Postnatal Care For Women Research Articles

Cost-effectiveness of gestational diabetes screening in middle-income countries: a systematic review

The majority of GDM occurs in low- and middle-income countries. GDM is associated with increased maternal and infant complications as well as an increased burden of health financing. Accurate and cost-effective screening is needed for prevention and further treatment. Unfortunately, there is a lack of research on the cost-effectiveness of GDM screening in middle-income countries. The objective of this study was to uncover scientific proof concerning the cost-effectiveness analysis of screening for gestational diabetes in middle-income countries. We conducted a systematic review using Pubmed and ScienceDirect. Four reviewers screened the title and abstract of each article, followed by the selection of the full text based on the inclusion criteria (cost-effectiveness analysis studies of GDM screening and original research). Quality articles were assessed using the CHEC-Extended tool. A total search of 1239 articles found 3 studies that met the inclusion criteria. A screening program is more cost-effective than no screening, this represents a savings of $1,329,671. The ICER value is less than 3x GDP per capita, which indicates that the intervention is cost-effective. Compared to two-step screening, one-step screening is more likely to be cost-effective since it detects more cases. As the prevention of DALYs is mainly due to the prevention of T2DM, middle-income countries should focus more on postnatal care for women with GDM in the future. It is advised that long-term follow-up studies be a major focus of future research in order to evaluate the follow-up GDM screening intervention's possible long-term health benefits and financial effects.

"Separated during the first hours"-Postnatal care for women and newborns during the COVID-19 pandemic: A mixed-methods cross-sectional study from a global online survey of maternal and newborn healthcare providers.

Routine postnatal care (PNC) allows monitoring, early detection and management of complications, and counselling to ensure immediate and long-term wellbeing of mothers and newborns; yet effective coverage is sub-optimal globally. The COVID-19 pandemic disrupted availability and quality of maternal and newborn care despite established guidelines promoting continuity of essential services. We conducted a cross-sectional global online survey of 424 maternal and newborn healthcare providers from 61 countries, to explore PNC provision, availability, content and quality following the early phase of the COVID-19 pandemic. The questionnaire (11 languages), included four multiple-choice and four open-text questions on changes to PNC during the pandemic. Quantitative and qualitative responses received between July and December 2020 were analysed separately and integrated during reporting. Tightened rules for visiting postpartum women were reported in health facilities, ranging from shorter visiting hours to banning supportive companions and visitors. A quarter (26%) of respondents reported that mothers suspected/confirmed with COVID-19 were routinely separated from their newborns. Early initiation of breastfeeding was delayed due to waiting for maternal SARS-CoV-2 test results. Reduced provision of breastfeeding support was reported by 40% of respondents in high-income countries and 7% in low-income countries. Almost 60% reported that women were discharged earlier than usual and 27% perceived a reduction in attendance to outpatient PNC. Telemedicine and home visits were mostly reported in high-income countries to ensure safe care provision. Beyond the early phase of the COVID-19 pandemic, severe disruptions to content and quality of PNC continued to exist, whereas disruptions in availability and use were less commonly reported. Depriving women of support, reducing availability of PNC services, and mother-newborn separation could lead to negative long-term outcomes for women, newborns and families, and deny their rights to respectful care. Protecting these essential services is imperative to promoting quality woman-centred PNC during and beyond the pandemic.

Facilitating better postnatal care with women-held documents in The Gambia: a mixed-methods study

