Pattern of prenatal care utilization in Tehran: A population based longitudinal study

Aim

To assess the pattern of prenatal care utilization in Tehran in 2015.

Facilitators of prenatal care access in rural Appalachia

BackgroundThere are many providers and models of prenatal care, some more effective than others. However, quantitative research alone cannot determine the reasons beneficial models of care improve health outcomes. Perspectives of women receiving care from effective clinics can provide valuable insight.MethodsWe surveyed 29 women receiving care at a rural, Appalachian birth center in the United States with low rates of preterm birth. Semi-structured interviews and demographic questionnaires were analyzed using conventional qualitative content analysis of manifest content.FindingsInsurance was the most common facilitator of prenatal access. Beneficial characteristics of the provider and clinic included: personalized care, unrushed visits, varied appointment times, short waits, and choice in the type and location of care.ConclusionThere is a connection between compassionate and personalized care and positive birth outcomes. Women were willing to overcome barriers to access care that met their needs. To facilitate access to prenatal care and decrease health disparities, healthcare planners, and policy makers need to ensure all women can afford to access prenatal care and allow women a choice in their care provider. Clinic administrators should create a welcoming clinic environment with minimal wait time. Unrushed, woman-centered prenatal visits can increase access to and motivation for care and are easily integrated into prenatal care with minimal cost.     

Survey of women's perceptions of information provided in the prevention or treatment of iron deficiency anaemia in an Australian tertiary obstetric hospital

BackgroundThere is limited literature to understand the perceptions of Australian women regarding the information provided by healthcare professionals relating to the prevention and treatment of iron deficiency anaemia in pregnancy.AimTo establish an insight into the key themes and trends within a tertiary obstetric hospital related to the provision of dietary advice and use of iron supplements in pregnancy.MethodsA prospective patient survey of pregnant women and women up to 4 weeks postnatal attending hospital.FindingsOf the 110 women who participated, 73.6% were provided with information on iron rich foods and 67% made dietary changes. Eighty percent of women were advised to take oral iron and 65.5% of women were taking it at the time of the survey. In women who had independently ceased oral iron, 41.7% failed to inform their healthcare professional. In the women who did inform their healthcare professional 89.5% received advice to help overcome the reason that led to cessation. The main causes included forgetfulness and side effects. Women were less likely to require intravenous iron if oral iron was commenced early.ConclusionsCompliance with recommended oral iron is variable within a population of pregnant women. Women are provided with information on a range of issues relating to the prevention and treatment of iron deficiency anaemia; yet there is a disparity between the information provided and the resulting action. Further research should focus on targeted measures to improve understanding and compliance with treatment from the both women's and health professionals perspective.     

Design,development and usability testing of Essential Coaching for Every Mother: A postnatal text message educational intervention

BackgroundThe transition to motherhood is an exciting yet challenging period that requires physical, emotional, and social adjustment. During the postpartum period, mothers require support and information to ensure a smooth transition and adjustment to motherhood. One innovative strategy to provide mothers with this information is mobile health (mHealth), and specifically, text messaging.ObjectiveTo describe the design, development and usability testing of a postnatal text message intervention called Essential Coaching for Every Mother.MethodsFirst time mothers (n = 11) and postpartum healthcare providers (n = 18) were involved in iterative interviewing in Halifax, Canada. Adaption of content occurred through three rounds of user testing using semi-structured interviews. The Information Assessment Method (IAM) Parents survey was also completed by mothers.ResultsThree cycles of iterative testing were conducted with eight participants (3 mothers, 5 healthcare providers), thirteen participants (8 mothers, 5 healthcare providers) and 8 participants (8 healthcare providers), respectively. Messages evolved from risk-focused to prevention and education focused. Mothers felt the messages addressed their needs and healthcare providers ensured the content was consistent with the messaging currently provided to postpartum mothers.ConclusionEssential Coaching for Every Mother is the first postnatal educational text message intervention developed for mothers in Halifax, Canada. We sought to involve first time mothers (end-users) and postpartum healthcare providers (experts) in the development and usability evaluation to ensure the intervention adequately met needs and was consistent with current practices related to postpartum education.     

