Labor and Delivery

BACKGROUND: The dominant biomedical narrative on pain relief interventions-such as epiduralsas being "safe" often overshadows the lived experiences of women's perceptions and experiences of technology in childbirth. Although medicalized reproduction is the norm globally, some women value "natural" childbirth, while many use epidural analgesia. OBJECTIVE: This study explores how the perspectives of Malay/Muslim women in Singapore on epidural are shaped by biomedical authoritative knowledge, traditional knowledge, and lived knowledge. METHODS: Qualitative interviews were done with 35 self-identified Malay/Muslim middle class, and working-class women in Singapore, a high-resource setting. Data collection utilized snowball purposive sampling for a heterogeneous sample. All participants signed institutional review board-approved consent forms. Narrative analysis was applied to identify themes, and grounded theory analysis was applied to ensure data saturation. FINDINGS: Personal experiences with epidural use and health care workers, and anecdotal evidence from other women influence women's perceptions of epidural. Generally, Malay/Muslim women use lived knowledge to emphasize the medical risks associated with epidural. CONCLUSIONS: There are nuances to agency and values surrounding childbirth in a medicalized context. Conceptual approaches that focus only on affluent women or low-resource settings fail to fully explain the experiences of diverse groups.

Objective: Several systematic reviews and meta-analyses have summarized the evidence on the efficacy and safety of various outpatient cervical ripening methods. However, the method with the highest efficacy and safety profile has not been determined conclusively. We performed a systematic review and network meta-analysis of published randomized controlled trials to assess the efficacy and safety of cervical ripening methods currently employed in the outpatient setting.

Data sources: With the assistance of an experienced medical librarian, we performed a systematic search of the literature using MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov. We systematically searched electronic databases from inception to January 14, 2020.

Study eligibility criteria: We considered randomized controlled trials comparing a variety of methods for outpatient cervical ripening.

Methods: We conducted a frequentist random effects network meta-analysis employing data from randomized controlled trials. We performed a direct, pairwise meta-analysis to compare the efficacy of various outpatient cervical ripening methods, including placebo. We employed ranking strategies to determine the most efficacious method using the surface under the cumulative ranking curve; a higher surface under the cumulative ranking curve value implied a more efficacious method. We assessed the following outcomes: time from intervention to delivery, cesarean delivery rates, changes in the Bishop score, need for additional ripening methods, incidence of Apgar scores <7 at 5 minutes, and uterine hyperstimulation.

Results: We included data from 42 randomized controlled trials including 6093 participants. When assessing the efficacy of all methods, 25 μg vaginal misoprostol was the most efficacious in reducing the time from intervention to delivery (surface under the cumulative ranking curve of 1.0) without increasing the odds of cesarean delivery, the need for additional ripening methods, the incidence of a low Apgar score, or uterine hyperstimulation. Acupressure (surface under the cumulative ranking curve of 0.3) and primrose oil (surface under the cumulative ranking curve of 0.2) were the least effective methods in reducing the time to delivery interval. Among effective methods, 50 mg oral mifepristone was associated with the lowest odds of cesarean delivery (surface under the cumulative ranking curve of 0.9).

Conclusion: When balancing efficacy and safety, vaginal misoprostol 25 μg represents the best method for outpatient cervical ripening.

Perdarahan postpartum (postpartum hemorrhage/PPH) merupakan salah satu komplikasi obstetri yang paling serius dan hingga saat ini masih menjadi penyebab utama morbiditas dan mortalitas ibu di berbagai negara, terutama di negara berpenghasilan rendah dan menengah. Kondisi ini merupakan kegawatdaruratan obstetri yang membutuhkan pengenalan dini, penanganan yang cepat, tepat, dan terkoordinasi untuk mencegah terjadinya syok hipovolemik, kegagalan multiorgan, hingga kematian maternal. Meskipun perkembangan ilmu pengetahuan, teknologi kesehatan, dan pelayanan obstetri telah mengalami kemajuan yang signifikan, angka kejadian serta dampak perdarahan postpartum masih menjadi tantangan besar bagi sistem pelayanan kesehatan di seluruh dunia. Oleh karena itu, pencegahan dan penanganan perdarahan postpartum menjadi salah satu prioritas utama dalam upaya meningkatkan keselamatan ibu selama masa persalinan dan nifas.
Secara klinis, World Health Organization (WHO) mendefinisikan perdarahan postpartum sebagai kehilangan darah sebanyak ≥500 mL setelah persalinan pervaginam atau ≥1.000 mL setelah persalinan melalui seksio sesarea, atau setiap kehilangan darah yang menyebabkan instabilitas hemodinamik dalam waktu 24 jam setelah persalinan. Namun demikian, perkembangan konsep terkini menekankan bahwa besarnya volume perdarahan tidak selalu mencerminkan tingkat keparahan kondisi pasien. Penilaian klinis terhadap tanda-tanda syok, perubahan status hemodinamik, dan kondisi umum ibu menjadi komponen penting dalam menentukan tingkat kegawatan dan kebutuhan intervensi segera. Pendekatan ini menunjukkan bahwa diagnosis perdarahan postpartum tidak hanya didasarkan pada kuantitas kehilangan darah, tetapi juga mempertimbangkan respons fisiologis ibu terhadap perdarahan.

