Search Results (434)

Objectives: We aimed to implement a multi-modal resuscitation curriculum that first focuses on mastering individual skills, followed by team communication training, and study its effect on adherence to neonatal resuscitation steps, including effective bag mask ventilation (BMV) during high-risk deliveries. Methods: This was a single-center prospective observational manikin study conducted in a low-resource regional referral hospital. It included three phases: 1. pre-assessment; 2. individual BMV skill assessment followed by BMV skill testing; and 3. team training with simulation practice. Clinical observations of high-risk deliveries followed. Results: During the pre-assessment, midwives and residents knew when to start BMV but not the parameters for efficacious BMV (such as rate and inflation pressure). Midwives initially outperformed residents in individualized manikin assessments with 88% vs. 27%, p < 0.01, respectively, demonstrating efficacious BMV on the first attempt. However, on BMV testing, midwives more often demonstrated poor BMV performance, as evidenced by a persistent heart rate <100 bpm (31% vs. 8%, p = 0.04, respectively). Ineffective BMV in both groups was often related to low inflation pressures presumed to be in part secondary to a mask leak. Clinical observations demonstrated close adherence to pre-delivery preparation, basic neonatal stabilization, and resuscitation interventions. BMV was effective in most observed resuscitations as evidenced by chest rise and an increase in heart rate. Debriefing was the least performed team-training skill. Conclusions: A multi-modal approach combining individual skills training with team training that focuses on preparation, communication, and immediate skill feedback may enhance neonatal resuscitation in low-resource settings. Full article

The United States faces a maternal health crisis marked by stark racial disparities. Although doula support has emerged as an evidence-based intervention to improve perinatal outcomes by addressing social determinants of health, its integration into healthcare systems remains limited. This qualitative study, informed by phenomenological principles, examined multi-level experiences, perceived barriers, and perceived facilitators of integrating doula services into perinatal care systems and their intersection with health equity goals. We conducted 17 semi-structured interviews with 20 participants across Nebraska and Tennessee, including doulas, midwives, physicians, Medicaid administrators, and public health professionals, and analyzed data using reflexive thematic analysis guided by the Socio-Ecological Model. Three themes emerged: the integration paradox, an overarching theme capturing tensions between doula independence and healthcare system demands for standardization, including divergent views on practice models, provider dynamics, and certification; sustainable financing as the prevailing barrier, encompassing grant limitations, private pay inequities, absent Medicaid reimbursement, and the need for cost-effectiveness evidence; and cultural concordance as the prevailing facilitator, including cultural matching, addressing social determinants, and lived experience as motivation. Sustainable doula integration requires reconciling system demands for standardization with the relational, culturally responsive characteristics that define effective care, through Medicaid reimbursement pathways and policy reforms developed in partnership with doula communities. Full article

Background/Objectives: Human immunodeficiency virus remains a significant public health challenge, with breastfeeding contributing to the risk of mother-to-child transmission. Although antiretroviral therapy significantly reduces this risk, obstetric nurses face complex challenges in translating evolving guidelines into clinical practice. This scoping review aims to map existing scientific evidence on obstetric nurses’ approaches to evidence-based practice regarding breastfeeding in the context of HIV. Methods: Following the Joanna Briggs Institute methodology and PRISMA-ScR guidelines, a search was conducted across PubMed, Scopus and EBSCOhost (MEDLINE Complete, CINAHL Complete, Cochrane Central Register of Controlled Trials, and Nursing & Allied Health Collection: Comprehensive) for studies published in English and Portuguese between 2015 and 2025. Studies were included if they focused on the role of obstetric nurses, nurse-midwives, or midwives in infant-feeding practices for women living with HIV. Results: Eight studies were included, predominantly from sub-Saharan Africa, with additional evidence from Europe and Canada. Findings reveal that infant-feeding counseling is shaped by a complex interplay of clinical protocols and personal beliefs. Significant gaps in knowledge translation were identified. While nurses demonstrate high technical confidence in lactation support, their distinct professional contribution is often obscured by research that aggregates all healthcare providers. Conclusions: The challenge of supporting breastfeeding in the context of HIV extends beyond technical protocol adherence. It points to persistent gaps in knowledge translation, variability in counselling practices, and the influence of contextual and professional factors on guideline implementation. Strengthening care requires sustained investment in profession-specific education, institutional support, and evidence-informed practice frameworks that enable obstetric nurses to exercise informed clinical judgement. Full article

