Maternity Providers Research Articles

Pendampingan Posyandu Kenanga Melalui Peningkatan Literasi Kesehatan Ibu Balita sebagai Upaya Penurunan Stunting di Desa Meteseh, Kecamatan Boja, Kabupaten Kendal

Stunting is a national program that involves specific and sensitive interventions in it. Activities carried out by cadres are still limited to registering, weighing, measuring length/height, filling out KMS and distributing PMT. Infrastructure facilities at the Posyandu Kenanga are still very limited. The measurement of the body length of toddlers who cannot stand only uses a cloth meter. This will affect the measurement results in the process of monitoring the growth and development of children under five. The purpose of this service activity is to provide education about stunting to improve maternal health literacy and provision of posyandu infrastructure facilities in the form of nameplates and digital baby scales. As a result, from around 54 mothers of children under five who participated in posyandu activities, 24 of them were successfully assessed for pretest and posttest scores. There was an increase in the knowledge score from 73 to 79 with an average of 3,042 increasing to 3,291. The value of the Gain Score calculation shows that the average value of N Gain Score for the experimental class (lecture method) is 12.76% which is included in the ineffective category. The handover of nameplates and digital baby scales is expected to improve the function and role of the posyandu.

Local adaptation in the transgenerational response to copper pollution in the bryozoan Bugula neritina.

Transgenerational plasticity (TGP)-when a parent or previous generation's environmental experience affects offspring phenotype without involving a genetic change-can be an important mechanism allowing for rapid adaptation. However, despite increasing numbers of empirical examples of TGP, there appears to be considerable variation in its strength and direction, yet limited understanding of what causes this variation. We compared patterns of TGP in response to stress across two populations with high versus low historical levels of stress exposure. Specifically, we expected that exposure to acute stress in the population experiencing historically high levels of stress would result in adaptive TGP or alternatively fixed tolerance (no parental effect), whereas the population with low levels of historical exposure would result in negative parental carryover effects. Using a common sessile marine invertebrate, Bugula neritina, and a split brood design, we exposed parents from both populations to copper or control treatments in the laboratory and then had them brood copper-naïve larvae. We then exposed half of each larval brood to copper and half to control conditions before allowing them to grow to maturity in the field. Maternal copper exposure had a strong negative carryover effect on adult offspring growth and survival in the population without historical exposure, especially when larvae themselves were exposed to copper. We found little to no maternal or offspring treatment effect on adult growth and survival in the population with a history of copper exposure. However, parents from this population produced larger larvae on average and were able to increase the size of their larvae in response to copper exposure, providing a potential mechanism for maintaining fitness and suggesting TGP through maternal provisioning. These results indicate that the ability to adjust offspring phenotype via TGP may be a locally adapted trait and potentially influenced by past patterns of exposure.

The Role of Maternal Grandmothers' Childcare Provision for Korean Working Adult Daughters.

Despite the Korean government's investment in childcare facilities for dual-earner households, maternal grandmothers are increasingly taking on the responsibility of caring for their grandchildren. This trend is examined in the current research. While many studies have been conducted on grandparents' experiences providing childcare for their grandchildren, significantly less research has been conducted on adult daughters' experiences with their mothers' childcare provision. This study utilized the concepts of intergenerational solidarity and a life-course approach to understand the experiences of 24 working adult daughters in Korea (ages 30-43) whose mothers provide childcare. Three major themes were identified following a grounded theory approach: gratitude vs. guilt, dependence vs. independence, and closeness vs. disagreement. The results indicated that adult daughters were found to have ambivalence toward their mothers, reflecting the lack of alternative options for childcare. The results from this study suggest that not only improving the quality of public childcare services, but also diversifying services to reflect the needs of dual-income families.

The emergence and development of behavioral individuality in clonal fish

Behavioral individuality is a ubiquitous phenomenon in animal populations, yet the origins and developmental trajectories of individuality, especially very early in life, are still a black box. Using a high-resolution tracking system, we mapped the behavioral trajectories of genetically identical fish (Poecilia formosa), separated immediately after birth into identical environments, over the first 10 weeks of their life at 3 s resolution. We find that (i) strong behavioral individuality is present at the very first day after birth, (ii) behavioral differences at day 1 of life predict behavior up to at least 10 weeks later, and (iii) patterns of individuality strengthen gradually over developmental time. Our results establish a null model for how behavioral individuality can develop in the absence of genetic and environmental variation and provide experimental evidence that later-in-life individuality can be strongly shaped by factors pre-dating birth like maternal provisioning, epigenetics and pre-birth developmental stochasticity.

