Maternity Providers Research Articles

Culturally appropriate care to support maternal positions during the second stage of labour: Midwives' perspectives in South Africa.

Background‘Doing what the Romans do in Rome’ was an expression raised by one of the midwives following workplace culture and disregarding women’s birth choices. Midwifery practice in South Africa caters for a culturally diverse ethnic groups of childbearing women. Culturally appropriate care highlights the importance of including women in decision-making concerning their birth preferences including maternal positions during labour. Women’s right to choose their maternal position and cultural preferences during labour has been overlooked, leading to poor maternal healthcare provision and negative birth experiences.AimIn this article, the researchers aimed to describe and explore midwives’ perspectives on culturally appropriate care to support maternal positions during the second stage of labour.SettingMidwives working in the maternity ward in a public hospital in South Africa.MethodsA qualitative descriptive design using individual interviews was used to collect data. The participants were selected using the purposive sampling method. The study population comprised 20 midwives who volunteered to participate in the study. Data were transcribed manually and analysed using thematic analysis.ResultsThe four main themes are as follows: (1) Caring for women from various ethnic groups, (2) midwives disregard women’s beliefs and culture, (3) midwife personal cultural attributes and (4) midwifery unit workplace culture.ConclusionThe authors concluded that culturally appropriate care towards the women’s choices of birth position during the second stage of labour should form an integral part of the midwifery care rendered.

Midwives’ experiences of providing maternity care to women and families during the COVID-19 pandemic in Northern Italy

ProblemThe COVID-19 pandemic has significantly challenged maternity provision internationally. Rapid and radical changes were implemented, with midwives facing anxiety and moral distress if not able to provide optimal and woman-centred care in line with professional values. BackgroundHealthcare professionals’ stress and burnout are commonly reported during other global emergencies, which may eventually contribute to reduced quality of care. There is lack of evidence of the challenges faced by midwives in Italy during the COVID-19 pandemic. AimTo explore midwives’ experiences of providing care to women and families during the COVID-19 pandemic. MethodsQualitative interpretive phenomenological approach, using semi-structured interviews and thematic analysis. The sample included 15 midwives. Ethical approval was obtained. FindingsFour themes were identified: 1) adjusting to the ever-evolving organisation of care; 2) physical, psychological and relational challenges; 3) support network; 4) deferred sense of awareness. DiscussionMidwives faced professional and personal challenges during the pandemic, displaying feelings of fear, anxiety, uncertainty, discomfort, lack of support and knowledge with potential long-term effects. Adjusting to the continuous, rapid and drastic re-organisation of maternity services was particularly challenging. Factors facilitating a safe, supportive and empowering workplace included support from colleagues and managers, access to appropriate PPE, reliable guidelines, good communication and emotional support. Positive aspects of personal and professional development included communication skills, establishment of trusting relationships, sense of empowerment and teamwork. ConclusionIn the context of a pandemic, optimisation of midwives’ physical, emotional and psychological wellbeing should be considered. Timely and comprehensive guidelines and appropriate resources should be provided to assist midwives in facilitating family-centred respectful maternity care and preserving childbirth as a bio-psychosocial event.

Quantifying maternal transfer of trace elements and stable isotopes in the endangered pelagic thresher shark (Alopias pelagicus)

To quantify maternal provisioning of nutrients in the pelagic thresher shark (Alopias pelagicus) and the potential for negative impacts, the concentrations of trace elements (essential: Co, Cr, Cu, Mn, Ni, Se, and Zn; nonessential: As, Ba, Cd, Hg, and Pb) and fractionation of stable isotopes (13C and 15N) were analyzed in the muscle and liver of 10 pregnant females and 18 associated embryos. Essential trace elements were observed to be offloaded at higher concentrations to embryos, with the exception of Zn and Ni in liver, while nonessential trace elements were unevenly distributed between maternal-embryo tissues. Observed Hg concentrations were at levels considered toxic in A. pelagicus, but the Se: Hg molar ratios in all embryonic tissues were all greater than one. A negative correlation was observed between transfer ratios and concentrations of all elements in maternal tissue, indicating the existence of a regulatory mechanism in maternal ovaries of A. pelagicus. Compared with maternal specimens, associated embryos had higher δ13C and δ15N values in muscle and liver tissue. Negative correlations were observed between δ13C, δ15N, and Δδ13C values and precaudal length in embryonic muscle tissue potentially reflecting either a dietary-habitat shift in pregnant females during the latter period of gestation or a physiological change modifying fractionation. Higher concentrations of essential elements are linked to potential benefits for embryos during early development, levels of Hg suggested a degree of anthropogenic impact with unknown consequences while the directionality of isotopic fractionation could suggest a potential reproductive migration as a protective mechanism for birthing.

