Maternity Providers Research Articles

Enhancing the usefulness of artificial seeds in seed beetle model systems research

Abstract Seed beetles are among textbook examples of experimental model systems used to better understand nature's complexities. A potential seed beetle model systems' strength is the use of artificial seeds to remove experimental confounds. This is particularly relevant for scaling life histories to population dynamics but requires many artificial seeds. Current methods of producing seeds are laborious, limiting their application. Building on previous work, we developed efficient methods to produce artificial seeds and expand their use. We outline steps to produce artificial seeds and describe a new technique for transferring beetle eggs laid on natural seeds to artificial seeds. Our methods yielded a 100‐fold increase in artificial seed production that is 80% more efficient than current methods. Burrowing success of beetle larvae from eggs laid on natural seeds and transferred to artificial seeds (85.4%) was comparable to rates on natural seeds. Streamlining artificial seed production enables highly replicated life‐history and time‐series assays with large sample sizes. The ability to transfer eggs from natural to artificial seeds allows research on many phenomena including oviposition strategies, maternal provisioning and competitive strategies, broadening the usefulness of seed beetle model systems in ecological and evolutionary research.

Incidence of maternal near-miss in Kenya in 2018: findings from a nationally representative cross-sectional study in 54 referral hospitals

Although the Kenyan government has made efforts to invest in maternal health over the past 15 years, there is no evidence of decline in maternal mortality. To provide necessary evidence to inform maternal health care provision, we conducted a nationally representative study to describe the incidence and causes of maternal near-miss (MNM), and the quality of obstetric care in referral hospitals in Kenya. We collected data from 54 referral hospitals in 27 counties. Individuals admitted with potentially life-threatening conditions (using World Health Organization criteria) in pregnancy, childbirth or puerperium over a three month study period were eligible for inclusion in our study. All cases of severe maternal outcome (SMO, MNM cases and deaths) were prospectively identified, and after consent, included in the study. The national annual incidence of MNM was 7.2 per 1,000 live births and the intra-hospital maternal mortality ratio was 36.2 per 100,000 live births. The major causes of SMOs were postpartum haemorrhage and severe pre-eclampsia/eclampsia. However, only 77% of women with severe preeclampsia/eclampsia received magnesium sulphate and 67% with antepartum haemorrhage who needed blood received it. To reduce the burden of SMOs in Kenya, there is need for timely management of complications and improved access to essential emergency obstetric care interventions.

Seasonal variation in the lipid profile of Acropora millepora at Halfway Island, Great Barrier Reef

To understand how environmental conditions and reproductive events affect coral energetic status, seasonal variations in lipid and fatty acid profiles of the common scleractinian coral, Acropora millepora, were studied from pre-spawning in November 2009 until post-spawning in November 2010 at Halfway Island (in the Keppel Island Group, Southern Great Barrier Reef, Australia). Seasonal chlorophyll levels, photosynthetically active radiation (PAR), rainfall and water temperature were major drivers of the overall coral lipid profile, and this was particularly pronounced in correlations with the important, high-energy lipid, triacylglycerol. This likely reflected changing food sources and feeding modes (i.e. phototrophy vs heterotrophy), which corresponds to the opportunistic feeding behaviour of corals. Water temperature was also a major influencer of the coral fatty acid profile. In particular, saturated fatty acids correlated positively with water temperature, while polyunsaturated fatty acids correlated negatively, reflecting cell membrane fluidity regulation, which is necessary for coral to tolerate changing temperatures. Spawning and maternal provisioning also proved to be a major driver of change in the coral lipid profile. The mass spawning events in spring for both 2009 and 2010 caused reductions in the important coral egg constituents: wax ester, triacylglycerol, phosphatidylcholine and fatty acid 10:0. Interestingly, lipid accumulation was significantly lower in the 2010 spawn compared to 2009, possibly due to lower PAR and chlorophyll levels, reflecting reduced photosynthetic activity and phytoplankton availability. Regardless, in 2010, resource provisioning to egg production was greater than in 2009, suggesting increased reproductive effort in the face of environmental stress. This study demonstrates the strong influence of opportunistic heterotrophy and autotrophy and maternal provisioning on the coral lipid profile. Such information is fundamental to understanding the environmental and biochemical processes underlying coral health and predicting how anomalous events and climate-driven changes will affect coral reef assemblages.

