Perinatal Health Care Providers Research Articles

Barriers and enablers to accessing perinatal health services for rural Australian women: A qualitative exploration of rural health care providers perspectives.

To identify perceived barriers and enablers for rural women in accessing perinatal care within their own community from the perspective of perinatal health care providers. A qualitative descriptive study design utilising reflexive thematic analysis, using the socioecological framework to organise and articulate findings. Victoria, Australia. Semi-structured interviews were conducted with nine perinatal health care providers who provide care to pregnant women or new mothers in rural communities. Participants were recruited across Victoria in 2023. Providers reported multi-level barriers and enablers that exist for rural women in accessing perinatal care within their communities. Barriers included women's personal circumstances, challenging professional relationships, inequitable service provision, ineffective collaboration between services and clinicians and government funding models and policies. Enablers included strength and resilience of rural women, social capital within rural communities, flexible care delivery and innovative practice, rural culture and continuity of care models. Rural perinatal health care providers perceived that rural women face multiple barriers that are created or sustained by complex interpersonal, organisational, community and policy factors that are intrinsic to rural health care delivery. Several addressable factors were identified that create unnecessary barriers for rural women in engaging with perinatal care. These included education regarding health systems, rights and expectations, equitable distribution of perinatal services, improved interprofessional relationships and collaborative approaches to care and equity-based funding models for perinatal services regardless of geographical location.

Perspectives of Certified Nurse-Midwives and Physicians on the Structural and Institutional Barriers that Contribute to the Reproductive Inequities of Black Birthing People in the San Francisco Bay Area.

Black birthing people in the United States disproportionately endure inequitable experiences and outcomes during pregnancy and childbirth via structural, interpersonal, and obstetric racism. In this study, the researchers explore provider perspectives of how racism is perpetuated in institutional perinatal and reproductive health care. Critical Race Theory, Reproductive Justice, and midwifery theory were operationalized through secondary thematic analysis of existing qualitative data from the Community Racial Equity and Training Interventions and Evaluation of Current and Future Healthcare Clinicians Study. Twenty-four perinatal providers (certified nurse-midwives [n = 7] and physicians [n = 17]) voluntarily participated in interviews. A comparative approach was used to determine how professional identity and model of care influence physicians' and certified nurse-midwives' perceptions of equity. Thematic analysis produced 5 themes: racism as a comorbidity, health care systems' inability to address the needs of Black birthing people, health care systems prioritizing providers over patients are failed systems, patients are the experts in the optimal health care model, and benefits of interprofessional teams grounded in Reproductive Justice. Additionally, both physicians and midwives expressed a need for a new care model. With these findings, our team proposes a modification of the midwifery model for application by all provider types that could radically shift the experience and outcomes of perinatal and reproductive health care and reduce mortality. Using a human rights approach to care, a Reproductive Justice-Public Health Critical Race praxis-informed midwifery model may be operationalized by all perinatal and reproductive health care providers. This novel model reflects an iterative process that may offer institutions and providers methods to build on past research supporting midwifery-centered care for improving outcomes for all patients by specifically focusing on improving care of Black birthing people. The implications of this work offer broad application in current clinical practice, quality improvement, research, technology, and patient resources.

Centering Equity and Fostering Stakeholder Collaboration and Trust-Pillars of the Maternal Health Innovation Program in Maryland.

To describe two main pillars of the Maryland Maternal Health Innovation Program (MDMOM): (1) centering equity and (2) fostering broad stakeholder collaboration and trust. We summarized MDMOM's key activities and used severe maternal morbidity (SMM) surveillance and program monitoring data to quantify MDMOM's work on the two pillars. We developed measures of hospital engagement with MDMOM (participation in quality improvement [QI] activities, participation in check-in meetings, staff involvement) and with other partners (participation in QI activities, representation in state-level groups). We examined Bonferroni-adjusted correlations between these hospital engagement measures and with key hospital characteristics: level of maternity care, annual delivery volume, and SMM rate. Over 100 national and state organizations and individual stakeholders contributed to our building the MDMOM program and implementing key activities centering equity: hospital-based SMM surveillance in 20 of Maryland's 32 hospitals; almost 5,000 trainings offered to perinatal health care providers; two telemedicine/telehealth interventions; training of home visitors and community-based organization staff. Birthing hospitals represent MDMOM's main implementation partners. The strength of their participation in MDMOM QI activities is positively correlated to their participation in check-in meetings and with the degree of involvement by physicians in such activities. Higher engagement in MDMOM QI activities is also positively correlated to hospitals' participation in other state-level maternal health initiatives or groups. Our experience with the MDMOM program demonstrates that an equity focus and broad stakeholder collaboration building strong relationships and providing implementation support can lead to high levels of engagement in innovative maternal health interventions.

