Maternity Healthcare Professionals Research Articles

Maternity health care professionals' views and experiences of fetal genomic uncertainty: A review.

The field of prenatal screening and diagnosis for fetal anomalies has been marked by a rapid succession of technological advances, including most notably, chromosomal microarray analysis, and next generation sequencing. Despite the diagnostic advantages of these technologies, their incorporation into prenatal testing has created additional challenges of revealing genomic variants of unknown or uncertain significance, and secondary findings. While detailed posttest counseling about uncertain variants is best performed by medical geneticists, many of the screening and diagnostic tests that lead to this information are actually ordered by general maternity health care professionals (HCPs), such as obstetricians, midwives, and family physicians. Maternity HCPs support pregnant women through to the conclusion of their pregnancy and the postpartum period, and thus are close observers of the psychosocial impart of fetal genomic uncertainty on women and their families. While there have been many studies exploring the handling of genomic uncertainty by genetics HCPs, there has been relatively less attention paid to maternity HCPs without speciality training in genetics. This review explores the current literature surrounding nongenetic maternity HCPs' views and experiences of genomic uncertainty and returning uncertain results in the prenatal setting.

Healthcare professionals\u2019 perceptions and experiences of using a cold cot following the loss of a baby: a qualitative study in maternity and neonatal units in the UK

BackgroundBest practice in perinatal bereavement care suggests offering parents the opportunity to spend time with their baby. Cold cots facilitate this purpose by reducing the deterioration of the body and evidence indicates their wide availability in maternity and neonatal units in the UK. This study aimed to examine healthcare professionals’ perceptions and experiences of using a cold cot following the loss of a baby.MethodsA qualitative cross-sectional study was designed. In-depth, semi-structured interviews were conducted with 33 maternity and neonatal unit healthcare professionals who worked across three UK hospital settings. Data were analysed using inductive reflexive thematic analysis.ResultsFindings revealed that staff had predominantly positive views about, and experiences of, using a cold cot. The technology was highly valued because it facilitated parents to spend time with their baby and participants reported that it was generally easy to use and smoothly embedded into the clinical environment. Cold cots were deemed useful when mothers were medically unwell and needed time to recover, when parents struggled to say goodbye to their baby, wished to take the baby home, or wanted their baby to stay in the unit instead of going straight to the mortuary. The use of technology was further perceived to be relevant in scenarios of unexpected loss, post-mortem examination and with babies of late gestations or neonates. Despite staff expressing comfort with the delay of visual and olfactory body changes, the coldness of the baby’s body that was accelerated with the use of a cold cot was a major concern as it connoted and possibly exacerbated the reality of death.ConclusionsCold cots allow the materialisation of modern bereavement care practices that recognise the importance of continuing bonds with the deceased that is made possible through the creation of memories within an extremely restricted timeframe. Simultaneously, the body coldness concentrates the ambivalence toward an inherently paradoxical death, that of a baby. Training in perinatal bereavement care, including the use of cold cots, would help staff support bereaved parents whilst acknowledging dilemmas and managing contradictions encompassed in death at the time or near the time of birth.

Antenatal and Postpartum Depression: Prevalence and Associated Risk Factors among Adolescents' in KwaZulu-Natal, South Africa.