Nutritional programming by maternal diet alters offspring lipid metabolism in a marine teleost

Nutritional programming - the association between the early nutritional environment and long-term consequences for an animal - is an emerging area of research in fish biology. Previous studies reported correlations between maternal provisioning of essential fatty acids to eggs and the whole-body fatty acid composition of larvae reared under uniform conditions for red drum, Sciaenops ocellatus. This study aimed to further investigate the nutritional stimulus and the consequences of nutritional programming by feeding adult red drum several distinct diets and rearing larvae under uniform conditions until 21days post-hatching when larval lipid and fatty acid compositions were assessed. Different maternal diets produced eggs with distinctive lipid and fatty acid compositions, and despite receiving the same larval diet for almost 3weeks, larvae showed differences in total fatty acid accumulation and in retention of highly unsaturated fatty acids (HUFA). Specifically, larvae reared from a maternal diet of shrimp generally showed elevated levels of fatty acids in the initial steps of the n-3 and n-6 HUFA biosynthetic pathways and reduced levels of fatty acid products of the same pathways, especially in triglyceride. Furthermore, the variations in larval fatty acid accumulation induced by maternal diet varied among females. Lipid metabolism altered by parental diet may have consequences for larval physiological processes and behavioral performance, which may ultimately influence larval survival.

Understanding the Healthcare Practitioners’ Experience in Managing Women with Postnatal Depression: A Qualitative Study in Malaysia

INTRODUCTION: Postnatal depression is largely underdiagnosed in many low-and middle-income countries, including Malaysia. Healthcare practitioners’ perceptions towards postnatal depression were identified as one of the main barriers to seeking help. Objective: This study aimed to explore the perceptions of healthcare practitioners about postnatal depression, and their experience in managing women with postnatal depression in Malaysia. Materials and methods: Eighteen healthcare practitioners (5 head nurses, 9 nurses, and 4 doctors) working in maternal and child health clinics and a female psychiatric ward in Kuala Lumpur were individually interviewed following a generic qualitative research design. Interview data were transcribed verbatim, and the transcripts were analyzed using framework analysis. Results: Healthcare practitioners reported that their management of women with postnatal depression was limited by the absence of a specific screening tool, and presence of stigma associated with postnatal depression. Discussion and conclusion: Healthcare practitioners were found to be aware of poor maternal mental health provision within their clinical setting and are ready to contribute to developing protocols to improve maternal mental health. As its diagnosis and treatments vary from general depression, there should be a specific direction addressed in the policy to assist in actions for managing postnatal depression. Professional training and continuous education on postnatal depression are a fundamental component in fostering quality of care, and public awareness as well as improving stigma within the Malaysian healthcare system.

Accessing Maternal Health Care in the Midst of the COVID-19 Pandemic: A Study in Two Districts of Assam, India.

