Obstetric Services Research Articles

Strategies supporting the implementation of simulation-based education in nursing and midwifery in Malawi: A mixed methods study

Background. Nursing and midwifery training institutions are responsible for preparing the future nursing and midwifery workforce to ensure that they practise in accordance with the applicable patient safety standards. As such, simulation-based education (SBE) is thoughtfully being implemented in many parts of the world to train nursing and midwifery students to help the graduates to acquire the technical and non-technical skills needed to deliver safe patient care. This study, therefore, attempted to identify strategies for implementing SBE in nursing and midwifery in Malawi. Objective. To identify strategies for implementing SBE in nursing and midwifery in selected education institutions and clinical sites in Malawi. Methods. The data were collected using mixed methods with questionnaires, in-depth interviews, focus group discussions and desk reviews of nursing and midwifery syllabuses and curricula documents in Malawi. Two hundred and ninety-three participants responded to the questionnaire (144 clinical instructors and 149 final-year nursing and midwifery students). Ten focus group discussions were held with fourth-year students. In-depth interviews with deputy hospital directors (nursing and midwifery services), college principals, deans, department heads and other key stakeholders were conducted. The College of Medicine Research and Ethics Committee granted ethical approval for the study. Quantitative data were entered into SPSS version 23.0 for descriptive statistics, and qualitative data were thematically analysed using NVivo 12. Results. The study identified several strategies for implementing SBE in Malawi, including building appropriate simulation infrastructure (n=115; 39.3%), training educators on simulation (n=130; 44.4%), training clinical instructors/preceptors (n=106; 36.3%) and purchasing appropriate equipment (n=202; 68.9%). Scenarios with standardised patients and collaborative work in simulation between clinical staff and academics in training institutions and clinical settings were critical strategies for implementing SBE in Malawi. Conclusion. The successful implementation of SBE in nursing and midwifery in Malawi relies on a holistic approach that encompasses infrastructure, educator training, collaboration, scenario development, curriculum integration and ongoing evaluation. The journey towards realising these goals will undoubtedly require dedication, persistence, and the collective efforts of all stakeholders involved in nursing and midwifery education in Malawi.

The Influence of General Facilities, General Service, Registration Service, Service Providers and Accessibility on Patient Satisfaction of Antenatal Care at XYZ Hospital

The aim of this research is to examine and analyze the influence of public facilities, public services, service providers and accessibility on patient satisfaction with antenatal services at XYZ Hospital. Testing of the modified research model from previous research was carried out using data from midwifery services at the hospital. The method in this research is a quantitative approach with surveys and cross sectional. Respondent data was taken in 2024 by purposive sampling with questionnaires from individuals who had received antenatal care services at XYZ Hospital. There are 180 samples that meet the requirements described by PLS-SEM. The results of this research show that the five variables are proven to have a significant and positive influence. This research adds a contribution that focuses more on antenatal care services in hospitals. It is recommended in future research to include more hospitals of various types and a larger sample size so that the analysis results can be more generalized at the population level. Future research is recommended to consider adding other variables that may potentially influence patient satisfaction.

Facilitators and Barriers to Access to Midwife-Led Birth Settings for Racialized Women in the UK: A Scoping Review.

In UK maternity care, racialized women have worse experiences and clinical outcomes than White women. Midwife-led birth settings (MLBS), including home births and midwife-led units, both freestanding and alongside hospitals, are all available as choices for low-risk women in the UK. MLBS deliver optimal outcomes for low-risk women with uncomplicated pregnancies, including for racialized women, and can offer culturally specific care, possibly mitigating existing social inequalities. Evidence suggests that racialized women access MLBS less than White women. To map existing literature on facilitators and barriers to accessing MLBS for racialized women and to identify emerging themes. A scoping review of UK literature over the last 10 years using OVID, Ebsco Host, and gray literature. Search, selection, and data extraction were performed using PRISMA and JBI guidelines. Data were analyzed using inductive thematic analysis. Fourteen articles met the inclusion criteria, only one addressing the research question directly and others containing some relevant material. Six themes were identified: admission criteria, information giving, the role of antenatal groups, bias and assumptions, beliefs about birth, and MLBS as empowering. There is a lack of research on racialized women's access to MLBS. Community outreach, having midwifery services embedded in the community, defaulting to MLBS for women categorized as low risk, continuity of carer, and interventions achieving a reduction in care-giver bias may improve access and outcomes.