Background Maternal depression is a major public health concern as it affects both mothers and their children. Antenatal depression, which is often underdiagnosed, has been associated with preterm labour, low birth weight, and intrauterine growth restriction. Research has demonstrated that postpartum depression is associated with mother-infant bonding impairment, child abuse, child neglect, maternal substance abuse, and self-harm. Globally, the prevalence of depression in pregnant and postpartum adolescents varies. This paper reports on the findings of the prevalence of depression and its associated risk factors among pregnant and postpartum adolescents in KwaZulu-Natal, South Africa. Methods Data were generated by means of a descriptive cross-sectional study that was conducted between June and November 2017 utilizing a sample of 326 adolescent females accessing maternal health services in a medium-sized rural peripheral district hospital in Ugu, Southern KwaZulu-Natal. The Edinburgh Postnatal Depression Scale questionnaire was used to screen participating pregnant and postnatal adolescents for depression. A cut-off score of ≥13 was used to identify pregnant and postnatal adolescents with symptoms of depression. The data were analysed using R software. Results The prevalence of depression among the pregnant participants was 15.9% (21/132), whereas it was 8.8% (17/194) among the postpartum participants. Antenatal depression was associated with physical violence (adjusted odds ratio (aOR) 6.47, 95% CI 1.36-30.53, p = 0.01) and verbal abuse (adjusted odds ratio (aOR) 4.8, 95% CI 1.5-15.16, p = 0.006). The pregnant participants who indicated they received a lot of support from their partners were 0.93% less likely to have depression. Postnatal depression was associated with physical violence (adjusted odds ratio (aOR) 7.32, 95% CI 1.66-29.44, p = 0.005), verbal abuse (adjusted odds ratio (aOR) 4.3, 95% CI 1.03-15.79, p = 0.03), and intimate partner violence (adjusted odds ratio (aOR) 9.58, 95% CI 1.58-48.82, p = 0.008). Conclusion The prevalence of antenatal depression was higher than postpartum depression in the study sample. In light of the findings, maternal healthcare professionals are cautioned to consider the mental health of pregnant and postpartum adolescents who seek their services at health facilities.

Acceptance of e-Learning Programs for Maternity Health Care Professionals Implemented by the Italian Obstetric Surveillance System.

Distance learning efficacy on physician performances and patient health outcomes has been demonstrated. This study explored the participation and evaluation of CME e-learning courses for Italian health care professionals addressing leading causes of maternal mortality identified by the Italian Obstetric Surveillance System (ItOSS) at the Italian National Health Institute, namely postpartum hemorrhage and pregnancy hypertensive disorders. A model for two online free 12-hour case-based training courses was used. Data on participants were collected, anonymized, and transferred to the Italian National Health Institute for later analysis. Participants were requested to sign an online informed consent form. Twenty-one thousand five hundred thirty-two health care professionals enrolled to the courses from 2014 to 2017 as follows: midwives (14,187, 65.9%); obstetricians (3,716, 17.2%); anesthesiologists (1,896, 8.8%); and other medical specialists (1,733, 8.0%). Overall, 85% of participants acquired CME credits. Participants' satisfaction on quality, efficacy, and relevance was very high. ItOSS courses were able to reach a substantial number of different professional profiles involved in perinatal care all over the country; ItOSS courses can be considered an effective way to spread evidence-based good clinical practices. Nevertheless, further studies are needed to verify the improvement in professional health care skills and patient outcomes.

Precautionary Principle: Cancer Prevention Efforts During Critical Periods of Growth and Development.

Although the mechanisms of action for all cancer types are not fully known, best practice recommends promoting a healthy lifestyle while avoiding certain substances. Based on environmental science, the precautionary principle is a guideline that suggests that preventive action should be taken when the effects of a substance are unknown or disputed. Oncology nurses and maternal child healthcare professionals can improve cancer prevention through efforts during pregnancy, childhood, adolescence, and adulthood. This article reviews the application of the precautionary principle during critical periods of growth and development and provides recommendations that may prevent epigenetic changes and reduce the risk for cancer.

Maternal health care for refugee women in Germany: A qualitative approach on the interaction level

