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Midwifery-Led Care and Practice: Promoting Maternal and Child Health

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Women's Health Care".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 11302

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Special Issue Editor

Dr. Joachim Graf

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Guest Editor

Institute for Health Sciences, University Hospital Tuebingen, Midwifery Science, Calwerstrasse 7, 72076 Tuebingen, Germany
Interests: public health; gender medicine; social determinants of health; midwifery science; women's health; health services research

Special Issue Information

Dear Colleagues,

Despite continuous advances in medicine, healthcare and society, pregnancy and birth are often characterized by vulnerability. In developing countries (but also in industrialized countries such as the USA), reducing maternal and infant mortality remains a key challenge. Even in industrialized countries, pregnancy and birth outcomes are clearly dependent on the social status of pregnant women, recurring from different health literacy and different perceptions of health rights. This results in phases of vulnerability, which, according to study results, affect more than 30% of all pregnant women as distress with insufficiently understood long-term effects on the health of the mother and child (fetal programming). Continuous midwifery care, which is based on the principles of evidence-based care but follows a holistic approach that also emphasizes the social causes of illness and health, can mitigate social inequalities in care and improve short and long-term outcomes. Against this background, the WHO and UN have identified midwives as key actors in improving women's health.

The Special Issue aims to publish innovative midwifery care projects that focus on improving maternal and child health. We are pleased to invite you to submit relevant research results.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

Research findings (including health service research) on innovations that improve care, even under complex conditions in individual phases of the care cycle (from pregnancy to breastfeeding);
Research findings on midwife-led care to improve women's and children's health;
Articles outlining women's health challenges in the context of pregnancy and childbirth;
Studies and reviews on the promotion of physiological processes even under complex conditions;
Research findings on the opportunities and risks of AI-based care in the context of midwifery science and women's health.

Thematically relevant studies from the field of teaching research are also welcome.

I look forward to receiving your contributions.

Dr. Joachim Graf
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

midwifery
women’s health
vulnerability in pregnancy
midwife-led care
fetal programming
pregnancy outcomes in the context of social inequality
improvement of child health
improvement of women’s health
gender-sensitive care

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Published Papers (8 papers)

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Research

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25 pages, 611 KiB

Open AccessArticle

Pregnancy Care in Times of Cannabis Legalization: Self-Rated Knowledge, Risk Perception and Communication Practices of Midwives in Germany

by Julia Wollscheid, Matthias Burke, Theresa Kimmel, Tobias Kaufmann, Anil Batra and Annette Binder

Healthcare 2025, 13(11), 1228; https://doi.org/10.3390/healthcare13111228 - 23 May 2025

Viewed by 56

Abstract

Background/Objectives: The legalization of recreational cannabis in Germany in 2024 has increased the relevance of cannabis use in maternal healthcare. Although prenatal cannabis exposure is associated with potential risks to fetal development, the topic remains underrepresented in midwifery research and education. Germany, midwives play a key role in prenatal care. This study investigates midwives’ self-rated knowledge, perceived risks, and the frequency of screening and counseling on cannabis use during pregnancy. Methods: This study presents a secondary analysis of cross-sectional survey data collected from midwives and physicians in Germany (N = 284) between May and October 2024. Statistical analyses included descriptive statistics, Wilcoxon signed-rank tests, chi-square tests, Spearman’s rank correlations, and multiple linear regression models. Results: Midwives rated their knowledge about cannabis-related risks during pregnancy as moderate. While most reported that substance use was addressed in initial training, only continuing education and older age were associated with higher self-rated knowledge. Knowledge was positively correlated with risk perception and communication frequency. Overall, risk perception was high—particularly regarding fetal outcomes—though cannabis was perceived as less harmful than alcohol and addressed less often. Fewer than half of the midwives routinely screened for cannabis use, and only 22% always provided counseling. Conclusions: To strengthen midwives’ preparedness, both the integration of cannabis-specific content into initial training and the expansion of continuing education may be beneficial. Clear, evidence-based, and non-stigmatizing communication strategies are essential to support maternal and fetal health in a changing legal and cultural landscape. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