Psychological distress in pregnancy and postpartum

PurposeDepression, stress, and anxiety, termed ‘psychological distress,’ are common in pregnancy and postpartum periods. However, it is unclear whether prenatal psychological distress predicts postpartum psychological distress. We studied the prevalence, comorbidity and associations of maternal depression, stress, and anxiety in the prenatal period in relation to the occurrence of these same measures in the postpartum period.MethodsData originated from the MotherToBaby study of pregnant women residing in the U.S or Canada (2016–2018). Risk ratios and 95% Confidence Intervals using modified-Poisson regression models were used to investigate associations between prenatal psychological distress and postpartum psychological distress.ResultsOf the 288 women in the analysis, 21.2% and 26.7% of women had evidence of prenatal and postnatal psychological distress, respectively. Among those with prenatal psychological distress, 43 (70.5%) also had postpartum psychological distress. Twenty-five (41%) of those with prenatal and 46 (60%) of those with postpartum psychological distress had comorbidity of at least two of the measures. Prenatal measures independently predicted the same postnatal measures; prenatal anxiety also independently predicted postpartum stress. Participants who experienced more types of prenatal psychological distress were at higher risk for postpartum depression, stress, and anxiety.ConclusionDepression, stress, and anxiety are common in pregnant women and often occur together. Prenatal psychological distress measures are associated with postnatal psychological distress measures, with stronger associations among women with more than one type of psychological distress in pregnancy. Interventions during pregnancy may reduce the risk of postpartum psychological distress.     

Best practices for online Canadian prenatal health promotion: A public health approach

Background

Prenatal health promotion provides information regarding pregnancy risks, protective behaviours and clinical and community resources. Typically, women obtain prenatal health information from health care providers, prenatal classes, peers/family, media and increasingly, Internet sites and mobile apps. Barriers to prenatal health promotion and related services include language, rural/remote location, citizenship and disability. Online public health platforms represent the capacity to reach underserved women and can be customised to address the needs of a heterogeneous population of pregnant women.

A selective review of prenatal exercise guidelines since the 1950s until present: Written for women,health care professionals,and female athletes

BackgroundTraditional society values have long-held the notion that the pregnant woman is construed as a risk to her growing fetus and is solely responsible for controlling this risk to ensure a healthy pregnancy. It is hard to ignore the participation of pregnant women in sport and exercise today, especially in high-level sports and popular fitness programs such as CrossFit™. This challenges both traditional and modern prenatal exercise guidelines from health care professionals and governing health agencies. The guidelines and perceived limitations of prenatal exercise have drastically evolved since the 1950s.AimThe goal of this paper is to bring awareness to the idea that much of the information regarding exercise safety during pregnancy is hypersensitive and dated, and the earlier guidelines had no scientific rigor. Research is needed on the upper limits of exercise intensity and exercise frequency, as well as their potential risks (if any) on the woman or fetus.DiscussionPregnant women are physically capable of much more than what was once thought. There is still disagreement about the types of exercise deemed appropriate, the stage at which exercise should begin and cease, the frequency of exercise sessions, as well as the optimal level of intensity during prenatal exercise.ConclusionResearch is needed to determine the upper limits of exercise frequency and intensity for pregnant women who are already trained. Healthy women and female athletes can usually maintain their regular training regime once they become pregnant.     

Midwife readiness to provide woman-centred weight gain support: Exploring perspectives across models of care

ProblemMore than half of women start pregnancy above a healthy weight and two-thirds gain excess weight during pregnancy, increasing the risk of complications.BackgroundLittle research has examined the influence model of care has on weight-related outcomes in pregnancy.AimTo explore how continuity vs non-continuity models of midwifery care influence perceived readiness to provide woman-centred interventions with women supporting pregnancy weight gain, healthy eating and physical activity.MethodsFocus groups were conducted with midwives working in either continuity or non-continuity models of care at a tertiary hospital in Queensland, Australia. Focus group questions elicited elements around practices, the healthcare environment and woman-centred care skills. Findings were analysed using the Framework Approach to qualitative research.FindingsFour focus groups, involving 15 participants from the continuity of care model and 53 from the non-continuity model, were conducted. Continuity of care participants reported greater readiness to provide woman-centred interventions than those from non-continuity models. Barriers faced by both groups included gaps in communication training, education resources and multidisciplinary support.DiscussionMidwives across models of care require greater support in this area, in particular training in communication and better multidisciplinary service integration to support women.ConclusionThe care model appears to influence capacity to deliver person/woman-centred interventions, highlighting the need for tailored training for the healthcare setting. The roles of other health professionals in delivering weight management interventions during pregnancy also need to be examined.     

