Perinatal Practices Research Articles

The Effects of COVID-19 Hospital Practices on Breastfeeding Initiation and Duration Postdischarge.

Background: Early in the COVID-19 pandemic, many birth hospitals separated SARS-CoV-2-positive mothers from their newborn infants and advised against breastfeeding to decrease postnatal SARS-CoV-2 transmission. Information on how these practices impacted breastfeeding postdischarge is limited. Objectives: In a statewide sample of SARS-CoV-2-positive mothers, we aimed to determine the extent to which (1) mother-infant separation and (2) a lack of breastfeeding initiation in-hospital were associated with breast milk feeding postdischarge. Design/Methods: From 11 birthing hospitals in Massachusetts, we identified 187 women who tested positive for SARS-CoV-2 from 14 days before to 72 hours after delivery (March 1-July 31, 2020) and their newborn infants. We abstracted chart data from the delivery hospitalization on main exposure variables (mother-infant separation, in-hospital breast milk feeding [expressed milk feeding and/or direct breastfeeding]) and from outpatient visits until 30 days postdischarge. We evaluated associations of in-hospital practices with outcomes up to 30 days postdischarge, adjusting for confounders using multivariable logistic and linear regression. Results: Mother-infant separation in-hospital was associated with a shorter duration of any breast milk feeding (regression coefficient estimate -5.29 days, 95% confidence intervals [CI] [-8.89 to -1.69]). Direct breastfeeding in-hospital was associated with higher odds of any breast milk feeding (adjusted odds ratios [AOR] 5.68, 95% CI [1.65-23.63]) and direct breastfeeding (AOR 8.19, 95% CI [2.99-24.91]) postdischarge; results were similar for any breast milk feeding in-hospital. Conclusions: Perinatal hospital care practices implemented early in the COVID-19 pandemic, specifically mother-infant separation and prevention of breast milk feeding initiation, were associated with adverse effects on breast milk feeding outcomes assessed up to 1 month postdischarge.

S’émanciper au nom d’un pluralisme médical : à propos de pratiques de santé périnatale chez des femmes d’origine chinoise à Paris

Cet article analyse deux pratiques de santé périnatale – le régime alimentaire et le repos post-partum – de mères d’origine chinoise à Paris, qui naviguent entre différents registres de soins et de normes médicales et paramédicales. À travers une enquête qualitative menée entre 2016 et 2018 auprès d’une trentaine de femmes d’origine chinoise, et dans certains cas également auprès de leur entourage familial (conjoints et parents), l’article met en relief les logiques sous-tendant leurs pratiques de santé périnatale qui relèvent de la médecine chinoise en contexte migratoire. Les matériaux empiriques montrent que les recours à un pluralisme médical dans le contexte français, pendant la période périnatale, peuvent être appréhendés par ces femmes comme une façon de s’émanciper, au moins de manière ponctuelle et limitée, de la domination des normes cliniques occidentales et des violences institutionnelles d’une part, et des rapports de force à l’intérieur du foyer et de la famille élargie d’autre part.

COVID-19 Vaccine Hesitancy during the Perinatal Period: Understanding Psychological and Cultural Factors to Improve Care and Address Racial/Ethnic Health Inequities.

COVID-19 Vaccine Hesitancy during the Perinatal Period: Understanding Psychological and Cultural Factors to Improve Care and Address Racial/Ethnic Health Inequities.

Transmission of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) through infant feeding and early care practices: A systematic review.

