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Total hip arthroplasty is indubitably one of the most performed operations worldwide. On the other hand, especially in the western world, the average age that women get pregnant has raised confoundedly. Consequently, a steadily increasing number of women become pregnant after they had hip arthroplasty surgery, with copious potential implications. The amount of knowledge on this particular field is considered inadequate in the existing literature. This paper aims to augment clinicians understanding surrounding this topic. A systematic literature review was conducted in accordance with the PRISMA guidelines. Papers from various computerized databases were scrutinized. Article selection was carried out by three authors independently employing specific pre-determined inclusion and exclusion criteria, while disagreements were elucidated with the contribution of other authors. A patently limited number of research articles were detected from our rigorous literature review, with only 12 papers meeting the inclusion criteria. The vast majority of studies were small-scale and examined confined population groups. Most studies had been performed in Finland, utilizing data from nationwide registries. Women with previous history of total hip arthroplasty feature increased rates of c-section delivery, although vaginal labor can be attempted with certain precautions. Hip implants' survival does not appear to be affected from gestation, which is predominately well-tolerated from these women. Metal ion circulation in mothers' blood has not been proven to trigger substantial complications concerning either mothers or offspring. It can be considered safe for women with such medical history to get pregnant; however, further multinational studies and pertinent research on this field are vital to attain more solid inferences. [ABSTRACT FROM AUTHOR]

Since 2016, China has progressively relaxed family planning policies to stimulate birth rates. This paper examines the behavioral health repercussions of China's 2016 universal two-child policy (UTCP) by analyzing sleep pattern data from China Family Panel Studies. Napping is a composite indicator that denotes health outcomes, job quality, and personal well-being. It reveals work conditions and environments to some extent. UTCP may lead to heightened social expectations regarding pregnancy likelihood, and changes in social expectations within the workplace may make work environments less equitable and more stressful for females. Leveraging a difference-in-difference model, this paper explores how napping behaviors among the working-age cohort have responded to the policy shifts. Our analysis reveals a gender discrepancy in response to the policy, specifically, females exhibit a discernible reduction in the likelihood of napping, as well as in the duration of both daytime naps and daily sleep. Conversely, such effects are not significant among males. These results suggest policy consequences extend beyond individuals directly impacted by childbirth or contemplating parenthood. Hence, while promoting fertility is still the government's goal, policymakers are encouraged to consider the broader challenges the female population faces from social and workplace environment factors. [ABSTRACT FROM AUTHOR]

Conrad's Heart of Darkness is often regarded as a great text in Western Literature. One of its most intriguing aspects is its portrayal of women, or rather, the lack thereof. The novella has been examined from various critical perspectives such as Freudian, Marxist, postcolonial, and deconstructive, just to name a few. However, the treatment of women has received little scholarly attention. In this light, Conrad's nuanced view of women, heavily influenced by Schopenhauer, deserves greater attention. In this male-centric novella, women are nameless, inferior, insignificant, and mostly silent, except for occasional cries. This paper explores Schopenhauer's perspective on women - as primarily suited for childbirth and domestic duties, as well as Conrad's mistrust of women in the novella may reflect personal experiences and societal norms, exemplified in his portrayal of his wife and fictional female characters. This perspective is further reinforced by Schopenhauer's derogatory views on women, emphasizing their perceived intellectual deficiency. Examining the female characters reveals how Conrad confines them to limited roles, echoing patriarchal attitudes of his time. From Marlow's aunt, who blindly supports the colonial project due to her lack of knowledge on important issues, to Kurtz's Intended, who idealizes Kurtz despite his dark deeds, women are depicted as out of touch with reality. Ultimately, this paper offers a deep insight into Conrad's view of women in Heart of Darkness through a Schopenhauerian lens. Our analysis suggests that the female characters represent Conrad's view of women and that he was influenced by Schopenhauer, who belittles women in much of his writing. [ABSTRACT FROM AUTHOR]

Christianity does not have as long of a history as other monotheistic religions and traditional ideologies in Korea, but—especially from the end of the 19th century—its new concepts have had a huge impact on the basic thoughts of Korean society. This paper focuses on the effects of Christianity and the activity of Christian communities on women's lives. According to my preliminary findings, in the late 1800s, the Christian missionaries and their newly formed communities offered opportunities for girls and women to get education, a profession, access to better health care, and learn self-care. After the complicated decades between 1910 and 1950, South Korea was experiencing remarkable changes, and Christians were an active part of this rebuilding, helping the lives of those who were struggling with poverty, lack of daily necessities, education, and health care. This paper aims to examine the thoughts and actions of Korean Christian communities towards decisions on childbirth, children out of wedlock, adoption, and single motherhood. This study investigates the approaches of South Korean Christian communities towards women related to the above-mentioned circumstances, focusing on the early examples and the last five to six decades. It is assumed that even though South Korea is now considered a modernized country, the government sometimes fails to cope with current problems, and traditional notions are still strong in familial matters. Therefore, not obeying conventional forms may cause social conflicts, or the decisions are hidden because of taboos and stigmas. This research is based on the publications of Christian communities and involves documentaries and case studies, including the baby box operation and adoption. This paper contributes to the expanding studies on Korean Christian communities, highlighting the social norms and their changes generated by new religious thoughts, while giving an insight into the daily struggles of Korean women's lives when it comes to decision-making about their motherhood. [ABSTRACT FROM AUTHOR]