Australian women’s perceptions and practice of sleep position in late pregnancy: An online survey

BackgroundGoing-to-sleep in the supine position in later pregnancy (≥28 weeks) has been identified as a risk factor for stillbirth. Internationally, public awareness campaigns have been undertaken encouraging women to sleep on their side during late pregnancy.AimThis study aimed to identify sleep practices, attitudes and knowledge in pregnant women, to inform an Australian safe sleeping campaign.MethodsA web-based survey of pregnant women ≥28 weeks’ gestation conducted from November 2017 to January 2018. The survey was adapted from international sleep surveys and disseminated via pregnancy websites and social media platforms.FindingsThree hundred and fifty-two women participated. Five (1.6%) reported going to sleep in the supine position. Most (87.8%) had received information on the importance of side-sleeping in pregnancy. Information was received from a variety of sources including maternity care providers (186; 66.2%) and the internet (177; 63.0%). Women were more likely to report going to sleep on their side if they had received advice to do so (OR 2.3; 95% CI 1.0–5.1). Thirteen (10.8%) reported receiving unsafe advice, including changing their going-to-sleep position to the supine position.DiscussionThis indicates high level awareness and practice of safe late-pregnancy going-to-sleep position in participants. Opportunities remain for improvement in the information provided, and understanding needs of specific groups including Aboriginal and Torres Strait Islander women.ConclusionFindings suggest Australian women understand the importance of sleeping position in late pregnancy. Inconsistencies in information provided remain and may be addressed through public awareness campaigns targeting women and their care providers.     

The outbreak of coronavirus disease in China: Risk perceptions,knowledge, and information sources among prenatal and postnatal women

BackgroundThe COVID-19 pandemic has created anxiety among members of the public, including all women over the childbirth continuum, who are considered to be at a greater risk of contracting most infectious diseases. Understanding the perspectives of health care consumers on COVID-19 will play a crucial role in the development of effective risk communication strategies. This study aimed to examine COVID-19-related risk perceptions, knowledge, and information sources among prenatal and postnatal Chinese women during the initial phase of the COVID-19 pandemic.MethodsA cross-sectional survey design was adopted, and a four-section online questionnaire was used to collect data. Using a social media platform, the online survey was administered to 161 participants during the outbreak of COVID-19 in Nanjing, China, in February 2020.ResultsThe participants perceived their risk of contracting and dying from COVID-19 to be lower than their risk of contracting influenza, however many of them were worried that they might contract COVID-19. The participants demonstrated adequate knowledge about COVID-19. The three major sources from which they obtained information about COVID-19 were doctors, nurses/midwives, and the television, and they placed a high level of confidence in these sources. There was no significant relationship between the perceived risk of contracting COVID-19 and knowledge about this disease.ConclusionThe present findings offer valuable insights to healthcare professionals, including midwives, who serve on the frontline and provide care to pregnant women. Although the participants were adequately knowledgeable about COVID-19, they had misunderstood some of the recommendations of the World Health Organisation.     

Stillbirth research: Recruitment barriers and participant feedback

BackgroundPrioritisation of stillbirth research in high-income countries is required to address preventable stillbirth. However, concern is raised by ethics committees, maternity providers and families, when pregnant and bereaved women are approached to participate. Our aim was to 1) assess factors influencing recruitment in a multicentre case-control stillbirth study and 2) gain insight into how women felt about their participation.MethodsEligible women were contacted through maternity providers from seven New Zealand health regions in 2011-2015. Cases had a recent singleton non-anomalous late stillbirth (≥28 weeks’ gestation). Controls were randomly selected and matched for region and gestation. Participants were interviewed by a research midwife and given a feedback form asking their views about participation. Feedback was evaluated using thematic analysis.Results169 (66.5%) of 254 eligible cases and 569 (62.2%) of 915 eligible controls were recruited. Non-participants consisted of 263 (22.5% of eligible) women who declined, 108 (9.2% of eligible) uncontactable women, and 60 (5.1% of eligible) women declined by the maternity provider, with no significant differences between the proportion of non-participating cases and controls in each of these three categories. The majority (63.2%) of women did not provide a specific reason for non-participation. Written feedback was provided by 111 participants (cases 15.3%, controls 14.9%) and all described their involvement positively. Feedback themes identified were ‘motivation to participate,’ ‘ease of participation,’ and ‘post-participation positivity.’ConclusionIdentification of recruitment barriers and our reassuring participant feedback may assist women’s participation in future research and support progress towards stillbirth prevention.     