South Asian and East Asian Immigrant Pregnant women in Canada, United Kingdom, United States of America, Australia, and New Zealand: Prevalence of common mental health conditions and women’s lived experience with them

The goal of this review is to investigate the prevalence rates of common mental health conditions among pregnant East and South Asian immigrant women, as well as to understand their lived experiences with these conditions in 5 English-speaking countries: Canada, United Kingdom, United States of America, Australia, New Zealand. Pregnancy is a critical time in a woman's life marked by intricate physical, emotional, and psychological transitions. The mental health of pregnant women emerges as a paramount concern given its associations with poor pregnancy outcomes. This is crucial within the context of South Asian and East Asian immigrant women, who navigate unique cultural, social, and economic challenges in their host countries that may influence their emotional wellbeing. This review will investigate the prevalence rates of common mental health conditions. This review will also explore their encounters with mental health care services and interactions with perinatal mental health care providers and services. Quantitative and Qualitative studies in English language that examine East and/or South Asian immigrant women in the perinatal period will be considered for this review. Published abstracts and mixed methods studies will also be included. All languages and publication dates will be included. However, only studies with an English language translation will be considered. This review will exclude books/book chapters, editorials, commentaries, and reviews. CINAHL (EBSCO), MEDLINE ALL will be searched. Furthermore, a grey literature search will be included in the search using CINAHL and PsycINFO as well as websites such as Society of Obstetricians and Gynecologists of Canada (SOGC), Canadian Perinatal Surveillance System (CPSS), Canadian Perinatal Mental Health Collaborative (CPMHC), Centre for Addiction and Mental Health (CAMH) and the Canadian Pediatric Society. Screening, conflict resolution data extraction and aggregation will be done by two independent reviewers.

Promoting Physical Activity During Pregnancy and the Postpartum Period.

Physical activity is important for improving and maintaining overall health across the life span, including during and after pregnancy. Achieving recommended levels of physical activity can be challenging during pregnancy and the postpartum period. The US Office of Disease Prevention and Health Promotion sought to promote physical activity during and after pregnancy through the development of health education materials for the Move Your Way campaign. Research was conducted with pregnant and postpartum people to learn what types of messages and materials would encourage physical activity in these populations. Participants were recruited from 3 regions of the United States to participate in 90-minute virtual focus groups. Eligible participants were aged 18 years or older and either pregnant or 6 weeks to 1 year postpartum. Participants were asked questions about their beliefs, attitudes, and perceptions about physical activity and prompted to provide feedback on health promotion messages and images. Sessions were recorded, transcribed, and analyzed for key themes. Twenty-four focus groups were conducted with 48 pregnant participants and 52 postpartum participants. Sixteen sessions were conducted in English and 8 were conducted in Spanish. Most participants had questions about how much physical activity is recommended, and many cited their health care provider as a trusted source of information. Participants responded positively to materials that acknowledged the uniqueness of each pregnant or postpartum experience, referenced gradually increasing physical activity levels, highlighted the benefits of physical activity, focused on safety, addressed common barriers, and displayed realistic representations of physical activity. There is an opportunity to improve messaging about physical activity during and after pregnancy. To better promote physical activity, perinatal health care providers and other health professionals can share information about recommended amounts of physical activity, communicate the benefits, and promote realistic and achievable physical activity messages that address common barriers in these populations.

Giving birth in a good way when it must take place away from home: Participatory research into visions of Inuit families and their Montreal-based medical providers.

