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European Journal of Midwifery 2024Childbirth is a unique experience for women. In Ireland, major obstetric hemorrhage (MOH) is the most frequently reported severe maternal morbidity (SMM) with an...
INTRODUCTION
Childbirth is a unique experience for women. In Ireland, major obstetric hemorrhage (MOH) is the most frequently reported severe maternal morbidity (SMM) with an incidence of 3.27 per 1000 maternities. Much is known now about the management of postpartum hemorrhage (PPH), and there is some research on women and their partner's experience. Less is known about how the woman feels emotionally following a PPH or what informational needs and emotional support are required. The aim of this study was to understand how women felt after experiencing a severe PPH, to listen to their first-hand experience, and to learn what improvements could be made for future care for women who experience a PPH.
METHODS
A descriptive, quantitative approach was conducted using semi-structured interviews with women who had a severe hemorrhage (blood loss) of ≥2.5 L between four and fourteen months postpartum.
RESULTS
Five women took part in this study. The women identified a lack of information provided to them about the reason for the significant bleeding. The women voiced they could overhear information about the event discussed between healthcare professionals but not with the woman. The care the women received in the High Dependency Unit (HDU) was significantly different from the care they received in the postnatal wards, and the women were not informed they were clinically well for transfer to the postnatal ward. It was reported that the postnatal wards were busy and short-staffed, and the women looked for more emotional support from staff, which was not available. This had an effect on their recovery in the postnatal period.
CONCLUSIONS
The women reported that they wanted more information in the early postnatal period following the event, and some still had unanswered questions at the time of the interviews several months later. Most of the participants did not receive adequate emotional support from the midwives caring for them, which resulted in the participants requesting early discharge home to get emotional support from members of their family.
PubMed: 38948117
DOI: 10.18332/ejm/183027 -
BMC Pregnancy and Childbirth Jun 2024In the United States, maternal health inequities disproportionately affect Global Majority (e.g., Asian, Black, and Hispanic) populations. Despite a substantial body of...
In the United States, maternal health inequities disproportionately affect Global Majority (e.g., Asian, Black, and Hispanic) populations. Despite a substantial body of research underscoring the influence of racism on these inequities, little research has examined how experiences of gendered racial microaggressions during pregnancy and birth impact racially and ethnically diverse Global Majority pregnant and birthing people in obstetric hospital settings. We evaluated the psychometric properties of an adapted version of Lewis & Neville's Gendered Racial Microaggressions Scale, using data collected from 417 Global Majority birthing people. Findings from our study indicate that our adapted GRMS is a valid tool for assessing the experiences of gendered racial microaggressions in hospital-based obstetric care settings among Global Majority pregnant and birthing people whose preferred languages are English or Spanish. Item Response Theory (IRT) analysis demonstrated high construct validity of the adapted GRMS scale (Root Mean Square Error of Approximation = 0.1089 (95% CI 0.0921, 0.1263), Comparative Fit Index = 0.977, Standardized Root Mean Square Residual = 0.075, log-likelihood c2 = -85.6, df = 8). IRT analyses demonstrated that the unidimensional model was preferred to the bi-dimensional model as it was more interpretable, had lower AIC and BIC, and all items had large discrimination parameters onto a single factor (all discrimination parameters > 3.0). Given that we found similar response profiles among Black and Hispanic respondents, our Differential Item Functioning analyses support validity among Black, Hispanic, and Spanish-speaking birthing people. Inter-item correlations demonstrated adequate scale reliability, α = 0.97, and empirical reliability = 0.67. Pearsons correlations was used to assess the criterion validity of our adapted scale. Our scale's total score was significantly and positively related to postpartum depression and anxiety. Researchers and practitioners should seek to address instances of gendered racial microaggressions in obstetric settings, as they are manifestations of systemic and interpersonal racism, and impact postpartum health.
