obstetric racism and combat social support for systemic change.

Attuning to the World of Peace of Mind and Trust: Women's Lived Experience of the Woman-Midwife Relationship in Japan.

In Japan, many pregnant women and mothers suffer from anxiety, depression, and other postnatal issues that can be exacerbated by their birth experiences. While benefiting from advanced medical care, these women's mental and psychological health may be disregarded in their maternity care. Midwives have the potential to play a significant role in improving women's birth experiences. Hence, this study aimed to explore the meaning of the woman-midwife relationship, with a specific focus on sensing peace of mind and trust to improve women's birth experiences. Using a hermeneutic phenomenological approach, 14 Japanese women were interviewed. Sensing peace of mind and trust was one of the significant meanings of the woman-midwife relationship and is articulated across five themes: (1) attuning to the world, (2) different kinds of safety and trust, (3) relying on and entrusting midwives, (4) making a mother, and (5) an emotional bridge. The positive relationship with midwives enhanced the women's mental well-being through allowing the women to attune to the peaceful mind which directed their future perspectives and sustained them in motherhood. They became confident mothers by trusting their midwives. The maternity care system in Japan needs to shift to more relationship-based care to ensure continuity of midwifery care that will improve women's birth experiences and their long-term well-being.

Obstetric outcomes and uptake of care among 149 non-Swedish speaking migrant women attending a birth preparation visit during pregnancy – An observational study from Sweden

IntroductionIn Sweden almost one third of the population is born in another country and a large number of the women who do not speak Swedish are of reproductive age. Women migrating from low-income countries have higher risks for poor obstetric outcomes than receiving country-born citizens. INFOR (a Swedish word for “before” or “ahead of”) is an intervention offering language-assisted, individual birth preparation for non-Swedish speaking pregnant women unfamiliar with the maternity care system. The aim of this study was to describe the uptake of care and obstetric outcomes among non-Swedish speaking migrant women attending INFOR. MethodsA descriptive study of the obstetric outcomes and uptake of care was conducted of the 149 non-Swedish speaking pregnant women who participated in INFOR between 2016 and 2020. The data were accessed retrospectively from the medical record system Obstetrix and the population-based Swedish Pregnancy Registry and analysed descriptively. ResultsWomen participating in INFOR originated from 44 countries and spoke 35 different languages. During late pregnancy, 20 percent of the women sought care for decreased fetal movements and 80 percent of the women attended the postpartum visit. While the majority of the participants were offered professional language support during pregnancy, almost none had a professional interpreter present during labour and birth. After birth, 80 percent of the primiparous women were asked to rate their birth experience, but only half of the multiparous women were asked. Further, only half of the primiparous women attending the postpartum visit were asked about their self-rated health. ConclusionINFOR may increase uptake of some important aspects of care during pregnancy, birth and postpartum among migrants of diverse backgrounds. The findings raise concerns however about communication support for migrant women, especially during labour and birth. The offer of professional interpreting as part of standard maternity care for women who need it is essential and must be improved in order to provide equitable care for all.

Integrating international policy standards in the implementation of postnatal care: a rapid review

IntroductionInternational legal and political documents can assist policy-makers and programme managers in countries to create an enabling environment to promote maternal and newborn health. This review aimed to map and...

Integration of maternity care as a part of social welfare and health care reform in Finland