A qualitative review of maternal health care provision for migrant and refugee women

Abstract Background The number migrants increased worldwide. Pregnant migrant/refugee women are considered a vulnerable group. How do professionals manage their care? The aim was to summarize the current evidence regarding maternal health care provision for migrant/refugee women. Methods We conducted a systematic review and searched the databases PubMed (MEDLINE); CINAHL; PSYNDEX, PsycINFO and Cochrane Library. Studies were judged for eligibility: a study had to address maternal health care provision for migrant/refugee women who immigrated to an OECD member state. Publication date was restricted to 1990-2019, and language to English or German. Results 16 primary (qualitative) studies were included. Heterogeneity of the included studies exists regarding e.g. origin of the women, migration background, receiving country. Nevertheless, synthesis can provide valuable information on challenges and how to deal with migrant/refugee women in maternal health care. Communication difficulties pose challenges on professionals (15 studies). Possibilities to deal with them: bridge-languages, non-verbal communication and interpreters. In addition, finding one's way in the unknown health care system is a barrier for women, which professionals can meet by informing the women and coordinating care (8 studies). The perceived diversity of women can lead to conflicts in care (10 studies). While some studies recommend 'cultural recipes', other authors emphasize the individuality of women and prefer a holistic care approach. Conclusions Professionals face different barriers when providing maternal health care to migrant/refugee such as communication barriers, coordinating care and handling women's diversity. Initiating and enhancing public health activities such as training courses for professionals that convey general principles such as woman-centered care, communication techniques are valuable opportunities to improve migrant/refugee women's maternal health care provision. Key messages Maternal health care professionals face different barriers when providing maternal health care to migrant/refugee such as communication barriers, coordinating care and handling women's diversity. Initiating and enhancing public health activities such as training courses for maternal health care professionals are valuable opportunities to improve migrant/refugee women’s maternal care.

Maternal health care provision for refugee women

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 were analyzed following the standards of qualitative thematic analysis. Results Maternal health care professionals face challenges in implementing and providing maternal health care concerning their professional practices and interventions. Due to a lack of resources (e.g. translators, time) and other conditions, gynaecologists and midwives are forced to find new solutions that maintain (medical care), adapt (vaginal examination) or miss out on (informed consent) ordinary professional practices. Key messages Maternal health care professionals face different barriers when providing maternal health care to migrant/refugee such as communication barriers and problems in relationship building. The identification of challenges and opportunities for professionals in maternal health care provision may contribute to improve maternal health (care) for refugee women.

Remembering your enemies: mechanisms of within-generation and multigenerational immune priming in Caenorhabditis elegans.

Pathogens are abundant and drive evolution of host immunity. Whilst immune memory is classically associated with adaptive immunity, studies in diverse species now show that priming of innate immune defences can also protect against secondary infection. Remarkably, priming may also be passed on to progeny to enhance pathogen resistance and promote survival in future generations. Phenotypic changes that occur independent of DNA sequence underlie both 'within-generation' priming and 'multigenerational' priming. However, the molecular mechanisms responsible for these phenomena are still poorly understood. Caenorhabditis elegansis a simple and genetically tractable model organism that has enabled key advances in immunity and environmental epigenetics. Using both natural and human pathogens, researchers have uncovered numerous examples of innate immune priming in this animal. Viral infection models have provided key evidence for a conserved antiviral RNA silencing mechanism that is inherited in progeny. Bacterial infection models have explored mechanisms of within-generation and multigenerational priming that span chromatin modification and transcriptional changes, small RNA pathways, maternal provisioning and pathogen avoidance strategies. Together, these studies are providing novel insight into the immune reactivity of the genome and have important consequences for our understanding of health and evolution. In this review, we present the current evidence for learned protection against pathogens in C. elegans, discuss the significance and limitations of these findings and highlight important avenues of future investigation.

