Search Results (10)

Postpartum hemorrhage (PPH) represents a critical emergency condition and the principal cause of maternal morbidity and mortality worldwide. It encompasses excessive bleeding following childbirth, which can arise from various causes. Prompt recognition and management are essential to mitigate severe outcomes and ensure maternal safety. The incidence of PPH in low- and middle-income countries (LMICs) is higher than in developed countries. Healthcare systems in developing countries face multiple challenges that may impact PPH management at policy, facility, and community levels. The mentioned barriers could be addressed by providing an empowering environment via the implementation of supportive policies, access to PPH care, planning supplies, allying strategies, providing training, and utilization of guidelines and algorithms for PPH management. Evidence-based international guidelines should serve as an integral part of appropriate management. On the other hand, LMICs have limited opportunities to implement the proposed international algorithms and guidelines. Therefore, some amendments based on the resource/expertise availability should be considered at the specific clinical site. This review summarizes and updates the accumulated knowledge on postpartum hemorrhage, focusing on challenging management options in developing countries. In many LMICs, maternal morbidity and mortality linked to PPH were improved after the implementation of standardized protocols and timely and purposeful interventions. International support in healthcare professionals’ training, enhancing resources, and the provision of an adapted evidence-based approach could assist in improving the management of PPH in LMICs. Refining our understanding of specific local circumstances, international support in specialists’ training, and the provision of evidence-based approaches may assist in improving the management of PPH in LMICs and contribute to safer childbirth. Full article

Maternal health is a serious concern for many nations due to a lack of appropriate healthcare facilities, healthcare staff, and late diagnoses of life-threatening diseases. Pregnant women suffer with numerous challenges during the pregnancy and childbirth. Non-communicable diseases, a lack of nutrition in diets, and unawareness of the risks associated with pregnancy are the primary reasons for these challenges. Sometimes these reasons become a direct cause of maternal mortality as well. Awareness of the risks and early detection may contribute to a reduction in maternal deaths during pregnancy and childbirth. Various ICTs have been incorporated into the healthcare industry to diagnose the issue as quickly as is feasible and an appropriate remedy can be initiated to treat diseases. Machine Learning (ML) techniques have the potential to predict the probable risk factors for timely interventions; however, challenge arises when the data are limited and unstructured. The Decision Tree (DT), Naive Bayes (NB), Logistic Regression (LR), Support Vector Machine (SVM), K-Nearest Neighbors (KNN), and Linear Discriminant Analysis (LDA) algorithms, with 10-fold cross validation, are used in this study. The dataset utilized in this study included both the present and past medical histories and important vitals of pregnant women. With a test score of 98.8%, the Decision Tree (DT) algorithm outperformed other algorithms, according to the results. Based on the predicted result, pregnant women can consult with medical specialists for their consultation to reduce the potential difficulties in the near future. Full article

Background: Despite progress in access to family planning services in many sub-Saharan African countries in recent decades, advances in early postpartum contraceptive adoption remain low, and the unmet need for early postpartum contraceptives is high. According to the Ethiopia Demographic and Health Survey report, early postpartum modern contraceptive method uptake is still unacceptably low in Ethiopia. Objectives: This study aimed to determine the magnitude of intention to adopt early postpartum modern contraceptive methods and its associated factors among pregnant women in Dessie and Kombolcha town zones, northeast Ethiopia. Methods: A community-based cross-sectional study was deployed from 15 January–15 February 2023, in the Dessie and Kombolcha zones, northeast Ethiopia, among pregnant women. The study involved 780 pregnant women using the cluster sampling technique. A census was conducted in 20 randomly selected clusters to identify eligible pregnant women. Actual data were collected home-to-home in the community through face-to-face interviews. Data were collected by Open Data Kit (ODK) and exported to STATA 17 for analysis. A multivariable logistic regression analysis was performed, and the goodness of the model was checked by Hosmer–Lemeshow’s test statistic and rock curve. An adjusted odds ratio with a 95% confidence interval and p-value < 0.05 was considered statistically significant. Result: The study revealed that 49.6% of pregnant women lack autonomy and 50% lack knowledge about early postpartum contraception, with participants’ wealth index status ranging from rich (36.6%) to poor (33.2%). The study found that 75.8% of pregnant women intended to adopt early postpartum modern contraceptive methods early after childbirth. After controlling the potential confounders, mother’s age (AOR = 6.2 [2.6–14.6], birth interval (AOR = 2.5 [1.6–3.7]), have paid work (AOR = 1.9 [1.3–2.8]), health facility from home (AOR = 2.6 [1.5–4.4]), last delivery Place (AOR = 2.4 [1.1–5.7]), knowledge on (AOR = 1.5 [1.1–2.1]), and antenatal care follow-up (AOR = 1.9 [1.2–3.3]) were significant associated factors of intention to uptake early postpartum modern contraceptive methods among pregnant women. Conclusions: The study found that 75% of the participants had the intention to adopt contraceptive methods during the early postpartum period. Identified factors influencing this intention were age, birth interval, women’s employment status, area of residence, distance to health facilities, last delivery place, knowledge of early postpartum modern contraception, gravidity, and antenatal care follow-up. These findings highlight the need for targeted interventions to address these factors, framing the intended users and enabling access to early adoption of postpartum contraceptive methods. Full article