How It All Begins: Bacterial Factors Mediating the Colonization of Invertebrate Hosts by Beneficial Symbionts.

Beneficial associations with bacteria are widespread across animals, spanning a range of symbiont localizations, transmission routes, and functions. While some of these associations have evolved into obligate relationships with permanent symbiont localization within the host, the majority require colonization of every host generation from the environment or via maternal provisions. Across the broad diversity of host species and tissue types that beneficial bacteria can colonize, there are some highly specialized strategies for establishment yet also some common patterns in the molecular basis of colonization. This review focuses on the mechanisms underlying the early stage of beneficial bacterium-invertebrate associations, from initial contact to the establishment of the symbionts in a specific location of the host's body. We first reflect on general selective pressures that can drive the transition from a free-living to a host-associated lifestyle in bacteria. We then cover bacterial molecular factors for colonization in symbioses from both model and nonmodel invertebrate systems where these have been studied, including terrestrial and aquatic host taxa. Finally, we discuss how interactions between multiple colonizing bacteria and priority effects can influence colonization. Taking the bacterial perspective, we emphasize the importance of developing new experimentally tractable systems to derive general insights into the ecological factors and molecular adaptations underlying the origin and establishment of beneficial symbioses in animals.

The effect of the capitation policy withdrawal on maternal health service provision in Ashanti Region, Ghana: an interrupted time series analysis

BackgroundPayment methods are known to influence maternal care delivery in health systems. Ghana suspended a piloted capitation provider payment system after nearly five years of implementation. This study aimed to examine the effects of Ghana’s capitation policy on maternal health care provision as part of lesson learning and bridging this critical literature gap.MethodsWe used secondary data in the District Health Information Management System-2 and an interrupted time series design to assess changes in level and trend in the provision of ANC4+ (visits of pregnant women making at least the fourth antenatal care attendance per month), HB36 (number of hemoglobin tests conducted for pregnant women who are at the 36th week of gestation) and vaginal delivery in capitated facilities-CHPS (Community-based Health Planning and Services) facilities and hospitals.ResultsThe results show that the capitation policy withdrawal was associated with a statistically significant trend increase in the provision of ANC4+ in hospitals (coefficient 70.99 p < 0. 001) but no effect in CHPS facilities. Also, the policy withdrawal resulted in contrasting effects in hospitals and CHPS in the trend of provision of Hb36; a statistically significant decline was observed in CHPS (coefficient − 7.01, p < 0.05) while that of hospitals showed a statistically significant trend increase (coefficient 32.87, p < 0.001). Finally, the policy withdrawal did not affect trends of vaginal delivery rates in both CHPS and hospitals.ConclusionsThe capitation policy in Ghana appeared to have had a differential effect on the provision of maternal services in both CHPS and hospitals; repressing maternal care provision in hospitals and promoting adherence to anemia testing at term for pregnant women in CHPS facilities. Policy makers and stakeholders should consider the possible detrimental effects on maternal care provision and quality in the design and implementation of per capita primary care systems as they can potentially impact the achievement of SDG 3.

Measure to improve: Is there a patient-acuity measurement tool suitable for use in maternity service provision in the Netherlands? A systematic review.

Background and AimsIt is difficult to overestimate the importance of safe staffing levels within the context of effective, quality healthcare. Poor staffing has been cited as a contributory factor in the number of unnecessary hospital deaths. This is particularly so in maternity care, where poor staffing has been inexorably linked to avoidable perinatal and maternal mortality. In the Netherlands, maternity service provision (MSP) is stratified into primary (community)‐ and secondary (hospital)‐based care. While most midwives (71%) work in primary care, the majority are self‐employed or work in small group practices. Where women birth at home, one‐to‐one care during labor is the norm. However, despite the existence of a national standard for birth‐related care, which states unequivocally that women birthing in hospitals should (also) receive one‐to‐one care, while in labor this is not always the case. The extent of compliance with the national care standard has until now not been the subject of scrutiny. We aim to identify evidence for the use of patient‐acuity measurement tools (PAMTs) in MSP to explore the extent of one‐to‐one care for women birthing in hospitals in the Netherlands and select and/or modify a valid PAMT suitable for use in maternity units in hospitals in the Netherlands to assess to what extent the quality standard of one‐to‐one care for birthing women is being met.MethodsIn this systematic literature review, all citations are first screened for title and abstract, then full text for suitability of inclusion.ResultsThree studies were identified for inclusion in the review. One PAMT is recommended.ConclusionOne PAMT suitable for use in maternity service was identified. However, the evidence level for use is low. Nevertheless, in view of the unique nature of midwifery service provision, a PAMT specifically developed for use in maternity service is preferable.