Maternal Healthcare in Rural Uttar Pradesh: Influence of free Services on Healthcare-Seeking behaviour of Women

This field-based study evaluates the impact of free maternal healthcare services on the healthcare-seeking behaviour of 125 pregnant women in six villages of Uttar Pradesh. The 87 Muslim and 38 non-Muslim women participating in this project appreciated the antenatal and postnatal care processes on offer. Yet, various government efforts to encourage women to give birth in government hospitals to comply with international benchmarks on reduction of maternal mortality rates were unsuccessful. The study explores the various reasons for the strategic choices made by these rural women, who continue to favour home-based delivery. The findings raise policy implications about how state financing of maternal healthcare provisions in India is to be delivered, in the best possible manner, at local levels.

Pregnancy after loss during the COVID19 pandemic

BackgroundRapid changes to how maternity health care is delivered has occurred in many countries across the globe in response to the COVID-19 pandemic. Maternity care provisions have been challenged attempting to balance the needs and safety of pregnant women and their care providers. Women experiencing a pregnancy after loss (PAL) during these times face particularly difficult circumstances. AimIn this paper we highlight the situation in three high income countries (Australia, Ireland and USA) and point to the need to remember the unique and challenging circumstances of these PAL families. We suggest new practices may be deviating from established evidence-based guidelines and outline the potential ramifications of these changes. FindingsRecommendations for health care providers are suggested to bridge the gap between the necessary safety requirements due to the pandemic, the role of the health care provider, and the needs of families experiencing a pregnancy after loss. DiscussionChanges to practices i.e. limiting the number of antenatal appointments and access to a support person may have detrimental effects on both mother, baby, and their family. However, new guidelines in maternity care practices developed to account for the pandemic have not necessarily considered women experiencing pregnancy after loss. ConclusionBereaved mothers and their families experiencing a pregnancy after loss should continue to be supported during the COVID-19 pandemic to limit unintended consequences.

Temperature alters reproduction and maternal provisioning in a fish ectoparasite

This study quantified the effects of temperature on reproduction and maternal provisioning of the ectoparasite, Neobenedenia girellae (Platyhelminthes: Monogenea), a species known to cause detrimental impacts to aquaculture fishes in tropical and subtropical environments worldwide. At 20 and 25 °C, parasites exhibited relatively slower production of larger eggs that were energy-dense. In contrast, parasites at 30 °C attained sexual maturity faster, were reproductively active over a shorter period, grew to a smaller size and laid smaller, less energy-rich eggs at a faster rate. As such, parasites exhibited two distinct reproductive patterns in response to temperature: parasites at lower temperatures produced larger eggs with higher energy content, while those at the higher temperature had a higher rate of egg production. Larger eggs produced under cooler conditions were better provisioned with energetic reserves and important, membrane-bound lipids that would likely facilitate larval longevity and development success. This is commensurate with previous observations of epizootics of this parasite species in aquaculture systems during winter. Meanwhile, eggs produced at 30 °C contained higher proportions of saturated fatty acids compared with polyunsaturated fatty acids, likely reflecting metabolic regulation of cell membrane fluidity, which is necessary for larvae to survive warm conditions. This study demonstrates that fish ectoparasites have evolved substantial reproductive and metabolic flexibility to maximise infection success under variable environmental conditions.

Climate Refugees and Maternity Care

In this article, Kai Hodgkin provides a personal reflection to situate the broader concerns regarding climate change and the displacement of people; either within their own country or where they have been forced to flee their country. In addition, the article explores cultural safety and how it applies to maternity care provision.