Despite the availability of clinical guidelines aimed at managing pregnancy complications, maternal deaths related to obstetric emergencies remain unacceptably high in South Africa, especially in rural provinces like Limpopo. These preventable deaths are often linked to delayed response to complications, poor adherence to protocols, and lack of essential resources. The study aimed to explore the experiences of health professionals regarding the implementation of maternal guidelines used to manage obstetric emergencies. The study adopted a qualitative, descriptive, and explorative design. Data were analysed thematically, and trustworthiness was maintained throughout the research process. Sixteen participants from four selected hospitals in a rural area of South Africa (Vhembe District, Limpopo Province) were purposively sampled and interviewed using semi-structured interviews; data were analysed thematically. The findings highlighted multiple critical barriers to guideline implementation, including shortages of printed clinical protocols, inconsistent patient follow-up, poor referral systems, infrastructure deficits, medication stock-outs, and negative staff attitudes. Most doctors and midwives working in maternity units lacked training on the Essential Steps in the Management of Obstetric Emergencies (ESMOE), resulting in insufficient knowledge and skills to manage obstetric emergencies. Therefore, there is an urgent need for comprehensive ESMOE training for all doctors and midwives in maternity units. Full article

Background/Objective: In Spain, 99% of births occur in hospital settings, and planned home birth is neither funded nor regulated by the Public Health System. Despite growing interest in this birth option, qualitative evidence exploring the experiences of women who opt for a planned home birth after a previous hospital birth remains scarce, particularly in contexts where this practice is not integrated into the healthcare system. This study aimed to explore the perceptions and experiences of Spanish women who opted for a planned home birth following a previous hospital birth, focusing on the reasons that motivated this decision and the care received during the process. Methods: A qualitative descriptive design was employed. Semi-structured interviews were conducted between July and December 2025 with 19 women who had experienced a planned home birth in Spain after a previous hospital birth. Data were analysed using inductive thematic analysis following Braun and Clarke’s approach. The study adhered to the Standards for Reporting Qualitative Research (SRQR). Results: Three main themes emerged: (1) motives related to choosing a planned home birth, including negative hospital experiences characterised by loss of autonomy, medicalisation of birth without consent, and fragmented care; (2) seeking a physiological and humanised birth, reflecting women’s desire for empowerment, control, and a transformative experience, alongside barriers such as lack of professional support and financial burden; and (3) the need to increase visibility and establish regulation, highlighting demands for professional training, dissemination strategies, and integration of planned home birth into the Public Health System to ensure equitable access. Conclusions: Women who opted for a planned home birth after a hospital experience reported highly positive and empowering outcomes. However, the absence of regulation, professional support, and public funding creates significant inequalities. Integrating planned home birth into the Public Health System, educating healthcare professionals, and developing strategies to increase the visibility of planned home births are essential to guarantee women’s right to choose where they give birth. Full article

The disproportionately severe disease course of diabetic patients with SARS-CoV-2 infection was repeatedly observed by clinicians during the COVID-19 pandemic. The overlap between metabolic impairment, viral pathophysiology, and chronic inflammation created a pattern that urged deeper examination. The aim of this paper was to review and synthesize evidence regarding the interaction between diabetes mellitus and COVID-19. We synthesized evidence across mechanistic pathways (immune dysregulation, chronic inflammation, ACE2/DPP-4-related signaling, endothelial dysfunction, and pancreatic involvement) and key clinical outcomes (severity, intensive care unit (ICU) admission, mortality, dysglycaemia/new-onset diabetes, and DKA). This systematic search was conducted in PubMed, Clinical Key, and Google Scholar. The eligibility criteria included papers on adults (≥18 years) with pre-existing diabetes mellitus (type 1 or type 2) or newly diagnosed diabetes/hyperglycemia and confirmed SARS-CoV-2 infection, published between January 2020 and October 2025, in English language. The PRISMA guidelines were used for data extraction. We identified 412 articles, out of which only 30 met all the inclusion criteria. Diabetes was consistently evoked as a major risk factor for severe COVID-19, being associated with higher susceptibility to pneumonia, respiratory failure, ICU admission, and mortality. The explanation lies in the impaired immune system, endothelial dysfunction, and metabolic repercussions imposed by hyperglycemia. Several antidiabetic drugs appeared protective in multiple cohorts. In conclusion, the accumulated evidence underscores the tight interplay between metabolic disease and COVID-19. Essentially, the clinical management of these patients would be a thoughtful selection of antidiabetic therapy and close metabolic monitoring. Full article