Transferring pregnant women out of their communities for childbirth continues to affect Inuit women living in Nunavik-Inuit territory in Northern Quebec. With estimates of maternal evacuation rates in the region between 14% and 33%, we examine how to support culturally safe birth for Inuit families when birth must take place away from home. A participatory research approach explored perceptions of Inuit families and their perinatal healthcare providers in Montreal for culturally safe birth, or "birth in a good way" in the context of evacuation, using fuzzy cognitive mapping. We used thematic analysis, fuzzy transitive closure, and an application of Harris' discourse analysis to analyze the maps and synthesize the findings into policy and practice recommendations. Eighteen maps authored by 8 Inuit and 24 service providers in Montreal generated 17 recommendations related to culturally safe birth in the context of evacuation. Family presence, financial assistance, patient and family engagement, and staff training featured prominently in participant visions. Participants also highlighted the need for culturally adapted services, with provision of traditional foods and the presence of Inuit perinatal care providers. Stakeholder engagement in the research resulted in dissemination of the findings to Inuit national organizations and implementation of several immediate improvements in the cultural safety of flyout births to Montreal. The findings point toward the need for culturally adapted, family-centered, and Inuit-led services to support birth that is as culturally safe as possible when evacuation is indicated. Application of these recommendations has the potential to benefit Inuit maternal, infant, and family wellness.

Integrated growth assessment in the first 1000 d of life: an interdisciplinary conceptual framework.

Prenatal growth affects short- and long-term morbidity, mortality and growth, yet communication between prenatal and postnatal healthcare teams is often minimal. This paper aims to develop an integrated, interdisciplinary framework for foetal/infant growth assessment, contributing to the continuity of care across the first 1000 d of life. A multidisciplinary think-tank met regularly over many months to share and debate their practice and research experience related to foetal/infant growth assessment. Participants’ personal practice and knowledge were verified against and supplemented by published research. Online and in-person brainstorming sessions of growth assessment practices that are feasible and valuable in resource-limited, low- and middle-income country (LMIC) settings. A group of obstetricians, paediatricians, dietitians/nutritionists and a statistician. Numerous measurements, indices and indicators were identified for growth assessment in the first 1000 d. Relationships between foetal, neonatal and infant measurements were elucidated and integrated into an interdisciplinary framework. Practices relevant to LMIC were then highlighted: antenatal Doppler screening, comprehensive and accurate birth anthropometry (including proportionality of weight, length and head circumference), placenta weighing and incorporation of length-for-age, weight-for-length and mid-upper arm circumference in routine growth monitoring. The need for appropriate, standardised clinical records and corresponding policies to guide clinical practice and facilitate interdisciplinary communication over time became apparent. Clearer communication between prenatal, perinatal and postnatal health care providers, within the framework of a common understanding of growth assessment and a supportive policy environment, is a prerequisite to continuity of care and optimal health and development outcomes.

Mâmawihitowin (bringing the camps together): Perinatal healthcare provider and staff participation in an Indigenous-led experiential intervention for enhancing culturally informed care—a mixed methods study

BackgroundIn partnership with a Nehiyawak (Plains Cree) community of Maskwacîs,central Alberta (Canada), we implemented an Indigenous-led intervention to provide experiential learning opportunities for perinatal health care providers (HCPs) and staff. Our objective was to capture the impact of participating in cultural safety learning opportunities on perceived self-awareness for HCPs and staff to provide enhanced culturally informed care.MethodsPerinatal HCPs and staff who work regularly with Indigenous women from our partnering community took part in a series of experiential learning activities designed by a Community Advisory Committee. We used an explanatory sequential mixed methods approach informed by community-based participatory research. We compared Cultural Intelligence Scale (CQS) and Maskwacîs-Specific Cultural Scale (MSCS) scores pre- and post-intervention using non-parametrical statistical analysis (Wilcoxon signed rank test). Post-intervention, we conducted a qualitative description study using semi-structured interviews. Qualitative data was analyzed using thematic analysis.ResultsA total of 17 participants completed pre- and post-intervention questionnaires. Responses indicated a shift in perceived cultural and community knowledge and comfort levels, with positive gains in overall mean scores for both the CQS (p = 0.01) and MSCS (p = 0.01). Nine participants completed qualitative interviews. Overall, participants felt better equipped to provide more culturally informed care to their patients post-intervention.ConclusionAn Indigenous-led experiential learning intervention was effective in enhancing overall perceived cultural awareness and preparedness to provide culturally informed care for perinatal HCPs and staff. This study provides evidence for fostering relationships between Indigenous communities and health systems toward enhanced perinatal care.

Experiences, Beliefs, and Values Influencing Midwives' Attitudes Toward the Use of Childbirth Interventions.