Midwives' perspectives on rural birthing experiences and newborn survival in Ghana

BackgroundAccess to essential and emergency newborn care services remains a challenge in low- and middle-income countries (LMICs), especially in rural and remote areas where various factors increase maternal and newborn vulnerability. The scarcity of midwives on a global scale further strains obstetric and neonatal services, as midwives work at the forefront in many LMICs. In Ghana, neonatal deaths at birth and within 24 h contribute significantly to infant mortality rate, with midwives caring as frontline health workers. However, there is limited exploration of midwives' experiences in managing these situations. This study aimed to unveil the meanings and articulate the experiences of midwives who face newborns with respiratory distress at birth in rural southern Ghana.MethodsInterpretive Phenomenological approach was used to explore thirteen (13) midwives’ experiences of managing newborns in respiratory distress in rural birth settings amidst scare life saving resources, skilled staff shortage and limited advanced health care. The midwives were purposively sampled from the Shai-Osudoku district and data were collected through face-to-face interviews. Content analysis was conducted on the interview transcripts and rich narratives developed in the research report.ResultsRural midwives have limited access to newborn lifesaving equipment, adequate training, skill staff support, and timely advance care for newborns. These issues are driving factors for newborn referral in rural health care, but transportation gaps impede timely advance care delivery. Rural midwives’ inadequate psychosocial support and lack of enabling work environment engender moral distress with emotional burden requiring sustained attention from national leadership, as well as midwifery professional networks and regulatory bodies.ConclusionNewly qualified midwives require sustainable support as they struggle in birth spaces where ethical questions emerge as family members are engaged as support persons in neonatal resuscitation. Future research is needed to investigate Chiefs, Queen Mothers and Community Elders’ engagement in community-based interventions to support timely access to quality care and midwives’ heroic practices of saving maternal/newborn lives in rural Ghana to help achieve SDG 3.2.

Obstetric Care Access at Rural and Urban Hospitals in the United States

This study quantifies losses and gains of obstetric care services at US rural and urban short-term acute care hospitals between 2010 and 2022.

Effects of White Noise and Therapeutic Touch on Pain and Comfort in Newborns during Heel Lance: A Randomized Controlled Study.

Nonpharmacological methods such as white noise and therapeutic touch can be used in pain management in neonates. This randomized controlled study evaluated the effects of white noise and therapeutic touch during heel lance procedures on pain, comfort levels, and physiological parameters in healthy neonates. This parallel, randomized controlled study was conducted in the Obstetrics and Gynecology Service of a regional hospital. The sample comprised 160 neonates with gestational ages of >35weeks randomly assigned to 4 groups (white noise [WN], therapeutic touch [TT], white noise+therapeutic touch [WT], and control [CG] group). Pain and comfort levels were evaluated according to the Neonatal Infant Pain Scale, and the COMFORTneo Scale. The primary outcomes were pain and comfort levels, and the secondary outcomes were heart rate and SpO2 levels. The Kruskal-Wallis test was used to compare the scale scores among groups. There were significant differences among groups in terms of Neonatal Infant Pain Scale and COMFORTneo scores (P <.05). The pain scores for the white noise, therapeutic touch, and white noise+therapeutic touch groups were 4.2±2.0, 5.2±1.6, and 3.3±1.7, respectively. There was a significant difference in average heart rate during the heel lance procedure among the groups (P <.05). Pain scores of the intervention groups were lower compared to the control group. The combination of white noise and therapeutic touch was more effective in reducing pain and increasing comfort levels. Nurses could reduce procedural pain by applying these pain relief methods.

Outcomes for women with diabetes admitted for labour care to midwifery units in the UK: a national prospective cohort study and survey of practice using the UK Midwifery Study System (UKMidSS)

ObjectivesTo describe outcomes in women admitted for labour care to midwifery units with gestational or pre-existing diabetes, compare outcomes with other women admitted to the same units and describe admission...