Buku Persalinan Normal membahas secara menyeluruh konsep dasar persalinan serta berbagai aspek penting yang berkaitan dengan proses kelahiran normal. Materi diawali dengan pembahasan mengenai pengertian persalinan, tahapan persalinan, faktor-faktor yang memengaruhi jalannya persalinan, hingga kebutuhan dasar ibu selama proses persalinan berlangsung. Penyajian materi dilakukan secara sistematis agar pembaca dapat memahami proses persalinan normal dari tahap awal hingga akhir dengan bahasa yang mudah dipahami namun tetap bernuansa akademik.

Selain membahas proses fisiologis persalinan, buku ini juga menguraikan asuhan kebidanan pada setiap kala persalinan, mulai dari kala I sampai kala IV. Di dalamnya dijelaskan berbagai bentuk dukungan kepada ibu bersalin, mekanisme persalinan normal, tindakan pertolongan persalinan sesuai standar, serta deteksi dini komplikasi dan penyulit yang dapat terjadi selama persalinan. Pembahasan juga dilengkapi dengan materi mengenai asuhan bayi baru lahir normal, penanganan awal bayi setelah lahir, hingga pentingnya bounding attachment antara ibu dan bayi.

Pada bagian akhir, buku ini memaparkan pentingnya dokumentasi kebidanan sebagai bagian integral dalam pelayanan persalinan. Pembaca diperkenalkan pada prinsip-prinsip dokumentasi, pencatatan asuhan kebidanan, serta aspek legal yang berkaitan dengan praktik kebidanan. Dengan susunan materi yang lengkap dan terstruktur, buku Persalinan Normal diharapkan dapat menjadi sumber pembelajaran dan referensi bagi mahasiswa, tenaga kesehatan, maupun pembaca umum yang ingin memahami proses persalinan normal dan asuhan kebidanan secara komprehensif.

The "milk coma" is a natural physiological state observed in breastfed infants characterized by post-feeding drowsiness, deep relaxation, and contentment [1, 6]. This phenomenon results from the synergistic actions of several hormones and neurotransmitters, including cholecystokinin (CCK), oxytocin, prolactin, melatonin, tryptophan, endorphins, GABA, serotonin, leptin, and endocannabinoids [1, 3, 4, 5, 9, 13-16]. These substances collectively regulate satiety, calmness, bonding, and circadian rhythms [1, 4, 9]. Understanding the neuroendocrine mechanisms of the milk coma has significant implications for nursing care and maternal education [6]. Nurses play a vital role in recognizing this state as a positive indicator of effective feeding, supporting mother-infant bonding, and educating families about the normal physiological processes that occur during breastfeeding.

This study investigates the impact of nurse staffing ratios on patient outcomes in tertiary care settings, focusing on the relationship between staffing levels and care quality. Using a quantitative approach, data were collected from 30 nurses in a tertiary care hospital to assess perceptions of staffing adequacy, workload distribution, and patient outcomes. Findings reveal significant concerns, with 76.7% of nurses reporting inadequate nurse-to-patient ratios and 73.3% indicating inequitable workload distribution. Key challenges included medication administration safety (70% expressing concerns), documentation accuracy (60% reporting difficulties), and hospital-acquired infection control (53.3% noting issues). Additionally, 70% of nurses believed that improving staffing ratios would reduce patient complications and errors. However, only 16.7% agreed that hospital management prioritizes adequate staffing, highlighting a disconnect between frontline needs and management decisions. The study concludes that lower nurse-to-patient ratios are associated with poorer patient outcomes, emphasizing the urgent need for policy changes to optimize staffing levels, enhance patient safety, and improve care quality in tertiary care settings. These findings provide critical insights for healthcare administrators and policymakers to address staffing challenges and ensure effective resource allocation.

Caesarean section is one of the oldest and most commonly performed surgical procedures in the history of surgery, and has become a much safer procedure. However, it confers an increased risk of complications in present as well as future pregnancies due to scar in the uterus. One and only specific risk factor involved in a post caesarean pregnancy is the fear of scar rupture. Closure of the uterine incision is a key step in caesarean section, particularly given the increasing awareness of future scar dehiscence. It is imperative therefore, that the optimal surgical technique be employed to minimize the morbidity in both the present case and in any future deliveries. Despite this, there is no universally accepted technique for performing caesarean section 1 to have a best scar which can withstand the stress of labor in future pregnancy.