BackgroundWomen-held documents are a basic component of continuity of maternity care. The use and completion of women-held documents following discharge could improve treatment and care for postnatal women. Using a mixed-methods study design, we aimed to assess the number, type, quality and completeness of women-held discharge documents, identify factors contributing to document completeness and facilitators or barriers for effective use of the documents.MethodsDocuments given to women at discharge from three hospitals in the Greater Banjul Area, The Gambia, were reviewed for content and quality. All women completed a questionnaire on the use of the documents. Poisson regression was used to estimate factors predicting document completion. Semi-structured interviews (n = 21) and focus groups (n = 2) were carried out with healthcare professionals (HCPs).ResultsNearly all (n = 211/212; 99%) women were given a document to take home. The most complete document (maternal record) had on average 17/26 (65%) items completed and 10% of women held an illegible document. None of the women’s sociodemographic or clinical characteristics predicted document completeness. The following facilitators for effective use of documents were identified from the women’s responses to the questionnaire and interviews with HCPs: 94% of women thought written information is important, 99% plan to have postnatal check-ups and 67% plan to use their documents, HCPs understand the importance of the documents and were familiar with the document’s use and content. The following barriers for effective use of documents were identified: HCPs had too many women-held documents to complete at discharge, there is no national protocol and HCPs think women do not understand the documents due to a lack of education and that women often lose or forget their documents.ConclusionsWomen-held documents are well established in The Gambia; though quality and completeness needs improving. Future research should determine the impact of using only one document at discharge, protocols and training on completeness, among other outcomes, and on ways to ensure all women are using the documents for their postnatal care.

Development and evaluation of online learning modules for family medicine residents: hypertensive disorders in pregnancy and physical activity in pregnancy

Hypertensive Disorders of Pregnancy (HDP) affect 7% of pregnancies in Canada. HDP increases women’s risk of future cardiovascular disease, and must be managed during and after pregnancy. Educators at Sunnybrook’s Department of Family and Community Medicine have identified barriers to providing comprehensive teaching on antenatal and postnatal care for women at risk of HDP. The objective of this project is to design, implement, and evaluate a series of online modules for family medicine residents to increase knowledge about preventing and managing HDP.

Predictors of Postnatal Care Service Utilization Among Women of Childbearing Age in The Gambia: Analysis of Multiple Indicators Cluster Survey.

BackgroundDespite the importance of postnatal care (PNC) in maternal and newborn health, however, such services have been underutilized in many resource-constrained settings including The Gambia. The objective of this study was to determine the coverage and factors of PNC in The Gambia.MethodsThe 2018 data from The Gambia Multiple Indicators Cluster Survey (MICS) were analyzed. Data from 9205 women with ages 15–49 years, who also have given birth, were extracted for the analysis. Percentages and Chi-square tests were used. In addition, multivariable logistic regression model was used to calculate the adjusted odds ratios (with corresponding 95% CI). The level of significance was set at p< 0.05.ResultsThe prevalence of PNC was 22.4% and 26.7% for women and children, respectively. Local government area (LGA) was associated with PNC for women and children alike. Furthermore, ethnicity was associated with PNC among women in The Gambia. Women who listened to radio almost every day had 1.51 increase in the odds of PNC (OR= 1.51; 95% CI: 1.15, 1.98) and 1.30 increase in the odds of PNC for children (OR= 1.30; 95% CI: 1.01, 1.67), respectively, when compared with women who do not listen to radio. Women who initiated antenatal care (ANC) at second or third trimester (late booking) had a 22% reduction in the odds of PNC (OR= 0.78; 95% CI: 0.64, 0.94), when compared with women who booked at first trimester.ConclusionThe findings showed that geographical locations, ethnicity, use of radio, and timing to antenatal care initiation were associated with PNC. Women’s enlightenment and early ANC programs can be designed to improve PNC coverage.

Personal, professional and workplace factors associated with burnout in Jordanian midwives: A national study