HUBUNGAN PEMAKAIAN KONTRASEPSI SUNTIK 3 BULAN DENGAN KENAIKAN BERAT BADAN AKSEPTOR KB DI BPM ENDAH SETIATI, SST DESA TONGAS WETAN

Injection contraception is a contraceptive method that is widely used in Indonesia. The proportion of injection contraception use was 62.77%. Most acceptors of 3-month injection KB experience an increase in body weight. This is because progesterone stimulates the appetite control center in the hypothalamus, thereby influencing eating behavior. One study showed that many injecting contraceptive users stopped due to side effects such as menstrual disturbances, weight gain, headaches, and stomach discomfort. The purpose of this study was to determine the correlation between the use of 3-month s injection contraception and the increase in the weight of family planning acceptors at Endah Setiati, SST Independent Midwife Practice Tongas Wetan village. This study used a retrospective, using secondary data. With correlation research design with a cross sectional study approach. The population in this study was the number of acceptors of 3-month s injectable family planning at Endah Setiati, SST Independent Midwife Practice. From January to December, 90 people using the total sampling technique and statistical tests used the Chi square test. The results of this study revealed that of the 90 acceptors of the 3-month s injection, most of the acceptors used it for a long time and experienced weight gain, namely 40 people (44.4%). The results of the Chi Square statistical test obtained p-value = 0.126. However, it can be concluded that there is no correlation between the use of 3-month s injectable birth control and weight gain in Endah Setiati, SST Independent Midwife Practice in Tongas Wetan village. The suggestion of this research, will be able to have an impact on midwifery services in the community, especially in providing explanations to patients about the side effects of using 3-month injectable birth control.

7. EVALUATION OF INPATIENT OBSTETRIC SERVICE QUALITY AT THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, PHUONG DONG GENERAL HOSPITAL IN 2024

Objective: Describe the perceptions of inpatients about the quality of services at the Department of Obstetrics and Gynecology, Phuong Dong General Hospital in 2024. Methods: This cross-sectional descriptive study, employing both qualitative and quantitative methods, was conducted on 223 obstetric inpatients from March 2024 to September 2024. Results: 91.0% of the inpatients evaluated the service quality as satisfactory. The satisfaction rates for specific aspects were as follows: 96.0% for reliability, 96.9% for responsiveness, 99.1% for assurance, 95.5% for empathy, and 97.3% for tangibility. Conclusion: The high level of satisfaction with obstetric service quality suggests that further efforts are needed to enhance and sustain the quality of services in the future.

ASSISTÊNCIA DE ENFERMAGEM NO PARTO HUMANIZADO

This article aimed to analyze the performance of the nursing team in the context of humanized birth, with the aim of improving the systematization of this practice and understanding the impact on the perception and experience of women and newborns. With a descriptive and exploratory approach, an integrative literature review was used, allowing a comprehensive analysis of nursing interventions that contribute to the humanization of childbirth. The research was conducted based on inclusion criteria that considered scientific articles published in the last five years, in Portuguese, and available in full in electronic databases, such as SciELO, LILACS and BDENF. The results indicate that nursing care is fundamental to women's positive experience during humanized childbirth. Factors such as continuous support, effective communication and active listening emerged as essential elements for the empowerment and satisfaction of parturient women, also highlighting the importance of continuous training of nursing professionals in humanized practices and adequate training. Public policies play a crucial role in promoting humanized practices, requiring institutional support and clear guidelines so that the nursing team can implement these practices effectively. It is concluded that nursing care in humanized birth has a direct impact on improving the birth experience, requiring greater appreciation and investment in health policies that prioritize humanization in obstetric services.