BackgroundCOVID-19 pandemic and the subsequent national lockdown in India compelled the health system to focus on COVID-19 management. Information from the field indicated the impact of COVID- 19 on the provision of maternal health services. This research presents users' and providers' perspectives about the effect of the pandemic on maternal health services in select districts of Assam.MethodsThe study was undertaken to understand the status of maternal health service provision and challenges faced by 110 pregnant and recently delivered women, 38 health care providers and 18 Village Health Sanitation and Nutrition Committee members during COVID-19 pandemic. Telephonic interviews were conducted with the users identified through simple random sampling. Healthcare providers and the community members were identified purposively.ResultsMost of the interviewed women reported that they could access the health services, but had to spend out-of-pocket (for certain services) despite accessing the services from government health facilities. Healthcare providers highlighted the lack of transportation facilities and medicine unavailability as challenges in providing routine services. The study revealed high proportion of Caesarian section deliveries (42.6%, n = 32) and stillbirths (10.6%, n = 8).DiscussionThis research hypothesizes the supply-side (health system) factors and demand-side (community-level) factors converged to affect the access to maternal health services. Health system preparedness by ensuring availability of all services at the last mile and strengthening existing community-reliant health services is recommended for uninterrupted good quality and affordable maternal health service provision.

'They didnae tell you nothin': The Failings of Sex Education, Antenatal Care, and Welfare Bureaucracies in Glasgow, c. 1970s-2000s.

Utilizing group oral histories from nineteen women who were pregnant and living in areas of social and economic deprivation in Glasgow, Scotland, between the late 1970s and early 2000s, this article analyses the difficulties the women faced in accessing information about pregnancy and welfare entitlements. It reveals a disconnect between women's knowledge about reproduction and maternal health and welfare benefits and the political initiatives designed to improve antenatal care and pregnancy outcomes in Britain since the 1980 Short Report. This divide was widened by a broader Scottish culture of reticence around sex education and the ongoing moral influence of the churches. The article clarifies the class-blind English arguments within the patient consumer model that was promoted since the 1960s. It demonstrates how marginal groups were ill equipped to participate as patient consumers, either individually or as a collective group. More broadly, this article gives voice to an underrepresented group and highlights how these women utilized adaptive decision-making to navigate their pregnancy journeys in a society with uneven maternity and welfare provision and inhibitions about sex education. By highlighting the realities of marginality and lived experiences, it adds nuance to conventional welfare and policy histories.

Common endosymbionts affect host fitness and sex allocation via egg size provisioning.

It is hard to overemphasize the importance of endosymbionts in arthropod biology, ecology and evolution. Some endosymbionts can complement host metabolic function or provide defence against pathogens; others, such as ubiquitous Wolbachia and Cardinium, have evolved strategies to manipulate host reproduction. A common reproductive manipulation strategy is cytoplasmic incompatibility (CI) between differently infected individuals which can result in female mortality or male development of fertilized eggs in haplodiploid hosts. Recently, an additional role of endosymbionts has been recognized in the modification of sex allocation in sexually reproducing haplodiploids. This was theoretically expected due to the maternal inheritance of endosymbionts and natural selection for them to increase infected female production, yet the underlying mechanism remained unknown. Here, we tested whether and how Cardinium and Wolbachia causing different CI types interact to increase female production in a haplodiploid thrips species where sex allocation depends on both maternal condition and egg size provisioning. We found that Cardinium augmented female production by increasing maternal fitness and egg size, thereby boosting fertilization rate and offspring fitness. Wolbachia, in contrast, reduced the beneficial effects of Cardinium. Our results demonstrate different invasion strategies and antagonistic effects of endosymbiotic bacteria on host fitness and evolution of sex allocation.

Health workers\u2019 and hospital administrators\u2019 perspectives on mistreatment of women during facility-based childbirth: a multicenter qualitative study in Ghana