Perinatal practices such as breast-feeding, kangaroo mother care, rooming-in, and delayed cord clamping have varied by institution during the COVID-19 pandemic. The goal of this systematic review was to examine the success of different practices in preventing viral transmission between SARS-CoV-2 positive mothers and their infants. Electronic searches were performed in the Ovid MEDLINE, Ovid Embase, Cochrane Library, EBSCOhost CINAHL Plus, Web of Science, and Scopus databases. Studies involving pregnant or breastfeeding patients who tested positive for SARS-CoV-2 by RT-PCR were included. Infants tested within 48 hours of birth who had two tests before hospital discharge were included. Infants older than one week with a single test were also included. Twenty eight studies were included. In the aggregated data, among 190 breastfeeding infants, 22 tested positive for SARS-CoV-2 (11.5%), while 4 of 152 (2.63%) among bottle-fed (Fisher's exact test p = 0.0006). The positivity rates for roomed in infants (20/103, 19.4%) were significantly higher than those isolated (5/300, 1.67%) (P < 0.0001). There was no significant difference in positivity rate among infants who received kangaroo care (25%vs 9%, p = 0.2170), or delayed cord clamping (3.62%vs 0.9%, p = 0.1116). Lack of robust studies involving large patient population does not allow meaningful conclusions from this systematic review. Aggregated data showed increased positivity rates of SARS-CoV-2 among infants who were breast fed and roomed-in. There were no differences in SARS-CoV-2 positivity rates in infants received skin to skin care or delayed cord clamping.

Perceptions of Pregnant Women on Traditional Health Practices in a Rural Setting in South Africa.

Though there are prenatal and perinatal protocols across the African continent, traditional practices are commonly used. Improving maternal health requires an understanding of local cultural approaches and traditional health systems. The purpose of this study was to determine the perceptions of pregnant mothers of various ages and gravidities towards traditional maternal health practices during pregnancy. A descriptive phenomenological study was carried out with 27 purposively selected pregnant women from the King Sabatha Dalindyebo health sub-district. Discussion from three focus groups yielded three major themes and eight sub-themes. Content analysis revealed strong opinions and support for traditional practices. Although specialist practitioners were mentioned, family members were the primary source of information on traditional perinatal health practices. African mahogany bark, herbal decoctions, and holy water were allegedly used to treat labor pains, postnatal care, and the warding off of evil spirits. During pregnancy, these were thought to be beneficial and necessary. Nonetheless, the protection of some traditional practices’ know-how prevents integration of the traditional health system into the national health system. Consequently, there is a need for dialogue to facilitate the exchange of ideas on maternal health between the two health systems in order to facilitate more efficient policy formulation and implementation.

Immigrant Asian Indian Mothers' Experiences With Pregnancy, Childbirth, and Infant Care in the United States.

The purpose of the study was to explore experiences of immigrant Asian Indian women with pregnancy, childbirth, and infant care in the United States. This study employed a qualitative descriptive approach using semi-structured interviews and followed COREQ (COnsolidated criteria for REporting Qualitative research) guidelines for reporting qualitative research. Nine immigrant Asian Indian mothers residing in the mid-Atlantic region of the United States participated in the study. Four themes emerged: experiencing cultural differences during the perinatal period in the United States, choosing the best perinatal practices for maternal and infant care, recognizing family as the main support system, and having positive experiences with health care providers. Findings of this study shed light on the need for culturally appropriate care, including proper assessment of Asian Indian mothers' sociocultural aspects and cultural preferences and provision of support and information needed during the perinatal period.

Risks of Infectious Diseases in Newborns Exposed to Alternative Perinatal Practices.

The purpose of this report is to educate providers about the risk of infectious diseases associated with emerging alternative peripartum and neonatal practices. This report will provide information pediatricians may use to counsel families before birth and to appropriately evaluate and treat neonates who have been exposed to these practices.

Maternal Depression and Early Parenting: A Comparison Between Culturally and Linguistically Diverse and Australian born Mothers.

To examine the risk of perinatal depression, parenting stress and infant sleep practices in Australian culturally and linguistically diverse (CaLD) women. Within the Mercy Pregnancy and Emotional Wellbeing Study, we examined 487 pregnant women of whom 52 were CaLD and 435 non-CaLD. Depression was measured using the Structured Clinical Interview for DSM-IV and the Edinburgh Postnatal Depression Scale. In addition, Parenting Stress Index and infant sleep measures were collected. Fewer CaLD women had a depression diagnosis but there were no differences between CaLD and non-CaLD women for perinatal mental health symptoms. More mothers in the CaLD group were bed sharing with their infant during the night at six months; however, bedsharing was only associated with higher parenting stress for non-CaLD mothers. Findings suggest both differences in infant sleep parenting practices and in parenting stress but not general emotional wellbeing. Future research is required to replicate these findings.