Abstract Background In the recent past, the number of forcibly displaced people increased worldwide. About 1/3 of the persons seeking asylum in Germany are female. The majority of all refugee women who are coming to Germany are currently of childbearing age. Refugee women are considered a highly vulnerable refugee subgroup, as they frequently experience physical strains and psychological burdens while fleeing their home countries and being pregnant at the same time. Moreover, pregnancy and the following period require specialized care and support in order to allow a transition to maternity without complications. The aim of this project is to analyze maternal health care services for refugee women on the level of interaction with maternal health care professionals in Germany. Methods Maternal health care professionals in outpatient and clinical settings with experiences of caring for refugee women were recruited. Semi-structured interviews were conducted. The interviews are currently analyzed following the standards of qualitative thematic analysis. Results Maternal health care professionals experience challenges in executing particular maternal health care actions, such as taking the medical history where there is no communication possible or performing examinations where there is no or little privacy (e.g. in camps). In addition there are changes in tasks, which are no subject to originally maternal health care, such as organizing translation and transportation. Furthermore they face a shortage of resources (e.g. translators, time), which constrains them to find solutions on an individual level. Conclusions Maternal health care professionals provide maternal health care to refugee women under special circumstances (e.g. communication barriers, discontinuity of care). As there are limited resources (e.g. translators, time) they develop solutions and strategies on an individual level. Key messages Challenges and opportunities are disclosed by examining maternal health care professionals’ actions. Maternal health care improves through understanding maternal health care professionals’ strategies.

The Impact of Refugee Women’s Accommodation on Maternal Health Care Provision

Abstract Background About 1/3 of the persons seeking asylum in Germany are female. The majority of all refugee women in Germany are currently of childbearing age. The maternity period requires specialized care. Maternal health care professionals monitor the physiological processes of maternity and the psychosocial well-being in order to allow an uncomplicated transition to maternity. On arriving in Germany there are different types of accommodation for refugee women: 1) shared reception centers (e.g. tents, containerbuildings, gyms), 2) collective shelters for particularly vulnerable refugees and 3) private apartments. Depending on the woman’s accommodation maternal health care professionals are confronted with different situations and conditions in providing care for these women. The aim is to analyze the impact of refugee women’s accommodation on maternal health care provision and professional’s actions. Methods Structured expert interviews were conducted with maternal health care professionals. The interviews were analyzed following the standards of qualitative thematic analysis with a special focus on refugee women’s accommodation and its impact on maternal health care provision. Results The accommodation situation does impact the provision of maternal health care as well as the actions and doings of maternal health care professionals. On the one hand there is a change in tasks, which are no subject to original maternal health care, such as organizing transportation. On the other hand there are challenges in actually executing particular maternal health care actions, such as taking the medical history or performing examinations where there is no or little privacy. Conclusions Accommodation conditions impact maternal health care provision in various ways. Therefore an enhancement of housing for refugee women may improve maternal health care provision and therefore maternal health for refugee women.

Determinants of influenza and pertussis vaccination uptake in pregnancy: a multi-centre questionnaire study of pregnant women and healthcare professionals

BackgroundUptake rates of influenza and pertussis vaccination in pregnancy remain suboptimal.AimTo determine the acceptability of routine vaccination among pregnant women; the confidence of maternity healthcare professionals (HCPs) discussing vaccination; and HCP opinion with regards to the optimum healthcare site for vaccine administration.MethodSeparate questionnaires for pregnant women and maternity HCPs were distributed within four NHS trusts in South England from July 2017–January 2018.ResultsResponses from 314 pregnant women and 204 HCPs (18% obstetricians, 75% midwives [both hospital and community], 7% unidentified) were analysed. Actual/intended uptake of influenza and pertussis vaccination was 78% and 92%, respectively. The commonest reason for declining vaccination was feared side effects for their child. White British women (79%) were significantly more accepting of influenza (odds ratio [OR] 3.25, 95% confidence interval [CI] = 1.67 to 6.32) and pertussis vaccination (OR 4.83, 95% CI = 1.77 to 13.19) compared with non-white British women. Among HCPs, 25% were not-at-all or slightly confident discussing vaccination. Obstetricians felt significantly more confident discussing pertussis vaccination than midwives (OR 2.05, 95% CI = 1.02 to 4.12). Among HCPs, 53%, 25%, and 16% thought vaccines should be administered in primary care (general practice), community midwifery, and the hospital setting, respectively.ConclusionMisconceptions exist regarding safety and efficacy of maternal vaccination, and framing information towards safety for the child may increase uptake. Education of HCPs is essential, and vaccine promotion should be incorporated into routine antenatal care, with an emphasis on women from ethnic minorities. Administration of vaccines in primary care may present a logistical barrier to women, however support for alternative sites appears low among HCPs.