BackgroundGlobally, mistreatment of women during facility-based childbirth continues to impact negatively on the quality of maternal healthcare provision and utilization. The views of health workers are vital in achieving comprehensive understanding of mistreatment of women, and to design evidence-based interventions to prevent it. We explored the perspectives of health workers and hospital administrators on mistreatment of women during childbirth to identify opportunity for improvement in the quality of maternal care in health facilities.MethodsA qualitative study comprising in-depth interviews (IDIs) with 24 health workers and hospital administrators was conducted in two major towns (Koforidua and Nsawam) in the Eastern region of Ghana. The study was part of a formative mixed-methods project to develop an evidence-based definition, identification criteria and two tools for measuring mistreatment of women in facilities during childbirth. Data analysis was undertaken based on thematic content via the inductive analytic framework approach, using Nvivo version 12.6.0.ResultHealth workers and hospital administrators reported mixed feelings regarding the quality of care women receive. Almost all respondents were aware of mistreatment occurring during childbirth, describing physical and verbal abuse and denial of preferred birthing positions and companionship. Rationalizations for mistreatment included limited staff capacity, high workload, perceptions of women’s non-compliance and their attitudes towards staff. Health workers had mixed responses regarding the acceptability of mistreatment of women, although most argued against it. Increasing staff strength, number of health facilities, refresher training for health workers and adequate education of women about pregnancy and childbirth were suggestions to minimize such mistreatment.ConclusionHealth workers indicated that some women are mistreated during birth in the study sites and provided various rationalizations for why this occurred. There is urgent need to motivate, retrain or otherwise encourage health workers to prevent mistreatment of women and promote respectful maternity care. Further research on implementation of evidence-based interventions could help mitigate mistreatment of women in health facilities.

Self-reported mental health status of pregnant women in Sweden during the COVID-19 pandemic: a cross-sectional survey

BackgroundThe COVID-19 pandemic has contributed to unprecedented worries and challenges for pregnant women due to social restrictions and changes in maternity care provision. We aimed to investigate the mental health impact of COVID-19 pandemic on pregnant women in Sweden and explore factors associated with poor perinatal mental health in this specific context.MethodThis was a nation-wide cross-sectional survey of pregnant women living in Sweden. Validated questionnaires were distributed through non-profit organizations´ websites and social media channels from May 2020 to February 2021. Perinatal depression, anxiety, and acute stress reaction were assessed using the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder-7 (GAD-7) and Impact Event Scale (Revised) (IES-R), respectively. Sociodemographic characteristics and self-perceived mental well-being were also obtained. Factors associated with mental health outcomes were analyzed using multivariate logistic regression model.ResultsAmong a total of 470 participants, 43.2% (n = 203) reported depression (EPDS ≥13), 25.7% (n = 121) moderate to severe anxiety (GAD-7 score ≥ 10), and 23.7% (n = 110) moderate to severe acute stress reaction (IES-R ≥ 33). 27.4% participants (n = 129) expressed concerns regarding their mental well-being during the pandemic. Pregnant mothers who had sick family members reported poorer mental health outcomes than those who did not (median [Interquartile range (IQR)] EPDS scores: 14.0 [8.75–18.0] vs 11.0 [6.25–15.0], p < .001; median (IQR) GAD7 scores: 7.0 [4.0–12.25] vs 6.0 [3.0–9.0], p = .003); median (IQR) IES-R scores: 20.0 [9.0–38.0] vs 15.0 [7.0–30.0], p = .048). Logistic regression analyses revealed that risk factors for poor mental health outcomes were having a sick family member with any illness, unemployment, and experiencing a substantially stressful life event. Having a higher educational level and a younger age during the pandemic were protective.ConclusionDepression and anxiety were highly prevalent among pregnant women in Sweden during the COVID-19 pandemic, indicating a need for professional mental health support for this vulnerable group of population. Unemployment was an associated risk factor whereas younger age and higher educational level were protective suggesting an important role of socio-economic factors in modulating the impact of COVID-19 pandemic on perinatal mental health.

Indonesian midwives’ perspectives on changes in the provision of maternity care during the COVID-19 pandemic: A qualitative study