How to stay attached-Formation of the ricefish plug and changes of internal reproductive structures in the pelvic brooding ricefish, Oryzias eversi Herder et al.(2012) (Beloniformes: Adrianichthyidae).

Teleost fishes show an enormous diversity of parental care, ranging from no care to viviparity with maternal provisioning of embryos. External brooders carry their developing eggs attached to their bodies. This requires the formation of novel morphological structures to support attachment. The pelvic brooding ricefish Oryzias eversi evolved such a structure, called the "plug."The plug anchors attaching filaments from the fertilized eggs inside the female reproductive system, allowing the female to carry the embryos until hatching. Using histological sections and µ-computed tomography scanning, we show that the plug is formed by several types of interstitial cells, blood capillaries, and collagen fibrils that encapsulate the end of the attaching filaments in the anterior part of the gonoduct. Even 15 days after the loss of the protruding attaching filaments, the plug remains. In addition, the developed plug contains multinucleated giant cells that are derived from fusing macrophages. We thus hypothesize that the ricefish plug, which is vital for egg attachment in O. eversi, evolved due to an inflammatory reaction. We assume that it forms similar to a foreign body granuloma, as a reaction to irritation or injury of the gonoduct epithelium by the attaching filaments. Our study further corroborates that pelvic brooding entails a complex set of adaptations to prolonged egg-carrying in the female reproductive system. During brooding, for instance, ovulation in the ovary is suppressed and the anterior part of the gonoduct is characterized by an intricate, recessed folding.

The evolution of parental care in salamanders

Complex parenting has been proposed to contribute to the evolutionary success of vertebrates. However, the evolutionary routes to complex parenting and the role of parenting in vertebrate diversity are still contentious. Although basal vertebrates provide clues to complex reproduction, these are often understudied. Using 181 species that represent all major lineages of an early vertebrate group, the salamanders and newts (Caudata, salamanders henceforth) here we show that fertilisation mode is tied to parental care: male-only care occurs in external fertilisers, whereas female-only care exclusively occurs in internal fertilisers. Importantly, internal fertilisation opens the way to terrestrial reproduction, because fertilised females are able to deposit their eggs on land, and with maternal care provision, the eggs could potentially develop outside the aquatic environment. Taken together, our results of a semi-aquatic early vertebrate group propose that the diversity and follow-up radiation of terrestrial vertebrates are inherently associated with a complex social behaviour, parenting.

Disparities in the timing of antenatal care initiation and associated factors in an ethnically dense maternal cohort with high levels of area deprivation

BackgroundLate access to antenatal care is a contributor to excess mortality and morbidity among ethnic minority mothers compared to White British in the UK. While individual ethnicity and socioeconomic disadvantage are linked to late antenatal care initiation, studies have seldom explored patterns of late initiation and associated factors in ethnically dense socially disadvantaged settings. This study investigated disparities in the timing of antenatal care initiation, and associated factors in an ethnically dense socially disadvantaged maternal cohort.MethodsA retrospective cross-sectional study using routinely collected anonymous data on all births between April 2007—March 2016 in Luton and Dunstable hospital, UK (N = 46,307). Late initiation was defined as first antenatal appointment attended at > 12 weeks of gestation and further classified into moderately late (13–19 weeks) and extremely late initiation (≥ 20 weeks). We applied logistic and multinomial models to examine associations of late initiation with maternal and sociodemographic factors.ResultsOverall, one fifth of mothers (20.8%) started antenatal care at > 12 weeks of gestation. Prevalence of late initiation varied across ethnic groups, from 16.3% (White British) to 34.2% (Black African). Late initiation was strongly associated with non-White British ethnicity. Compared to White British mothers, the odds of late initiation and relative risk of extremely late initiation were highest for Black African mothers [adjusted OR = 3.37 (3.05, 3.73) for late initiation and RRR = 4.03 (3.51, 4.64) for extremely late initiation]. The odds did not increase with increasing area deprivation, but the relative risk of moderately late initiation increased in the most deprived ([RRR = 1.53 (1.37, 1.72)] and second most deprived areas [RRR = 1.23 (1.10, 1.38)]. Late initiation was associated with younger mothers and to a lesser extent, older mothers aged > 35 years. Mothers who smoked during pregnancy were at higher odds of late initiation compared to mothers who did not smoke.ConclusionsThere is a need to intensify universal and targeted programmes/services to support mothers in ethnically dense socially disadvantaged areas to start antenatal care on time. Local variations in ethnic diversity and levels of social disadvantage are essential aspects to consider while planning services and programmes to ensure equity in maternity care provision.