Determinants of Influenza and Pertussis Vaccination Uptake in Pregnancy: A Multicenter Questionnaire Study of Pregnant Women and Healthcare Professionals.

Uptake rates of antenatal vaccination remain suboptimal. Our aims were to determine (1) the acceptability of routine vaccination among pregnant women, (2) the confidence of maternity healthcare professionals (HCPs) discussing vaccination and (3) HCP opinion regarding the optimum healthcare site for vaccine administration. Separate questionnaires for pregnant women and HCPs were distributed within 4 national health service (NHS) trusts in South England (July 2017 to January 2018). Responses from 314 pregnant women and 204 HCPs (18% obstetricians, 75% midwives, 7% unidentified) were analyzed. Previous/intended uptake of influenza and pertussis vaccination was 78% and 92%, respectively. The commonest reason for declining vaccination was feared side effects for their child. White British women (79%) were significantly more accepting of influenza [85% vs. 61%; odds ratio (OR) 3.25; 95% confidence interval [CI], 1.67-6.32] and pertussis vaccination (96% vs. 83%; OR 4.83; 95% CI: 1.77-13.19) compared with nonwhite British women. Among HCPs, 25% were slightly or not at all confident discussing vaccination. Obstetricians felt significantly more confident discussing pertussis vaccination than midwives (68% vs. 55% were very/moderately confident; OR 2.05; 95% CI: 1.02-4.12). Among HCPs, 53%, 25% and 16% thought vaccines should be administered in primary care (general practice), community midwifery and in hospital, respectively. Misconceptions exist regarding safety/efficacy of antenatal vaccination, and framing information towards the child's safety may increase uptake. Education of HCPs is essential, and vaccine promotion should be incorporated into routine antenatal care, with an emphasis on women from ethnic minorities. Administration of vaccines in primary care presents logistical barriers; however, support for alternative sites appears low among HCPs.

Prenatal bed rest in developed and developing regions: a systematic review and meta-analysis.

Bed rest is prescribed by most maternity health care professionals for high-risk pregnancy complications, but the impact of bed rest at home and in hospital has not been explored. Our aim was to quantify the influence of bed rest on maternal/fetal health outcomes in developed and developing regions. We conducted a systematic review and meta-analysis of randomized controlled trials. We conducted a structured search through MEDLINE, Embase, CINAHL, Web of Science and the Cochrane Library through Mar. 7, 2019. Trials comparing standard care to standard care plus bed rest after 20 weeks' gestation were assessed. Outcomes included infant birth weight, being small for gestational age, gestational age, premature or very premature birth, perinatal death, admission to the neonatal intensive care unit, preterm rupture of membranes, hypertensive disorders of pregnancy, preeclampsia and gestational diabetes mellitus. We identified 1191 publications, of which 43 were assessed for eligibility. Sixteen publications reporting on 14 unique studies (2608 women, 3328 infants) were included in the analysis. Overall, maternal/newborn outcomes were similar between women on bed rest and those not on bed rest. In subgroup analyses of developed and developing regions, length of gestation was shorter with bed rest (weighted mean difference -0.77 wk, 95% confidence interval [CI] -1.26 to -0.27, I 2 = 0%), and the risk of a very premature birth was increased (risk ratio 2.07, 95% CI 1.15 to 3.73, I 2 = 0%) in developed countries. In developed regions, treatment of complicated pregnancies with more than 1 week of bed rest results in worse newborn outcomes. Additional studies are required to determine whether bed rest or hospital admission improves outcomes in developing regions. PROSPERO Trial registration number: CRD42018099237.