ObjectiveTo explore how COVID-19 influenced the provision of high-quality maternity care in Indonesia. Design and methodsA qualitative descriptive study using in-depth interviews was undertaken. Thematic analysis was used to analyse data, and behaviour change frameworks (Theoretical Domain Framework (TDF) and Capability, Opportunity, and Motivation (COM-B)) were used to identify and map facilitators and barriers influencing maternity care provision during the COVID-19 pandemic. Setting and participantsFifteen midwives working in community maternity care facilities in Surabaya and Mataram, Indonesia were included. Surabaya is in western Indonesia, with around 56,000 births per year and a population of around 3 million. Mataram is in eastern Indonesia, with around 7,000 births per year and a population of around 500,000. FindingsThe main changes to maternity care provision during the COVID-19 pandemic were reduced frequency of antenatal and postpartum care visits, reduced support for women, including unavailability of maternity care and reduced number of antenatal care and labour companions, changes in location of provision of care, and public health changes related to COVID-19. The main factors influencing the provision of high-quality maternity care during the COVID-19 pandemic were behavioural regulation, professional role and identity, and environmental context and resources. Key conclusions and implications for practiceMaternity care provision underwent substantial changes during the COVID-19 pandemic in Indonesia. Findings from this study can contribute to better understanding of how maternity care provision changed during the pandemic, and how positive changes can be reinforced, and negative changes can be addressed.

Maternal Milk Provision in the Neonatal Intensive Care Unit and Mother-Infant Emotional Connection for Preterm Infants.

Maternal milk (MM) intake during neonatal intensive care unit (NICU) hospitalization is associated with improved neurodevelopment in preterm infants. Underlying mechanisms may include stronger mother–infant emotional connection. This paper examines associations between MM provision in the NICU with maternal connection to her infant using three factors validated in our sample: maternal sensitivity, emotional concern, and positive interaction/engagement. We studied 70 mothers of infants born <1500 g and/or <32 weeks’ gestation. Associations between MM provision and mother–infant connection were modeled using median regression adjusted for clustering. Mothers who provided exclusive MM (i.e., 100% MM, no other milk) reported higher levels of maternal sensitivity by a median score of 2 units (β = 2.00, 95% CI: 0.76, 3.24, p = 0.002) than the mixed group (i.e., MM < 100% days, other milk ≥1 days), as well as greater emotional concern (β = 3.00, 95% CI: −0.002, 6.00, p = 0.05). Among mothers of very preterm infants, greater milk provision was associated with greater maternal sensitivity, but also with greater emotional concern about meeting the infant’s needs. These findings highlight the importance of supporting MM provision and early infant care as an integrated part of lactation support. The findings may also provide insight into links between MM provision in the NICU and infant neurodevelopment.

Actions and Adaptations Implemented for Maternal, Newborn and Child Health Service Provision During the Early Phase of the COVID-19 Pandemic in Lagos, Nigeria: Qualitative Study of Health Facility Leaders.

Background:The early phase of the COVID-19 pandemic led to significant disruptions in provision of maternal, newborn, and child health (MNCH) services, especially in low- and middle-income countries (LMICs) with fragile health systems, such as Nigeria. Measures taken to ‘flatten the curve’ such as lockdowns, curfews, travel restrictions, and suspension of public services inadvertently led to significant disruptions in provision of essential health services. In these countries, health facility leaders are directly responsible for driving changes needed for service delivery.Objective:To explore perspectives of health facility leaders in Lagos, Nigeria, on solutions and adaptations implemented to support MNCH service provision during the early phase of the COVID-19 pandemic.Methods:Key informant interviews were remotely conducted with purposively sampled 33 health facility leaders across primary, secondary, and tertiary public health facilities in Lagos between July and November 2020. Following verbatim transcription of recordings, data familiarization, and coding, thematic analysis was used to synthesize data.Results:Health facility leaders scaled down or discontinued outpatient MNCH services and elective surgeries. However, deliveries, newborn, immunization, and emergency services continued. Service provision was reorganized with long and staggered patient appointments, collapsing of wards and modification of health worker duty rosters. Some secondary and tertiary facilities leveraged technology like WhatsApp, webinars, and telemedicine to support service provision. Continuous capacity-building for health workers through training, motivation, psychological support, and atypical sourcing of PPE was instituted to be able to safely maintain service delivery.Conclusion:Health facility leaders led the frontline of the COVID-19 response. While they took to implementing global and national guidelines within their facilities, they also pushed innovative facility-driven adaptations to address the indirect effects of COVID-19. Insights gathered provide lessons to foster resilient LMIC health systems for MNCH service provision in a post-COVID-19 world.