Mothers’ Lives Matter: Reaffirming Commitments from the Past to Strengthen the Future

The death of a woman from pregnancy or childbirth is one death too many. The death of a mother immediately cuts into half her newborn child’s chances of survival.Maternal death is of great concern worldwide, with eight to nine women dying daily, succumbing to various medical and compounding reasons. Approximately 75% of maternal mortalities during or following birth are due to severe bleeding, infections, pre-eclampsia and eclampsia, complications from delivery, and unsafe abortions.1&#x0D; Delays in seeking, reaching, and receiving adequate maternity or obstetric services contribute to maternal mortality.2 The last five decades saw tremendous efforts at the national and international level to improve maternal and neonatal care and mitigate maternal and child mortalities. From the 1978 Alma Ata Declaration on Primary Health Care to the Millennium and Sustainable Development Goals at the turn of the century, global commitment has been continuous.The Department of Health launched the National Safe Motherhood Program (NSMP) which envisions Filipino women having full access to health services for safe pregnancy and delivery by providing technical assistance to and collaborating with Local Government Units (LGUs) in the provision of maternity and newborn services.3&#x0D; The Maternal Newborn and Child Health and Nutrition (MNCHN) strategy framework is a corollary to the NSMP and also aims to reduce the maternal and neonatal mortality rates. MNCHN integrates services and programs for maternal health, family planning, and the prevention of sexually transmitted infections by proposing a continuum of care from pregnancy to delivery and ensures care for children and adolescents.&#x0D; Basic Emergency Obstetric and Newborn Care, or BEmONC, is one of the service packages of the MNCHN strategy that capacitates health care workers at the primary health care level to perform emergency obstetric and newborn resuscitation functions and refer to more equipped facilities for definitive management of obstetric emergencies. Rural health units (RHUs), district hospitals, and private lying-in clinics all over the country were capacitated as BEmONC-provider facilities.4 &#x0D; These facilities were particularly needed in rural areas to reduce the delays in pregnant women reaching and receiving adequate obstetric care. Delays in seeking care may be attributed to women’s beliefs and perceptions of the availability and adequacy of maternityservices in their communities. Articles in this issue give voice to pregnant women, their experiences, and their apprehensions on accessing care in various contexts, including during the COVID-19 pandemic. Also expressed in this issue are the perspectives of health workers on providing much-needed maternal health care.&#x0D; This collection provides but a brief snapshot of the compendium of challenges faced by Filipino women and children, the two great vulnerable groups in our society today. This issue pushes an essential dialogue forward: the importance we give to the lives of women in general, and mothers and children in particular.&#x0D; This is a continuing dialogue that everyone should hear and partake of.&#x0D; Ma. Carmeriza B. Buñing, MD, FPOGS Assistant Professor IADepartment of Anatomy, College of Medicine, UERMMMCI&#x0D; &#x0D; REFERENCES1. World Health Organization. Maternal Mortality [Internet]. 2019 [cited 2022 Aug 30]. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality.2. Thaddeus S, Maine D. Too Far to Walk: Maternal Mortality in Context. Soc Sci Med. 1994; 38(8):1091-1110. https://doi.org/10.1016/0277-9536(94)90226-7 3. Department of Health. National Safe Motherhood Program [Internet]. 2018 [cited 2022 Aug 30]. Available from: https://www.doh.gov.ph/national-safe-motherhood-program. 4. Department of Health. Implementing Health Reforms towards Rapid Reduction in Maternal and Neonatal Mortality: Manual of Operations [Internet]. 2009 [cited 2022 Aug 30]. Available from: https://www.doh.gov.ph/sites/default/files/publications/maternalneonatal.compressed.pdf.