This essay examines childbirth as a rite of initiation, articulating anthropological theory, symbolic analysis, and first-person birth narratives to argue that childbirth constitutes a genuine liminal experience with long-term effects on female subjectivity. Drawing on classical theories of rites of passage and contemporary reflections on embodiment, the text situates birth beyond its biomedical framing, emphasizing its potential to function as a transformative threshold where body, psyche, and social identity are reconfigured.
Through detailed birth testimonies, the essay explores childbirth as an encounter with radical vulnerability, irreversibility, and self-confrontation, characteristics central to initiatory processes across cultures. It argues that modern technocratic childbirth practices often operate as mechanisms of dissociation that neutralize the initiatory dimension of birth, reinforcing a broader cultural separation between body and subjectivity.
By framing childbirth as an embodied initiation rather than a purely physiological or medical event, the essay contributes to interdisciplinary debates on women’s health, embodiment, and symbolic experience, proposing childbirth as a rare contemporary site where the sacred, the corporeal, and subjective transformation converge.
Keywords:
Childbirth; initiation rites; embodiment; liminality; women’s subjectivity; birth narratives; body–mind integration; symbolic anthropology; post-jungian psychoanalysis; Feminine experience.

A Quasi Experimental study was conducted to assess the Effectiveness of Guided Imagery on pain and anxiety during first stage of labour among 40 primi mothers (20 from control group and 20 from Experimental group) selected by Convenience sampling technique in selected Hospital at Virudhunagar district. Quasi Experimental design was adopted. Numerical rating scale and modified Spielberg state anxiety scale were used to collect data regarding socio demographic variables, pain and anxiety level during first stage of labour. The result revealed that the level of pain and anxiety of experimental group was significantly lesser than the control group at (p<0.001).

This paper offers a critical analysis of the modern obstetric paradigm by examining how hospital-based childbirth practices transform a physiological and symbolic process into a medical event governed by intervention, control, and professional authority. Drawing on women’s narratives, observation of obstetric routines, and a psychoanalytically informed clinical perspective, the text explores how fear, misinformation, and institutional power asymmetries undermine female autonomy during childbirth.
The analysis addresses recurrent practices such as unnecessary cesarean sections, routine episiotomy, and cascades of iatrogenic intervention, emphasizing their physical, psychological, and symbolic consequences for women. Rather than framing childbirth as a technical problem to be solved, the paper approaches birth as a complex bodily, subjective, and relational experience.
Written prior to the institutional consolidation of the “humanized birth” discourse, this work anticipates later critiques while also interrogating the limits of their subsequent incorporation into medical protocols and public policy. The text is presented here in an adapted version for an international readership, preserving its original critical framework while removing local references.

Keywords:
• Childbirth
• Medicalization
• Obstetric Violence
• Female Autonomy
• Episiotomy
• Cesarean Section
• Iatrogenesis
• Psychoanalysis
• Feminist Health Studies

Infants born preterm compared with infants born at term are at an increased risk of dying and of serious morbidities in early life, and those who survive have higher rates of neurological impairments. It remains unclear whether exposure to repeat courses of prenatal corticosteroids can reduce these risks. This individual participant data (IPD) meta-analysis (MA) assessed whether repeat prenatal corticosteroid treatment given to women at ongoing risk of preterm birth in order to benefit their infants is modified by participant or treatment factors. Trials were eligible for inclusion if they randomised women considered at risk of preterm birth who had already received an initial, single course of prenatal corticosteroid seven or

Although there are studies showing that mobile phone solutions can improve health service delivery outcomes in the developed world, there is little empirical evidence that demonstrates the impact of mHealth interventions on key maternal health outcomes in low income settings. A non-randomized controlled study was conducted in the Amhara region, Ethiopia in 10 health facilities (5 intervention, 5 control) together serving around 250,000 people. Health workers in the intervention group received an android phone (3 phones per facility) loaded with an application that sends reminders for scheduled visits during antenatal care (ANC), delivery and postnatal care (PNC), and educational messages on dangers signs and common complaints during pregnancy. The intervention was developed at Addis Ababa University in Ethiopia. Primary outcomes were the percentage of women who had at least 4 ANC visits, institutional delivery and PNC visits at the health center after 12 months of implementation of the intervention.