Background: During pregnancy, women's bodies undergo rapid body weight and size changes within a relatively short period. Pregnancy may therefore, be associated with an increased vulnerability for developing body image dissatisfaction linked to adverse health outcomes for the mother (e.g., depression, eating disorders) and child (e.g., impaired self-regulation, childhood obesity). The present study aims to examine the prevalence and trajectories of body image dissatisfaction during pregnancy and postpartum and its relationship to pre-pregnancy BMI. This is the first study that investigates prevalence rates of body image dissatisfaction not only ante- but also postpartum, and that compares trajectories of women with normal weight and overweight. Methods: A prospective longitudinal design with a quantitative approach was applied. Healthy pregnant women (N = 136) answered paper-pencil or online questionnaires at four time points (18th-22nd and 33rd-37th week of gestation, 3 and 6 months postpartum). Body image dissatisfaction was assessed using the German version of the Body Shape Questionnaire (BSQ) and the Eating Disorder Examination Questionnaire (EDE-Q). Both questionnaires are considered reliable and valid measures of several aspects of body image, and the BSQ allows for calculating prevalence rates by providing cut-off values. Using not just one but two body image questionnaires, trajectories of body image dissatisfaction can be compared. Pre-pregnancy BMI was assessed retrospectively via self-reported weight and height. Results: The proportion of women reporting elevated levels of body image dissatisfaction was 6.6% (n = 9) in the second trimester, 2.9% (n = 4) in the third trimester, 11.0% (n = 15) three months postpartum, and 10.3% (n = 14) six months postpartum. Repeated measures ANOVA revealed that body image dissatisfaction significantly decreased from pre-pregnancy to pregnancy, remained stable during pregnancy, and returned to pre-pregnancy levels three to six months postpartum. Mixed between-within ANOVA showed that the overweight/obese group reported significantly higher levels of body image dissatisfaction at each measurement point except during the third trimester than women in the normal weight group. Significant but small interaction effects between time and pre-pregnancy BMI were found. Conclusions: The results revealed that approximately every tenth woman is affected by body image dissatisfaction after childbirth. Women with a higher BMI level before pregnancy are particularly at risk of experiencing body image dissatisfaction. Healthcare providers should screen for body image dissatisfaction, in particular after childbirth, and inform affected women about possible adverse health outcomes and treatment options. Study limitations concern the drop-out rate of 51.4% and the retrospective and self-reported assessment of pre-pregnancy BMI. Future studies should include additional assessment points in the first trimester and more than six months postpartum and try to include a matched control group of non-pregnant women to compare prevalence rates and trajectory of body image dissatisfaction. [ABSTRACT FROM AUTHOR]

Suicide accounts for 33% of deaths of women during the postnatal period in many low- and middle-income countries (LMICs). Resilience refers to an ability to adapt and recover from adversity or misfortune. Resilience building against mental health challenges during pregnancy and the postnatal period is critical for women to raise their child efficiently and maintain a healthy life. The exploration of maternal resilience against mental health challenges including its developmental processes and the determinants of its successful or unsuccessful cultivation among mothers during pregnancy and childbirth is of paramount importance. Understanding why a subset of mothers effectively develops resilience while others significantly struggle is critical for devising targeted interventions and support mechanisms aimed at improving maternal well-being. This inquiry not only seeks to delineate the factors that contribute to or hinder the development of resilience but also aims to inform the creation of comprehensive support systems that can bolster maternal health outcomes. This paper endeavors to present a comprehensive analysis of maternal resilience, aiming to cultivate a nuanced and profound understanding of the concept within the framework of previous traumatic events and adverse pregnancy outcomes in LMICs. The eight-step method approach proposed by Walker and Avant was utilized for this concept analysis. Several defining attributes were identified in the analysis including social adaptation, support system, optimistic approach, and mindfulness. This analysis contributes to knowledge advancement regarding maternal resilience and provides nurses and other healthcare professionals with a clear understanding of the concept of maternal resilience to help promote resilience among mothers. [ABSTRACT FROM AUTHOR]

Background: The birth experience plays a pivotal role in the mother´s mental well-being and has a crucial effect on the mother-child bond. Unanticipated medical interventions, including fundal pressure, episiotomy, assisted vaginal delivery (AVD), or unplanned cesarean section (CS) during labor, may adversely affect the birth experience. The objective of this study is to identify factors contributing to the diminished evaluation of the birth experience after assessing the prevalence of unplanned obstetrical interventions in Germany. Methods: For this cross-sectional analysis, 4000 mothers whose children were born 8 or 12 months before were asked about their birth experience via a paper-based questionnaire. Overall 1102 mothers participated in the study, representing a response rate of 27.6%. The revised Childbirth Experience Questionnaire (CEQ2) was used to measure the childbirth experience. In addition to descriptive and bivariate analyses using the Wilcoxon rank-sum test and Kruskal-Wallis-test, we calculated multivariate linear regression models for each dimension of the CEQ2. Results: In general, the participants evaluated their childbirth experience favorably, assigning an average rating of 3.09 on a scale ranging from 1 to 4. Women who experienced fundal pressure, an AVD, or an unplanned CS rated their birth experience significantly worse compared to women who gave birth without interventions. Unplanned CSs received the lowest ratings for "personal capability" and "perceived safety," and an AVD resulted in lower scores for "professional support" and "participation." However, the interventions we studied did not account for much of the variation in how the childbirth experience plays out for different individuals. Conclusion: Obstetric interventions have a significant effect on different dimensions of the birth experience. If a high level of birth satisfaction is to be achieved, it is important to know which dimension of satisfaction is affected by the intervention so that explicit measures, like fostering communication, participation or safety can be taken to promote improvement. German Clinical Trial Register: DRKS00029214, retrospectively registered (Registration Date 22.06.2023). [ABSTRACT FROM AUTHOR]

This paper has as its theme the autonomy of pregnant women in relation to choosing the method of birth for their child. The objective was to carry out a scoping review to study the literature and evidence of how autonomy is being offered to parturient women. Study design and location: In October 2023, a search was carried out using the terms "pregnant women" AND "delivery" AND "autonomy" in the following databases: PubMed, Web of Science, Scopus, Scielo and LILACS. The search included articles from 2016 to 2023. Of the 179 articles found, 15 met the criteria and were selected for this review. Results: the pregnant woman's autonomy in choosing the method of childbirth is influenced by several factors, such as the obstetrician's recommendation, the medical team, and negative and positive experiences. Thus, when this autonomy is shared with the obstetrician, the obstetrician recommends cesarean section as the safest route, but does not explain the benefits and harms of both routes (vaginal and cesarean section), causing the woman to accept the cesarean section. Midwives recommend vaginal birth because they believe it to be natural and safe and explain the benefits and harms of both methods, respecting the pregnant woman's choice of the method she prefers. Conclusion: women have the fundamental right to choose their method of birth and must be properly guided throughout prenatal care, whether by an obstetrician or a midwife, about the options, risks and benefits of each method of childbirth, respecting the ethical principle of beneficence. [ABSTRACT FROM AUTHOR]