Intervention rates in perinatal care vary between and within countries, without populations' characteristics as a full explanation. Research suggests that one factor in this variation might be the attitudes of perinatal health care providers. Systematic knowledge on the background of midwives' attitudes and how this influences the use of interventions is limited. The study aim was to to explore experiences, beliefs, and values that influence midwives' attitudes toward interventions in perinatal care. A qualitative study using in-depth interviews with primary care midwives (n = 20) in the Netherlands. The interviews were performed in June 2019 and combined a narrative approach with a semistructured interview guide. Inductive content analysis was applied. We identified 2 main themes: attitudes toward interventions and influences on midwives' attitudes. The midwives in our study described their attitudes toward interventions as oriented to either wait and see or check and control. Care based on wait and see displayed a more supportive style of behavior, and care based on check and control appeared to display a more directive style of behavior. In the theme of influences on midwives' attitudes, 3 subthemes emerged: experiences in collaboration, trust and fear, and woman-centeredness. Midwives with a wait and see attitude seem to have a more restricted approach toward interventions compared with midwives with a check and control attitude. Midwives need to be aware how their experiences, beliefs, and values shape their attitudes toward use of interventions. This awareness could be a first step toward the reduction of unwarranted interventions.

The Experiences of Women and Healthcare Providers in Assessing the History of Gender-Based Violence During Perinatal Care.

Despite its prevalence and consequences, perinatal healthcare providers’ identification of gender-based violence (GBV) remains controversial in British Columbia. This study investigated women and healthcare providers’ perspectives regarding their experiences with and views of inquiring about GBV during perinatal care. Twelve in-depth interviews were conducted with women with a history of GBV and 16 perinatal healthcare providers. Data were analyzed thematically. Three themes, including “barriers to disclosure,” “healthcare providers hesitate to open Pandora's Box,” and “how to ask in a culturally safe way,” emerged from the data. Study participants support inquiry about GBV during perinatal healthcare.

Perawatan Kolaborasi untuk Kesehatan Mental Perinatal: Tinjauan Literatur

Factors that enhance women's experience in health care during the perinatal period are providing opportunities to develop interrelated relationships with professional health care. The services provided are high-quality information for women, families, and health professionals. Collaborative practice can also reduce complications, hospital care, health team conflicts, and mortality rates. General patients report higher satisfaction, better service, and better health outcomes. In the health sector, collaborative practice can improve patient and health team satisfaction, reduce the duration of care, reduce maintenance costs, reduce the incidence of self-defense, and reduce outpatient visits. Objective: The literature of this review is to summarize collaborative care for perinatal mental health. Method: This study is a journal publication with a literature summary, and article search using comparative studies of computerized databases (PubMed and BMC). Results: In improving mental health care services Collaboration between health care institutions, general practitioners, and mental health professional services is needed. Access to mental health care is inadequate, this is because perinatal health care providers are not sufficient to make initial preparations, referrals, complaints about aspects of maternal emotional care, and psychological services only benefit a portion of the population. Conclusion: The main problem of this collaboration is the knowledge of doctors and general nurses on perinatal maternal mental health problems, poor supervision systems, inadequate information systems, and clinical technology. Collaboration between professionals in the health and health sector as well as adequate health program policy support, as well as increasing shared awareness will improve mental health for mothers in the perinatal period.

Unravelling the epidemiology and clinical impact of SARS-CoV-2 infection in neonates.