‘We are not going to shut down, because we cannot postpone pregnancy’: a mixed-methods study of the provision of maternal healthcare in six referral maternity wards in four sub-Saharan African countries during the COVID-19 pandemic

IntroductionReferral hospitals in sub-Saharan Africa are located in crowded urban areas, which were often epicentres of the COVID-19 pandemic. This paper prospectively assesses how maternal healthcare was provided in six...

Cold shock induces a terminal investment reproductive response in C. elegans

Challenges from environmental stressors have a profound impact on many life-history traits of an organism, including reproductive strategy. Examples across multiple taxa have demonstrated that maternal reproductive investment resulting from stress can improve offspring survival; a form of matricidal provisioning when death appears imminent is known as terminal investment. Here we report a reproductive response in the nematode Caenorhabditis elegans upon exposure to acute cold shock at 2 °C, whereby vitellogenic lipid movement from the soma to the germline appears to be massively upregulated at the expense of parental survival. This response is dependent on functional TAX-2; TAX-4 cGMP-gated channels that are part of canonical thermosensory mechanisms in worms and can be prevented in the presence of activated SKN-1/Nrf2, the master stress regulator. Increased maternal provisioning promotes improved embryonic cold shock survival, which is notably suppressed in animals with impaired vitellogenesis. These findings suggest that cold shock in C. elegans triggers terminal investment to promote progeny fitness at the expense of parental survival and may serve as a tractable model for future studies of stress-induced progeny plasticity.

Molecular insights into the transgenerational inheritance of stress memory

There is accumulating evidence to show that environmental stressors can regulate a variety of phenotypes in descendants through germline-mediated epigenetic inheritance. Studies of model organisms exposed to environmental cues (e.g., diet, heat stress, toxins) indicate that altered DNA methylations, histone modifications, or non-coding RNAs in the germ cells are responsible for the transgenerational effects. In addition, it has also become evident that maternal provision could provide a mechanism for the transgenerational inheritance of stress adaptations that result from ancestral environmental cues. However, how the signal of environmentally-induced stress response transmits from the soma to the germline, which may influence offspring fitness, remains largely elusive. Small RNAs could serve as signaling molecules that transmit between tissues and even across generations. Furthermore, a recent study revealed that neuronal mitochondrial perturbations induce a transgenerational induction of the mitochondrial unfolded protein response mediated by a Wnt-dependent increase in mitochondrial DNA levels. Here, we review recent work on the molecular mechanism by which parental experience can affect future generations and the importance of soma-to-germline signaling for transgenerational inheritance.

Turtle Nest-Site Choice, Anthropogenic Challenges, and Evolutionary Potential for Adaptation

Oviparous animals, such as turtles, lay eggs whose success or demise depends on environmental conditions that influence offspring phenotype (morphology, physiology, and in many reptiles, also sex determination), growth, and survival, while in the nest and post-hatching. Consequently, because turtles display little parental care, maternal provisioning of the eggs and female nesting behavior are under strong selection. But the consequences of when and where nests are laid are affected by anthropogenic habitat disturbances that alter suitable nesting areas, expose eggs to contaminants in the wild, and modify the thermal and hydric environment experienced by developing embryos, thus impacting hatchling survival and the sexual fate of taxa with temperature-dependent sex determination (TSD) and genotypic sex determination (GSD). Indeed, global and local environmental change influences air, water, and soil temperature and moisture, which impact basking behavior, egg development, and conditions within the nest, potentially rendering current nesting strategies maladaptive as offspring mortality increases and TSD sex ratios become drastically skewed. Endocrine disruptors can sex reverse TSD and GSD embryos alike. Adapting to these challenges depends on genetic variation, and little to no heritability has been detected for nest-site behavior. However, modest heritability in threshold temperature (above and below which females or males develop in TSD taxa, respectively) exists in the wild, as well as interpopulation differences in the reaction norm of sex ratio to temperature, and potentially also in the expression of gene regulators of sexual development. If this variation reflects additive genetic components, some adaptation might be expected, provided that the pace of environmental change does not exceed the rate of evolution. Research remains urgently needed to fill current gaps in our understanding of the ecology and evolution of nest-site choice and its adaptive potential, integrating across multiple levels of organization.