Introduction: The vertical integration of primary and specialized care has been identified as a key challenge internationally. In Finland, 23 wellbeing services counties will be responsible for organizing integrated social and health care of primary and specialized care starting 2023. Primary maternity care services are offered in antenatal clinics. Specialized care is offered at 23 maternity hospitals including specialized ante- and postnatal care and childbirth. Specialized maternity care has been burdened due to the ever-increasing number of visits and the insufficient information flow between primary and specialized care. In some wellbeing services counties, services have already been integrated, but no information is available whether this integration has improved processes, outcomes or customer satisfaction. &#x0D; Aims and methods: The first aim is to investigate whether there are differences in maternity care service processes, outcomes and customer satisfaction between the wellbeing services counties. The second aim is to find out perceptions of maternity care managers about the integration of maternity care. Three data sets will be used: the Finnish Medical Birth Register data on all newborns in Finland in 2021 (N=49 726), FinChildren survey on parents with 3-6 months old babies (N=14 820) and qualitative thematic interview among maternity care managers (N=8). All data have been collected and analysis of register and survey data is ongoing. Interview data have been analyzed. &#x0D; Highlights: There are differences in the outcomes and customer satisfaction between the wellbeing services counties. However, more detailed data analyses are needed by adjusting for the most evident confounders and comparing the counties with integrated care to the other counties. These results will be presented at the conference. Maternity care managers felt that the structures within maternity care together with organizational boundaries pose a challenge to integration. Political decision-making was considered to have an influence on maternity care structures. Furthermore, more expertise in maternity care was expected from policy makers to support decision-making. Shared maternity care structure, management, and information systems were seen as factors promoting integration. A partial ambiguity or overlap in the roles between maternity clinics and maternity care at hospitals was observed, as well as inter-professional tensions between public health nurses who are working on primary maternity care and midwives who are working both in primary and specialized maternity care.&#x0D; Conclusions: The maternity care system should be more integrated in terms of governance structures, resources, and management. The expertise of maternity care professionals should be utilized in a customer-oriented and cost-effective way. More conclusions will be drawn after finalizing the quantitative analyses.&#x0D; Implications: New models of integrated maternity care should be developed, paying attention to the optimal continuity of care from the perspective of pregnant mothers and families. The results of this study can be used to develop the maternity care systems in different countries.&#x0D;

Reflexive dialogues of multidisciplinary care professionals and clients as part of the development of integrated maternity care: bridging perspectives, building resilience

Background: Limitations of traditional structures and approaches in the health care system to further enhance patient safety, satisfaction and systemic sustainability, are becoming increasingly visible. Amplifying resilience is considered important to defy these issues in the complex adaptive system that health care has become. There is increasing recognition that embedding reflexive learning would contribute to realizing this. However, health care organizations are still reticent, and struggling with whether and how this could be implemented in health care practice. Through participatory action research (PAR), we aimed to develop a method with and for professionals and clients in maternity care, to systematically reflect on daily care practice and explore potential improvements, while balancing their values, interests and perspectives. &#x0D; Methods: To improve quality of care, two groups of multidisciplinary and multiorganizational maternity care professionals and clients (n=30) from two regions in the Netherlands, participated in ‘reflexive learning meetings’. Cases from participants’ own practice were discussed, with a Safety-2 approach and using the functional resonance analysis method (FRAM) to explore variability in everyday performance. 22 meetings took place from 2020-2022, mostly online, supported by an independent chairperson and two researchers. Additionally, 22 participants were interviewed. All data were audio recorded, transcribed and thematically analyzed. Stakeholders (maternity care professionals, clients and managers from the participating regions) were engaged in all stages of the project; from the initial design, through constant monitoring and until the project evaluation and development of an ‘Intervision Toolkit’ to share lessons learned and practical tools with the field.&#x0D; Findings: Although critical about working with the FRAM, participants were generally positive about the meetings and Safety-2 approach. Learning from everyday care practice instead of adverse events (common in Safety-1) was considered valuable and motivating. Barriers for partaking predominantly related to organizational and systemic impediments, especially high workload and lacking support from superiors. In the meetings, participants felt psychologically safe and challenged to critically reflect on their own and each other’s care practices. Through this, insight in and understanding of alternative perspectives and approaches grew, as well as awareness of interpersonal and interorganizational similarities. This fostered mutual relationships and job satisfaction, and helped to discover potential for further alignment. Although implementing improvements beyond the individual level proved difficult within the time frame and context of the study, participants became more conscious of their acting and decision-making habits, which in turn stimulated them to experiment with alternatives and share new insights with colleagues and peers. Evaluating the project, participants articulated the wish to continue and embed multidisciplinary and multiorganizational reflexive meetings as standard practice in maternity care. Some initiated actions to contribute to realizing this.&#x0D; Conclusions: This study indicates that reflexive dialogues between multidisciplinary and multiorganizational professionals and clients foster alignment, quality, people centeredness and resilience in maternity care. By structurally stimulating, facilitating and embedding such meetings, their transformative potential could be further unleashed and reinforce the development of an integrated and sustainable maternity care system.