The impact of the SARS-CoV-2 pandemic has transformed the means by which health care is delivered, including perinatal care. Given neonates have unique vulnerabilities to acquiring infections,1 determining optimal practices to prevent and respond to neonatal SARS-CoV-2 infections has been an area of much discussion and debate amongst perinatal healthcare providers. Published information on the clinical characteristics and mode of acquisition for neonatal SARS-CoV-2 infection was scarce earlier in the pandemic, largely limited to case reports. An early cohort study from China revealed higher disease severity in young infants than older children, by criteria which defined severe and critical cases as including early respiratory and in some cases gastrointestinal symptoms, or progression to severe respiratory or systemic illness, respectively.2 Gale et al.'s paper presents data from a peak period of SARS-CoV-2 infection in the United Kingdom (UK) and is an important contribution to our understanding of the incidence, disease severity and transmission modes for neonatal SARS-CoV-2 infection. This study found that COVID-19 disease severe enough to require hospitalisation was rare in neonates, at 5.6 per 10 000 livebirths. While many infections were mild, the study confirms a higher propensity to severe disease in neonates than older children.2, 3 42% of cases were defined as severe, albeit using criteria that may include neonates who, while unwell, would not necessarily require intensive care.2 Data on transmission modes for neonatal SARS-CoV-2 infection have been limited and conflicting. World Health Organisation (WHO) guidelines endorse keeping mother and baby together in cases of maternal SARS-CoV-2 infection.4 However, confusion as to the likelihood of viral transmission may have influenced adherence to these guidelines, with a number of cases where separation of mothers and babies occurred, including in this cohort. This study confirms that vertical transmission is rare and that transmission by close contact is unlikely to occur with maternal SARS-CoV-2 infection, even where a mother with active infection co-rooms with her baby. This finding supports the ongoing implementation of WHO guidelines to keep mothers and babies together, a practice important for bonding, the establishment of feeding, and newborn survival.5 Nosocomial transmission did occur, underscoring a need for stringent infection control procedures for all centres which provide care for patients with SARS-CoV-2 infection. This paper also highlights inequality in disease incidence for SARS-CoV-2 for babies of Black, Asian and Minority Ethnic (BAME) groups, with an incidence three to four-fold that of individuals classified as having white ethnicity. This finding is not isolated to neonates, with a disproportionately high disease incidence amongst individuals of BAME groups amongst pregnant women and wider adult populations.6, 7 This observation is a substantial public health concern that likely speaks to the influence of social determinants of health. Providers of perinatal health care still have much to learn about SARS-CoV-2. Ongoing collection and analysis of comprehensive perinatal epidemiologic data will remain paramount for our capacity to respond this pandemic in a manner that is well-informed, evidence-based and effective in optimising the health and well-being of all mothers and babies affected. None to declare. https://ebneo.org/sars-cov-2-epidemiology

Perinatal health care providers' approaches to recommending and providing pertussis vaccination in pregnancy: a qualitative study.

In 2018, the Canadian National Advisory Committee on Immunization and the Society of Obstetricians and Gynaecologists of Canada recommended a single dose of tetanus toxoid, reduced diphtheria toxoid and reduced acellular pertussis (Tdap) vaccine in every pregnancy. To understand how perinatal health care providers in Canada are translating recent recommendations for universal antenatal Tdap vaccine into routine clinical practice, we examined health care providers' perceptions of what influences their ability to recommend and provide Tdap vaccine consistently to pregnant women. Between June 2018 and July 2019, we conducted semistructured telephone interviews with perinatal health care providers (nurses, midwives, family physicians and obstetricians) from 5 provinces (British Columbia, Manitoba, Ontario, Quebec and Nova Scotia) representing diverse educational experiences, practice settings and models of care. We analyzed the data using interpretive description. We interviewed 44 perinatal health care providers (13 family physicians, 12 midwives, 10 obstetricians and 9 nurses) practising in a variety of settings. Health care providers' ability to recommend and provide antenatal Tdap vaccine was strongly influenced by structural constraints in the Canadian perinatal health care system. The participants' clinical training varied, which resulted in different knowledge and practices. Participants felt hindered by a lack of lay information resources. Consistent and convenient vaccine access was perceived to be key to promoting confidence and encouraging uptake, yet antenatal Tdap vaccine was not easily accessible for all women. Our findings suggest that Canada's fragmented health care model has a detrimental effect on health care providers' ability to recommend and ensure access to antenatal Tdap vaccine. Lessons from this study are pertinent to the implementation of successful pertussis vaccine programs and future pregnancy vaccination initiatives.

Women's Questions About Perinatal Cannabis Use and Health Care Providers' Responses.