Healthy weight services in England before, during and after pregnancy: a mixed methods approach

BackgroundMaternal overweight and obesity are associated with numerous adverse outcomes including higher rates of maternal and infant mortality and morbidity. Overweight and obesity before, during and after pregnancy are therefore a significant public health priority in England. This project explored and mapped healthy weight service availability at different stages of the childbearing cycle.MethodsA mixed methods approach included a questionnaire-based survey disseminated through Local Maternity Systems and semi-structured interviews or focus groups with providers and commissioners. Current maternal weight service provision was explored along with some of the barriers and facilitators for providing, delivering and accessing healthy weight services. Descriptive statistics were reported for quantitative data and content analysis was used for thematic reporting of qualitative data.ResultsA total of 88 participants responded to the survey. All services were offered most frequently during pregnancy; with healthy eating and/or weight management services offered more often than physical activity services. Few services were targeted specifically at women with a raised body mass index. There was a high degree of inconsistency of service provision in different geographical areas.Several themes were identified from qualitative data including “equity and variation in service provision”, “need for rigorous evaluation”, “facilitators” to encourage better access or more effective service provision, including prioritisation, a change in focus and co-design of services, “barriers” encountered including financial and time obstacles, poor communication and insufficiently clear strategic national guidance and “the need for additional support”.ConclusionsThere is a need to reduce geographical variation in services and the potential health inequalities that this may cause. Improving services for women with a raised body mass index as well as services which encourage physical activity require additional emphasis. There is a need for more robust evaluation of services to ensure they are fit for purpose. An urgent need for clear national guidance so that healthcare providers can more effectively assist mothers achieve a healthy weight gain was identified. Commissioners should consider implementing strategies to reduce the barriers of access identified such as childcare, transport, location and making services free at the point of use.

Trends in Female Workers' Childbearing Intentions in South Korea.

This study aimed to analyze trends of South Korean working women's childbearing intentions to provide directions for strategies to increase South Korea's birth rate. This study used the data generated by the Korean Longitudinal Panel Survey of Women and Families in South Korea from 2007 to 2016, and included 2,341 working women. This study showed that female workers' intention to bear children is decreasing. In 2007, age and the number of children were considered in predicting the characteristics of those with childbearing intentions. In 2016, the provision of maternity leave at work, job satisfaction regarding relationships and communication, and work-family conflicts were added. When identifying the factors by category, the impact level of occupational factors increased, although the impact level of individual factors decreased. There should be a balance between work and family roles, and employers should provide ample maternity leave and promote an organizational culture that supports job satisfaction.

Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic

IntroductionThe COVID-19 pandemic has substantially impacted maternity care provision worldwide. Studies based on modelling estimated large indirect effects of the pandemic on services and health outcomes. The objective of this...

Quality-Adjusted Coverage of Nutrition Interventions Across the Continuum of Care: Insights from Household and Health Facility Data in Bangladesh

Abstract Objectives Improving the impact of nutrition interventions requires adequate measurement of both reach and quality of interventions, but limited evidence exists on advancing coverage measurement. We adjust crude health coverage estimates, taking into consideration the inputs required to deliver quality nutrition services, across the continuum of care in Bangladesh. Methods We used data from Bangladesh Demographic and Health Surveys 2014 to assess use of maternal and child health services and Service Provision Assessments 2014 to determine facility readiness to deliver nutrition interventions during antenatal (ANC), institutional delivery, and postnatal care (PNC). Service readiness was computed as the mean availability of four nutrition-specific inputs, capturing human resources and training, equipment, diagnostics, and medicines. Crude coverage was combined with service readiness to create a measure of input-adjusted nutrition coverage at the national and regional levels, across place of residence, and by maternal educational and household socio-economic quintiles. Results Crude coverage varied, with greater use of any ANC (79%) and postnatal care (61–81%), than institutional delivery (37%). Nutrition service readiness was lower than crude coverage at each time point, such that nutrition input-adjusted coverage was 45% for ANC, 25% for institutional delivery, and 38–49% for preventive and sick child postnatal care, respectively. Input-adjusted coverage varied by 10–22 percentage points (pp) between regions within the country. Inequalities in input-adjusted coverage were large during ANC and institutional delivery (12–17 pp between urban and rural areas, ∼17pp between low and high education, and 30–36pp between highest and lowest wealth quintiles), and less variable for postnatal care (<10%). Conclusions Nutrition input-adjusted coverage was suboptimal and varied sub-nationally and across the continuum of care in Bangladesh. Special efforts are needed to improve the reach as well as the quality of health and nutrition services to achieve the Sustainable Development Goals. Funding Sources Bill & Melinda Gates Foundation through A4NH.