Influenza and pertussis vaccination in pregnancy: Portrayal in online media articles and perceptions of pregnant women and healthcare professionals

IntroductionOnline media may influence women’s decision to undergo vaccination during pregnancy. The aims of this mixed-methods study were to: (1) examine the portrayal of maternal vaccination in online media and (2) establish the perceived target of vaccine protection as viewed by pregnant women and maternity healthcare professionals (HCPs). MethodsOnline media articles on maternal vaccination (published July-December 2012 or November 2015-April 2016) were identified through the London School of Hygiene & Tropical Medicine’s Vaccine Confidence Database and thematically analysed. Questionnaires for pregnant women and HCPs were distributed within four English hospitals (July 2017-January 2018). ResultsOf 203 articles identified, 60% related to pertussis vaccination, 33% to influenza and 6% both. The majority positively portrayed vaccination in pregnancy (97%), but inaccurate, negative articles persist which criticize pertussis vaccination’s safety and efficacy. Positively-worded articles about pertussis tended to focus on infant protection and highlight examples of recent cases, whereas positively-worded articles about influenza focused on maternal protection. These themes were reflected in questionnaire responses from 314 pregnant women and 204 HCPs, who perceived pertussis vaccination as protecting the baby, and influenza vaccination as protecting the mother, or mother and baby equally. A minority of the pregnant women surveyed intended to decline influenza (22%) or pertussis (8%) vaccination. ConclusionsThe majority of online articles support pertussis and influenza vaccination during pregnancy. The portrayal of pertussis vaccination as primarily benefiting the child, using real-examples, may influence its higher uptake compared with influenza. This approach should be considered by HCPs when recommending vaccination. HCPs should be prepared to provide advice to women hesitant about vaccination, including addressing any negative media, and consider educational strategies to counteract inaccurate information. Future studies should directly assess the influence of media on vaccine decision-making and establish which media platforms are typically used by pregnant women to gather information.

Complementary and herbal supplement use in pregnancy: recommendations and information sources of maternity healthcare professionals

Complementary and herbal supplement use in pregnancy: recommendations and information sources of maternity healthcare professionals

Breastfeeding after Gestational Diabetes: Does Perceived Benefits Mediate the Relationship?

Introduction. Breastfeeding is recognized as one of the best ways to decrease infant mortality and morbidity. However, women with gestational diabetes mellitus (GDM) may have breastfeeding barriers due to the increased risk of neonatal and pregnancy complications. While the prevalence of GDM is increasing worldwide, it is important to understand the full implications of GDM on breastfeeding outcomes. The current study aims to investigate the (1) direct effect of GDM on breastfeeding duration and (2) indirect effect of GDM on breastfeeding duration through perceived benefits of breastfeeding. Methods. Prospective cohort data from the Infant Feeding and Practices Study II was analyzed (N = 4,902). Structural equation modeling estimated direct and indirect effects. Results. Perceived benefits of breastfeeding directly influenced breastfeeding duration (β = 0.392, p ≤ 0.001). GDM was not directly associated with breastfeeding duration or perceived benefits of breastfeeding. Similarly, GDM did not have an indirect effect on breastfeeding duration through perceived benefits of breastfeeding. Conclusions. Perceived benefits of breastfeeding are an important factor associated with breastfeeding duration. Maternal and child health care professionals should enhance breastfeeding education efforts.

Attitudes towards antenatal vaccination, Group B streptococcus and participation in clinical trials: Insights from focus groups and interviews of parents and healthcare professionals

IntroductionAntenatal vaccination has become a part of routine care during pregnancy in the UK and worldwide, leading to improvements in health for both pregnant women and their infants. However, uptake remains sub-optimal. Other antenatal vaccines targeting major neonatal pathogens, such as Group B streptococcus (GBS), the commonest cause of sepsis and meningitis in the neonatal period, are undergoing clinical trials but more information is needed on how to improve acceptance of such vaccines. MethodsQualitative study using focus groups and interviews; involving 14 pregnant women, 8 mothers with experience of GBS, and 28 maternity healthcare professionals. Questions were asked regarding antenatal vaccines, knowledge of GBS, attitudes to a potential future GBS vaccine and participation in antenatal vaccine trials. ResultsAll participants were very cautious about vaccination during pregnancy, with harm to the baby being a major concern. Despite this, the pregnant women and parents with experience of GBS were open to the idea of an antenatal GBS vaccine and participating in research, while the maternity professionals were less positive. Major barriers identified included lack of knowledge about GBS and the reluctance of maternity professionals to be involved. InterpretationIn order for a future GBS vaccine to be acceptable to both pregnant women and the healthcare professionals advising them, a major awareness campaign would be required with significant focus on convincing and training maternity professionals.