Topics: Humans; Female; Psychometrics; Racism; Pregnancy; Adult; United States; Reproducibility of Results; Surveys and Questionnaires; Hispanic or Latino; Male; Young Adult; Healthcare Disparities; Aggression; Black or African American; Delivery, Obstetric
PubMed: 38943057
DOI: 10.1186/s12884-024-06642-5 -
Evidence-based Nursing Jun 2024
PubMed: 38942467
DOI: 10.1136/ebnurs-2023-103888 -
Medicine Jun 2024To explore the effects of tracking linkage self-management mode on the compliance of prenatal examinations and delivery modes in primiparas. A total of 270 primiparas... (Observational Study)
Observational Study
To explore the effects of tracking linkage self-management mode on the compliance of prenatal examinations and delivery modes in primiparas. A total of 270 primiparas undergoing prenatal examinations in Shijiazhuang Obstetrics and Gynecology Hospital were enrolled for prospective study between January 2021 and January 2022. They were divided into control group and observation group, 135 cases in each group. The control group was given routine management mode, while observation group was given tracking linkage self-management mode. All were intervened till discharge. The compliance (time and frequency of prenatal examinations), cognition of prenatal examinations, score of exercise of self-care agency scale, self-rating anxiety scale and self-rating depression scale, delivery modes and the occurrence of neonatal adverse outcomes were compared between the 2 groups. After intervention, total compliance rate of prenatal examinations in observation group was higher than that in control group (84.44% vs 72.59%) (P < .05). The scores of pregnancy care, genetic diseases counseling, prevention of birth defects and reasonable nutrition during pregnancy in observation group were higher than those in control group (P < .05), scores of health cognition, self-care skills, self-care responsibility and self-concept were higher than those in control group (P < .05), scores of self-rating anxiety scale and self-rating depression scale were lower than those in control group (P < .05), natural delivery rate was higher than that in control group (85.93% vs 74.81%) (P < .05), and incidence of neonatal adverse outcomes was lower than that in control group (0.74% vs 5.93%) (Fisher exact probability = 0.036). The application of tracking linkage self-management mode can significantly improve cognition to prenatal examinations, improve compliance of prenatal examinations and self-care ability, relieve anxiety and depression, increase natural delivery rate and reduce the incidence of neonatal adverse outcomes in primiparas.
Topics: Humans; Female; Pregnancy; Adult; Self-Management; Prospective Studies; Patient Compliance; Prenatal Care; Delivery, Obstetric; Parity; Self Care
PubMed: 38941437
DOI: 10.1097/MD.0000000000038494 -
Frontiers in Medicine 2024Medical errors are not uncommon, but they are seldom reported. Patient safety practices are among the key areas for service improvement. This study aimed to assess...
INTRODUCTION
Medical errors are not uncommon, but they are seldom reported. Patient safety practices are among the key areas for service improvement. This study aimed to assess factors associated with self-reported medical errors among undergraduate health science students in southern Ethiopia.
METHODS
A facility-based cross-sectional study was conducted among health science students of Arba Minch University in 2018. The sample size was calculated using a single population proportion formula. A total of 287 medical students in their fourth year and above, nursing and midwifery students in their second year and above, and other health science students in their third year and above were included.
RESULTS
The majority (82.1, 95%CI: 77.63-86.67) of the study participants had a 'good' knowledge score on patient safety. Approximately 62.5% (95%CI: 56.8-68.2) of the participants had a 'favorable' patient safety attitude. Only 38.6% (95%CI: 32.8-44.3) of the study participants had 'good' patient safety practices. At adjusted analysis, the practical attachment unit, having ever managed a patient independently, having ever witnessed harm to patients by colleagues or other healthcare workers, and having ever witnessed harm to a close friend or family member were statistically significantly associated with self-reported medical errors. Participants who were doing their practical clinical attachment in the surgical and obstetric units were three times more likely to self-report medical errors as compared to those practicing in the pediatrics, internal medicine, and other units (AOR = 2.72, 95%CI: 1.16-6.39.97). Students who had never managed a patient independently were less likely to self-report medical error (AOR = 0.24, 95%CI: 0.08-0.72). The odds of self-reporting medical errors were less among among participants who had not ever witnessed harm to patients by colleagues or other healthcare workers (AOR = 0.12, 95%CI: 0.05-0.29) and participants who had not ever witnessed harm to a close friend or family member (AOR = 0.36, 95%CI: 0.16-0.80).
CONCLUSION
One in five of the participants reported having harmed patients while practicing. Most of the students had good patient safety knowledge, while approximately two-thirds of the participants had a favorable attitude toward patient safety. Only 38.6% of the study participants had good patient safety practices. Having worked in surgical and obstetrics units, having managed a patient independently, and having witnessed harm to a patient were associated with self-reporting of medical errors.
PubMed: 38938384
DOI: 10.3389/fmed.2024.1354270 -
MCN. the American Journal of Maternal...To describe the experiences of registered nurses and certified nurse midwives who provided labor support and care in the early months of the COVID-19 pandemic.
PURPOSE
To describe the experiences of registered nurses and certified nurse midwives who provided labor support and care in the early months of the COVID-19 pandemic.
STUDY DESIGN AND METHODS
A descriptive, qualitative approach was used to explore nurses' and midwives' perceptions via in-depth interviews. Data were analyzed via thematic analysis.