Maternal mortality rates within the United States have reached an all-time high.  Annually, nearly seven hundred women die from pregnancy-related complications, a number of which were highly preventable.  When taking a closer look at these statistics, these deaths disproportionately affect Native American and African American women, making them two to three times more likely to suffer from poorer pregnancy outcomes.  This paper examines the variety of factors that contribute to such a disproportionate maternal mortality rate, including geographic differences, racial and economic inequalities, and the accessibility of healthcare.  Despite attempts to fix these issues, systemic and intrinsic issues persist, and individuals continue to suffer.  This paper highlights the need to address maternal mortality disparities that affect marginalized groups, improved accessibility to healthcare for all, and overall policy reform in order to solve this issue indefinitely.

Background: Midwives can play a pivotal role in promoting natural-birth experiences. However, limited information is available about Jordanian laboring women’s experiences of natural childbirth guided by midwives. Understanding women’s experiences of natural birth can inform healthcare providers and policymakers to improve the care provided for laboring women. Purpose: This study aims to explore women's experiences of natural childbirth in a midwife-led care unit. Methods: A qualitative descriptive approach guided the study protocol. Data was collected through in-depth, semi-structured telephone interviews with 10 Jordanian women who experienced natural childbirth in a midwife-led care unit. Results: Two main themes emerged: “The journey of empowerment “and “being prepared for natural childbirth". The first theme consisted of two sub-themes: Making an informed decision, and being supported. The second theme consisted of three sub-themes: The power of the place, being satisfied with natural-childbirth practices, and feeling relieved. Conclusion: Women had positive childbirth experiences shaped by having autonomy in decision-making, perceived support, and being satisfied with the midwife-led care unit. Women’s positive experiences emphasize the need for social and political change to promote natural childbirth. Implications for Nursing: This paper provides evidence that supports the incorporation of midwife-led units to promote natural childbirth. New data will play a critical role in strengthening the responsibilities of nurses and midwives by raising public awareness and calling for policy changes to promote natural childbirth. [ABSTRACT FROM AUTHOR]

This paper examines changes in the completeness of documentation in clinical practice before and during the implementation of the Safer Births Bundle of Care (SBBC) project. This observational study enrolled parturient women with a gestation age of at least 28 weeks at the onset of labour. Data collectors extracted information from facility registers and then a central data manager summarised and reported weekly statistics. Variables of clinical significance for CQI were selected, and the proportion of non-documentation was analysed over time. A Pearson chi-square test was used to test for significant differences in non-documentation between the periods. Between 1 March 2021 and 31 July 2022, a total of 138,442 deliveries were recorded. Overall, 75% of all patient cases had at least one missing variable among the selected variables across both periods. A lack of variable documentation occurred more frequently at the district hospital level (81% of patient cases) and health centres (74%) than at regional referral hospitals (56%) (p < 0.001). Non-documentation decreased significantly from 79% to 70% after the introduction of the SBBC (p < 0.001). A tendency towards negative correlations was noted for most variables. We noted an increased attention to data quality and use which may have a positive impact on the completeness of documentation. However, halfway through the project's implementation, the completeness of documentation was still low. Our findings support the recommendation to establish short-spaced feedback loops of locally collected data using one data platform. [ABSTRACT FROM AUTHOR]

Background: Home delivery is a nonclinical childbirth practice that takes place in one's home with or without traditional birth attendants and postnatal care is the care given to the mother and her newborn baby; according to world health organization (WHO), the postnatal phase, begins one hour after birth and lasts six weeks (42 days). This paper aimed to study the spatial pattern and determinant factors of low utilization of delivery care (DC) services and postnatal check-up (PNC) after live births in Ethiopia. Methods: This study used the 2016 Ethiopian Demographic and Health Survey data as a source. A total weighted samples of 11023 women-children pairs were included. The bivariate binary logistic regression analyses with spatial effect were modeled using SAS version 9.4 and ArcGIS version 10.8 was used for mapping. Results: The spatial distribution of low utilization of delivery care service and postnatal check-up were significantly clustered in Ethiopia (Moran's I statistic 0.378, P-value < 0.001 and 0.177, P-value < 0.001 respectively). Among 11023 children-women pair, the prevalence of home delivery and no postnatal check-up within two months following birth were 72.6% and 91.4% respectively. The Liben, Borena, Guji, Bale, Dolo and Zone 2 were predicted to have high prevalence of home delivery and part of Afder, Shabelle, Korahe, Dolo and Zone 2 were high risk areas of no postnatal checkup. Conclusion and recommendations: Lack of occupation, region, large family size, higher birth order, low utilization of antenatal care visit, unable to access mass media, big problem of health facility distance and the spatial variable were found to be jointly significant predictors of low utilization of DC and PNC in Ethiopia. Whereas older age, being reside in rural area and low wealth status affects delivery care service utilization. We suggest health providers, policy makers and stakeholders consider those variables with priority given to Liben, Borena, Guji, Bale, Dolo, Zone 2, Afder, Shabelle and Korahe, where home delivery and no PNC were predicted relatively high. We also recommend researchers to conduct further studies using latest survey data set. [ABSTRACT FROM AUTHOR]