20 pages, 257 KiB

Open AccessArticle

Care Providers’ and Parents’ Experiences with Implementing the Conversational Health Literacy Assessment Tool (CHAT)-Maternity-Care in the Netherlands: A Mixed Methods Study

by Evi M. E. Vlassak, Judit K. J. Keulen, Elina Miteniece, Rianneke de Ritter, Marijke J. C. Hendrix and Marianne J. Nieuwenhuijze

Healthcare 2025, 13(10), 1173; https://doi.org/10.3390/healthcare13101173 - 17 May 2025

Viewed by 207

Abstract

Background/Objectives: Care providers’ understanding of patients’ health literacy is crucial to tailoring care and reducing health inequalities. This study explores the experiences, facilitators, and barriers encountered by maternity care providers when implementing CHAT-maternity-care: a conversational tool that supports care providers in estimating (expectant) parents’ health literacy. As a secondary objective, the study also examines the experiences of (expectant) parents. Methods: Maternity care providers used CHAT-maternity-care after finalizing an e-learning. Implementation was evaluated among maternity care providers with a questionnaire and in-depth focus group meetings and among (expectant) parents with semi-structured interviews. Results: Providers experienced that using CHAT-maternity-care enhanced their health literacy insight, improved health literacy awareness, and fostered easier, more comprehensive and structured estimation of parents’ health literacy. Key facilitators for implementing CHAT-maternity-care as perceived by providers were the perceived value of health literacy insights; the tool’s relevance, user-friendliness, and familiarity; and social factors. The main barriers were time constraints, the tool’s novelty, and social factors. (Expectant) parents were positive and open to having conversations based on CHAT-maternity-care. Questions based on CHAT-maternity-care were perceived as beneficial by parents in uncovering previously unaddressed concerns. Conclusions: CHAT-maternity-care is mostly well received and assessed as helpful to improving health literacy insights. The findings underscore the importance of education, peer support, and organizational alignment for broader adoption and implementation of CHAT-maternity-care. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

24 pages, 754 KiB

Open AccessArticle

A Retrospective Observational Study on Post-Pandemic Effects of Endogenous and Exogenous Factors on Prematurity in Pregnant Women Under 18 Years of Age

by Florin Țovîrnac, Alina Mihaela Călin, Eva Maria Elkan, Nicoleta Andreea Țovîrnac, Valentin Marian Antohi and Alexandru Nechifor

Healthcare 2025, 13(2), 197; https://doi.org/10.3390/healthcare13020197 - 19 Jan 2025

Viewed by 1248

Abstract

Background/Objectives: This research investigates the impact of exogenous and endogenous factors on fetal health in pregnant women under the age of 18, with a special focus on the influence of educational level, adherence to vices (smoking and alcohol), comorbidities (diabetes and hypertension), and poor sanitary conditions. Methods: The study uses retrospective data collected from a medical institution in the Southeast region of Romania, including a sample of 3639 births during the post-pandemic period (2022–2023). This period was considered to be a reference period for the study because, as a result of measures to combat the spread of COVID-19 disease in the pandemic, there was an increase in the birth rate among patients under 18 years of age. The APGAR clinical score was evaluated at 5, 10, and 20 min after birth and measured on an inverted scale to reflect the increased risk to fetal health. Results: The results indicate that lack of education is a significant exogenous factor associated with an increased risk of preterm births and a lower APGAR score. Additionally, adherence to vices is more pronounced among pregnant women with low educational levels and smoking and alcohol consumption negatively impact fetal health. Regarding comorbidities, diabetes did not significantly affect the short-term APGAR score, while hypertension had a complex effect, though medical interventions mitigated the associated risks. Conclusions: The conclusions of the research emphasize the need for appropriate educational and medical interventions to reduce the risks associated with preterm births and newborn health in adolescent pregnancies, especially in disadvantaged environments. The study suggests future research directions to expand the analysis to other geographical regions and for long-term monitoring of newborn health. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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16 pages, 1494 KiB