RESULTS
Thirteen nurses, four of whom were also midwives, participated in semi-structured interviews. All provided care during the first 9 months of the pandemic and represented seven states across the United States. The analysis revealed an overarching theme, A New World but still a Celebration. This overarching theme encompasses participants' accounts of trying to provide the same support, presence, and celebration while dealing with constant policy changes, the impact of limited family presence in labor, and their own fears and risks. Four sub-themes were identified: The Impact of Nursing during COVID-19; Challenges, Changes, and Consequences; Unexpected Benefits; and The Cost.
CLINICAL IMPLICATIONS
The first year of the COVID-19 pandemic saw unprecedented challenges for nurses. Practice changes due to these changing policies had negative and positive effects. Negative practices affected family support, decreased interprofessional collaboration, and caused shorter hospital stays for new mothers. Some positive aspects of practice changes included additional time for mother-newborn bonding due to restrictive visitation policies, increased initiation of breastfeeding, and focused patient education. Nurses across the United States are still coping with practice changes from the pandemic. Our study highlights the need to support nurses in adapting care in the midst of practice changes.
Topics: Humans; COVID-19; United States; Female; Pregnancy; Qualitative Research; Adult; SARS-CoV-2; Pandemics; Nurse Midwives; Labor, Obstetric; Interviews as Topic; Middle Aged
PubMed: 38926919
DOI: 10.1097/NMC.0000000000001021 -
Journal of Robotic Surgery Jun 2024Fibroids are the most common benign tumours of the uterus, often requiring surgery when symptomatic. This study aims to investigate the impact of surgery using two... (Comparative Study)
Comparative Study
Fibroids are the most common benign tumours of the uterus, often requiring surgery when symptomatic. This study aims to investigate the impact of surgery using two methods, laparoscopy and laparotomy, on the thickness and vascularity of the uterine myometrium at the site of myomectomy scar (comparing sonographic features at the surgical scar site, including thickness, vascularity, and the extent of fibrotic tissue, in both open and laparoscopic surgical approaches). In this clinical trial, 100 women with type 2-5 fibroids and clinical symptoms, seeking surgery et al. Zahra Hospital, were enrolled in two groups: laparoscopy and laparotomy. Inclusion criteria were a maximum fibroid size of 8 cm and, in the case of multiple fibroids, a maximum of three, with the largest being 8 cm. 6 months post-surgery, sonographic assessments of the myomectomy scar site were compared between both groups. Participants showed no significant differences in demographic and obstetric factors. The most common clinical symptom (87%) in both groups was abnormal uterine bleeding (AUB). The mean hospital stay duration was statistically significantly lower in the laparoscopy group at 1.64 (SD 0.56) compared to 1.89 (SD 0.58) in the laparotomy group (p = 0.028). Additionally, the decrease in haemoglobin levels was 0.89 (SD 0.92) and 1.87 (SD 2.24) units, respectively, which showed a statistically significant difference (p = 0.003). The duration of surgery was significantly shorter in the laparotomy group (p = 0.001). Abdominal pressure was not observed in the laparoscopy group, while 12% of the laparotomy group reported complaints (p = 0.013). Based on the results obtained in this study, it can be concluded that there was no difference between these two methods in terms of improving uterine thickness and associated complications. However, the decrease in haemoglobin levels and the length of hospital stay were lower in patients undergoing laparoscopy.
Topics: Humans; Female; Laparoscopy; Uterine Myomectomy; Cicatrix; Adult; Myometrium; Laparotomy; Leiomyoma; Uterine Neoplasms; Ultrasonography; Length of Stay; Middle Aged
PubMed: 38926240
DOI: 10.1007/s11701-024-01983-x -
Nursing Open Jun 2024To establish a comprehensive understanding of the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of postpartum... (Review)
Review
AIMS
To establish a comprehensive understanding of the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of postpartum haemorrhage (PPH) following normal vaginal delivery.
DESIGN
We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) recommendations.
METHODS
We considered studies related to the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of PPH during vaginal delivery. We excluded guidelines, consensuses, abstracts of meetings and non-English language studies. Databases, including the Cochrane Library, PubMed, Web of Science, Ovid, Medline, Embase, JBI EBP and BIOSIS Previews, were searched on January 1, 2023, with no time limitations.
RESULTS
We included 28 publications. Midwives play important roles in the prevention, diagnosis and management of postpartum haemorrhage during vaginal delivery. In the prevention of PPH, midwives' roles include identifying and managing high-risk factors, managing labour and implementing skin-to-skin contact. In the diagnosis of PPH, midwives' roles include early recognition and blood loss estimation. In the management of PPH, midwives are involved in mobilizing other professional team members, emergency management, investigating causes, enhancing uterine contractions, the repair of perineal tears, arranging transfers and preparation for surgical intervention. However, midwives face substantial challenges, including insufficient knowledge and skills, poor teamwork skills, insufficient resources and the need to deal with their negative emotions. Midwives must improve their knowledge, skills and teamwork abilities. Health care system managers and the government should give full support to midwives. Future research should focus on developing clinical practice guidelines for midwives for preventing, diagnosing and managing postpartum haemorrhage.