Four studies previously indicated that the effect of malaria infection during pregnancy on the risk of low birthweight (LBW; &lt;2,500 g) may depend upon maternal nutritional status. We investigated this dependence further using a large, diverse study population. We evaluated the interaction between maternal malaria infection and maternal anthropometric status on the risk of LBW using pooled data from 14,633 pregnancies from 13 studies (6 cohort studies and 7 randomized controlled trials) conducted in Africa and the Western Pacific from 1996-2015. Studies were identified by the Maternal Malaria and Malnutrition (M3) initiative using a convenience sampling approach and were eligible for pooling given adequate ethical approval and availability of essential variables. Study-specific adjusted effect estimates were calculated using inverse probability of treatment-weighted linear and log-binomial regression models and pooled using a random-effects model. The adjusted risk of delivering a...

Four studies previously indicated that the effect of malaria infection during pregnancy on the risk of low birthweight (LBW; &lt;2,500 g) may depend upon maternal nutritional status. We investigated this dependence further using a large, diverse study population. We evaluated the interaction between maternal malaria infection and maternal anthropometric status on the risk of LBW using pooled data from 14,633 pregnancies from 13 studies (6 cohort studies and 7 randomized controlled trials) conducted in Africa and the Western Pacific from 1996-2015. Studies were identified by the Maternal Malaria and Malnutrition (M3) initiative using a convenience sampling approach and were eligible for pooling given adequate ethical approval and availability of essential variables. Study-specific adjusted effect estimates were calculated using inverse probability of treatment-weighted linear and log-binomial regression models and pooled using a random-effects model. The adjusted risk of delivering a...

A concrete and useful way to create an action plan for improving the quality of maternity care in the United States is to start with a view of the desired result, a common definition and a shared vision for a high-quality, high-value maternity care system. In this paper, we present a long-term vision for the future of maternity care in the United States. We present overarching values and principles and specific attributes of a high-performing maternity care system. We put forth the ''2020 Vision for a High-Quality, High-Value Maternity Care System'' to serve as a positive starting place for a fruitful collaborative process to develop specific action steps for broad-based maternity care system improvement.

Aim: This study aims to extract the environmental strategies affecting pain control and labormanagement from the healthcare staff's point of view. Background: The physical childbirthenvironment has significant effects on mothers’ labor, but the direct influence of the environment onpain control and labor management has not been well studied. The current childbirth spaces provokestress interrupting the delicate neuro-hormonal influences that drive labor and birth. Methods: Thestudy was a descriptive-analytical survey conducted in four health facilities. The consideration madehere, based on the existing literature and deep interviews with midwives and obstetricians aboutenvironmental factors affecting pain control and labor progress, have led to the extraction ofenvironmental strategies. Thus a research project was carried out, using a structured questionnairefor the Pearson correlation test and exploratory factor analysis methodology selected. Results: Theresults indicate that the most important environmental factors which can affect pain control and labormanagement are “Optimal function (Eigenvalue of 9.311)”, “Facilities and decoration (Eigenvalueof 5.680)”, “A suitable environment for husband's presence (Eigenvalue of 3.880)” and “Mother'sprivacy (Eigenvalue of 2.731)”. Conclusion: The factors extracted from the healthcare staff's view,provide a calming environment reducing stress and supporting physiologic childbirth. In addition to"Optimal function" the most important factor, "A suitable environment for husband's presence" as asecondary factor affecting other three factors and affected by them, should be considered. It shouldbe noted that respondents' feedback may be influenced by their work pressure or to facilitate theirworkload.

Schizophrenia (SCZ) is a severe, debilitating mental illness which has a significant genetic component. The identification of genetic factors related to SCZ has been challenging and these factors remain largely unknown. To evaluate the contribution of de novo variants (DNVs) to SCZ, we sequenced the exomes of 53 individuals with sporadic SCZ and of their non-affected parents. We identified 49 DNVs, 18 of which were predicted to alter gene function, including 13 damaging missense mutations, 2 conserved splice site mutations, 2 nonsense mutations, and 1 frameshift deletion. The average number of exonic DNV per proband was 0.88, which corresponds to an exonic point mutation rate of 1.7×10(-8) per nucleotide per generation. The non-synonymous-to-synonymous mutation ratio of 2.06 did not differ from neutral expectations. Overall, this study provides a list of 18 putative candidate genes for sporadic SCZ, and when combined with the results of similar reports, identifies a second proband c...

Childbirth and the postpartum period are critical times for both mothers and babies. Traditional cultural practices often play a significant role in providing support during this time. However, in exceptional circumstances, such as those faced by refugees giving birth in disrupted social environments, these practices may be inaccessible, leading to emotional distress and delayed physical recovery. Aim: To explore the cultural significance of traditional motherhood practices in Syria that are still observed by some Syrian refugees in Lebanon. Methods: The study used a phenomenological approach and included in-depth interviews with eight Syrian mothers residing in informal settlements in Lebanon. Findings: Findings were organized around three themes: (1) Familial Support during the Postpartum Period, (2) Specific Cultural Practices during the Postpartum Period, and (3) Emotional Experiences during the Postpartum Period Discussion: Understanding these cultural practices is essential for developing culturally sensitive interventions that can improve wellbeing of refugee mothers.