Open AccessArticle

Prenatal Maternal Psychological Stress (PMPS) and Its Effect on the Maternal and Neonatal Outcome: A Retrospective Cohort Study

by Joana Kathleen Aldinger, Harald Abele and Angela Kranz

Healthcare 2024, 12(23), 2431; https://doi.org/10.3390/healthcare12232431 - 3 Dec 2024

Viewed by 1464

Abstract

Background/Objectives: Prenatal psychology studies show that stress, depression, and psychological stress during pregnancy can have a significant impact on maternal and fetal health and are highly prevalent. The aim of the study was to compare maternal and neonatal short-term outcomes in pregnant women* (the asterisk (*) is used at the appropriate places in this text to indicate that all genders are included) with a history of prenatal maternal psychological stress (PMPS) with those of pregnant women* not exposed to PMPS to determine differences and identify risk factors. Methods: Statistical tests for differences and relative risks between the groups were carried out with the perinatal data of University Hospital Tübingen from 2022 using IBM SPSS. Results: The study shows that PMPS has significant negative effects on various parameters, including the rate of premature births, preeclampsia, induction of birth, birth duration, and fetal asphyxia, as well as the birth weight of the children and their Apgar values (an assessment of newborn health scored shortly after birth). In addition, the risk of PMPS increases in women* with stillbirths and two or more previous miscarriages. However, the practical relevance must be critically scrutinized and confirmed by bigger studies. Conclusions: PMPS has a significant impact on the maternal and neonatal birth outcomes and must be identified as a risk factor in pregnancy. There is still a need for further research with larger samples, more balanced groups, and multivariate regression models to generate detailed, more transferable results and a deeper insight into the significant effects of PMPS and the role midwives can play in helping it. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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14 pages, 645 KiB

Open AccessArticle

Psychometric Evaluation of Women’s Knowledge of Healthcare Rights and Perception of Resource Scarcity during Maternity

by Claudia Susana Silva-Fernández, María de la Calle, María A. Suta, Silvia M. Arribas, Eva Garrosa and David Ramiro-Cortijo

Healthcare 2024, 12(20), 2045; https://doi.org/10.3390/healthcare12202045 - 15 Oct 2024

Cited by 1 | Viewed by 1048

Abstract

Background/Objectives: Resources to cope with maternity and women’s participation are essential modulators of maternal well-being. Therefore, it is relevant that the psychosocial factors of woman be monitored during maternity to promote adequate healthcare. This study involved the design and the validation of two new tools that identify women’s knowledge of healthcare rights (MatCODE) and perception of resource scarcity (MatER) during pregnancy, labor and early postpartum; Methods: The content validity was carried out using the Aiken’s V coefficient and the content validity index (CVI-i) based on five experts. In addition, for the face validity, the pilot cohort was considered the INFLESZ scale. Finally, the questionnaires were applied to 185 women, which allowed to assess the construct validation by factorial and Rasch analysis. The divergent validity was also studied with validated psychological questionnaires; Results: MatCODE and MatER questionnaires received CVI-i and Aiken’s V > 0.80 values, and the INFLESZ demonstrated acceptable semantic understanding. The analysis confirms the unidimensionality of the questionnaires, with fit values for MatCODE of RMSEA = 0.113 [0.105; 0.122] and for MatER of RMSEA = 0.067 [0.063; 0.072]. The divergent validity showed significant and consistent correlations with the constructs assessed. For MatCODE, ω = 0.95 and α = 0.94, and for MatER, ω = 0.79 and α = 0.78; Conclusions: MatCODE and MatER are useful new tools for monitoring maternal healthcare, with adequate psychometric characteristics in the Spanish context. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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Review