Topics: Humans; Postpartum Hemorrhage; Female; Delivery, Obstetric; Pregnancy; Midwifery; Nurse Midwives
PubMed: 38923309
DOI: 10.1002/nop2.2221 -
Revista Gaucha de Enfermagem 2024To understand the experiences and vulnerabilities for cross-cultural nursing care for immigrant women during pregnancy and delivery.
OBJECTIVE
To understand the experiences and vulnerabilities for cross-cultural nursing care for immigrant women during pregnancy and delivery.
METHOD
Exploratory, qualitative research, in the light of the Theory of Diversity and Universality of Cultural Care, in Foz do Iguaçu, Brazil, through interviews with eight postpartum woman and 18 nurses, between February and September 2022. The interpretation of meanings was adopted for analysis.
RESULTS
The categories of analysis emerged: Experiences, vulnerabilities and acculturation of immigrant women during pregnancy and delivery; Cross-cultural care and vulnerabilities experienced by immigrants in Brazilian health services. Vulnerabilities were identified in Cultural and Social Structure Dimensions expressed in access to work, low socioeconomic conditions, lack of family and social support and specific services for this population. The potentialities experienced included good care provided by health services, quality of the multidisciplinary team and appreciation of professional knowledge, however, the understanding of expectations and cultural aspects needs to be deepened.
FINAL CONSIDERATIONS
Understand that immigrant women experience situations of vulnerability in pregnancy and childbirth, in the Brazilian context, mainly related to social and programmatic dimensions. However, potentialities were also experienced, evidenced by positive aspects in cross-cultural nursing care in Brazil.
Topics: Humans; Female; Pregnancy; Emigrants and Immigrants; Brazil; Qualitative Research; Adult; Parturition; Culturally Competent Care; Transcultural Nursing; Acculturation; Obstetric Nursing
PubMed: 38922234
DOI: 10.1590/1983-1447.2024.20230161.en -
Frontiers in Global Women's Health 2024Home delivery, which is the process of childbirth at one's residence rather than in a health facility, is a major reason for maternal mortality caused by obstetric...
INTRODUCTION
Home delivery, which is the process of childbirth at one's residence rather than in a health facility, is a major reason for maternal mortality caused by obstetric complications, such as sepsis, hypertensive disorders, and hemorrhage. Maternal and child mortality remains high in developing countries despite efforts made to reduce these outcomes. This is mainly due to poor utilization of institution-based healthcare services. Moreover, there is a limited number of studies that have addressed the determinants of home delivery in Ethiopia, including the study area. This study aims to identify the determinants of home delivery in Bore District, East Guji Zone, Southern Ethiopia, in 2022.
METHODS
A community-based unmatched case-control study was conducted from 18 May to 5 July 2022 among 498 women (249 cases and 249 controls) who gave birth in Bore District. The case group included women who gave birth at home, while the control group included those who gave their last birth at health institutions. A multistage sampling technique was employed to select the study participants. Data were collected using the KoboToolbox digital software and exported to SPSS Version 26.0 for analysis. A multivariable logistic regression analysis was done to declare the statistical significance of the association of the the independent variables and home delivery.
RESULTS
The study included a total of 496 respondents with a mean age of 32.5 (SD = ±5.5) for the case group and 33.7 (SD = ±5.2) for the control group. Among the assessed determinants of home delivery were not attending antenatal care (ANC) visits [adjusted odds ratio (AOR) = 5.6, 95% CI: 2.0-15.16], missing pregnant women's conferences (AOR = 3.2, 95% CI: 1.65-8.32), not receiving health education on pregnancy-related complications (AOR = 2.2, 95% CI: 1.1-4.3), inadequate knowledge of pregnancy-related danger signs (AOR = 6.0, CI: 3.0-11.9), inadequate knowledge about pregnancy-related complications (AOR = 3.0, CI: 1.55-6.13), and unfavorable attitude (AOR = 6.9, 95% CI: 2.16-22.6).
CONCLUSION
In this study, not attending ANC visits, missing pregnant women's conferences, not receiving health education on pregnancy-related complications, inadequate knowledge of pregnancy-related danger signs, inadequate knowledge about pregnancy-related complications, and unfavorable attitudes were identified as determinants of home delivery. The district health office and other stakeholders should work on strengthening maternal health service delivery through appropriate ANC visits and participation in pregnant women's conferences and improving community awareness about pregnancy at all levels.
PubMed: 38912412
DOI: 10.3389/fgwh.2024.1236758