Stockpiling by pups and self-sacrifice by their fasting mothers observed in birth to weaning serum metabolomes of Atlantic grey seals

During the uniquely short lactations of true seals, pups acquire a greater proportion of maternal body resources, at a greater rate, than in any other group of mammals. Mothers in many species enter a period of anorexia but must preserve sufficient reserves to fuel hunting and thermoregulation for return to cold seas. Moreover, pups may undergo a period of development after weaning during which they have no maternal care or nutrition. This nutritionally closed system presents a potentially extreme case of conflict between maternal survival and adequate provisioning of offspring, likely presenting strains on their metabolisms. We examined the serum metabolomes of five mother and pup pairs of Atlantic grey seals, Halichoerus grypus, from birth to weaning. Changes with time were particularly evident in pups, with indications of strain in the fat and energy metabolisms of both. Crucially, pups accumulate certain compounds to levels that are dramatically greater than in mothers. These include compounds that pups cannot synthesise themselves, such as pyridoxine/vitamin B6, taurine, some essential amino acids, and a conditionally essential amino acid and its precursor. Fasting mothers therefore appear to mediate stockpiling of critical metabolites in their pups, potentially depleting their own reserves and prompting cessation of lactation.

Effects of maternal and dietary vitamin A on growth performance, meat quality, antioxidant status, and immune function of offspring broilers

The aim of this study was to evaluate the effects of maternal and dietary vitamin A (VA) level on growth performance, meat quality, antioxidant status, and immune function of offspring broilers. Chinese yellow-feathered breeder hens were fed a basal diet supplemented with 0, 5,400, 10,800, and 21,600 IU/kg VA for 8 wk, with 6 replicates of 22 hens per replicate. Then the offspring hatched from each of the 4 maternal groups were fed a basal diet supplemented with 0 or 5,000 IU/kg VA for 63 D. Overall, there were 8 treatment combinations, each with 6 replicate pens of 20 birds. Results showed that (1) providing VA in offspring diets increased final body weight (FW), average daily gain, and average daily feed intake but reduced feed-to-gain ratio and mortality of offspring broilers (P < 0.05), whereas maternal provision of VA did not significantly affect the growth performance and mortality of offspring broilers. Maternal or offspring VA did not affect proportion of breast or thigh muscle (P > 0.05). (2) Maternal feeding with 21,600 IU/kg VA increased (P < 0.05) pH 24 h postmortem of breast muscle, compared with those without maternal supplication of VA. Dietary provision of 5,000 IU/kg VA in the posthatching diet decreased (P < 0.05) drip loss, yellowness (b∗) value and lightness (L∗) value, and increased shear force and pH of breast muscle compared with those without dietary VA supplication. (3) Maternal or offspring VA did not affect the activities of total superoxide dismutase and glutathione peroxidase (GSH-Px) or the content of malondialdehyde; however, there was a significant interaction (P < 0.05) between maternal and offspring VA on the activity of GSH-Px in serum. (4) Dietary provision of 5,000 IU/kg VA increased (P < 0.05) the weight proportion of liver and bursa of fabricius, whereas maternal feeding with 21,600 IU/kg VA increased the hatchling BW. Maternal feeding with 5,400 and 21,600 IU/kg VA decreased (P < 0.05) splenic interferon-γ (IFN-γ) transcripts and increased (P < 0.05) those of interleukin-2 (IL-2) in the progeny. There were interactions (P < 0.05) between maternal and offspring VA on splenic IL-2, IL-1β, and IFN-γ expression. In summary, maternal and offspring provision of VA both had influence on meat quality and immune function in progeny broilers. Dietary VA increased growth performance, whereas the maternal VA affected the initial body weight of progeny when hatched, but the difference in performance caused by maternal VA level was able to be eliminated by dietary VA supplementation. Therefore, offspring provision had greater importance than maternal VA in the production; however, both should be considered in broiler nutrition to achieve good meat quality and immune status of broilers.