Mechanisms for providing obstetric service with medical supplies in accordance with the National classifier of medical devices NK 024:2023

Every woman has an indisputable right to realize reproductive health and ensure the birth of a child in professional conditions. The reform of the medical service of Ukraine is aimed at ensuring the efficiency and accessibility of the provision of medical services to every citizen, and improving their quality. In addition to improving the quality of coordination between different levels of medical care, the qualification of medical personnel, it is necessary to provide health care facilities with medical equipment.In order to bring the country’s regulatory framework in the field of application of medical devices to international approaches in Ukraine, the classification of medical devices has been coordinated with the international nomenclature of medical devices Global Medical Device Nomenclature.Mechanisms for providing the obstetric service with medical supplies in accordance with the National Classifier of Medical Devices of Ukraine NC 024:2023 is presented in the article as a result of the study with the application of bibliosemantic method and the method of structural-and-logical analysis. The practical application of the classifier is ensured by the use of a five-digit numerical code of the classifier, which is cross-referenced with the exact wording of the term of the medical device, its definition, and description in Ukrainian and English. Practical mechanisms for providing the obstetric service with medical supplies in accordance with the National Classifier of Medical Devices of Ukraine NC 024:2023 consist in the use of methodological recommendations approved by the Ministry of Health of Ukraine and the computer program “System of on-line access to the classifier of medical devices”, which ensure the methodological and technical use of the specified National Classifier of Medical Devices. The use of these methodological materials makes it possible to establish the availability of the necessary medical device in Ukraine, its manufacturer, price and providers.

Women's empowerment model in treatment of pregnant women at risk of anemia in Indonesia: Literature review

Anemia in pregnancy has remained a major problem in Indonesia over the past decade. The women's empowerment model in the health sector can be a solution to the problem of pregnant women who are at risk of anemia and towards accelerating the SDGs achievement target in the third "Decade of Action" goal in 2030. Objective: to find out the evidence based on the women's empowerment model in handling pregnant women at risk of anemia in Indonesia. Method: Literature review search usingarticle 2014-2024 withdatabase (pubmed, sciencedirect, and google scholar) relevant to the keywords used maternity; obstetrics and pregnancy; women's empowerment; prevention; anemia. There were 10 articles used in this study which will then be extracted data, as well as compiled, summarized and reported the results. Results: The study showed that the women's empowerment model of knowledge, attitudes, family and community roles, diet, health services and health worker professionalism is effective in handling mothers at risk of anemia.Conclusion: The importance of p supportgovernment andmidwife in givingquality midwifery services, access to credible sources of information, and encouraging the involvement of women, families and communities to realize women's health and well-being globally.

Red Blood Cell Transfusion Practices.

Opportunities to improve transfusion safety occur at lower hemoglobin (Hgb) thresholds and single-unit transfusions. Efforts to improve compliance with transfusion guidelines and single-unit transfusion practices reduce transfusions and lead to improved outcomes. To evaluate demographic and practice characteristics associated with lower Hgb thresholds and single red blood cell (RBC) unit transfusion practices. This study used the College of American Pathologists (CAP) Q-Probes format with the recent 2020 and 2017 surveys of participating institutions. High rates of transfusion review and compliance were observed with institutions reporting RBC transfusions meeting institutional guidelines. CAP inspection participants and those with a formal policy to encourage single-unit transfusions showed a trend toward greater compliance. Comparison of 2020 and 2017 survey results showed favorable downward trends in the Hgb threshold for transfusion compliance review and pretransfusion and posttransfusion Hgb values. Institutions reporting initiatives to decrease transfusions, teaching hospitals, and those with updated guidelines in alignment with recent literature reported lower pretransfusion Hgb levels in both studies. The 2020 study showed greater single-unit transfusion use among hospitals with patient blood management programs, larger institutions, and those training pathology residents. Single-unit transfusion rates varied by hospital service, with highest rates reported within hematology/oncology (99 of 138 [71.7%]), intensive care (147 of 215 [68.4%]), and medicine (419 of 666 [62.9%]) services. Transfusion practice improvement programs to decrease RBC transfusions include the use of single-unit transfusions and lower institutional pretransfusion Hgb thresholds. Opportunities to lower transfusion thresholds and increase single-unit transfusions exist in surgical and obstetrics services.