Background: Cannabis use is common among individuals of reproductive age. We examined publicly posted questions about perinatal cannabis use and licensed United States health care provider responses. Materials and Methods: Data were medical questions on perinatal cannabis use posted online from March 2011 to January 2017 on an anonymous digital health platform. Posters were able to "thank" health care providers for their responses and providers could "agree" with other provider responses. We characterized 364 user questions and 596 responses from 277 unique providers and examined endorsement of responses through provider "agrees" and user "thanks." Results: The most frequent questions concerned prenatal cannabis use detection (24.7%), effects on fertility (22.6%), harms of prenatal use to the fetus (21.3%), and risks of baby exposure to cannabis through breast milk (14.4%). Provider sentiment in responses regarding the safety of perinatal cannabis use were coded as 55.6% harmful, 8.8% safe, 8.8% mixed/unsure, and 26.8% safety unaddressed. Half of providers (49.6%) discouraged perinatal cannabis use, 0.5% encouraged use, and 49.9% neither encouraged nor discouraged use. Provider responses received 1,004 provider "agrees" and 583 user "thanks." Provider responses indicating that perinatal cannabis use is unsafe received more provider "agrees" than responses indicating that use is safe (B = 0.42, 95% CI 0.02-0.82, p = 0.04). User "thanks" did not differ by provider responses regarding safety or dis/encouragement. Conclusion: The data indicate public interest in cannabis use effects before, during, and after pregnancy. While most health care providers indicated cannabis use during pregnancy and breastfeeding is not safe, many did not address safety or discourage use, suggesting a missed educational opportunity.

Improving the Knowledge, Attitudes, and Behavioral Intentions of Perinatal Care Providers Toward Childbearing Individuals Identifying as LGBTQ: A Quasi-Experimental Study.

This study explores the impact of gender and sexuality awareness training on perinatal health care providers' (HCPs') knowledge, attitudes, and intended behavior toward childbearing individuals identifying as lesbian, gay, bisexual, transgender, and/or queer (LGBTQ). A nonrandom convenience sample of HCPs (n = 187) comprised an experimental group (n = 99) who attended grand rounds trainings covering gender and sexuality topics and a control group (n = 88) who attended sessions on other unrelated topics. All participants completed a pre-posttraining questionnaire to assess changes in knowledge, attitudes, and intended behavior toward LGBTQ patients. Participants in the experimental group demonstrated significant improvement in knowledge, misconception, prejudice, sensitive language, and normativity regarding LGBTQ pregnant patients from pretest to posttest. These findings suggest that a 40-minute gender and sexuality training can immediately improve HCPs' knowledge, attitudes, and intended behavior toward LGBTQ childbearing patients. [J Contin Educ Nurs. 2019;50(7):303-312.].

Vaginal Birth and Pelvic Floor Trauma

Over the last two to three decades, a growing body of research has shown that vaginal childbirth is more traumatic to mothers than generally assumed. Apart from obstetric anal sphincter tears which have been extensively studied, trauma to the levator ani muscle is a form of maternal injury that is less well recognised and often undiagnosed. In the context of an increasing push towards vaginal birth, this article will review the recent literature to better inform health care providers regarding the significance of pelvic floor trauma. Imaging studies have shown that levator avulsion, where the puborectalis muscle has detached from the os pubis, occurs in up to 1/3 of vaginally primiparous women, depending on demographic factors and obstetric management. Forceps is a well-established risk factor for levator avulsion with an odds ratio of 4–5 compared to vacuum, which does not seem to convey additional risk over unassisted vaginal birth. Levator injuries are significantly associated with pelvic organ prolapse and treatment failure. Such trauma can also lead to significant psychological morbidity, up to and including post-traumatic stress disorder. Antenatal prediction does not appear feasible. Modification of obstetric practice by abandoning forceps would significantly reduce pelvic floor trauma and the future need for prolapse surgery. Vaginal childbirth is more traumatic than commonly assumed. Levator trauma is associated with significant physical and psychological morbidity. Perinatal health care providers need to understand and recognise the significance of maternal birth trauma and its potential impact on women’s health.

Inter-Observer Variability of the Apgar Score of Preterm Infants between Neonatologists, Obstetricians and Midwives