Background: Early-career registered nurses and midwives often encounter intense stressors that affect their physical, mental, emotional, and social well-being. While some challenges serve as valuable learning opportunities, others are traumatic and burdensome. These negative experiences can profoundly influence ongoing professional development and, for some, act as a catalyst for burnout and premature departure from the profession. Methods: This qualitative phenomenological study involved 51 registered nurses and midwives within their first three years of practice at an Australian hospital. The research aimed to identify the challenges faced by participants during their initial years and to explore how these experiences shaped their perceptions of ongoing practice. Results: Many participants in their second and third years of practice, who had difficult first-year experiences, described in detail the impact of their initial encounters on their formative nursing practice during the interviews. The challenges faced in the second and third years were often considered insignificant in comparison to the traumatic events of the first year. Some participants reported requiring long-term psychological support as a result of first year experiences and expressed uncertainty about continuing in the nursing profession. Conclusions: Ensuring that first-year experiences are positive, supportive, and rewarding is crucial for new nurses and midwives. When this period is marked by trauma, emotional distress can escalate, leading to burnout and an increased likelihood of professional attrition. Supporting graduates’ well-being and addressing their individual needs during these formative years is essential for workforce sustainability. Full article

Background: Evidence shows that simulation-based education for nurses and midwives contributes to strengthening patient safety and quality of care in healthcare settings. Nevertheless, it is implemented to a limited degree in Sub-Saharan African (SSA) higher education institutions, including Tanzania. This demands that Tanzania shift from a traditional model of teaching to incorporate simulation-based education to produce a skilled workforce. Objective: To explore perceptions and experiences of nurse educators (lecturers) and midwives on simulation-based education in Tanzania. Methods: The study employed a generic qualitative descriptive study design with purposive sampling. The data were collected through individual semi-structured interview guides with nurse educators and midwives (nine nurse educators and 11 midwife graduates) from two selected universities in the School of Nursing and their respective teaching hospitals. Qualitative inductive content analysis was used to analyze the data. Results: The data analysis revealed three themes and nine sub-themes: 1. Knowledge and skills in simulation-based education. 2. Challenges in the implementation of simulation-based education. 3. Ensuring patients’ safety. Conclusions: Students were indeed experienced, but not trained in how to use simulation-based education, and nurse educators had inadequate skills. A high number of students with inadequate infrastructure and resources is the major challenge experienced by participants. Simulation-based education is at an early stage of adoption in Tanzania and will require ongoing development, support and resources to fulfilll its potential in promoting patient safety. Full article

Background: Maternity care for vulnerable pregnant women presents a particular challenge within midwifery practice. In Germany, maternity services lack standardized frameworks to adequately address the specific needs of individuals who have experienced, among other factors, sexualized violence, poverty, female genital mutilation/cutting (FGM/C), or discrimination. Limited access to healthcare among these populations contributes to increased maternal and neonatal morbidity and mortality. Emerging evidence indicates that comprehensive medical and psychosocial support provided by midwives can substantially improve obstetric outcomes for marginalized pregnant women. Methods: An elective course, Antenatal Care for Vulnerable Women, was offered in the sixth semester of the Bachelor’s program in Midwifery Science at the University of Tübingen in 2025. The course provided insights into the psychosocial challenges faced by vulnerable pregnant women and prepared students for these specific aspects of midwifery practice. The curriculum incorporated foundational lectures and innovative teaching formats aimed at cultivating constructivist approaches to problem-solving. All sixth-semester midwifery students were asked to assess their knowledge and skills across five vulnerability categories: asylum-seeking, FGM/C, intimate partner violence, trauma, and racism. A pilot pre–posttest analysis using a 6-point Likert scale (1 = very good, 6 = poor) was conducted as hypothesis-generating and curriculum-guiding. The pretest included 38 respondents. The posttest included 11 respondents who attended the course. Results: Students who attended the course demonstrated observable gains in knowledge and skills across all categories, with the greatest improvements in asylum-seeking, median of 5 (IQR 4–5) vs. 2 (2–3); FGM/C, 5 (4–5) vs. 2 (2–3); and racism, 5 (3–5) vs. 2 (2–3). Conclusions: Innovative teaching methods may contribute to preparing midwifery students for targeted care of vulnerable pregnant women. Findings from the pre- and posttests provide preliminary insight into the potential value of experiential learning and may inform the further development of practice-oriented teaching methods. Full article