Opportunities to Integrate Primary Health Care Digital Innovations in Maternal and Child Health Care Services in Kenya

Background: Adequate and quality Maternal and Child Health (MNCH) care is considered essential in reduction of maternal and child mortality. More than half of the global maternal deaths (66%) are in sub-Saharan Africa with infant mortality of 51/1000 live births in the WHO Africa region [1]. There is potential to improve access and utilization of health services through investing in Primary Health Care (PHC) digital innovations [2] especially in underserved settings [3]. In the last quarter of the year 2021 after lifting of the COVID-19 restrictions, Tekeleza project, aims to integrate digital health innovations into MNCH care within PHC settings in Kenya. The project team undertook a baseline survey in three rural counties (Kisii, Kajiado and Migori) characterized with low social-economic status to identify opportunities to leverage on the use of evidence-based digital innovations to reverse the adverse trends in Maternal and Child Health. Methods: A cross-sectional and descriptive study was conducted in 15 Community Health Units (CHUs) in Kenya that were linked to selected Primary Health Care (PHC) facilities from three rural counties. Mixed methods were used to collect data from 404 Households (HHs) selected across the sampled CHUs on Probability Proportionate to Size (PPS). The selected households were assigned unique household or respondent identifiers. The sampling frame for household surveys consisted of all women 18 - 49 years of age, who were either pregnant or in their 18 months post-delivery. From the constructed sampling frame, a simple random sampling procedure was used to select the study sample. An audit was also carried out at the selected PHC facilities and sixty-two (62) Primary Health Workers (PHCWs) including facility managers were interviewed to establish challenges affecting ICT infrastructure and sustainable financing of MNCH services. Findings: The majority of the sampled women (64.9%) were lactating at the time of the study, with 34.4% being pregnant and 0.7% both pregnant and lactating. Despite the high proportions of mothers who received Skilled Birth Attendance, discontinuity in seeking antenatal and postnatal care services was observed in all three counties. The proportion of mothers (n = 404) who reported to have attended at least one ANC was 46.8%. This was attributed to limited access to health facilities, poor staff attitude, and negative cultural practices that got exacerbated by the COVID-19 pandemic. An average of 53.2% of the respondents started attending ANC clinics much later after 12 weeks of gestation to minimize the costs and time they will spend on attending ANC clinics. It also emerged that 68.7% of the respondents had low knowledge levels of selected perinatal and infant care practices. On the making of Sexual and Reproductive Health (SRH) health-seeking decisions, 54.7% of the respondents said, it is their husbands who decide. The PHCWs expressed limited access to Continuing Professional Development (CPDs), a situation that worsened with the COVID-19 Pandemic. Notably, only 54.9% of the PHCWs reported having access to either a Smartphone or desktop at the point of service delivery. Nearly the same proportion (54.8%) has access to the internet at their workstations. Facilities reported delayed reimbursement of National Hospital Insurance Fund (NHIF) and only 54% of the women interviewed had registered in Linda mama NHIF package meant to enable them to access free maternity care. Only one county (Migori) had significant utilization of CHVs. Conclusion: There is increasing access to Skilled Birth Attendance (SBA) in rural Kenya but discontinuous pregnancy care is still a problem and it got worse during the COVID-19 pandemic. Rural PHC facilities have poor ICT infrastructure and despite the 98% rural access to a phone by women, there is limited bankable usage of handheld technology to improve health information literacy on self and infant care among women of reproductive age. Recommendations: Feasibility studies to be conducted on how to sustainably deploy Primary Health Care digital solutions to improve the quality of, access to, and Utilization of Maternal and Child Health (MNCH) services.