Layers of inequality: gender, medicalisation and obstetric violence in Ghana

BackgroundThis study explored how gender inequalities in health systems influence women’s experiences of obstetric violence in Ghana. Obstetric violence is recognised as a major public health concern and human rights violation. In particular, it reduces women’s trust and use of health facilities for childbirth, thereby increasing the risks of maternal and neonatal mortality. In Ghana, obstetric violence is pervasive and normalised; yet, little is known about the gendered dynamics of this phenomenon.MethodologyA qualitative study was conducted in eight public health facilities in Ghana. Specifically, semi-structured interviews were conducted with 30 midwives who work in the maternity units and 35 women who have utilised the obstetric services of the hospitals for childbirth. The midwives and women were selected using the purposive sampling technique. The transcripts of the interviews were coded using NVivo qualitative data analysis software and were thematically analysed. Secondary materials such as existing data on the medical profession in Ghana were utilised to complement the primary data.ResultsThe study revealed that there are huge structural inequalities that keep women at the lower cadres of the health system. Five major themes depicting how gender inequalities contribute to women’s experiences of obstetric violence emerged: gender inequality in the medical profession, unequally and heavily tasked, feminisation of midwifery, patriarchal pressures and ideologies, and gender insensitivity in resource provision. These inequalities impact the kind of care midwives provide, which is often characterised by mistreatment and abuse of women during childbirth. The study also discovered that patriarchal ideologies about women and their bodies lead to power and control in the delivery room and violence has become a major instrument of domination and control.ConclusionThe hierarchical structure of the healthcare profession puts the midwifery profession in a vulnerable position, with negative consequences for maternity care (obstetric violence). The study recommends that gender-responsive approaches that address structural inequalities in health systems, women’s empowerment over their bodies and male involvement in women’s reproductive care are crucial in dealing with obstetric violence in Ghana.

Revitalizing obstetrics and gynecology, a pathway to restoring medicine in Republic of Korea

Background: In February 2024, the Korean government introduced the “Essential Medical Package,” along with an increase in medical school admissions of 2,000 students, resulting in a total annual intake of 5,058 for the beginning of 2025. This sudden policy shift precipitated significant turmoil within the medical sector, prompting many resident doctors to resign and medical students to take leaves of absence. Despite numerous appeals for the revision of these policies, the government has widely disregarded these concerns and adopted more restrictive measures, thereby exacerbating tensions within the healthcare community.Current Concepts: Despite Korea’s doctor-to-population ratio being lower than the OECD average, Korea demonstrates remarkable positive health indicators, including low avoidable mortality rates and high life expectancy. Nevertheless, critical specialties, particularly obstetrics and gynecology, are facing significant challenges. These challenges are compounded by policies that offer public health services such as complementary prenatal screenings, which reduce revenue for private clinics. Nevertheless, critical specialties, particularly obstetrics and gynecology, are facing significant challenges, compounded by policies that offer public health services, such as complementary prenatal screenings, which reduce revenue for private clinics. Consequently, this situation has exacerbated the decline of private obstetric services, placing additional strain on the healthcare system.Discussion and Conclusion: To effectively address the challenges facing the Korean healthcare system, it is imperative to implement targeted reforms that prioritize increasing compensation and mitigating legal risks for high-risk specialties, rather than merely expanding medical school admissions indiscriminately. Furthermore, transparent and data-driven workforce planning is essential to foster sustainable improvements that support the efficiency and accessibility of healthcare services in Korea. Without these reforms, there is a significant risk that the quality of medical services will continue to decline, thereby adversely affecting future generations’ access to essential healthcare.

Translating Priorities Into Practice: Midwifery Care for Uninsured Migrant Populations Across Canada.