Background: There is increasing evidence that a companionship is an important tool for improving the quality of care provided to pregnant women during the labour and delivery process. The literature review shows very limited studies assessing the role of companions during childbirth from the companion's point of view. Many published papers studied the role and satisfaction of pregnant women but not their companions. Therefore, this study aimed to assess the role and effect of companions during childbirth in Oman. Methods: This cross-sectional observational study was conducted at Sultan Qaboos University Hospital, Oman, between June 2022 and April 2023. Companions were interviewed face-to-face at a time convenient to them. A telephone interview was conducted with those who left the hospital early. The questionnaire comprised sociodemographic data and other sections, including the nature of the help provided by the supportive companion, their effects on the women who gave birth, and the timing of their presence during companionship. Results: A total of 214 companions were included in this study with the mean age of 42.54 years. The most common relationship to the pregnant women was mothers (35.7%), followed by husbands (30.5%). The majority of companions provided support during admission (62.6%), in the immediate post-partum ward (56.5%) and during delivery (54.2%), while a minority helped from admission to discharge (22.4%). The most common type of support provided was encouraging words (89.7%) followed by transferring things (43.9%), massage (37.4%) and touch (33.6%). The majority of companions (96.7%) reported that their support helped very much, and the pregnant women felt better and calmer. Conclusions: Labouring women felt better and calmer because of the presence of companions. Companions preferred to be present in the postpartum and during labour and delivery. The majority of companions support their labouring women by encouraging wards. Companions love and encourage others to support their labouring women during their critical times. [ABSTRACT FROM AUTHOR]

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This paper identifies the impact of increasing post-childbirth work incentives on mothers' long-run careers. We exploit variation in work incentives across mothers based on the timing of a first birth and eligibility for the 1993 expansion of the Earned Income Tax Credit. Ten to nineteen years after a first birth, single mothers who were exposed to the expansion immediately after birth ("early"), rather than 3–6 years later ("late"), have 0.62 more years of work experience and 4.2 percent higher earnings conditional on working. We show that higher earnings are primarily explained by improved wages due to greater work experience. (JEL H24, H31, J16, J22, J31) [ABSTRACT FROM AUTHOR]

INTRODUCTION In the early phases of the COVID-19 pandemic, inadequate intrapartum care protocols were in place. Many organizations have responded promptly and recognized the importance of adherence to appropriate guidelines. The International Confederation of Midwives issued an official statement on 29 March 2020, which states that every woman has the right to information, to give consent, to refuse consent, and to have her choices and decisions respected and upheld. No research has been conducted in Lithuania to reveal the care of women who gave birth during the COVID-19 pandemic and the application of informed consent to interventions. METHODS This study is quantitative of cross-sectional design. An anonymous questionnaire survey method was used. One hundred fifty-two women who gave birth in Lithuania during the COVID-19 pandemic (March 2020 - May 2022) and had COVID-19 infection during childbirth, participated in the study. Statistical data analysis was performed. RESULTS During the COVID-19 pandemic, women's care was characterized by always or almost always adequate information from health professionals on all issues to minimize the stress of new procedures necessitated by the COVID-19 pandemic and allowing them to stay with newborns as long as possible. The application of the principle of informed consent to interventions during the COVID-19 pandemic was not always applied to the performance of transvaginal examination manual compression of the uterine fundus to facilitate the expulsion period. CONCLUSIONS Most women said that they were properly informed by healthcare professionals about all questions related to the new procedures that became necessary due to the COVID-19 pandemic and felt included in their own choice. However, mothers felt the need of relatives during childbirth, and consent was often not asked for vaginal examination. [ABSTRACT FROM AUTHOR]

INTRODUCTION Childbirth experiences depend on environmental factors, the provision of qualified medical and non-medical care, and the woman's psychological well-being. Stress experienced during pregnancy and childbirth affects a woman's psychological well-being. The aim of this study was to determine the care of women who gave birth during the COVID-19 pandemic in Lithuania. METHODS This qualitative study used an interview method to reveal women's childbirth experiences during and before the pandemic in Lithuania. The data obtained during the interview were analyzed using qualitative content analysis. Interviews were taken from 15 women who gave birth at least twice, i.e. the first time until March 2020 (but not earlier than March 2019) and gave birth again during the COVID-19 pandemic (March 2020 - January 2021). RESULTS A total of 15 women participanted in the interviews. The experience of childbirth before the COVID-19 pandemic was seen as largely positive by women, but childbirth during the COVID-19 pandemic was mentioned as more complex and negative because of the challenges posed by the pandemic, but easier for other reasons not affected by the pandemic. The results of our study show that a higher proportion of women were satisfied with delivery care in hospitals, were happy, and praised the work of midwives and other staff, which mainly contributed to a positive experience. CONCLUSIONS The COVID-19 pandemic posed particular challenges to women's childbirth experiences, and not enough attention was paid to mental health. The stress that was exacerbated during the pandemic period had a profound impact on the pregnant woman in Lithuania. [ABSTRACT FROM AUTHOR]

Background: Women in South Asia often return to their natal home during pregnancy, for childbirth, and stay through the postpartum period—potentially impacting access to health care and health outcomes in this important period. However, this phenomenon is understudied (and not even named) in the demographic or health literature, nor do we know how it impacts health. Objective: The aim of this study is to measure the magnitude, timing, duration, risk factors and impact on care of this phenomenon, which we name Temporary Childbirth Migration. Methods: Using data from 9,033 pregnant and postpartum women collected in 2019 in two large states of India (Madhya Pradesh and Bihar) we achieve these aims using descriptive statistics and logistic regression models, combined with qualitative data from community health workers about this practice. Results: We find that about one third of women return to their natal home at some point in pregnancy or postpartum, mostly clustered close to the time of delivery. Younger, primiparous, and non-Hindu women were more likely to return to their natal home. Women reported that they went to their natal home because they believed that they would receive better care; this was born out by our analysis in Bihar, but not Madhya Pradesh, for prenatal care. Conclusions: Temporary childbirth migration is common, and, contrary to expectations, did not lead to disruptions in care, but rather led to more access to care. Contribution: We describe a hitherto un-named, underexplored yet common phenomenon that has implications for health care use and potentially health outcomes. [ABSTRACT FROM AUTHOR]