Midwife-led continuous labor and childbirth support reduces the episiotomy rate and increases the rates of vaginal delivery and early initiation of breastfeeding. However, no studies have yet been conducted in Ethiopia. This study aimed to evaluate the effect of midwife-led continuous labor and childbirth support. A quasi-experimental study involving 419 primigravida women compared an intervention given by trained midwives at two hospitals to routine at two others. Data were collected from July to December 2024 through interviews and record reviews. The McNemar test was used to compare changes, with a p-value of less than 0.05. Midwife-led continuous labor support increased the rate of spontaneous vaginal delivery among primigravida women from 55.8% in the control group to 81.2% in the intervention group, resulting in a net increase of 25.4%. The intervention reduced the episiotomy rate from 25.2% in the control group to 16.4% in the intervention group, with a net reduction of 8.8%. It also increased early initiation of breastfeeding from 56.8% in the control group to 73.3% in the intervention group, with a net increase of 16.5%. Midwife-led continuous labor and childbirth support was effective in this study. The intervention enhances positive childbirth outcomes and could be implemented and sustained. Full article

Background/Objectives: Midwifery workforce sustainability faces critical challenges including high burnout and turnover rates threating the service quality and the maternal health outcomes. While self-leadership and self-compassion represent promising psychological resources, their roles relative to organizational factors remain underexplored. This study examined associations between self-leadership, self-compassion, and workforce outcomes (job satisfaction, turnover intention, performance) among Turkish midwives. Methods: A cross-sectional survey was conducted with 346 midwives working in diverse healthcare settings across Turkey from May 2021 to April 2022. Data were collected through an online self-report questionnaire using validated scales for self-leadership and self-compassion as well as measures of job satisfaction, turnover intention, and job performance, and including demographic and organizational items. Descriptive statistics, one-way ANOVA (with Eta-squared [η²] calculated to determine effect size), and correlation analyses were conducted, followed by hierarchical multiple regression and binary logistic regression to examine predictive relationships, with organizational factors entered before psychological resources. Results: Self-leadership and self-compassion demonstrated a moderate positive correlation (r = 0.342, p < 0.01). Self-leadership strongly predicted job performance (OR = 2.497, p = 0.001), particularly through natural reward strategies emphasizing intrinsic motivation (OR = 1.970, p < 0.001). However, neither psychological resource significantly predicted job satisfaction or turnover intention when organizational factors were included. Work schedule, healthcare setting, professional position, and income emerged as primary predictors of satisfaction and retention. Work experience predicted increased psychological distress (OR = 1.073, p = 0.003). Conclusions: Psychological resources demonstrate domain-specific effects on workforce outcomes in midwifery: self-leadership strategies strongly enhance job performance, whereas job satisfaction and turnover intention are influenced primarily by organizational conditions. These findings highlight the need for multi-level strategies to support the sustainability of the midwifery workforce. Full article

Background/Objectives: In Japan, hospital births predominate, with home births comprising only 0.1% of deliveries. This study assessed how documented practices for planned home births attended by independent midwives align with national guidelines and WHO intrapartum care recommendations, and assess maternal and neonatal differences before and after the COVID-19 pandemic. Methods: Records of 430 low-risk pregnant women who received continuous care at a private midwifery home over 25 years were reviewed. After excluding 8 maternal and 22 neonatal transfers, 400 records were analyzed. Descriptive statistics were compared with WHO recommendations and between the pre-pandemic (1999–2019) and post-pandemic (2020–2024) periods. Results: All women experienced spontaneous singleton cephalic labors with intermittent fetal heart rate auscultation. The mean gestational age was 277.3 days and the median labor duration was 303.5 min. Labor onset was spontaneous in 83.5% of cases. Nearly half of the women had no perineal lacerations. Postpartum blood loss ≥500 mL occurred in 14.1% of cases. Family presence was nearly universal. Neonates had a mean birth weight of 3129.0 g and high Apgar scores. Skin-to-skin contact occurred in 52.9%; exclusive breastfeeding reached 93.8% at 1 month. Post-pandemic births showed higher maternal age and higher neonatal birth weight, although these differences should be interpreted cautiously due to the small post-pandemic sample. Conclusions: Independent midwives provided evidence-based, physiologically oriented care, partially aligning with selected WHO intrapartum recommendations during planned home births. Midwife-led home births may support positive childbirth experiences and favorable maternal/neonatal outcomes for low-risk women. Post-pandemic shifts underscore the need for continued monitoring and flexible, community-based perinatal support, while recognizing the limitations of retrospective, single-site data. Full article