Immigrants and newcomers are identified by many provincial midwifery associations as "priority populations." Recently, newcomer populations have shifted considerably, with more people coming to Canada with precarious immigration status who are increasingly ineligible for public healthcare insurance and facing barriers to accessing care. Our aims were to: (1) gain an understanding of the policies related to equitable access to midwifery care and how they may apply to migrant groups without public healthcare insurance and (2) identify existing policy themes, gaps, and regulatory barriers that limit access for this vulnerable population in Canada. We conducted a high-level document content analysis using a health equity framework. We aimed to identify language related to equitable access in midwifery services, with particular emphasis on uninsured populations. A total of 64 documents were analyzed, including legislation and publicly available statements from midwifery regulatory bodies and associations. Midwifery regulatory authorities and associations across Canada are consistent in establishing an expectation that midwives will provide accessible care to diverse clientele. However, how these commitments are put into practice varies considerably between jurisdictions. We compared the cases of Manitoba and Ontario to illustrate the disconnect between commitments to priority populations and implementation. While there is a clearly demonstrated intention to provide equitable access to midwifery care to all people, including "priority populations" like migrants and newcomers, in practice, these commitments have not been fully realized. Equity is encumbered by broader structural issues, such as the growth in the number of newcomers without access to public health insurance. Moves toward equity within midwifery and healthcare more broadly need to meaningfully engage with other policy sectors, such as immigration, to be able to adapt to emerging issues affecting reproductive care, such as the growing precarity of newcomer populations in Canada.

Maternal and newborn health prioritization in Yobe State, Nigeria: analysis of stakeholders' perspective.

Maternal and newborn mortality and morbidity in conflict-affected northeastern areas of Nigeria, such as Yobe State, are disproportionately higher than those in the rest of the country. There is limited evidence on the factors that influence maternal and newborn health (MNH) policymaking and implementation in this region, particularly with respect to the impact of conflict and context-specific issues. This study explores the political, economic and health system factors that drive the prioritization of MNH policies in Yobe State. The aim of this study was to elucidate the conflict-related factors influencing MNH outcomes, which could inform targeted interventions to improve MNH. The study is a descriptive case study that relies on multiple data sources and is guided by the Health Policy Analysis Triangle. We reviewed national and subnational research, technical reports and policies related to reproductive health and the MNH in Nigeria since 2010. Following stakeholder mapping, we identified and invited prospective participants in the MNH policymaking space. Nineteen stakeholders from the government, civil society and nongovernmental organizations, donor agencies, and public and private sector health providers in Yobe State participated in the semistructured in-depth interviews. Data were collected from November 2022 through January 2023 and were thematically analysed via Dedoose software. MNH services in Yobe State have received considerable attention through initiatives such as the National Midwifery Service Scheme, free MNH services, training of midwives with deployment to rural areas, and health facility renovations. The effective implementation of MNH services and policies faces challenges due to insufficient funding, and sustainability is hampered by changes in governance and political transitions. The Boko Haram insurgency exacerbated the humanitarian crisis in Yobe State and disrupted MNH services due to the displacement of populations and the decline in the number of health workers. Additionally, sociocultural and religious beliefs hinder timely access to and utilization of MNH services. Although policies and guidelines for MNH services exist in the state, they are inadequately disseminated to health providers, which affects their effective implementation across facilities. Collaboration and intersectoral coordination platforms exist, but competition and rivalries among unions, political entities, and implementing agencies sometimes impede progress. Enhancing MNH services in Yobe state requires increased commitment for funding through the Northeast Development Commission rehabilitation fund; strengthening the health workforce, safety and retention plan; promoting gender inclusivity within the health sector; and addressing sociocultural barriers to women's health-seeking behaviors. Concrete, time-bound plans for policy dissemination are necessary to ensure effective service implementation.

Cautionary lessons from the COVID-19 pandemic: Healthcare systems grappled with the dual responsibility of delivering COVID-19 and non-COVID-19 care.