Sub-Saharan African women’s views and experiences of risk factors for obstetric fistula: a qualitative systematic review

BackgroundObstetric fistula used as synonymous with VVF in this study, is an abnormal communication/hole between the urinary tract and the genital tract or the gastrointestinal tract and the genital tract, resulting from prolonged obstructed labour. VVF may cause sufferers to experience chronic urinary/faecal incontinence, and the stigma of continuing foul odour. VVF is primarily caused by prolonged obstructed labour, which is brought about by a range of causes. Recently, it has been proposed that women’s groups and fistula survivors should suggest interventions to reduce or prevent the incidence of obstetric fistula.ObjectiveThe objective of this review was to synthesise what is reported about women’s views and experiences of the risk factors underlying the causes of VVF.MethodsA systematic approach outlined in the Joanna Briggs Institute Manual for Evidence synthesis was followed for this review, articles published since the last 11 years from 2011 to 2021 were selected against several criteria and critically appraised using JBI Critical Appraisal Checklist for qualitative studies.ResultsNine studies were retained for inclusion in this review and the data were then synthesised into five themes: (1) Cultural beliefs and practices impeding safe childbirth, (2) Lack of woman’s autonomy in choices of place to birth safely, (3) Lack of accessibility and social support to safe childbirth, (4) Inexperienced birth attendants and, (5) Delayed emergency maternal care (childbirth).ConclusionsThis review highlights the complexity of risk factors predisposing women to the known causes of VVF. It also illuminates the absence of women’s voices in the identification of solutions to these risks. Women are most directly affected by VVF. Therefore, their knowledge, views, and experiences should be considered in the development and implementation of strategies to address the issue. Exploring women’s views on this issue would enable the identification of gaps in maternity care provision, which would be of interest to community and health service leaders as well as policymakers in Sub-Saharan Africa.

O92 - COVID-19 and beyond – changes to provision of maternity care and future plans in Victorian maternity services

BackgroundDue to the COVID-19 pandemic, rapid service changes were made to maternity care provision in Victorian maternity services. From March 2020 many routine face-to-face visits in pregnancy were replaced by telehealth (telephone or video), along with changes to routine screening. Many providers plan to continue these changes despite a lack of evidence to guide practice. We aimed to describe the changes in maternity care provision, understand the perceived impact and explore services’ future plans regarding these changes.MethodsA population-based cross-sectional study of midwifery managers of all Victorian public and private maternity services was conducted between March and October 2021. Questions explored health service characteristics, changes to maternity care delivery, telehealth practices, perceived impact of changes, and future plans.ResultsFifty percent of services (34/68, 27 public and 6 private) responded, with broad representation of location, birth numbers and size of service. Around 50% of all pregnancy visits became telehealth. There were multiple combinations of which visits were face-to-face and which were telehealth. No visit was conducted face-to-face by all responding services. Visits most likely to be face-to-face were at 39 and 40 weeks gestation (65%). For telehealth appointments there was an ad hoc approach to advising women on routine screening, e.g., measuring blood pressure (11% did not advise at all), fetal growth (26% – no specific strategy) and fetal heart rate (15% – no specific strategy). Over half (52%) would consider maintaining telehealth post-pandemic.ConclusionsEven in a single state there is great variation in telehealth timing, when pregnant women should have face-to-face visits, and what routine screening is maintained. In light of emerging evidence of some potentially poorer clinical outcomes associated with telehealth in pregnancy, these findings need to be considered.

P39 - Women’s experiences of obstetric fistula risk factors and the need for skilled birth attendance in North-central Nigeria: An Interpretive Description

An obstetric fistula is an abnormal opening between the vagina, bladder, or rectum that causes uncontrolled and abnormal leaking of urine or feces. A prolonged obstructed labor and ischemic necrosis of the women’s bladder, vagina, or rectum is the major cause of obstetric fistula. Recently, it has been proposed that obstetric fistula survivors the women, should suggest interventions to mitigate or resolve the incidence of VVF which would enable the identification of gaps in maternity care provision, and would be of interest to community and health service leaders as well as policymakers. This study explores birthing women's experiences of obstetric fistula risk factors and the need for skilled birth attendance in Northern-central Nigeria. The design was an interpretive qualitative study involving face-to-face semi-structured interviews with 15 women with an obstetric fistula at a repair Centre in North-central Nigeria. A thematic approach to data analysis was employed to generate findings. Three core themes emerged from this study: • Delayed or suboptimal skilled maternal health care services • Absence or inadequately skilled birth attendance • Lack of women’s empowerment impeding access to maternal health The collective expression of women’s views through the interaction between the midwife and women with obstetric fistula is a call for quality health care for birthing women specially trained and skillful midwives to shape service development and delivery for improved maternity care and fistula prevention in Nigeria.