The anti‐natalist philosopher David Benatar defends a position asserting that all life is harmful, and that it is, therefore, wrong to have children. In this paper, I critique Benatar's less‐discussed claim that his anti‐natalism provides solutions to population ethics problems, such as the Non‐Identity Problem, the Repugnant Conclusion, and the Mere Addition Problem, all of which are presented in Derek Parfit's Reasons and Persons. Since the publication of his Better Never to Have Been, Benatar has continued to claim that its provision of such solutions strengthens his defense of anti‐natalism. Although Benatar's view has received much criticism, this argument has not been discussed at length. I undertake a thorough examination of the argument and identify reasons to reject it. The central point of my critique is that the implications of Benatar's views in determining ranges of wrong and not‐wrong cases of procreation are extensionally inadequate when applied to the problems of population ethics. [ABSTRACT FROM AUTHOR]

INTRODUCTION Positive birth experiences can be a decisive factor in the well-being and future health of both women and their newborns. The quality of care is a multidimensional concept influenced by the external structure of the organization, the administrative qualities of the environment, and the individual patient’s preferences about care. The aim was to describe women’s preferences and experiences concerning support and treatment, and their perception of quality of care during all phases of labor and the postnatal period. METHODS Free-text comments of 635 women from four different open comment questions were analyzed. A qualitative content analysis was conducted in two steps: an inductive phase followed by a deductive phase using the Quality of care from a Patient’s Perspective framework (QPP). RESULTS A total of 1148 free-text comments were coded; and 10 sub-categories were created and inserted under the QPP framework covering the latent meaning of the subcategory. Five of the sub-categories were sorted under the identity-oriented approach, four under physical-technical conditions, and one under the sociocultural atmosphere and reflected the women’s experiences and needs regarding support and treatment during early labor, the active phase of labor, and the postnatal period. CONCLUSIONS High-quality care and support are important aspects for women during childbirth, irrespective of the phase of labor or postnatal period. The need for individualized care, active participation in one’s own birth and using a family centered approach were also emphasized. Organizational factors influenced the quality of care and were particularly noticeable during birth. [ABSTRACT FROM AUTHOR]

Christianity does not have as long of a history as other monotheistic religions and traditional ideologies in Korea, but—especially from the end of the 19th century—its new concepts have had a huge impact on the basic thoughts of Korean society. This paper focuses on the effects of Christianity and the activity of Christian communities on women’s lives. According to my preliminary findings, in the late 1800s, the Christian missionaries and their newly formed communities offered opportunities for girls and women to get education, a profession, access to better health care, and learn self-care. After the complicated decades between 1910 and 1950, South Korea was experiencing remarkable changes, and Christians were an active part of this rebuilding, helping the lives of those who were struggling with poverty, lack of daily necessities, education, and health care. This paper aims to examine the thoughts and actions of Korean Christian communities towards decisions on childbirth, children out of wedlock, adoption, and single motherhood. This study investigates the approaches of South Korean Christian communities towards women related to the above-mentioned circumstances, focusing on the early examples and the last five to six decades. It is assumed that even though South Korea is now considered a modernized country, the government sometimes fails to cope with current problems, and traditional notions are still strong in familial matters. Therefore, not obeying conventional forms may cause social conflicts, or the decisions are hidden because of taboos and stigmas. This research is based on the publications of Christian communities and involves documentaries and case studies, including the baby box operation and adoption. This paper contributes to the expanding studies on Korean Christian communities, highlighting the social norms and their changes generated by new religious thoughts, while giving an insight into the daily struggles of Korean women’s lives when it comes to decision-making about their motherhood.

Background: Routine health facility data are an important source of health information in resource-limited settings. Regular quality assessments are necessary to improve the reliability of routine data for different purposes, including estimating facility-based maternal mortality. This study aimed to assess the quality of routine data on deliveries, livebirths and maternal deaths in Kampala City, Uganda. Methods: We reviewed routine health facility data from the district health information system (DHIS2) for 2016 to 2021. This time period included an upgrade of DHIS2, resulting in two datasets (2016–2019 and 2020–2021) that were managed separately. We analysed data for all facilities that reported at least one delivery in any of the six years, and for a subset of facilities designated to provide emergency obstetric care (EmOC). We adapted the World Health Organization data quality review framework to assess completeness and internal consistency of the three data elements, using 2019 and 2021 as reference years. Primary data were collected to verify reporting accuracy in four purposively selected EmOC facilities. Data were disaggregated by facility level and ownership. Results: We included 255 facilities from 2016 to 2019 and 247 from 2020 to 2021; of which 30% were EmOC facilities. The overall completeness of data for deliveries and livebirths ranged between 53% and 55%, while it was < 2% for maternal deaths (98% of monthly values were zero). Among EmOC facilities, completeness was higher for deliveries and livebirths at 80%; and was < 6% for maternal deaths. For the whole sample, the prevalence of outliers for all three data elements was < 2%. Inconsistencies over time were mostly observed for maternal deaths, with the highest difference of 96% occurring in 2021. Conclusions: Routine data from childbirth facilities in Kampala were generally suboptimal, but the quality was better in EmOC facilities. Given likely underreporting of maternal deaths, further efforts to verify and count all facility-related maternal deaths are essential to accurately estimate facility-based maternal mortality. Data reliability could be enhanced by improving reporting practices in EmOC facilities and streamlining reporting processes in private-for-profit facilities. Further qualitative studies should identify critical points where data are compromised, and data quality assessments should consider service delivery standards. [ABSTRACT FROM AUTHOR]