During the COVID-19 pandemic, hospitals were challenged to provide both COVID-19 and non-COVID treatment. A survey questionnaire was designed and distributed via email to hospitals empanelled under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana(AB-PMJAY), the world's largest National Health Insurance Scheme. Telephonic follow-ups were used to ensure participation in places with inadequate internet. We applied support vector regression to quantify the hospital variables that affected the use vs. non-use of hospital services (Model-1), and factors impacting COVID-19 revenue and staffing levels (Model-2).We quantified the statistical significance of important input variables using Fisher's exact test. The survey, conducted early in the pandemic, included 461 hospitals across 20 states and union territories. Only 55.5% of hospitals were delivering emergency care, 26.7% were doing elective surgery and 36.7% providing obstetric services. Hospitals with adequate supplies of PPE, including N95 masks, and separate facilities designated for COVID-19 patients were more likely to continue providing emergency surgeries and services effectively. Data analysis revealed that large hospitals (> 250 beds) with adequate PPE and dedicated COVID-19 facilities continued both emergency and elective surgeries. Public hospitals were key in pandemic management, large private hospital systems were more likely to conduct non-COVID-19 surgeries, with not-for-profit hospitals performing slightly better. Public and large private not-for-profit hospitals faced fewer staff shortages and revenue declines. In contrast, smaller hospitals (< 50 beds) experienced significant staff attrition due to anxiety, stress and revenue losses. They requested government support for PPE supplies, staff training, testing kits, and special allowances for healthcare workers. The inclusion of COVID-19 coverage under AB-PMJAY improved access to healthcare for critical cases. Maintaining non-COVID-19 care during the pandemic indicates healthcare system resiliency. A state-wide data-driven system for ventilators, beds, and funding support for smaller hospitals, would improve patient care access and collaboration.

Exploring the attitudes and beliefs of women regarding the implementation of midwife-led care in India: A mixed methods study

ProblemDespite the recent introduction of midwifery services in India to improve maternal and newborn healthcare, there is limited research on women’s perspectives on midwife-led care. BackgroundThe Government of India initiated midwifery services guidelines in 2018 to improve the quality of care for pregnant women and newborns across the country. It is important to develop evidence-based strategies which can optimise the implementation of these new midwifery services. AimThis study explored women’s attitudes and beliefs towards the implementation of midwife-led care in two southern states of India. MethodsA convergent mixed methods design was employed using an online questionnaire and semi-structured online interviews. Quantitative data was analysed using descriptive statistics and qualitative analysis used a framework approach. Data from both sources were then integrated through merging techniques. FindingsA total of 307 women completed the online survey, and 23 participated in in-depth interviews. The study highlighted inadequate knowledge of midwife-led care among women. Despite this, 60 % expressed optimism about its benefits. Key factors to women’s acceptance included better understanding outcomes, having trust in midwives, receiving respectful care, and having autonomy in decision-making. They also required midwife-led birthing units would be clean, accessible, and well resourced. DiscussionMost participants perceived midwife-led care as beneficial, valuing its skilled, responsive and compassionate services. ConclusionInsights from this study have implications for the implementation of midwife-led care which should consider the informational needs, safety standards and cultural contexts of women and their families living in both urban and rural areas of India.

Provision of maternal health services among Ohio community pharmacists practicing in maternity care deserts

BackgroundOver 2.3 million reproductive-age women in the United States live in a maternity care desert, a county without obstetric services or providers; over 3 million more reside in a county with low access to maternity care. The National Alliance of State Pharmacy Associations (NASPA) issued a toolkit outlining maternal health services community pharmacists are positioned to provide within their scope of practice. ObjectivesThe primary objective of this study was to determine whether community pharmacists practicing in maternity care deserts/low access areas in Ohio provide NASPA-recommended maternal health services. Secondary objectives were to assess knowledge and attitudes related to maternal health; interest and barriers for developing new services; and screening and referrals for key social determinants of health. MethodsAn anonymous cross-sectional survey was electronically distributed to Ohio community pharmacists working in maternity care deserts/low access areas (n = 216) in fall/winter 2023 to evaluate their awareness, practices, and attitudes. ResultsThirty-one pharmacists responded (14%). Almost half knew that maternal mortality had increased in recent years. Although 61% reported familiarity with the term “maternity care desert,” only 35% recognized they are currently practicing in one. Provision of NASPA-recommended services to reproductive-age women ranged from 90% (immunizations) to 11% (alcohol use screening/counseling). About 96% believed that community pharmacists can help optimize women’s health before and during pregnancy. The majority of respondents reported “never” screening for social determinants of health, but 48% were interested in learning more. While 67% of respondents are interested in providing more services for women at their pharmacy, they also reported obstacles like lack of time and staff. ConclusionThere is a need to raise awareness about maternal mortality and maternity care deserts among Ohio community pharmacists. Given the interest expressed in providing additional services, pharmacists should receive more support to provide needed care for medically-underserved populations.