Introduction: Expanding access to doula care is a key strategy for improving the perinatal experiences and health outcomes of birthing people of color in the U.S. This study investigates the future of maternal healthcare in the U.S. from the perspective
of doulas and highlights emerging technology and other opportunities related to strengthening the doula workforce.
Methods: The study recruited community doulas from 12 unique U.S. states, ensuring at least half of the doulas predominantly
served communities of color. Doulas (N = 26) participated in semi-structured, futures-oriented interviews that explored their
experiences providing care during the COVID-19 pandemic and utilization of technology. A subset of doulas (n = 8) were
engaged in interactive workshops where they envisioned alternative futures for doula care and childbirth. Interviews and
workshops were analyzed using the Framework Method.
Results: The COVID-19 pandemic heightened technology use among doulas and increased client accessibility. Social media
serves as a unique space for critical community building and client outreach. Doulas reported opportunities to strengthen
and mobilize the future workforce: recognizing doula care as a reimbursable service by health insurers, utilizing doula
collectives for community practice to decrease burnout, increasing emotional support for doulas, and instilling a chain of
learning through mentorship.
Discussion: Futures thinking served as a valuable approach for doulas to illuminate the implications of present-day challenges
and empowered doulas to design roadmaps toward better futures for doulas and maternal health. Doulas should be engaged as
partners to hold a meaningful decision-making role when discussing policies, employment structures, emerging technology,
and other aspects of doulas’ positioning within the healthcare system.

Result of the research, the role of environmental events, namely physical, chemical, biological, socio-cultural factors in the development of diseases was investigated. In particular, the lack of toxic substances in the body is a direct cause of cardiovascular disease. The emergence of diseases such as cardiac arrhythmia, ischemic heart injury, cardiomyopathy, peripheral artery occlusion, coronary artery disease, hypertension, etc. is always relevant today. The most common cause of selenium deficiency is an element that occurs naturally in the soil and has an antioxidant effect, passing into the body through food and drinking water.. The article explains that epidemiological and clinical observations in the development of cardiovascular diseases are influenced not only by the main risk factors and genetics, but also by environmental factors. Experts have shown that minerals or chemicals in the soil play an important role in the development of cardiovascular disease. In particular, physical and chemical pollution of the environment increases the risk of cardiovascular disease. Many studies have linked the effects of chemicals to coronary heart disease, cardiomyopathy, and arrhythmias. Chemicals, especially arsenic, lead, cadmium, various pollutants and solutions, pesticides, play an important role in the development of cardiovascular diseases. This depends on the strength of the chemicals entering the body and the effectiveness of the body's defense mechanisms, as well as symptoms such as the duration of exposure. In places subject to prolonged exposure to chemicals, methyl chloride can also cause acute toxic effects such as acute myocardial infarction. Scientific novelty: As a result of the research, the role of environmental events, namely physical, chemical, biological, socio-cultural factors in the development of diseases was investigated.

Result of the research, the role of environmental events, namely physical, chemical, biological, socio-cultural factors in the development of diseases was investigated. In particular, the lack of toxic substances in the body is a direct cause of cardiovascular disease. The emergence of diseases such as cardiac arrhythmia, ischemic heart injury, cardiomyopathy, peripheral artery occlusion, coronary artery disease, hypertension, etc. is always relevant today. The most common cause of selenium deficiency is an element that occurs naturally in the soil and has an antioxidant effect, passing into the body through food and drinking water.. The article explains that epidemiological and clinical observations in the development of cardiovascular diseases are influenced not only by the main risk factors and genetics, but also by environmental factors. Experts have shown that minerals or chemicals in the soil play an important role in the development of cardiovascular disease. In particular, physical and chemical pollution of the environment increases the risk of cardiovascular disease. Many studies have linked the effects of chemicals to coronary heart disease, cardiomyopathy, and arrhythmias. Chemicals, especially arsenic, lead, cadmium, various pollutants and solutions, pesticides, play an important role in the development of cardiovascular diseases. This depends on the strength of the chemicals entering the body and the effectiveness of the body's defense mechanisms, as well as symptoms such as the duration of exposure. In places subject to prolonged exposure to chemicals, methyl chloride can also cause acute toxic effects such as acute myocardial infarction. Scientific novelty: As a result of the research, the role of environmental events, namely physical, chemical, biological, socio-cultural factors in the development of diseases was investigated.