Background: National level Sex Ratio at Birth (SRB) is normal in Bangladesh despite its patriarchal social structures, strong son preference, and low fertility level, widely recognized as preconditions for Gender-Biased Sex Selection (GBSS). To better understand this anomaly, we examine the trend in SRB in a sub-district in Bangladesh and assess the impact of the introduction of fetal sex-detection technology and the history of induced abortion on child sex using longitudinal data. Methods: We have used secondary data collected routinely by icddr, b's Matlab Health and Demographic Surveillance System (HDSS) between 1982 and 2018. All births occurring during this period (N = 206,390) were included in the analyses. We calculated the SRB and used multivariate logistic regression analyses to assess the likelihood of birth of a male child before and after the introduction of ultrasonogram in Matlab. Results: Overall, SRB was within the natural limit (106) during 1982–2018 in Matlab. SRB among women with a history of induced abortion was 109.3 before the introduction of ultrasonography in 2001 and 113.5 – after 2001. Women's history of induced abortion prior to introduction of ultrasonogram (1982–2000) increased the likelihood of birth of a male child 1.06 times (AOR 1.06; 95% CI- 1.01–1.11). In the period after, however, this likelihood was 1.08 (AOR 1.08; 95% CI- 1.02–1.15). Conclusions: In a context with normal SRB, it was found to be skewed among women who had induced abortion. SRB was relatively more skewed among such women after the advent of ultrasonogram compared to a period without ultrasonogram. Moreover, induced abortion after introduction of fetal sex determination technology increased the likelihood of birth of a male child. These findings suggest the plausibility of GBSS in a sub-group. Further research is needed, particularly in regions with skewed SRB to examine whether GBSS is indeed a threat to Bangladesh. [ABSTRACT FROM AUTHOR]

Background: Many young couples are planning to share paid work, childcare, and housework equally between each other. But implementing such a 50/50-split-model is difficult and parents often return to traditional gender role distributions after the birth of a child. This return has potential negative effects on mental health, physical health, and relationship satisfaction. Therefore, this study aims to find practicable strategies on a behavioral-level which new parents can apply in their daily routine to successfully implement the 50/50-split-model if they wish to do so. Methods: This qualitative study, DREAMTALK, is part of the multi-method, prospective Dresden Study on Parenting, Work, and Mental Health (DREAM). For DREAMTALK, N = 25 parents implementing a 50/50-split-model were selected based on quantitative data regarding time use, which participants had provided in questionnaires. In DREAMTALK, problem-centered interviews were conducted with the selected sample at 17 months postpartum. Those were analyzed via qualitative content analysis, which is systematic, rule-guided, and based on the criteria of validity and reliability. Results: The qualitative content analysis revealed a catalog of 38 practicable strategies to manage daily routine, which can help parents to successfully implement a 50/50-split-model. Individual participants used 23 success strategies on average. Examples include having a regular coordination appointment with the other parent, planning foresightedly, flexibility, reducing cleaning, optimization of routes, or moderate split-shift parenting. Some of these strategies seem opposing, e.g., planning foresightedly, and at the same time, meeting unpredicted changes with flexibility. Those seemingly opposing strategies were well balanced by the participants, which was an additional strategy. Conclusions: Parents can use the success strategies relatively independently of external circumstances. This behavioral perspective extends prior theories, which have focused on explaining unequal gender role distributions with external circumstances. A behavioral perspective can be a gateway to assist more parents to pioneer in implementing the 50/50-split-model, which might in turn lead to a healthier and more satisfied public population. [ABSTRACT FROM AUTHOR]

Background: While previously considered a transient condition, with no lasting adverse impact, gestational diabetes mellitus (GDM) is now a well‐established risk factor for developing type 2 diabetes mellitus (T2DM). The risk of developing T2DM appears to be particularly high in the first few years after childbirth, providing a compelling case for early intervention. This review provides an up‐to‐date systematic review and meta‐analysis to assess the effectiveness of interventions to reduce incidence of T2DM in women with a recent history of GDM. Methods: The search was conducted on October 20, 2023 with an annual surveillance planned for the next 5 years to maintain a living systematic review. The inclusion criteria were randomized controlled trials of any type in women within 5 years of GDM‐complicated pregnancy that reported outcomes of T2DM diagnosis or measures of dysglycemia with a follow‐up of at least 12 months. Results: Seventeen studies met our inclusion criteria and have been included in this review. There were 3 pharmacological and 14 lifestyle interventions. Intervention was not associated with significant reduction in the primary outcome of T2DM (risk ratio, 0.78; 95% confidence interval [CI]: 0.43–1.41; p = 0.41; I2 = 79%) compared with the control group (placebo or usual care). However, meta‐analysis of the four studies reporting hazard ratios suggested a reduction in diabetes incidence (hazard ratio, 0.68; 95% CI: 0.48–0.97; p = 0.03; I2 = 31%). Conclusion: This review provides equivocal evidence about the efficacy of interventions to reduce the risk of T2DM in women within 5 years of GDM‐complicated pregnancy and highlights the need for further studies, including pharmacotherapy. [ABSTRACT FROM AUTHOR]

Background: Promoting the work adaptation of nurses returning to work after childbirth is key to improving their physical and mental health and ensuring the quality of nursing care. Although postpartum nurses have reported high work stress and poor adaptation after returning to work, little is known regarding the experiences, problems and further needs. This study aimed to explore the adaptation experiences of postpartum nurses returning to work. Methods: This was a qualitative study with descriptive phenomenological approach. Individual semi-structured interviews were conducted between March and May 2023 in four tertiary hospitals in Changsha, mainland China, which were selected using convenience sampling. A total of 16 postpartum nurses returning to work within one year were recruited using purposive sampling and maximum variation sampling. The interviews were analysed using the Colaizzi's 7-step method. Results: 'Breakdown and healing' is a strong thread in postpartum nurses' work adaptation. It links 13 subthemes in the interview data, which can be grouped under three overarching themes: (a) changes and challenges of multiple roles; (b) self-coping and social support; and (c) further needs after returning to work. The phrase 'breakdown and healing' reflects the mutual relationship between stress and coping among postpartum nurses. The changes and challenges associated with being required to fulfil multiple roles of mothers, wives and nurses make the subjects feel on the verge of 'breakdown'. When returning to work, most of them move slowly towards 'healing' through positive self-management and support from their partners, families, supervisors and colleagues. Moreover, their ongoing demands and unsolved problems – such as their desire for a workplace that is friendly and serves their needs – were generated by the constant process of 'breakdown and healing'. Conclusions: Understanding how postpartum nurses returning to work perceive adaptation experiences is essential for nursing managers, who can use the findings to implement targeted measures to shorten postpartum nurses' maladaptation period after returning to work and promote their work adaptation. This study underscores the critical importance of personalized return-to-work training, flexible work arrangements, support from colleagues and managers, well-established maternal facilities and services, and targeted policy efforts in enhancing postpartum nurses' work adaptation. [ABSTRACT FROM AUTHOR]