Stunting remains a major public health challenge in Indonesia, with a national prevalence of 21.6% in 2022. Rural regions such as Madura face heightened vulnerability due to cultural dietary taboos, gendered caregiving structures, intergenerational authority, and digital disparities that shape household nutrition decision-making. This formative qualitative study explores stakeholders’ perceptions to inform the conceptual development of gender-sensitive serious games for nutrition communication in rural Indonesia. Using an exploratory design, 42 informants, including mothers of children under five, brides-to-be, health cadres, midwives, religious and community leaders, and local digital actors, were recruited across rural Madura. Thematic analysis examined trust-based communication patterns, gender dynamics, perceptions of artificial intelligence (AI), and contextual conditions influencing digital health acceptance. Findings indicate that acceptance of gender-sensitive serious games depends on cultural alignment, institutional endorsement, perceived credibility, and usability in low-resource settings. Participants consistently positioned serious games and AI-supported features as complementary communication layers rather than replacements for health workers. Game-based tools were considered potentially relevant when designed to support intergenerational co-play, integrate local narratives and religious values, and function in low-connectivity environments. Rather than evaluating an implemented intervention, this study proposes a conceptual design framework grounded in feminist communication perspectives, serious games scholarship, and technology acceptance theory. The findings provide context-sensitive insights to guide future prototype development and pilot testing within hybrid, community-based nutrition communication systems. Full article

Indigenous Kichwa women in the Ecuadorian Amazon experience disproportionately high levels of obstetric violence, yet their experiences remain largely absent from national demographic data. This study aims to measure the prevalence and forms of obstetric violence among Kichwa women while demonstrating the utility of community-designed demographic tools for documenting marginalized reproductive health experiences. We developed a participatory survey in collaboration with Kichwa midwives and women, several of whom are co-authors, and administered 139 structured surveys and 69 ethnographic interviews across 43 Indigenous communities in the Napo province to women who had given birth in a public hospital within the past five years. Quantitative data were analyzed using descriptive statistics to estimate prevalence across domains of obstetric violence, and interviews were thematically analyzed to contextualize these patterns. Findings indicate pervasive obstetric violence, including non-consensual procedures, verbal and psychological abuse, structural barriers to care, and suppression of traditional practices such as midwifery and plant medicine. Over 80% of participants reported at least one non-consensual procedure and at least one form of cultural or epistemic suppression, with most experiencing violence across multiple domains. These results position obstetric violence in the Amazon as a compounded, population-level exposure shaped by structural, environmental, and cultural determinants, underscoring the need for intercultural health reforms and Indigenous-led models of health governance. Full article

Background: The mother’s bond with her newborn is important for the child’s development and their relationship. Midwives are well placed to witness first-hand the beginning of this relationship. Objectives: This study examined, based on mothers’ perceptions, the contribution of midwives to the development of the bond with their baby from pregnancy to the first postnatal months. Methods: We conducted a descriptive qualitative interpretative study in Quebec, Canada (from 2022 to 2025), with 10 primiparous mothers who were cared for by midwives in a model of continuity of care, and gave birth in a birth center, at home, or in a hospital. Semi-structured retrospective interviews were conducted between two and four months after childbirth, and were complemented by interviews with two midwives. Results: Most participants developed a bond with their baby during pregnancy. They discussed their midwifery care and what they felt were significant elements in the development of their bond with the baby. Midwives encouraged them to develop this bond through their approach and various means: letting them feel the fetus during palpation, talking to it, encouraging mothers to do the same, and reinforcing the bond throughout pregnancy. The birth and first moments after birth were also key moments for promoting contact between mother and baby. Midwives were also creative in promoting bonding in more difficult situations, such as when a transfer to the hospital for delivery was needed. Conclusions: Midwives play an important role in initiating and developing the mother–child bond during pregnancy, especially if they practice within a model of relational continuity. Full article