Overview of Perinatal Practices with Potential Neurodevelopmental Impact for Children Affected by Preterm Birth

There is increasing recognition of the importance of addressing both medical care practices and interventions, as well as nonmedical factors and interventions for the mother–infant dyad in neonatal intensive care. This update addresses the evidence for medical and nonmedical practices affecting the outcomes of infants born preterm who require intensive care.

Mortality and significant neurosensory impairment in preterm infants: an international comparison

ObjectiveTo compare mortality and rates of significant neurosensory impairment (sNSI) at 18–36 months’ corrected age in infants born extremely preterm across three international cohorts.DesignRetrospective analysis of prospectively collected neonatal and...

Good practices in perinatal care and breastfeeding protection during the first wave of the COVID-19 pandemic: a national situation analysis among BFHI maternity hospitals in Spain

BackgroundAlthough the positive effects of good clinical quality standards in perinatal care and breastfeeding support for women, newborns and families have been already demonstrated, many of these practices were disrupted during the COVID-19 pandemic. The objective of this study was to analyse the impact of the COVID-19 pandemic on perinatal care and breastfeeding support practices offered by the Spanish maternity hospitals committed to the UNICEF Baby-friendly Hospital Initiative (BFHI), to women with and without COVID-19.MethodsImplementation of perinatal practices was assessed by a cross-sectional survey conducted in May 2020 using an online questionnaire. Comparison with pre-pandemic situation and level of commitment to BFHI practices was performed.ResultsResponse rate was 50% (58/116). Mothers with COVID-19 suffered greater restrictions in the practices compared to women without COVID-19, with lower rates of companion of choice during labour (84% vs 100%; p = 0.003), skin-to-skin contact (32% vs 52%; p = 0.04), rooming-in (74% vs 98%; p < 0.001), companion of choice during hospital stay (68% vs 90%; p = 0.006), and breastfeeding support (78% vs 94%; p = 0.02). Practices were significantly less prevalent in COVID-19 mothers compared to pre-pandemic situation. A lower accompaniment rate was observed in non-COVID-19 group during delivery (24% vs 47.9%; p < 0.01). Hospitals with higher commitment to BFHI practices reported higher rates of skin-to-skin contact (45.2% vs 10.5%; p = 0.01) and rooming-in (83.9% vs 57.9%; p < 0.05) in COVID mothers. Fewer restrictions were observed in hospitals located in the regions where the pandemic hit harder. In these regions there was a significantly higher level of BFHI commitment of the hospitals, but no significant differences were observed in the average size of the hospital. All the practices suffered even more restrictions during the first weeks of the pandemic.ConclusionAll mothers suffered restrictions in perinatal care during the COVID-19 pandemic. Women with COVID-19 infection suffered more restrictions in perinatal practices than women without infection. The degree of commitment to WHO-UNICEF perinatal quality standards, integrated into the BFHI, was associated with maintenance of good clinical practices.

Leveraging the Massachusetts perinatal quality collaborative to address the COVID-19 pandemic among diverse populations.

ObjectiveWe leveraged the Massachusetts perinatal quality collaborative (PQC) to address the COVID-19 pandemic. Our goals were to: (1) implement perinatal practices thought to reduce mother-to-infant SARS-CoV-2 transmission while limiting disruption of health-promoting practices and (2) do so without inequities attributable to race/ethnicity, language status, and social vulnerability.MethodsMain outcomes were cesarean and preterm delivery, rooming-in, and breastfeeding. We examined changes over time overall and according to race/ethnicity, language status, and social vulnerability from 03/20-07/20 at 11 hospitals.ResultsOf 255 mothers with SARS-CoV-2, 67% were black or Hispanic and 47% were non-English speaking. Cesarean decreased (49% to 35%), while rooming-in (55% to 86%) and breastfeeding (53% to 72%) increased. These changes did not differ by race/ethnicity, language, or social vulnerability.ConclusionsLeveraging the Massachusetts PQC led to rapid changes in perinatal care during the COVID-19 crisis in a short time, representing a novel use of statewide PQC structures.