Is it possible to incorporate evidence-based professional midwifery practices into public health services in Mexico?

Problem and backgroundDuring the past two decades, Mexico has launched innovative maternal health initiatives to improve maternal and neonatal outcomes, placing emphasis on the incorporation of professional midwifery practices into the healthcare system. This study explored the perceptions of healthcare providers and women using public birth care services regarding professional midwifery practices and how can the inclusion of evidence-based midwifery techniques improve the quality of service.MethodologyWe conducted a qualitative, cross-sectional study of three healthcare networks in Mexico. A content analysis was performed of data collected through 109 semi-structured interviews: 72 with healthcare providers and 37 with women.ResultsHealthcare providers and women had minimal knowledge of the competencies and skills of professional midwives. Medical personnel accepted the incorporation of some evidence-based midwifery practices. Women had experienced fear and anguish during childbirth so they considered that incorporating professional midwifery practices into maternal health services would be favourable in that it would render birth care more respectful.Discussion and conclusionsHealthcare providers are willing to consider the inclusion of some evidence-based midwifery practices in health services and regard assistance from professional midwives. They believe that structural conditions will complicate their incorporation. Although the women interviewed had experienced fear, anxiety and loneliness during childbirth, most of them admitted to feeling “safer” in a hospital (secondary-care health centre) setting where possible complications could be resolved. This perception of safety served to justify the delivery of healthcare in a manner that is inattentive to women’s needs, which go beyond biomedical issues and include emotions and the positive experience of childbirth.     

Determinants of prenatal health care utilisation by low-risk women: A prospective cohort study

BackgroundPrenatal health care is pivotal in providing adequate prevention and care to pregnant women.AimWe examined the determinants of inadequate prenatal health care utilisation by low-risk women in primary midwifery-led care in the Netherlands.MethodsWe used longitudinal data from the population-based DELIVER study with 20 midwifery practices across the Netherlands in 2009 and 2010 as the experimental setting. The participants were 3070 pregnant women starting pregnancy care in primary midwifery care.FindingsWe collected patient-reported data on potential determinants of prenatal care utilisation derived from the Andersen model. Prenatal health care utilisation was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and number of visits. Low-risk pregnant women (not referred during pregnancy) were more likely to use prenatal care inadequately if they intended to deliver at a hospital, if they did not use folic acid adequately periconceptionally, or if they were exposed to cigarette smoke during pregnancy. Among those who were referred to secondary care, women reporting a chronic illnesses or disabilities, and women who did not use folic acid periconceptionally were more likely to make inadequate use of prenatal care.ConclusionInadequate prenatal health care use in primary midwifery care is more likely in specific groups, and the risk groups differ when women are referred to secondary care. The findings suggest routes that can target interventions to women who are at risk of not adequately using prenatal prevention and care services.     

The need for improved emotional support: A pilot online survey of Australian women’s access to healthcare services and support at the time of miscarriage

ProblemWomen need improved emotional support from healthcare professionals following miscarriage.BackgroundSignificant psychological morbidity can result following miscarriage and may be exacerbated by poor support experiences. Women frequently report high levels of dissatisfaction with healthcare support at this time.AimThis study was developed to pilot a survey aimed at exploring women’s access to healthcare services and support at the time of miscarriage.MethodsWomen over 18 years, residing in Australia, who had experienced a miscarriage in the past two years completed a 29-item online survey.FindingsA total of 399 women completed the survey. Two key findings arose: 1) More than half of women (59%) were not offered any information about miscarriage or pregnancy loss support organisations or referral/access to counselling services at the time of miscarriage, despite almost all reporting they would have liked various forms of support from items listed 2) More than half (57%) did not receive follow up care, or emotional support at this time, beyond being asked how they were coping emotionally. Other findings showed 3) Women accessed various healthcare services at the time of miscarriage and 4) Women often saw a general practitioner at the time of miscarriage despite having a private obstetrician.ConclusionThere is clear mismatch between the support women want at the time of miscarriage and the care they receive from healthcare professionals. Despite considerable structural barriers, it seems likely there is scope within healthcare professionals’ usual practice for improved support care through simple measures such as increased acknowledgement, information provision and referral to existing support services.     