ObjectiveTo investigate the prevalence of burnout and explore associated socio-demographic and work-related factors among Jordanian midwives. DesignA cross-sectional survey design. The survey tool included the Copenhagen Burnout Inventory (CBI) and socio-demographic and work-related data forms. SettingAll government-funded hospitals in Jordan (18 hospitals) that provide antenatal, labour and birth, or postnatal care for women. ParticipantsA sample of 321 midwives participated. Data analysisFrequencies, means, and standard deviations were calculated as appropriate on the demographic variables and scale scores. The CBI was assessed for internal consistency using Cronbach's alpha. Multiple regression analyses using backward elimination were undertaken to determine associations between variables and CBI subscales. An alpha level of 0.05 was used for all statistical tests. FindingsOver three-quarters of midwives reported personal (78.1%), work-related (82.2%), and client-related (71.3%) burnout (scored >50 on CBI). Compared to midwives aged between 21 - 30 years, those between 31 - 40 years of age scored on average a 11.75 (95% CI = 7.05 - 16.45) points lower personal burnout score. Married midwives had on average a 6.44 (95% CI = 1.57 - 11.31) points higher personal burnout score compared to single midwives. Midwives with ≥ 10 years' experience had on average a 4.29 (95% CI = 1.93 - 6.64), 5.27 (95% CI = 3.17 - 7.36), and 7.31 (95% CI = 4.84 - 9.78) points lower personal, work-related, and client-related burnout scores respectively compared to midwives with < 10 years' experience.Compared to midwives providing care for 1 - 5 women per shift, those providing care for > 10 women per shift reported 9.98 (95% CI = 6.06 - 13.90) and 5.35 (95% CI = 0.71 – 9.99) points higher work-related and client-related burnout scores respectively. Midwives who rotated between shifts had on average a 5.87 (95% CI = 1.27 - 10.48) and 11.2 (95% CI = 5.78 - 16.66) points higher work-related and client-related burnout scores respectively than those who did not rotate. Key conclusions and implications for practiceThe high prevalence of burnout identifies the urgent need for a national plan to address midwives’ psychological health in Jordan. Midwives should be appropriately trained to recognize the signs and symptoms of burnout in a timely way, and for support services to be offered. The government could consider implementing continuity of midwifery care models, reducing the administrative burden on midwives, and empowering them to work to their full scope of practice.

Pregnancy after bariatric surgery: Consensus recommendations for periconception, antenatal and postnatal care.

SummaryThe objective of the study is to provide evidence‐based guidance on nutritional management and optimal care for pregnancy after bariatric surgery. A consensus meeting of international and multidisciplinary experts was held to identify relevant research questions in relation to pregnancy after bariatric surgery. A systematic search of available literature was performed, and the ADAPTE protocol for guideline development followed. All available evidence was graded and further discussed during group meetings to formulate recommendations. Where evidence of sufficient quality was lacking, the group made consensus recommendations based on expert clinical experience. The main outcome measures are timing of pregnancy, contraceptive choice, nutritional advice and supplementation, clinical follow‐up of pregnancy, and breastfeeding. We provide recommendations for periconception, antenatal, and postnatal care for women following surgery. These recommendations are summarized in a table and print‐friendly format. Women of reproductive age with a history of bariatric surgery should receive specialized care regarding their reproductive health. Many recommendations are not supported by high‐quality evidence and warrant further research. These areas are highlighted in the paper.

The Support for New Mums Project: A protocol for a pilot randomized controlled trial designed to test a postnatal psychoeducation smartphone application.

To report a pilot trial protocol for testing the effectiveness of the Support for New Mums smartphone application in a cohort of first-time mothers. A pilot/feasibility randomized controlled trial using a two-group pre-test and repeated post-test design. This protocol follows the Standard Protocol Items: Recommendations for Intervention Trials (SPIRIT) guidelines. The Intervention group will receive access to the smartphone application for 6weeks post birth. Both Intervention and control groups will receive standardized institutional postnatal care services. Trial funding was gained from respective grant sponsors in May and November 2016. The Support for New Mums smartphone application could be a novel method for addressing the gap in provision of postpartum care services providing psychoeducation and improving maternal parental self-efficacy for Australian childbearing women. Australian New Zealand Clinical Trials Registry ACTRN12618001580268.

Is Caseloading Sustainable? Lessons from the Front Line at King’s College Hospital

At King’s College Hospital in Camberwell, south London, we have a 25-year tradition of NHS caseloading, with named midwives providing continuity for all antenatal, intrapartum and postnatal care for women and their families (Wiseman and Holland 2018). Caseloading midwives care for 900-1,000 mixed-risk women each year, about 18 per cent of King’s 5,000-5,500 births. In this second part of the article, we describe the experience of caseloading from the perspective of the 30 midwives at King’s working in this way. We discuss how our teams are organised, and how we managed major organisational change. Finally, we reflect on our outcomes and what contributes to the sustainability of the caseloading model.