Perceptions of labour pain management of Dutch primary care midwives: a focus group study.

BackgroundLabour pain is a major concern for women, their partners and maternity health care professionals. However, little is known about Dutch midwives’ perceptions of working with women experiencing labour pain. The aim of this study was to explore midwives’ perceptions of supporting women in dealing with pain during labour.MethodsWe conducted a qualitative focus group study with four focus groups, including a total of 23 midwives from 23 midwifery practices across the country. Purposive sampling was used to select the practices. The constant comparison method of Glaser and Straus (1967, ren. 1995) was used to gain an understanding of midwives’ perceptions regarding labour pain management.ResultsWe found two main themes. The first theme concerned the midwives’ experienced professional role conflict, which was reflected in their approach of labour pain management along a spectrum from “working with pain” to a “pain relief” approach. The second theme identified situational factors, including time constraints; discontinuity of care; role of the partner; and various cultural influences, that altered the context in which care was provided and how midwives saw their professional role.ConclusionMidwives felt challenged by the need to balance their professional attitude towards normal birth and labour pain, which favours working with pain, with the shift in society towards a wider acceptance of pharmacological pain management during labour. This shift compelled them to redefine their professional identity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0795-6) contains supplementary material, which is available to authorized users.

Interventions to change maternity healthcare professionals' behaviours to promote weight-related support for obese pregnant women: a systematic review.

BackgroundThere has been a rapid increase in the publication of guidelines for managing obesity and weight gain during pregnancy over the past five years. Healthcare professionals have identified multiple barriers to this area of practice, including the need to improve their communication skills, beliefs that pregnant women will have negative reactions to weight-related discussions, and a lack of weight management knowledge. This systematic review aimed to identify: the effectiveness of interventions in changing healthcare professionals’ practice relating to maternal obesity or weight management during pregnancy; and which behaviour change techniques and modes of intervention delivery have been used in interventions to date.FindingsThe search strategy included searching electronic databases, trial registers, and citation searching. Inclusion criteria were intervention studies targeted towards changing healthcare professionals’ practice in relation to maternal obesity or weight management. The searches identified 3,608 studies. However, no eligible completed studies were identified. One registered Canadian randomised controlled trial was identified. The trial includes a training intervention for family physicians with the aim of supporting adherence to gestational weight gain guidelines. The trial had not yet commenced therefore no effectiveness data were available.ConclusionsThe current focus of maternal obesity and weight management research is targeted towards changing pregnant women’s behaviours. These interventions do not address the multiple healthcare professionals’ barriers to maternal obesity and weight management practice. Further research is required to identify the most effective approaches to support healthcare professionals to implement maternal obesity and weight management guidelines into practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0097-9) contains supplementary material, which is available to authorized users.

Majority of women are influenced by nonprofessional information sources when deciding to consult a complementary and alternative medicine practitioner during pregnancy.

Up to 87% of women are using some form of complementary and alternative medicine (CAM) during their pregnancy, and this study was conducted to investigate the information sources that these women find influential in relation to such use. The study sample was obtained via the Australian Longitudinal Study on Women's Health. This article is based on a substudy of 1835 pregnant women who were surveyed in 2010. The women answered questions about CAM use, pregnancy-related health concerns, and influential information sources in relation to CAM use. Logistic regression models were used to determine the information sources that women reported as influential in their decision making regarding CAM use. Of the respondents (n=1835, 79.2% response rate), 48.1% (n=623) of the pregnant women consulted a CAM practitioner and 91.7% (n=1485) used a CAM product during pregnancy. The results show that, of the women who used CAM, nearly half (48%, n=493) were influenced by their own personal experience of CAM and 43% (n=423) by family and friends. Other popular sources of information were general practitioners 27% (n=263), the media (television, radio, books, magazines, newspapers) 22% (n=220), obstetricians 21% (n=208) and midwives 19% (n=190). Numerous statistically significant associations between influential information sources and pregnancy-related health conditions were identified. Women utilize a wide variety of information sources regarding their CAM use during pregnancy. Nonprofessional sources of information were found to be particularly influential, and maternity health care professionals need to have a nonjudgmental and open discussion with women about their CAM use during pregnancy in order to ensure safe and effective maternal outcomes.