Objective To assess the inter-observer variability of the Apgar Score (AS) across various perinatal Health Care Providers (HCP) taking care of newly born premature infants in the delivery room. Methods Design: Prospective observational study. Setting: 4 general hospitals and 3 university hospitals in Switzerland. Subjects: 43 neonatologists, 68 obstetricians and 55 midwives assessed the AS from 15 video sequences showing delivery room stabilisations or resuscitations of 15 preterm infants born below 34 0/7 weeks gestational age. Results Overall and for all observers, the mean inter-observer variability was low (ICC 0.72). There was a significant difference between the professions (p < 0.001) and hospitals (p < 0.001). The AS assigned by neonatologists for this group of preterm infants were significantly higher than the scores given by midwifes (p = 0.001). The scores assigned by obstetricians were the lowest for all infants; the difference from neonatologists being -0.53 (pairwise comparison). There was no significant difference between the AS assessed by professionals working in university hospitals compared to HCPs from general hospitals (p = 0.86). For all observers and in the majority of the sequences, heart rate showed the lowest and skin colour the highest standard deviation. Conclusion Our study revealed a relatively high inter-observer agreement in assessing the AS for premature infants among all perinatal health care professionals for the whole group of infants. A significant difference however was seen between the AS given by the different perinatal professional groups and between hospitals. A clearer definition and assessment method of each Apgar parameter in the setting of infants born premature and of resuscitation measures are needed. This may contribute to reduce the variations between professionals and hospitals, and to increase the value of this scoring within national and international databases to describe study populations for research, for benchmarking in neonatal intensive care and for comparison of outcome data.

"…like because you are a grownup, you do not need help": Experiences of Transition from Pediatric to Adult Care among Youth with Perinatal HIV Infection, Their Caregivers, and Health Care Providers in the Dominican Republic.

With the introduction of combination antiretroviral therapy (ART) worldwide, youth with perinatal HIV infection are increasingly surviving childhood and transitioning to adult care. Although a normal life span is anticipated posttransition, successful transition to adult HIV care has proven difficult, with worse outcomes posttransition than in pediatric and adult care. This study is a qualitative analysis of data from 4 focus groups of pre- and posttransition patients, caregivers, and healthcare providers in the Dominican Republic at an institution that provides comprehensive treatment including ART for HIV-infected persons of all ages. All groups discussed the problems and challenges that patients, caregivers, and providers experience while living the transition process and beyond. Five major themes emerged: the trauma of transition itself, ART adherence, experience and impact of stigma, social supports and barriers, and recommendations for improving outcomes. Participants' insights offered approaches for a versatile structured transition process.

Male-Partnered Sexual Minority Women: Sexual Identity Disclosure to Health Care Providers During the Perinatal Period.

Male-partnered sexual minority women (SMW) have received little research attention, despite the fact that they represent a large proportion of SMW - particularly child-bearing SMW. Male-partnered SMW are less "out" than female-partnered SMW and will likely be "read" as heterosexual by perinatal providers. Given this, and evidence that pregnant women have unique mental health care needs, the current study focuses on male-partnered SMW (n = 28) during the perinatal period, recruited from Toronto, Canada and Massachusetts, USA, in an effort to understand disclosure and concealment processes in general and to perinatal heath care providers specifically. Women generally reported that they did not disclose (but made no effort to conceal) their sexual identities and histories in new or unfamiliar relationships, largely because the topic rarely came up, although some women highlighted bisexual invisibility and fear of biphobia as reasons for non-disclosure. Despite overall positive experiences with perinatal providers, less than one-quarter of the sample (n = 6) had disclosed their sexual identities and histories to them. Most women felt that this information was generally not relevant to their health care, and particularly their reproductive/obstetric care, although some believed that disclosure would be appropriate under conditions of sexual health risk (n = 8). Others noted that although they did not feel the need to disclose, they did prefer an LGBQ-affirming provider (n = 7). Findings provide insight into male-partnered SMW's views and patterns of disclosure during the perinatal period, and have implications for providers, organizations, and scholars who interface with SMW. Pregnant sexual minority women with male partners are often assumed to be heterosexual, raising questions about whether and when these women disclose their sexual minority status in the perinatal context. This qualitative study of 28 women found that most participants did not share their sexual identity or sexual histories with their perinatal health care providers because this information was perceived as not relevant to their care, although some women nevertheless valued having LGBTQ friendly providers.

Working together for women's empowerment: Strategies for interdisciplinary collaboration in perinatal care.

Women's experiences of pregnancy, birth, and postpartum adjustment are often characterized by feelings of disempowerment, trauma, and emotional pain. Psychosocial perinatal care has not kept up with medical advances in perinatal care. Access to psychosocial care appears to be inadequate because of the following: (a) perinatal health care providers are insufficiently prepared to address emotional aspects of maternal care and (b) traditional, compartmentalized psychological services benefit only a subsection of perinatal women, often in an untimely manner. Practical and innovative psychosocial services, integrated into routine perinatal care, can provide widespread access to psychosocial resources for mothers and supports providers in delivering optimal care.