Background: Childbirth pain is a physiological phenomenon during the delivery process, the intense pain of childbirth could bring harmful effects to pregnant women and their babies. Assessment of childbirth pain is the first step in childbirth pain intervention. Some pain assessment scales have shortcomings such as interfering in the birthing process and affecting pain perception during delivery, while the Rating Scale of Pain Expression during Childbirth (ESVADOPA) could be used as an auxiliary scale to compensate for these shortcomings. The purpose of this study was to introduce the ESVADOPA and adapt it among Chinese pregnant women to check on the psychometric properties of the translated version of ESVADOPA. Methods: A new translation model based on Brislin's classical back translation model was used to translate and cross-cultural adapt the ESVADOPA. During June 2021 and June 2022, pregnant women at Shandong Provincial Hospital Affiliated to Shandong First Medical University were invited. In the stage of translation and cross-culturally adaptation, 18 midwives and 30 pregnant women were invited to participate in the first round of pre-experiment. And in the second round of pre-experiment, 15 midwives and 20 pregnant women were invited to participate. The Chinese version of ESVADOPA was tested on a group of pregnant women (N = 487). Construct validity was evaluated by exploratory factor analysis, confirmatory factor analysis and criterion-related validity. Reliability was assessed by Cronbach's α coefficient, McDonald Omega, Spearman-Brown split-half reliability and Guttman split-half reliability. Results: The item statistical analysis and construct validity resulted in six items and one factor that explained 61.064% of the total variance. Confirmatory factor analysis showed that the data fit the one-factor structure. Criterion-related validity indicated that the scale is significantly and positively correlated with the Numeric Rating Scale (NRS). Cronbach's α coefficient, McDonald Omega, Spearman-Brown split-half reliability, and Guttman split-half reliability of the Chinese version of ESVADOPA were 0.868, 0.896, 0.845, 0.842, respectively. Conclusion: The Chinese version of the ESVADOPA with good reliability and validity data could be used to assess the pain rating of pregnant women during childbirth without interfering in the birthing process. [ABSTRACT FROM AUTHOR]

Background: Testing positive for COVID-19 was associated with higher rates of detrimental psycho-social and physical health outcomes. The COVID-19 pandemic caused unprecedented disruption to everyday life. This included major reconfiguration of maternal, child, and perinatal mental health and care services and provision. This study aimed to investigate the experiences of those who tested positive for COVID-19 during pregnancy, labour and birth, or the early postnatal period. Methods: National on-line recruitment from across the United Kingdom resulted in sixteen mothers being invited to qualitative semi-structured interviews to understand the experiences of mothers who had been infected by COVID-19 during pregnancy, labour and birth, or the early postnatal period. Interviews were conducted, recorded, and transcribed using video-conferencing software. A Grounded Theory approach was used to analyse the data gathered pertaining to women's experiences of their positive COVID-19 diagnosis during pregnancy, labour and birth, or the early postnatal period. Results: The theory of 'Oscillating Autonomy – Losing and Seeking to Regain Control by Striving for Agency' was developed, comprising three main themes: 'Anxious Anticipation: The fear of infection was worse than COVID-19 itself'; 'Fluctuating Agency: What changed when COVID-19 took control'; and 'Reclaiming Control: Seeking reassurance during COVID-19 positivity'. Testing positive for COVID-19 whilst pregnant, during labour or birth, or in the early postnatal period was associated with a perceived loss of control. Those who were able to regain that control felt more secure in their situation. Conclusions: Support was paramount to manage increased vulnerability, as was reassurance achieved by information seeking and positive action including increased health monitoring and COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

Background: According to the Seventh National Census, China's fertility rate is less than 1.5, marking a significant national issue with potential risks. To counter this low birth rate, the Chinese government has relaxed family planning policies and introduced supportive measures. Purpose: Changes in birth policy have attracted considerable attention from the people of China. This article aims to study the public's response to the three-child support policy using Weibo as a window. The goal is to provide a more balanced evaluation of current perspectives, enabling policymakers to formulate better fertility information, particularly when anticipating a poor public response to controversial policies. Methodology: This research uses a crawler to gather data from Sina Weibo. Through opinion mining of Weibo posts on the three-child policy, Weibo users' online opinions on the three-child policy are analyzed from two perspectives: their attention content and sentiment tendency. Using an interrupted time series, it examines changes in online views on the policy, matching policy documents to the time nodes of Weibo posts. Findings: The public has shown great interest in and provided short-term positive feedback on policies related to improving maternity insurance, birth rewards, and housing subsidies. In contrast, there has been a continuous negative response to policies such as extending maternity leave, which has particularly sparked concerns among women regarding future employment and marital rights protection. On social media, the public's attention to the three-child birth policy has focused mainly on the protection of women's rights, especially legal rights after childbirth, and issues related to physical and mental health. Child-rearing support and economic pressure are also hot topics, involving the daily expenses of multichild families, childcare services, and housing pressure. However, this study also revealed that infertile or single women express a strong desire to have children, but due to limitations in the personal medical insurance system, this desire has not been fully satisfied. Contributions: Our study demonstrates the feasibility of a rapid and flexible method for evaluating the public response to various three-child supportive policies in China using near real-time social media data. This information can help policy makers anticipate public responses to future pandemic three-child policies and ensure that adequate resources are dedicated to addressing increases in negative sentiment and levels of disagreement in the face of scientifically informed but controversial, restrictions. [ABSTRACT FROM AUTHOR]