Assessing prevalence of alcohol consumption in early pregnancy: Self-report compared to blood biomarker analysis

Providing appropriate antenatal and postnatal care for women who drink alcohol in pregnancy is only possible if those at risk can be identified. We aimed to compare the prevalence of alcohol consumption in the first trimester of pregnancy using self-report and blood biomarker analysis. Six-hundred routine blood samples from 2014, taken at the antenatal booking appointment, in the first trimester of pregnancy, were anonymously analysed for the presence of Carbohydrate Deficient Transferrin (CDT), a validated marker of chronic alcohol exposure (normalising 2–3 weeks from abstinence) and Gamma-glutamyltransferase (GGT), a liver enzyme elevated for up to 8 weeks after alcohol exposure. In a separate sample of women, from 2015, data taken during the antenatal visit, documenting women's self-reported alcohol consumption, were collected. The percentage of women who reported alcohol intake in the first trimester was 0.8%. This compared to 74.1% of women who reported consuming alcohol before pregnancy. CDT analysis revealed a prevalence rate of 1.4% and GGT a prevalence rate of 3.5% in the first trimester of pregnancy. Although those with elevated CDT generally had high levels of GGT, only one person was positive for CDT and GGT. Results from CDT analysis and self-report may underestimate prevalence for different reasons. GGT appeared to lack specificity, but it may have value in supporting findings from CDT analysis. Further studies using additional blood biomarkers, or a combination of blood biomarkers and self-report, may be beneficial in accurately detecting alcohol drinking history in pregnancy.

Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa \u2013 a qualitative study

BackgroundWomen with a prior gestational diabetes have an increased lifetime risk of developing type 2 diabetes. Although post-partum follow-up for GDM women is essential to prevent progression to type 2 diabetes, it is poorly attended. The need for health systems interventions to support postpartum follow-up for GDM women is evident, but there is little knowledge of actual current practice. The aim of this study was to explore current policies and clinical practices relating to antenatal and post-natal care for women with GDM in South Africa, as well as health sector stakeholders’ perspectives on the barriers to -- and opportunities for -- delivering an integrated mother - baby health service that extends beyond the first week post-partum, to the infant’s first year of life.MethodsFollowing a document review of policy and clinical practice guidelines, in-depth interviews were conducted with 11 key informants who were key policy makers, health service managers and clinicians working in the public health services in South Africa’s two major cities (Johannesburg and Cape Town). Data were analysed using qualitative content analysis procedures.ResultsThe document review and interviews established that it is policy that health services adhere to international guidelines for GDM diagnosis and management, in addition to locally developed guidelines and protocols for clinical practice. All key informants confirmed that lack of postpartum follow-up for GDM women is a significant problem. Health systems barriers include fragmentation of care and the absence of standardised postnatal care for post-GDM women. Key informants also raised patient - related challenges including lack of perceived future risk of developing type 2 diabetes and non-attendance for postpartum follow up, as barriers to postnatal care for GDM women. All participants supported integrated primary health services but cautioned against overloading health workers.ConclusionAlthough there is alignment between international guidelines, local policy and reported clinical practice in the management of GDM, there is a gap in continuation of care in the postpartum period. Health systems interventions that support and facilitate active follow-up for women with prior GDM are needed if high rates of progression to type 2 diabetes are to be avoided.

Zika Virus infection and microcephaly: anxiety burden for women

The re-emergence of Zika virus in Brazil and other contiguous countries is a source of anxiety for pregnant women on account of its association with microcephaly. Adverse pregnancy outcome has huge mental health implications. It is essential for health providers to incorporate psychosocial care as part of pre and postnatal care for women in all countries affected by the Zika virus infection.

Rural Women's Experience of Living and Giving Birth in Relief Camps in Pakistan.