An exploration of maternity and newborn exposure, training and education among staff working within the North West Ambulance Service.

Providing emergency and urgent care to pregnant patients and newborns in the pre-hospital setting often presents some of the most challenging and complex incidents attended to by ambulance staff. A service evaluation survey was undertaken to explore current levels of maternity and newborn education, preferred methods of training delivery, exposure and perceived support surrounding maternity and newborn care provision among pre-hospital clinicians working within the North West Ambulance Service (NWAS) NHS Trust. An online, anonymised survey compromising of 22 questions using multiple choice options and free-text questions was circulated among NWAS staff between 27 May 2021 and 21 June 2021. Questions explored the levels of training, education, exposure and confidence relating to maternal and newborn care in the pre-hospital setting. Insights into preferred approaches to engaging with continuing professional development (CPD) activities were also captured. Data were analysed using built-in Microsoft Forms analytics for quantitative response, with a basic thematic analysis undertaken to synthesise qualitative responses. The survey received 509 responses, with data providing valuable insight relating to gaps in training provision, preferred approaches to CPD and barriers to engagement. Key themes focused on 'pre-registration standards and variations', 'barriers and facilitators to continuing professional development' and 'exposure and skill decline: confidence and knowledge'. Areas for service improvement are highlighted, providing ambulance trusts and integrated care systems with key recommendations. These include maternity and newborn standards for education among paramedic science degree programmes; recognition of pre-hospital emergency maternity and newborn care among maternity providers; the need for exposure and regular multidisciplinary team (MDT) skills training for staff; and a collaborative system-led approach to scaling up and delivering MDT training that acknowledges pre-hospital clinicians as key care providers.

Pdf 03. Sexually dimorphic growth and maturity in captive mountain chicken frogs Leptodactylus fallax

ABSTRACT - Sexual dimorphism is commonly encountered in amphibians. Its presence and its ontogeny in a given species has implications for ecology, conservation and captive husbandry. We monitored changes in length and mass of captive mountain chicken frogs Leptodactylus fallax. Initially, sexes were no different in snout-vent length or mass, but by about 17 months after metamorphosis females became significantly larger and heavier than males. Diverging growth trajectories between male and female frogs appeared to coincide with the development of secondary sexual characters in males, indicating sexual maturity, while female frogs did not produce nests until the following breeding season, suggesting later reproductive maturity. The absence of similar dimorphism in other large leptodactylids suggests that its presence in L. fallax may be linked to its unique and energy-intense reproductive strategy, which involves extended maternal provisioning of their young.

Precarity and preparedness during the SARS-CoV-2 pandemic: A qualitative service evaluation of maternity healthcare professionals.

IntroductionThe SARS‐CoV‐2 pandemic has devastated populations, posing unprecedented challenges for healthcare services, staff and service‐users. In the UK, rapid reconfiguration of maternity healthcare service provision changed the landscape of antenatal, intrapartum and postnatal care. This study aimed to explore the experiences of maternity services staff who provided maternity care during the SARS‐CoV‐2 pandemic to inform future improvements in care.Material and methodsA qualitative interview service evaluation was undertaken at a single maternity service in an NHS Trust, South London. Respondents (n = 29) were recruited using a critical case purposeful sample of maternity services staff. Interviews were conducted using video‐conferencing software, and were transcribed and analyzed using Grounded Theory Analysis appropriate for cross‐disciplinary health research. The focus of analysis was on staff experiences of delivering maternity services and care during the SARS‐CoV‐2 pandemic.ResultsA theory of “Precarity and Preparedness” was developed, comprising three main emergent themes: “Endemic precarity: A health system under pressure”; “A top‐down approach to managing the health system shock”; and “From un(der)‐prepared to future flourishing”.ConclusionsMaternity services in the UK were under significant strain and were inherently precarious. This was exacerbated by the SARS‐CoV‐2 pandemic, which saw further disruption to service provision, fragmentation of care and pre‐existing staff shortages. Positive changes are required to improve staff retention and team cohesion, and ensure patient‐centered care remains at the heart of maternity care.