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26 pages, 550 KiB

Open AccessReview

Pregnant Women’s Knowledge of Pelvic Floor and Related Dysfunctions: A Scoping Review

by Konstanze Weinert and Claudia F. Plappert

Healthcare 2025, 13(8), 847; https://doi.org/10.3390/healthcare13080847 - 8 Apr 2025

Viewed by 470

Abstract

Pregnancy and childbirth can have far-reaching effects on women’s pelvic floor health. It is important to educate pregnant women about pelvic floor health and potential birth-related pelvic floor (PF) changes as part of continuous midwifery care. This scoping review aims to identify the current state of research on knowledge and knowledge gaps in pregnant women regarding the PF and PF dysfunction (PFD) in order to derive conclusions and recommendations for midwifery care and midwifery science. This review follows the Arksey and O’Malley framework and the PRISMA Statement. The literature search was conducted on databases PubMed, CINAHL, and Web of Science using various search terms and defined inclusion criteria. Eleven articles were included. The results show a considerable context-related knowledge deficit among pregnant women, with a high prevalence of PFDs such as urinary incontinence (UI), fecal incontinence (FI), or prolapse symptoms (POP). All contributions emphasize the importance of improved specific education and health advice regarding the PF and PFD for pregnant women to close knowledge gaps and promote sustainable PF health. Demands are made on the professional group ‘midwife’, which emphasize the importance of specific and target group-appropriate educational concepts on the subject of the PF and PFD. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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26 pages, 1339 KiB

Open AccessReview

Challenges and Choices in Breastfeeding Healthy, Sick and Preterm Babies: Review

by Susanne H. Bauer, Harald Abele and Joachim Graf

Healthcare 2024, 12(23), 2418; https://doi.org/10.3390/healthcare12232418 - 2 Dec 2024

Cited by 2 | Viewed by 2252

Abstract

Although breastfeeding is associated with many health-related benefits for both mothers and children, the WHO recommendation for exclusive breastfeeding is not achieved by the majority in any WHO region. This paper aims to present the current state of research on challenges and choices in breastfeeding healthy, sick and preterm babies. The research was organized as a systematic search in PubMed and the study was performed as a narrative review after applying the PRISMA protocol. Finally, n = 57 studies were included. Both barriers and support factors emerge as a complex interaction of individual, group and societal factors, the precise understanding of which is relevant to increasing breastfeeding rates in the future. Knowledge as well as practical skills proved to be generally helpful, whereas the lack of breastfeeding support for mothers, who are often separated from their premature babies in hospital, was identified as a key risk factor for this subgroup. Appropriate training for healthcare professionals can improve the situation as a result. After discharge, workplace-related barriers are of major concern to allow further breastfeeding when maternity leave ends. Thus, the promotion of breastfeeding must be perceived as a task for society as a whole. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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13 pages, 569 KiB

Open AccessReview

The Impact of Artificial Intelligence (AI) on Midwifery Education: A Scoping Review

by Angela Kranz and Harald Abele

Healthcare 2024, 12(11), 1082; https://doi.org/10.3390/healthcare12111082 - 24 May 2024

Cited by 5 | Viewed by 3215

Abstract

As in other healthcare professions, artificial intelligence will influence midwifery education. To prepare midwifes for a future where AI plays a significant role in healthcare, educational requirements need to be adapted. This scoping review aims to outline the current state of research regarding the impact of AI on midwifery education. The review follows the framework of Arksey and O’Malley and the PRISMA-ScR. Two databases (Academic Search Premier and PubMed) were searched for different search strings, following defined inclusion criteria, and six articles were included. The results indicate that midwifery practice and education is faced with several challenges as well as opportunities when integrating AI. All articles see the urgent need to implement AI technologies into midwifery education for midwives to actively participate in AI initiatives and research. Midwifery educators need to be trained and supported to use and teach AI technologies in midwifery. In conclusion, the integration of AI in midwifery education is still at an early stage. There is a need for multidisciplinary research. The analysed literature indicates that midwifery curricula should integrate AI at different levels for graduates to be prepared for their future in healthcare. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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