Background: Women are more vulnerable than men in the same natural disaster setting. Preexisting gender inequality, socio-cultural community dynamics and poverty puts women at significant risk of mortality. Pregnant women are particularly vulnerable because of their limited or no access to prenatal and obstetric care during any disaster or humanitarian emergency setting.Methods: In-depth interviews were conducted with 15 women who gave birth during the 2011 floods in Sindh Province, Pakistan. Thematic analysis explored women’s experiences of pregnancy and giving birth in natural disaster settings, the challenges they faced at this time and strategies they employed to cope with them. Results: Women were not afforded any control over decisions about their health and safety during the floods. Decisions about the family’s relocation prior to and during the floods were made by male kin and women made no contribution to that decision making process. There were no skilled birth attendants, ambulances, birthing or breastfeeding stations and postnatal care for women in the relief camps. Women sought the assistance of the traditional birth attendants when they gave birth in unhygienic conditions in the camps.Conclusion: The absence of skilled birth attendants and a clean physical space for childbirth put women and their newborn infants at risk of mortality. A clean physical space or birthing station with essential obstetric supplies managed by skilled birth attendants or community health workers can significantly reduce the risks of maternal morbidity and mortality in crisis situations.

Are Maternity Experiences of Rural Women Getting Better with Time? Results from a Survey in Tasmania

This study investigates the maternity experiences of rural women in Tasmania; and whether the childbirth experiences between women who have had childbirth experiences within the last five years and those more than five years ago are different due to closure of local maternity services. A questionnaire explored women’s experiences of rural maternity services from antenatal to postnatal care in six rural communities in Tasmania, Australia. 210 women completed the questionnaire with a response rate of 35%. Nearly 50% (n=100) of surveyed women did not have a choice where they could get antenatal care, while more than 50% (n=108) of participants lacked the choice about who would provide care during their pregnancy. Women who gave birth recently were more likely to have to travel further to the nearest maternity units. These women were less likely to experience continuity of care and to be satisfied with the antenatal care and care during labour. In contrast, the women who gave birth more than five years ago had shorter travel time to the nearest maternity units and were more likely to have experienced continuity of care and greater satisfaction with care given during their pregnancy, labour and delivery. Maternity experiences of Tasmanian rural women have not improved with time due to the closure of small rural maternity units. Reopening small rural maternity units would not be feasible with the current shortage of health workforce in Australia. However, in order to improve maternity experiences for rural women, it is recommended that basic services including antenatal and postnatal services should be provided in their local communities. The existing maternity health providers in rural communities such as GP obstetricians and multi-skilled rural nurses should be encouraged and provided with incentives to deliver greater antenatal and postnatal care for women. In addition, maternity health providers from major hospitals could come to a local hospital regularly to provide antenatal check-ups and antenatal classes. This will reduce the need of traveling to access services and increase opportunities for continuity of care which in turn may increase the satisfaction with care of rural women.

Implementation of a new birth record in three hospitals in Jordan: a study of health system improvement

This study tested the introduction of a new integrated clinical record in Jordan where currently no clinical report links antenatal, birth and postnatal care for women. As a result, no continuity of information is provided to clinicians nor are there national statistics on trends, or performance of hospitals around birth. Our study was conducted in the Jordanian Ministry of Health, the maternity wards and registration departments of three hospitals in Jordan and in the Maternal and Child Health Centres located near these hospitals. We used an exploratory, descriptive design and practice-research engagement to investigate and report on the process of change to improve and implement the new birth record. Through engaging practitioners in research, care improved, the quality of reporting changed, managers developed more effective measures of hospital performance and policy makers were provided with information that could form the basis of a national maternity data monitoring system. Quantitative and qualitative audit data demonstrated improved clinical reporting, organizational development and sustained commitment to the new record from clinicians, managers and policy leaders.

Improving postnatal care for every woman

The government recognises and values the vital work that midwives undertake for pregnant women and their families from the first antenatal visit through to the early weeks after the birth of their baby. But how can midwives and government work together to further improve postnatal care for women?