Cesarean sections have become increasingly common globally, including in Nigeria. This qualitative study explores the perceptions and experiences of postpartum women who underwent cesarean sections within the distinct contexts of Ibadan in Oyo State, Nigeria. In-depth interviews and focus group discussions were conducted with 24 postpartum women in selected health facilities in urban and rural areas. A diverse sample was purposively selected to capture a range of experiences based on age, residence, education, and cultural backgrounds. Thematic analysis was employed to identify patterns and themes within the data. The findings revealed diverse emotional responses among participants, ranging from relief and gratitude to disappointment and feelings of loss for not experiencing a vaginal birth. Societal pressures and cultural expectations played a significant role in influencing women’s perceptions and experiences of cesarean sections. Future childbirth preferences and support systems, including healthcare provider–patient relationships and community support, were identified as crucial factors impacting postoperative recovery. This study contributes to the understanding of women’s perceptions of cesarean sections within the local context of Ibadan, Nigeria. The findings underscore the importance of culturally sensitive healthcare practices, clear communication, and support systems to enhance the birthing experiences of women undergoing cesarean sections. Full article

A free maternal health policy started in Ghana in 2008, however, health facility utilization is still low, and out-of-pocket payments (OOPPs) are putting households at risk of catastrophic expenditure. To improve this situation, some rural communities have assigned a midwife to a health post called community-based health planning and services (CHPS), where only assistant nurses are allocated. This study explored the effectiveness of the new approach in Upper West Region, Ghana. We conducted a cross-sectional study and interviewed women who gave birth in the last year. We systematically selected communities matched into four criteria: communities near CHPS (functional CHPS), communities near CHPS with a midwife (advanced CHPS), communities near a health centre, and communities without a health facility in their neighbourhood. In total, 534 women were interviewed: functional CHPS 104, advanced CHPS 131, near health centre 173, and no facility 126. About 78% of the women were 20 to 34 years old. About half of the women incurred OOPP, however, catastrophic payment (household spending > 5% of annual income) was significantly lower in advanced CHPS communities for normal delivery compared with the other three communities. The new local approach of assigning a midwife to CHPS functioned well, improving access to healthcare facilities for childbirth. Full article

Tools to evaluate pregnancy-specific anxiety are lacking in Japan. This study aimed to develop a Japanese version of the Pregnancy-Related Anxiety Questionnaire—Revised-2. After scale translation and cognitive interviews, we conducted a cross-sectional study among 120 ≥18-year-old, singleton (pregnant with one baby) Japanese women before 15 weeks of pregnancy, recruited from four facilities. A total of 112 women completed the questionnaires. We tested the internal consistency, measurement error and reliability, structural validity, measurement invariance across nulliparous and parous women, construct validity by calculating omega, standard error of measurement (SEM), intraclass correlation coefficient (ICC), confirmatory factor analysis (CFA), multigroup CFA, multitrait-scaling analysis, correlational analyses with other measurements, and t-test to compare nulliparous and parous groups. Omega was 0.90 for the total score. SEM was 3.4 and ICC was 0.76. The CFA revealed an optimal fit for the three-factor model based on the original scale. Multigroup CFA supported measurement invariance across the nulliparous and parous groups, and multitrait-scaling analysis revealed 100% scaling success. The correlation coefficients with other scales of childbirth anxiety and general anxiety were 0.70 and 0.24. The mean total score of the nulliparous women was higher than that of the parous women (34.5 vs. 30.3, p = 0.001). Therefore, the scale was determined to have good validity and reliability. Full article