Tobacco use in the third trimester of pregnancy and its relationship to birth weight. A prospective study in Spain

BackgroundFew studies have been carried out in Spain examining the use of tobacco amongst expectant mothers and its effect on birth weight.AimsTo observe the proportion of expectant mothers who smoke during their pregnancy, and the impact of tobacco consumption on maternal and birth weight. We also aimed to identify the trimester of pregnancy in which tobacco use produced the greatest reduction in birth weight.MethodsProspective observational study in Spain. A random sampling strategy was used to select health centres and participant women. A total of 137 individuals were enrolled in the study. Exposure to tobacco was measured through a self-reported questionnaire. Regressions were performed to obtain a predictive model for birth weight related to smoking.FindingsOverall, 35% of study participants were smokers during the pre-gestational period (27% in the first trimester, 21.9% in the second and 21.2% in the third). 38.7% of smoking cessation attempts took place in the third-trimester. Pregnant women who smoked up to the third trimester had a higher risk of giving birth to a baby under 3000 g, compared to non-smokers (OR = 5.94, CI 95%: 1.94–18.16). Each additional unit of tobacco consumed daily in the 3rd trimester led to a 32 g reduction in birth weight.ConclusionAn important proportion of pregnant women in Spain smoke during pregnancy. Pregnant women exposed to tobacco have newborns with lower birth weight. Smoking during the 3rd trimester of pregnancy is associated with the greatest risk of lower birth weight.     

Are midwifery clients in Ontario making informed choices about prenatal screening?

BackgroundInformed choice is often lacking in women's decisions about prenatal screening.AimThe aim of this study is to evaluate how well midwives in Ontario, Canada are facilitating informed choice in this area.MethodsAn Internet-based survey was used to investigate 171 midwifery clients’ knowledge, attitude towards and experience of prenatal genetic screening tests, and to determine the proportion of study participants who made an informed choice about prenatal screening.FindingsAll participants demonstrated adequate knowledge of prenatal screening. The vast majority (93.0%) of participants made an informed choice. Participants who chose to screen had lower knowledge scores than those who opted out of screening. Client satisfaction rates in regard to care received in this area ranged from 97% to 100%.ConclusionsResults of this study suggest that Ontario midwives are effective in conveying information on prenatal genetic screening, contributing to high levels of client knowledge and satisfaction in comparison to similar studies in other jurisdictions.     

The experiential knowledge of migrant women about vulnerability during pregnancy: A woman-centred mixed-methods study

ProblemWithin maternity care policies and practice, pregnant migrant women are regarded as a vulnerable population.BackgroundWomen’s experiential knowledge is a key element of woman-centred care but is insufficiently addressed in midwifery practice and research that involves migrant women.AimTo examine if pregnant migrant women’s experiential knowledge of vulnerability corresponds with sets of criteria of vulnerability, and to explore how migrant women make sense of vulnerability during pregnancy.MethodsA sequential two-phased mixed-methods study, conducted in the Netherlands, integrating survey data of 89 pregnant migrant women and focus group data obtained from 25 migrant mothers - living in deprived areas according to the Dutch socio-economic index.ResultsCriteria associated with vulnerability were reported by 65.2% of the participants and 62.9% of the participants reported adverse childhood experiences. On a Visual Analogue Scale, ranging from 0 (not vulnerable) to 10 (very vulnerable), participants self-reported sense of vulnerability showed a mean score of 4.2 (±2.56). Women’s experiential knowledge of vulnerability significantly correlated with the mean sum score of clinical criteria of vulnerability (r .46, p .002) and with the mean sum score of adverse childhood experiences (r .48, p < .001). Five themes emerged from the focus group discussions: “Look beyond who you think I am and see and treat me for who I really am”, “Ownership of truth and knowledge”, “Don’t punish me for being honest”, “Projection of fear” and “Coping with labelling”.ConclusionPregnant migrant women’s experiential knowledge of vulnerability is congruent with the criteria. Calling upon experiential knowledge is an attribute of the humane woman-midwife relationship.