The utilization of maternal healthcare services during the COVID-19 pandemic in South Sulawesi, Indonesia

Aim: The aim of this study was to evaluate the utilization of healthcare services for pregnant women during the COVID-19 pandemic in South Sulawesi, Indonesia. Design: An analytical cross-sectional study. Methods: A group of 226 pregnant women completed the study questionnaire. The questionnaire was developed based on the basic health research questionnaire from the Ministry of Health, Indonesia, and the Navigating Pregnancy during the COVID-19 Pandemic article from UNICEF. Results: Of the 226 pregnant women, 122 (54%) had poor knowledge related to COVID-19 and negative attitudes regarding health protocols for COVID-19 (79.6%). Most (n = 189; 83.6%) experienced anxiety; however, this did not affect their intention to use healthcare services. Utilization of antenatal care services during the pandemic was associated with antenatal care visiting behavior (p = 0.000) and access to healthcare services (p = 0.000). The most significant predictor of utilization of antenatal care services during the pandemic was antenatal care visiting behavior (p = 0.002; OR = 5.904). Conclusion: These findings provide important information on maternal healthcare provision during the pandemic in Indonesia.

Negative carry-over effects on larval thermal tolerances across a natural thermal gradient.

Under climate change, marine organisms will need to tolerate or adapt to increasing temperatures to persist. The ability of populations to cope with thermal stress may be influenced by conditions experienced by parents, by both genetic changes and transgenerational phenotypic plasticity through epigenetics or maternal provisioning. In organisms with complex life cycles, larval stages are particularly vulnerable to stress. Positive parental carry-over effects occur if more stressful parental environments yield more tolerant offspring while the opposite pattern leads to negative carry-over effects. This study evaluated the role of parental effects in determining larval thermal tolerances for the intertidal mussel, Mytilus californianus. We tested whether thermal environments across a natural gradient (shoreline elevation) impacted mussel temperature tolerances. Lethal thermal limits were compared for field-collected adults and their larvae. We observed parental effects across one generation, in which adult mussels exposed to warmer habitats yielded less tolerant offspring. Interestingly, although parental environments influenced offspring tolerances, we found no clear effects of habitat conditions on adult phenotypes (tolerances). We found indicators of trade-offs in energy investment, with higher reproductive condition and larger egg diameters in low stress environments. These results suggest that parental effects are negative, leading to possible adverse effects of thermal stress on the next generation.

A scoping review of maternal near miss assessment in Australia, New Zealand, South-East Asia and the South Pacific region: How, what, why and where to?

Severe maternal morbidity or maternal near miss (MNM) events can have significant consequences for individuals, their families and society and the study of these events may inform practices to reduce future adverse pregnancy outcomes. To review the scope of MNM studies undertaken in Australia, New Zealand, South-East Asia and the South Pacific region. A systematic search of four online databases (MEDLINE, EMBASE, SCOPUS and CINAHL) and the World Health Organization Library was conducted to identify all relevant studies published between 1 January 2011 and 31 December 2020. The studies were reviewed and included if they assessed MNM using a composite outcome or a predefined set of indicators. The literature search yielded 143 articles of which 49 are included in this review. There were substantial differences in the monitoring approach to MNM in the Australasian region. Overall rates of MNM in the region ranged from two to 100/1000 births and the most common aetiologies identified were direct obstetric causes such as postpartum haemorrhage, pre-eclampsia and sepsis. Multidisciplinary review indicated a substantial number of MNM cases were preventable or amenable to improved management, mostly from a provider perspective. Assessment of MNM is an important part of the evaluation of maternity care provision. Reaching a consensus on indicators and how best to collect information will allow a more discerning assessment of MNM including longer-term health outcomes, aspects of preventability and financial implications for health services.