Building experience in midwife-led care at freestanding midwifery units is needed to enhance assessment, technical, and care competencies specific to midwives. This study aimed to develop a self-assessment scale for midwifery practice competency based on the characteristics of midwife-led care practices in freestanding midwifery units. This study was conducted at 65 childbirth facilities in Japan between September 2017 and March 2018. The items on the scale were developed based on a literature review, discussion at a professional meeting, and a preliminary survey conducted at two timepoints. The validity and reproducibility of the scale were evaluated based on item analysis, compositional concept validity, internal consistency, stability, and criterion-related validity using data from 401 midwives. The final version of the scale consisted of 40 items. Cronbach’s α for the overall scale was 0.982. The results for compositional concept validity, internal validity, and criterion-related validity demonstrated that this scale is capable of evaluating a midwife’s practice competencies in intrapartum care. Repeated self-assessment using this scale could improve the competencies of midwives from an early stage, maximize the roles of physicians and midwives, and create an environment that provides high-quality assistance to women. Full article

Facility-based delivery is an important strategy to prevent poor labor outcomes, and midwives are at the center of maternal care. However, disrespectful and abusive maternal care by midwives is prevalent and leads to poor antenatal care utilization and increased numbers of home deliveries. The objective of the study was to assess the views of women about the care they received during labor and childbirth and describe the interactions between the women and the midwives. This was a qualitative study using in-depth interviews with women who had delivered in midwife obstetric units at a district hospital in Tshwane District, South Africa. Twenty-six women aged 18–41 years, and had delivered within the previous six months were selected, using purposive sampling. A thematic content analysis approach and NVivo11 computer software were used to identify emergent themes. Most women had had negative experiences of the maternity services they had received during labor and childbirth. Shouting and rude remarks by midwives caused tension between the midwives and the women and had created a major barrier for communication. The abuse and disrespect that the women were subjected to had created a hostile and uncaring environment for them. They felt stressed, fearful, and anxious throughout labor and childbirth. In response to the hostile environment, they employed manipulative tactics such as pushing before time in the hope of getting attention. These acts resulted in punitive responses from the midwives who joined forces against them, reprimanded, or ignored them. Good interactions, described as being respectful, approachable, and polite, and the sharing of information yielded positive experiences of maternity care. The state of maternity services rendered during labor and childbirth is counterproductive to the existing plan of increasing early antenatal care bookings and presentation to the facilities for labor and childbirth. There is a need to retrain midwives in the respectful care of women during labor and childbirth to facilitate a change in their attitudes. Full article

Inequity in immigrants’ health during pregnancy and childbirth has been shown. We studied the Danish regional organization of public midwifery-based antenatal care (ANC) for immigrant women to assess the strengths and weaknesses of organizing ANC as either universal or immigrant-targeted. A telephone survey in 2012 to all the Danish maternity wards (n = 20) was conducted. Semi-structured interviews with midwives providing targeted care (n = 6) were undertaken and characteristics of care were qualitatively analyzed, having the immigrant density of the facilities, the Danish ANC policy, and theories of cultural competence as the frame of reference. Six maternity wards were providing immigrant-targeted ANC. Targeted care implied longer consultations and increased attention to the individual needs of immigrant women. At these facilities, navigation in the health care system, body awareness, and use of interpreter services were key topics. The selection of women for targeted care was based on criteria (including names) that risk stigmatizing immigrant women. The arguments for not providing targeted care included that immigrant-targeted care was considered stigmatizing. Current universal care may overlook the needs of immigrant women and contribute to inequities. A strategy could be to improve dynamic cultural competencies of midwives, interpreter services, and flexibility of the care provision of the universal ANC system. Full article

Negative experiences of care may act as a deterrent to current and/or future utilization of facility-based health services. To examine the situation in Tanzania, we conducted a sub-analysis of a cross-sectional household survey conducted in April 2016 in the Mara and Kagera regions of Tanzania. The sample included 732 women aged 15–49 years who had given birth in a health facility during the previous two years. Log binomial regression models were used to investigate the association between women’s experiences of care during childbirth and the receipt of early postnatal checks before discharge. Overall, 73.1% of women reported disrespect and abuse, 60.1% were offered a birth companion, 29.1% had a choice of birth position, and 85.5% rated facility cleanliness as good. About half of mothers (46.3%) and newborns (51.4%) received early postnatal checks before discharge. Early postnatal checks for both mothers and newborns were associated with no disrespect and abuse (RR: 1.23 and 1.14, respectively) and facility cleanliness (RR: 1.29 and 1.54, respectively). Early postnatal checks for mothers were also associated with choice of birth position (RR: 1.18). The results suggest that a missed opportunity in providing an early postnatal check is an indication of poor quality of the continuum of care for mothers and newborns. Improved quality of care at one stage can predict better care in subsequent stages. Full article