Amaç: Obstetrik jel uygulamas›n›n nullipar gebelerde, travay›n birinci ve ikinci evresi üzerine etkisi, perine üzerine koruyucu etkisinin varl›¤› ve bu yönteme ba¤l› fetal ve maternal sonuçlar›n› arafl-t›rmak amaçlanm›flt›r. Yöntem: Hastanemize 37-41 gebelik haftalar›nda baflvuran nullipar gebeler randomize edilerek jel uygulanan ve uygulanmayanlar olmak üzere gruplar oluflturuldu. Gebelere travaylar› boyunca do-¤um indüksiyonu veya augmentasyonu verilmedi, rutin amniyotomi uyguland›, do¤um s›ras›nda rutin epizyotomi uygulanmad›. Her iki grup perineal laserasyon, epizyotomi gereksinimi, do¤um evrelerinin süreleri, laboratuvar verileri ve yenido¤an verileri aç›-s›ndan karfl›laflt›r›ld›. Bulgular: Çal›flma kriterlerine uygun 200 nullipar gebe (Grup I: n=102, spontan izlem; Grup II: n=98, jel uygulanan) de¤erlendirildi. Maternal demografik verileri, laboratuvar verileri ile yenido¤an sonuçlar›nda herhangi bir fark saptanmad›. Jel uygulanan hastalarda do¤umun birinci ve ikinci evre süreleri istatistiksel aç›dan anlaml› olarak k›sa saptand›. Epizyotomi uygulamas› / gereksinimi aç›s›ndan gruplar aras›nda herhangi bir fark saptanmad›. Laserasyonun olufl-mad›¤› durumlar ile hafif perineal laserasyonlar (1. ve 2. derece) aç›-s›ndan jel uygulanan gebelerde sonuçlar göreceli olarak daha iyi olarak de¤erlendirilirken, ileri derece perineal laserasyonlarda (3. ve 4. derece) istatistiksel fark saptanmad›. Sonuç: Nulliparlarda travayda obstetrik jel kullan›m›, do¤um evrelerinde anlaml› bir k›salma sa¤larken, daha az laserasyonlar görülmektedir.

Background Coronavirus currently cause a lot of pressure on the health system. Accordingly, many changes occurred in the way of providing health care, including pregnancy and childbirth care. To our knowledge, no studies on experiences of maternity care Providers during the COVID-19 Pandemic have been published in Iran. We aimed to discover their experiences on pregnancy and childbirth care during the current COVID-19 pandemic. Methods This study was a qualitative research performed with a descriptive phenomenological approach. The used sampling method was purposive sampling by taking the maximum variation possible into account, which continued until data saturation. Accordingly, in-depth and semi-structured interviews were conducted by including 12 participants, as 4 gynecologists, 6 midwives working in the hospitals and private offices, and 2 midwives working in the health centers. Data were analyzed using Colaizzi’s seven stage method with MAXQDA10 software. Results Data analysis...

Disrespect and abuse of women during institutional childbirth services is one of the deterrents to utilization of maternity care services in Ethiopia and other low- and middle-income countries. This paper describes the prevalence of respectful maternity care (RMC) and mistreatment of women in hospitals and health centers, and identifies factors associated with occurrence of RMC and mistreatment of women during institutional labor and childbirth services. This study had a cross sectional study design. Trained external observers assessed care provided to 240 women in 28 health centers and hospitals during labor and childbirth using structured observation checklists. The outcome variable, providers&#39; RMC performance, was measured by nine behavioral descriptors. The outcome, any mistreatment, was measured by four items related to mistreatment of women: physical abuse, verbal abuse, absence of privacy during examination and abandonment. We present percentages of the nine RMC indicator...

Background Infants born preterm compared with infants born at term are at an increased risk of dying and of serious morbidities in early life, and those who survive have higher rates of neurological impairments. It remains unclear whether exposure to repeat courses of prenatal corticosteroids can reduce these risks. This individual participant data (IPD) meta-analysis (MA) assessed whether repeat prenatal corticosteroid treatment given to women at ongoing risk of preterm birth in order to benefit their infants is modified by participant or treatment factors. Methods and findings Trials were eligible for inclusion if they randomised women considered at risk of preterm birth who had already received an initial, single course of prenatal corticosteroid seven or

Four studies previously indicated that the effect of malaria infection during pregnancy on the risk of low birthweight (LBW; &lt;2,500 g) may depend upon maternal nutritional status. We investigated this dependence further using a large, diverse study population. We evaluated the interaction between maternal malaria infection and maternal anthropometric status on the risk of LBW using pooled data from 14,633 pregnancies from 13 studies (6 cohort studies and 7 randomized controlled trials) conducted in Africa and the Western Pacific from 1996-2015. Studies were identified by the Maternal Malaria and Malnutrition (M3) initiative using a convenience sampling approach and were eligible for pooling given adequate ethical approval and availability of essential variables. Study-specific adjusted effect estimates were calculated using inverse probability of treatment-weighted linear and log-binomial regression models and pooled using a random-effects model. The adjusted risk of delivering a...