Iron mobilization during lactation reduces oxygen stores in a diving mammal

The profound impacts that maternal provisioning of finite energy resources has on offspring survival have been extensively studied across mammals. This study shows that in addition to calories, high hemoprotein concentrations in diving mammals necessitates exceptional female-to-pup iron transfer. Numerous indices of iron mobilization (ferritin, serum iron, total-iron-binding-capacity, transferrin saturation) were significantly elevated during lactation in adult female Weddell seals (Leptonychotes weddellii), but not in skip-breeders. Iron was mobilized from endogenous stores for incorporation into the Weddell seal’s milk at concentrations up to 100× higher than terrestrial mammals. Such high rates of iron offload to offspring drew from the female’s own heme stores and led to compromised physiologic dive capacities (hemoglobin, myoglobin, and total body oxygen stores) after weaning their pups, which was further reflected in shorter dive durations. We demonstrate that lactational iron transfer shapes physiologic dive thresholds, identifying a cost of reproduction to a marine mammal.

"Everything is revolved around me being heavy … it's always, always spoken about." Qualitative experiences of weight management during pregnancy in women with a BMI of 40kg/m2 or above.

IntroductionMaternal weight management services have been recognised as a good opportunity to influence lifestyle and dietary behaviour of mothers and families. Exploring women’s views of maternal weight management services is paramount to understand what constitutes the most suitable service. This study therefore explored experiences among women with a raised body mass index (BMI) of maternal weight management service provision and the barriers and facilitators to weight management during pregnancy.MethodThirteen women with a BMI≥40kg/m² undertook semi-structured interviews around weight management experiences during pregnancy. Interviews were audio recorded and transcribed verbatim. Inductive thematic analysis was undertaken.ResultsFour themes emerged. 1). "Understanding where I am at" showed current readiness and motivation of women varied, from being avoidant to being motivated to make changes. 2). "Getting information" revealed inconsistent information provision during pregnancy. Women particularly wanted practical advice. Some attempted to find this for themselves from friends or the internet, however this left some women feeling confused when different sources provided inconsistent advice. 3). "Difficulties I face" identified physical, emotional and financial barriers and the strategies some women used to overcome these. 4). "Encountering professionals–a mixed experience" demonstrated women wanted to be treated with respect and sensitivity and that how weight management information was addressed was more important than who provided it. The fine line professionals tread was demonstrated by women thinking that they had received inadequate information and yet too much focus was placed on their weight and the associated risks during pregnancy without practical solutions to their weight management challenges.DiscussionWomen were empowered when practical advice was provided, not just the continual repetition of the risks of being obese during pregnancy. Antenatal weight management services need to be clear, sensitive and respectful. Services centred on individual women’s needs and on their current and previous experiences are required. The psychological and social contexts of weight management also need to be addressed.

Maternity provision, contract status, and likelihood of returning to work: Evidence from research intensive universities in the UK

AbstractReliance on fixed‐term contracts and a lack of adequate maternity provision for fixed‐term workers could be contributing to the loss of women from academia―the so called “leaky pipeline”―but evidence on this is lacking. This paper describes variation, between research intensive universities in the UK, in the maternity provision they offer to fixed‐term workers and presents preliminary staff data on the likelihood of returning to work following a period of maternity leave for academic and non‐academic staff on fixed‐term versus open‐ended contracts. A gendered lens is applied, investigating how the intersection between contractual status and maternity provision contributes to gender inequality in academia within the context of hierarchical neoliberal academic organizing and the masculinized “ideal” academic. Staff data was obtained using a Freedom of Information request made to the 24 Russell Group universities in the United Kingdom. The odds of returning to work after maternity leave were 59% lower for staff on fixed‐term compared to open‐ended contracts (pooled odds ratio: 0.41, 95% confidence interval: 0.26–0.64). Maternity provision for fixed‐term workers varied between institutions, with most operating policies that limit access to enhanced maternity pay for staff on fixed‐term contracts. Wider adoption of maternity policies that are more compatible with employment on fixed‐term contracts, including: no continuous service or return to work requirement, full financial support for staff facing redundancy during maternity leave, and appropriate signposting of redeployment obligations, could help to support more women to stay in academia.