Vaccine Willingness and Impact of the COVID-19 Pandemic on Women's Perinatal Experiences and Practices-A Multinational, Cross-Sectional Study Covering the First Wave of the Pandemic.

The COVID-19 pandemic may be of particular concern for pregnant and breastfeeding women. We aimed to explore their beliefs about the coronavirus and COVID-19 vaccine willingness and to assess the impact of the pandemic on perinatal experiences and practices. A multinational, cross-sectional, web-based study was performed in six European countries between April and July 2020. The anonymous survey was promoted via social media. In total, 16,063 women participated (including 6661 pregnant and 9402 breastfeeding women). Most responses were collected from Belgium (44%), Norway (18%) and the Netherlands (16%), followed by Switzerland (11%), Ireland (10%) and the UK (3%). Despite differences between countries, COVID-19 vaccine hesitancy was identified among 40–50% of the respondents at the end of the first wave of the pandemic and was higher among pregnant women. Education level and employment status were associated with vaccine hesitancy. The first wave had an adverse impact on pregnancy experiences and disrupted access to health services and breastfeeding support for many women. In the future, access to health care and support should be maintained at all times. Evidence-based and tailored information on COVID-19 vaccines should also be provided to pregnant and breastfeeding women to avoid unfounded concerns about the vaccines and to support shared decision making in this population.

Parents' experiences of care offered after stillbirth: An international online survey of high and middle-income countries.

Stillbirth, the death of a baby before birth, is associated with significant psychological and social consequences that can be mitigated by respectful and supportive bereavement care. The absence of high-level evidence to support the broad scope of perinatal bereavement practices means that offering a range of options identified as valued by parents has become an important indicator of care quality. This study aimed to describe bereavement care practices offered to parents across different high-income and middle-income countries. An online survey of parents of stillborn babies was conducted between December 2014 and February 2015. Frequencies of nine practices were compared between high-income and middle-income countries. Differences in proportions of reported practices and their associated odds ratios were calculated to compare high-income and middle-income countries. Over three thousand parents (3041) with a self-reported stillbirth in the preceding five years from 40 countries responded. Fifteen countries had atleast 40 responses. Significant differences in the prevalence of offering nine bereavement care practices were reported by women in high-income countries (HICs) compared with women in middle-income countries (MICs). All nine practices were reported to occur significantly more frequently by women in HICs, including opportunity to see and hold their baby (OR=4.8, 95% CI 4.0-5.9). The widespread occurrence of all nine practices was reported only for The Netherlands. Bereavement care after stillbirth varies between countries. Future research should look at why these differences occur, their impact on parents, and whether differences should be addressed, particularly how to support effective communication, decision-making, and follow-up care.

The unfinished work of neonatal very low birthweight infants quality improvement: Improving outcomes at a continental level in South America

Neonatal mortality rate varies between 4.2 and 18.6 per thousand by country in South America. There is little information regarding the outcomes of very low birth weight infants in the region and mortality rates are extremely variable ranging from 6% to over 50%. This group may represent up to 50–70% of the neonatal mortality and approximately 25–30% of infant mortality. Some initiatives, like the NEOCOSUR Network, have systematically collected and analyzed epidemiological information on VLBW infants’ outcomes in the region. Over a 16-year period, survival without major morbidity improved from 37 to 44%. However, mortality has remained almost unchanged at approximately 27%, despite an increase in the implementation of the best available evidence in perinatal practices over time. Implementing quality improvement initiatives in the continent is particularly challenging but represents a great opportunity considering that there is a wide margin for progress in both care and outcomes.