Influence of Covid-19 Pandemic on Prenatal Care Utilization and Birth outcome - Qualitative Systematic Review Protocol

The COVID pandemic disrupted routine prenatal care, yet little is known about expectant mothers’ experiences during this time. This qualitative systematic review aims to synthesize evidence on the experiences, views and impact of COVID on prenatal care utilization and birth outcomes. A systematic search is conducted in 5 databases and Google Scholar. Studies providing qualitative data on pregnant women’s experiences accessing prenatal care during COVID are included. Methodological quality is assessed using CASP and thematic synthesis is used to analyse the data. Even among these patients from affluent backgrounds, those who responded to the survey stated that the pandemic had significantly disrupted many parts of their daily lives and medical care, especially regarding social activities and postpartum support. Our findings make it clear that, in addition to increased support from healthcare systems, counseling on coping mechanisms and stressor adaptation techniques should be a part of perinatal care during public health emergencies for everyone. Results have provided an in-depth understanding of pregnant women’s experiences with barriers and facilitators to prenatal care during COVID, and the impact on maternal and neonatal outcomes. This review has identified recommendations to improve prenatal care access and quality during future health crises, contributing to more resilient and equitable maternity care systems.

Economic and Social Implications of Negative Population Growth

With the rapid development of China’s socioeconomic status, the increasing life quality, and the changing attitudes on marriage and childbearing among people of childbearing age, China has entered an era of negative population growth since 2022. Although China has introduced various policies to encourage births since 2013, the number of births has not increased as expected, but has declined rapidly. Looking back at the historical trend of population change in some developed countries, population decline is an “inevitable” process that many countries have to go through in the process of social and economic development. For China, after more than 30 years of its one-child policy, its population situation has some unique features. Although the willingness of young couples to have children is declining and the number of births is decreasing, there are significant problems such as advanced pregnancy, infertility, and childbearing after caesarean section, which in turn pose a threat to the health of mothers and children and lead to heavy medical burdens. Therefore, how to improve the treatment effectiveness and safety of infertility, the quality of maternal and child health care and the ability to treat high-risk maternal and foetal complications are major issues that China’s maternal and child health care system has to face and deal with urgently.

Assessment of Organ Dysfunction and Underlying Causes in Maternal Near-miss Cases at Health Care Facilities in Doiwala Block of District Dehradun - A Retrospective Study.

The extent of maternal morbidity is a good gauge of a nation's maternal health care system. Maternal near-miss (MNM) cases need to be reviewed because they can indirectly contribute significantly to reducing the maternal mortality ratio in India. MNM cases can provide useful information in this context. Such women who survive these life-threatening conditions arising from complications during pregnancy, childbirth and post partum (42 days) share many commonalities with those who die because of such complications. To assess the organ dysfunction and the underlying causes, associated/contributory factors associated with "maternal near-miss" cases in pregnant, in labor, post-partum women (upto42 days) in the health care facilities of Doiwala block, district Dehradun. The present study was conducted over a period of 6 months under the Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh. The cross-sectional study included the medical record files of all pregnant women attending the Department of Obstetrics and Gynecology, in the selected healthcare facilities of Doiwala block, district Dehradun. This study was conducted as per the WHO criteria for "near-miss" by using convenience sampling for the selection of healthcare facilities. The medical record files of all women who were pregnant, in labor, or who had delivered or aborted up to 42 days were included from a period of 01.06.2021 - 31.05.2022. It was found that Out of the women with maternal near-miss (n=91), the majority of women had coagulation /hematological dysfunction (n=45, 49.4%), followed by neurologic dysfunction (n=15, 16.4%), cardio-vascular dysfunction (n=11, 12%). Out of the total women with a maternal near-miss (n = 91), 10 women underwent multiple organ dysfunctions. Of the total 91 maternal near-miss cases, the underlying cause of near-miss was obstetric hemorrhage in almost half the participants (n=45, 49.5%) followed by hypertensive disorders (n=36, 39.5%). Eleven women had a pregnancy with abortive outcomes (12%) and 7 women had pregnancy-related infection. It was also seen that, out of 91 near-miss women, the leading contributory /associated cause was Anemia (n=89, 97.8%) followed by women having a history of previous cesarean section (n=63, 69.2%). Sixteen women had prolonged /obstructed labor (n = 16, 17.58%). Pregnancy should be a positive experience for every woman of childbearing age. A better understanding of pregnancy-related conditions enables early detection of complications and prevents the conversion of mild to moderate maternal morbidity outcomes to severe maternal outcomes with long-term health implications or death. There are already effective measures in place to reduce maternal and newborn mortality and morbidity.