Legal regulation of certain types of social leave in Ukraine and the EU

Legal regulation of certain types of social leave in Ukraine and the EU:this article highlights the basic standards followed and fully supported by the European Union and Ukraine as regards the provision of both maternity and paternity leave, as well as parental leave as a whole notion with its particularities. Moreover, it discloses and explains the important difference between these two notions and provides appropriate European and Ukrainian rules of law. It also contains comparison of the effective laws in labor sphere in Ukraine and existing draft legislation which is currently under consideration in this field by the authorized representatives. The article also considers the most prioritized areas for further amending Ukrainian labor laws and rules to be approved for the support and implementation of these specific laws in this field related to these issues. On a separate note, it gives the bright examples of the relevant experience lived through the European Union member states regarding the term of such leave and ensuring the father’s right to take parental leave alongside the one existing and exercising by mothers. It proves that nowadays the European Union elaborates approaches to work on ensuring a proper balance between responsibilities of people as family members and their career. Based on this, it provides for a gender equality and an equal enjoyment of both mother’s and father’s rights. From what we can currently see in Ukraine, unfortunately, our country nowadays is far from practical implementation of these ideas. However, it should be emphasized that after all our legislation has already stipulated some provisions allowing the fathers to take parental leave (so called paternity leave, as already mentioned). The article also has some considerations concerning other labor guarantees for pregnant women. The presented study allows us to identify areas for improving and facilitating the Ukrainian labor legislation in the nearest future and highlights the best European practices which are definitely useful and helpful in the elaborating and developing a new draft Ukrainian Law "On Labor" to be shortly considered by the parliament.

Is development aid to strengthen health systems during protracted conflict a useful investment? The case of South Sudan, 2011–2015

IntroductionIs achievement of Sustainable Development Goal (SDG) 16 (building peaceful societies) a precondition for achieving SDG 3 (health and well-being in all societies, including conflict-affected countries)? Do health system investments...

‘They follow the wants and needs of an institution’: Midwives’ views of water immersion

BackgroundA midwife’s ability to fully support women’s autonomy and self-determination with respect to midwifery care is often challenging. This is particularly true of water immersion for labour and birth. However, the woman’s agency over what happens to her body and that of her unborn baby should be key considerations for maternity care provision. ObjectivesA three phased mixed-methods study was undertaken to examine how water immersion policies and guidelines are informed. Phase three of this study captured the knowledge and experiences of Australian midwives, their support for water immersion and their experiences of using policies and guidelines to inform and facilitate the practice. MethodsCritical, post structural, interpretive interactionism was used to examine more than 300 responses to three open-ended questions included in a survey of 233 midwives. Comment data were analysed to provide further insight, context and meaning to previously reported results. FindingsFindings demonstrated a complex, multidimensional interplay of factors that impacted on both the midwife’s ability to offer and the woman’s decision to use water immersion under the themes ‘the reality of the system’, ‘the authoritative ‘others’’ and ‘the pseudo decision-makers’. Multiple scaffolded levels were identified, each influenced by the wider macro-socio-political landscape of Australian midwifery care. ConclusionsThe insight gained from examining midwives’ views and opinions of water for labour and birth, has aided in contextualising previously reported results. Such insight highlights the importance of qualitative research in challenging the status quo and working towards woman-centred practice and policy.

The influence of distance and quality on utilisation of birthing services at health facilities in Eastern Region, Ghana

ObjectivesSkilled birth attendance is the single most important intervention to reduce maternal mortality. However, studies have not used routinely collected health service birth data at named health facilities to understand...