Validation of an instrument on safe perinatal practices in the COVID-19 context

Introduction: the care of the pregnant woman, her family and the newborn in the context of a pandemic, is located in a place of vulnerability of rights, due to different dimensions that causes not being able to predict how she will present childbirth and even more if it produces a premature birth, because not all hospital institutions currently comply with the right of childbirth respected and the right of the patient. Aim: to analyze the internal consistency and reliability of an instrument on safe perinatal practices in the COVID-19 context. Methods: a descriptive, cross-sectional study was carried out in a public institution of the Autonomous City of Buenos Aires in the period September-October 2021. The sample consisted of 37 nurses. An instrument composed of 35 items was used that was organized in four dimensions. After applying the data collection instrument in the selected sample, the construct validation was carried out by analyzing the factors and verifying the internal consistency using Cronbach's alpha. Results: the analysis of internal consistency (reliability) was carried out through Cronbach's Alpha. The descriptive results with the 35 items showed a variance of each item of 4,980; a total variance of 24,088, with a total Cronbach's Alpha of 0,817, showing that the instrument presents internal consistency. Conclusions: the results show that the proposed instrument has good validity and reliability and that it can be used to evaluate safe perinatal practices in the COVID-19 context

Predicting Long-Term Respiratory Outcomes in Premature Infants: Is It Time to Move beyond Bronchopulmonary Dysplasia?

Premature birth has been shown to be associated with adverse respiratory health in children and adults; children diagnosed with bronchopulmonary dysplasia (BPD) in infancy are at particularly high risk. Since its first description by Northway et al. about half a century ago, the definition of BPD has gone through several iterations reflecting the changes in the patient population, advancements in knowledge of lung development and injury, and improvements in perinatal care practices. One of the key benchmarks for optimally defining BPD has been the ability to predict long-term respiratory and health outcomes. This definition is needed by multiple stakeholders for hosts of reasons including: providing parents with some expectations for the future, to guide clinicians for developing longer term follow-up practices, to assist policy makers to allocate resources, and to support researchers involved in developing preventive or therapeutic strategies and designing studies with meaningful outcome measures. Long-term respiratory outcomes in preterm infants with BPD have shown variable results reflecting not only limitations of the current definition of BPD, but also potentially the impact of other prenatal, postnatal and childhood factors on the respiratory health. In this manuscript, we present an overview of the long-term respiratory outcomes in infants with BPD and discuss the role of other modifiable or non-modifiable factors affecting respiratory health in preterm infants. We will also discuss the limitations of using BPD as a predictor of respiratory morbidities and some of the recent advances in delineating the causes and severity of respiratory insufficiency in infants diagnosed with BPD.

Perinatal depression screening rates, correlates, and treatment recommendations in an obstetric population.

The current study aimed to assess perinatal depression (PD) screening and treatment practices of obstetrical health care providers. Retrospective record reviews (n = 557) evaluated the PD screening, referral, and treatment practices at an Obstetrician/Gynecology practice. This study assessed the frequency of screening for PD, rates of elevated Edinburgh Postnatal Depression Scale (EPDS) scores, treatment recommendations, demographic correlates, and predictors of elevated EPDS scores. PD screening completion rates were: 60.1% (intake), 35% (glucola test), and 85.5% (6-week follow-up). Rates of clinically elevated EPDS scores were: 18.21% (intake), 17.43% (glucola test), and 13.00% (6-week follow-up). Correlates of clinically elevated EPDS scores at intake and 6-week follow-up were history of depression, history of anxiety, and young age. History of depression and anxiety were associated with an increased likelihood of having a clinically significant EPDS score at intake. Intake EPDS score and history of depression were associated with an increased likelihood of having a clinically significant EPDS score at 6-week follow-up. Obstetric/gynecology providers should screen for perinatal depression at every obstetrical appointment. It is important to thoroughly assess history of depression and anxiety. Education and training for health care providers and perinatal women may improve the mental health experience of perinatal women. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Community interventions with women’s groups to improve women’s and children’s health in India: a mixed-methods systematic review of effects, enablers and barriers

IntroductionIndia is home to over 6 million women’s groups, including self-help groups. There has been no evidence synthesis on whether and how such groups improve women’s and children’s health.MethodsWe did...