A new prediction model of vaginal birth after cesarean containing factors available at the time of admission was tested and it was found to be a good tool. Öz Amaç: Bu çalışma, başvuruda olan değişkenleri kullanarak sezaryen sonrası vajinal doğum (SSVD) olasılığını tahmin etmek için yeni ve basit bir model oluşturmak için yapılmıştır. Gereç ve Yöntemler: Haryana'daki üçüncü basamak sağlık merkezinde 12 aylık bir süre boyunca (Ocak 2018-Aralık 2018) doğumhaneye başvuran, daha önce bir kez sezaryen ile doğum yapan ve "Gebelerde Sezaryen Sonrası Doğum Çalışması" (TOLAC) kriterlerini karşılayan gebelerde prospektif bir gözlemsel çalışma yapıldı ve örneklem büyüklüğü 150 idi. Her hasta için SSVD skoru, maternal yaş, gebelik yaşı, Bishop skoru, vücut kitle indeksi, birincil sezaryen endikasyonu ve klinik olarak tahmin edilen fetal ağırlık gibi hastaneye başvurudaki değişkenleri içeren yeni bir tahmin modeli kullanılarak hesaplandı. SSVD skorunun sonuçları, başarılı veya başarısız SSVD şeklinde sonlanım ile ilişkilendirildi. Gruplar arası karşılaştırmada ki-kare testi ve Student's t-testi kullanıldı. Çalışma değişkenleri için tanımlayıcı analiz ve regresyon analizi yapılmıştır. Bulgular: Yüz elli TOLAC kriterlerine uyan gebenin %78'inde başarılı SSVD ve %22'sinde başarısız SSVD gözlendi. SSVD skoru 0-3 için başarılı bir SSVD'ye sahip olma olasılığı %34, 4-6 için 68, 7-9 için %90 ve >10 için %97 idi. Tahmin modeli, alıcı çalışma karakteristikleri analizinde; 0,77'lik (%95 güven aralığı 0,68 ila 0,85) eğri altındaki alan ile iyi performans göstermiştir. Sonuç: Bu çalışma, önerilen SSVD tahmin modelinin TOLAC sonucunu tahmin etmek için iyi bir araç olduğunu ve kadınlara mevcut ve sonraki gebeliklerde doğum şekli konusunda danışmanlık yapmak için kullanılabileceğini göstermektedir. Bu modelle ve farklı permütasyonlara ve değişken kombinasyonlarına sahip diğer bu tür modellerle ilgili daha fazla çalışma yapılması gerekmektedir.

This updated edition of Care Practice Paper #3 presents the evidence for the benefits of continuous support in labor. The role of the doula is explained. Women are encouraged to plan for continuous support during labor and to consider including a woman experienced with childbirth among their labor support team.

Teaching Lamaze International classes in a patient-centered medical home allows the childbirth educator the best environment for giving evidence-based information and empowering parents to give birth their way. Patient-centered medical home facilities and providers practice evidence-based care and adhere to the principles of family-centered maternity care. In patient-centered medical homes, women can expect to give birth using the Lamaze Healthy Birth Practices and to fully participate in their care with appropriate interventions and the right to informed consent and informed refusal.

This updated edition of Care Practice Paper #3 presents the evidence for the benefits of continuous support in labor. The role of the doula is explained. Women are encouraged to plan for continuous support during labor and to consider including a woman experienced with childbirth among their labor support team.

Background: The present study aims to understand the perceptions, apprehensions, and fears of peripartum COVID-positive women in lowresource settings. Study design: Cross-sectional observational study. Methodology: All COVID-positive postpartum women who delivered in the institution (vaginal delivery and cesarean section) were included in the study. Exclusion criteria included ICU admission and known mental illness. Results: A total of 61 COVID-positive women delivered in the facility during the study period. About 33 out of 61 women were nulliparous, while 28 were multigravida. Two babies tested positive for COVID-19 within 24 hours of birth. Majority of the patients were anxious prior to coming to hospital (51/61, i.e., 83.6%). The most common perceived fear reported by patients was fear of not receiving support from partner and provider (80%). Due to restrictions imposed on birth companion, 80% (49/61) women feared loneliness during labor. Apprehension of not receiving respectful maternity care was experienced by 75.4% (46/61) of women. Only 16 (26.2%) patients feared progression of disease, and 32 women (52%) were afraid of infection being transmitted to baby. However, 85% of the women reported a positive birthing experience. Good support from the family was observed in 76% of women. Despite regular visits by the doctors, eight patients (13%) felt a lack of connect due to the prevailing situation. Inability to celebrate joyful moments with family, neonatal separation, and delay in discharge were the major causes of discontent among the postpartum women. Conclusion: The study shows that the excitement and joy of pregnancy and delivery in pre-COVID times has been replaced by fear, anxiety, and uncertainty in this COVID era. Strategies, like good communication and provision of adequate support, may be particularly useful to help these women have a positive birthing experience.