Trauma-Informed Care With Childhood Maltreatment Survivors: What Do Maternity Professionals Want to Learn?

BACKGROUND: Posttraumatic stress disorder (PTSD) affects 8% of pregnant women, and the biggest risk factor for pregnancy PTSD is childhood maltreatment. The care they receive can lead to positive outcomes or to retraumatization and increased morbidity. The purpose of this study is to gather information from a range of clinicians about their continuing education needs to provide perinatal care to women with a maltreatment history and PTSD.METHOD: Maternity health care professionals were interviewed by telephone. Network sampling and purposive sampling were used to include physicians, nurse practitioners, midwives, nurses, and doulas (n = 20), and results were derived from content analysis.RESULTS: Most providers received little or no training on the issue of caring for women with a history of childhood maltreatment or PTSD during their original education but find working with this type of patient rewarding and wish to learn how to provide better care. Providers identified a range of educational needs and recommend offering a range of formats and time options for learning.CONCLUSIONS: Maternity health care providers desire to work effectively with survivor moms and want to learn best practices for doing so. Thus, educational programming addressing provider needs and preferences should be developed and tested to improve care experiences and pregnancy outcomes for women with a history of trauma or PTSD.

Organisation of maternity care and choices of mode of birth: A worldwide view

Drawing on the findings from a Cochrane systematic review of midwife-led care vs. other models of maternity care, this article discusses maternity organisation of care, women's choice of mode of birth and a global trend in reducing normality of childbirth.The review included 11 trials involving 12,276 women. The results showed that women who received models of midwife led care were less likely to experience fetal loss before 24 weeks' gestation, less likely to have regional analgesia, less likely to have instrumental birth, less likely to have an episiotomy (with no significant differences in perineal lacerations), and were more likely to be attended at birth by a known midwife, more likely to have a spontaneous vaginal birth, initiate breast feeding and more stated to feel in control. In addition, their babies were more likely to have a shorter length of hospital stay. No statistically significant differences were observed in fetal loss/neonatal death of at least 24 weeks or in overall fetal/neonatal death between women who were allocated to the midwifery led care and those in the medical led care. In light of these findings, the interrelationship between social organisation of maternity care, philosophy of care and choice is explored using case examples with high and low rates of caesarean section rates. A worldwide overview of vaginal birth and caesarean section rates as indicators of normality (and lack of it) is also presented. Questions are raised with regard to the fast growing rate of caesarean section rates particularly among middle income countries. The rate of caesarean section is twice as much in private settings compared to public hospitals in these countries.In conclusion, the importance of sharing good practice among countries with particular attention to social location of midwifery, mobilisation of consumer groups as well as education of maternity health-care professionals and women, in facilitation of an effective ‘informed choice’, is highlighted. Areas for further global research on factors, which may influence women's choice of mode of birth are debated.

Maternal health care professionals' perspectives on the provision and use of antenatal and delivery care: a qualitative descriptive study in rural Vietnam

BackgroundHigh quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam.MethodThe study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis.ResultTwo main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment.ConclusionContextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and reduce their possibility to make independent decisions about their own reproductive health. This issue should be further addressed by policy-makers. Strategies to reduce inequities in maternal health care for pregnant women are needed. The quality of client-provider interaction and management of pregnancy may be strengthened by education, human resources, re-training and provision of essential equipment.