In this column, the editor of The Journal of Perinatal Education discusses the importance of confronting racial and other health disparities in birth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

In this column, the editor of The Journal of Perinatal Education discusses the importance of confronting racial and other health disparities in birth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

Background Low quality and frequency of antenatal care (ANC) are associated with lower uptake of facility-based deliveries-a key intervention to reduce maternal and neonatal mortality. We implemented group ANC (G-ANC), an alternative service delivery model, in Kenya and Nigeria, to assess its impact on quality and attendance at ANC and uptake of facility-based delivery. Methods From October 2016-January 2018, we conducted a facility-based, pragmatic, cluster-randomized controlled trial with 20 clusters per country. We recruited women <24 weeks gestation during their first ANC visit and enrolled women at intervention facilities who agreed to attend G-ANC in lieu of routine individual ANC. The G-ANC model consisted of five monthly 2-hour meetings with clinical assessments alongside structured gestationally specific group discussions and activities. Quality of care was defined as receipt of eight specific ANC interventions. Data were obtained through facility records and self-report during a home-based postpartum survey. Analysis was by intention to treat.

Background Variations in intervention rates, without subsequent reductions in adverse outcomes, can indicate overuse. We studied variations in and associations between commonly used childbirth interventions and adverse outcomes, adjusted for population characteristics. Methods and findings In this multinational cross-sectional study, existing data on 4,729,307 singleton births at �37 weeks in 2013 from Finland,

Pathophysiological, pathomorphological and functional changes in the kidneys after left ventricular assist device implantation have not yet been fully understood and represent an actual problem of our time. Changes in renal function following left ventricular assist device implantation have been disclosed in many studies with inconsistent results. Some studies have shown that patients with renal dysfunction after left ventricular assist device implantation had worse outcomes, despite stabilization or even improvement of kidney function during the postoperative period, other studies have shown the progression of chronic kidney disease requiring renal replacement therapy.

Amaç: Obstetrik jel uygulamas›n›n nullipar gebelerde, travay›n birinci ve ikinci evresi üzerine etkisi, perine üzerine koruyucu etkisinin varl›¤› ve bu yönteme ba¤l› fetal ve maternal sonuçlar›n› arafl-t›rmak amaçlanm›flt›r. Yöntem: Hastanemize 37-41 gebelik haftalar›nda baflvuran nullipar gebeler randomize edilerek jel uygulanan ve uygulanmayanlar olmak üzere gruplar oluflturuldu. Gebelere travaylar› boyunca do-¤um indüksiyonu veya augmentasyonu verilmedi, rutin amniyotomi uyguland›, do¤um s›ras›nda rutin epizyotomi uygulanmad›. Her iki grup perineal laserasyon, epizyotomi gereksinimi, do¤um evrelerinin süreleri, laboratuvar verileri ve yenido¤an verileri aç›-s›ndan karfl›laflt›r›ld›. Bulgular: Çal›flma kriterlerine uygun 200 nullipar gebe (Grup I: n=102, spontan izlem; Grup II: n=98, jel uygulanan) de¤erlendirildi. Maternal demografik verileri, laboratuvar verileri ile yenido¤an sonuçlar›nda herhangi bir fark saptanmad›. Jel uygulanan hastalarda do¤umun birinci ve ikinci evre süreleri istatistiksel aç›dan anlaml› olarak k›sa saptand›. Epizyotomi uygulamas› / gereksinimi aç›s›ndan gruplar aras›nda herhangi bir fark saptanmad›. Laserasyonun olufl-mad›¤› durumlar ile hafif perineal laserasyonlar (1. ve 2. derece) aç›-s›ndan jel uygulanan gebelerde sonuçlar göreceli olarak daha iyi olarak de¤erlendirilirken, ileri derece perineal laserasyonlarda (3. ve 4. derece) istatistiksel fark saptanmad›. Sonuç: Nulliparlarda travayda obstetrik jel kullan›m›, do¤um evrelerinde anlaml› bir k›salma sa¤larken, daha az laserasyonlar görülmektedir.