Objectives: The use of internet-based search engines for health information is very popular and common. The Internet has become an important source of health information and has a considerable impact on patient's decision making process. Knowledge of pregnant women about childbirth comes from health professionals and personal experiences described by friends or family members. There is a growing interest in digital sources used by pregnant women. Analysis of queries related to regarding to natural childbirth and cesarean section in the Google search engine. Material and methods: In this infodemiology, descriptive study tool "AlsoAsked" was used. This is a tool for analyzing data appearing in Google search results. "AlsoAsked" search was conducted on April 19, 2023. Search phrases "natural childbirth" and "cesarean section" in polish language were used. Questions that were typed into the Google search engine, ranked according to popularity (volume) and thematic connections have been discussed. Results: The most frequently asked questions were related to the course and duration of labor as well as the preparation for labor and cesarean section (CS). Comparison between a natural labour and CS in the context of safety and pain received a great deal of attention. Conclusions: The most popular questions regarding CS were related to elective CS and indications for it. Some questions concerned the connection between labor and clinical state of a newborn. Women's healthcare should include education about the possibility of incorrect information provided by the Internet Web sites and information about trustworthy Web sites. [ABSTRACT FROM AUTHOR]

Background: Today, person-centred care is seen as a cornerstone of health policy and practice, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). The aim of this study was to explore Swedish health professionals' perspectives on CSMR and analyse them with regard to potential conflicts that may arise from person-centred care, specifically in relation to shared decision-making. Methods: A qualitative study using both inductive and deductive content analysis was conducted based on semi-structured interviews. It was based on a purposeful sampling of 12 health professionals: seven obstetricians, three midwives and two neonatologists working at different hospitals in southern and central Sweden. The interviews were recorded either in a telephone call or in a video conference call, and audio files were deleted after transcription. Results: In the interviews, twelve types of expressions (sub-categories) of five types of conflicts (categories) between shared decision-making and CSMR emerged. Most health professionals agreed in principle that women have the right to decide over their own body, but did not believe this included the right to choose surgery without medical indications (patient autonomy). The health professionals also expressed that they had to consider not only the woman's current preferences and health but also her future health, which could be negatively impacted by a CSMR (treatment quality and patient safety). Furthermore, the health professionals did not consider costs in the individual decision, but thought CSMR might lead to crowding-out effects (avoiding treatments that harm others). Although the health professionals emphasised that every CSMR request was addressed individually, they referred to different strategies for avoiding arbitrariness (equality and non-discrimination). Lastly, they described that CSMR entailed a multifaceted decision being individual yet collective, and the use of birth contracts in order to increase a woman's sense of security (an uncomplicated decision-making process). Conclusions: The complex landscape for handling CSMR in Sweden, arising from a restrictive approach centred on collective and standardised solutions alongside a simultaneous shift towards person-centred care and individual decision-making, was evident in the health professionals' reasoning. Although most health professionals emphasised that the mode of delivery is ultimately a professional decision, they still strived towards shared decision-making through information and support. Given the different views on CSMR, it is of utmost importance for healthcare professionals and women to reach a consensus on how to address this issue and to discuss what patient autonomy and shared decision-making mean in this specific context. Plain English summary: Person-centered care is today a widespread approach, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). This study examines Swedish health professionals' views on CSMR. Interviews with 12 health professionals reveal conflicts between CSMR and key aspects of person-centered care, in particular shared decision-making. While professionals acknowledge women's autonomy, they question CSMR without medical need. Concerns include for example treatment quality and patient safety, and avoiding treatments that harm others. The Swedish context, balancing collective solutions with individualized care, complicates decision-making. Unlike countries with more private healthcare, where CSMR support might be higher, Swedish health professionals emphasize shared decision-making despite viewing the mode of delivery as primarily a professional decision. This study sheds light on the challenges in integrating CSMR into person-centered care frameworks. [ABSTRACT FROM AUTHOR]

Introduction: Data concerning the mechanical properties of the perineum during delivery are very limited. In vivo experiments raise ethical issues. The aim of the study was to describe some of the biomechanical properties of each perineal tissue layer collected from sows in order to better understand perineal tears during childbirth. Material and methods: Samples of each perineal tissue layer were obtained from the skin, the vagina, the external anal sphincter (EAS), the internal anal sphincter (IAS), and the anal mucosa of fresh dead sows. They were tested in quasi‐static uniaxial tension using the testing machine Mach‐1®. Tests were performed at a displacement velocity of 0.1 mm·s−1. Stress–strain curves of each perineal tissue layer before the first damage for each sow were obtained and modeled using a hyperelastic Yeoh model described by three coefficients: C1, C2, and C3. Pearson correlation coefficients were calculated to measure the correlation between the C1 hyperelastic coefficient and the duration between the first microfailure and the complete rupture for each perineal tissue layer. Pearson correlation was computed between C1 and the number of microfailures before complete rupture for each tissue. Results: Ten samples of each perineal tissue layer were analyzed. Mean values of C1 and corresponding standard deviations were 46 ± 15, 165 ± 60, 27 ± 10, 19 ± 13, 145 ± 28 kPa for the perineal skin, the vagina, the EAS, the IAS, and the anal mucosa, respectively. According to this same sample order, the first microfailure in the population of 10 sows appeared at an average of 54%, 27%, 70%, 131%, and 22% of strain. A correlation was found between C1 hyperelastic coefficient and the duration between the first microfailure and the complete rupture (r = 0.7, p = 0.02) or the number of microfailures before complete rupture only for the vagina (r = 0.7, p = 0.02). Conclusions: In this population of fresh dead sow's perineum, the vagina and the anal mucosa were the stiffest tissues. The IAS and EAS were more extensible and less stiff. A significantly positive correlation was found between C1 and the duration between the first microfailure and the complete rupture of the vagina, and the duration between the first microfailure and the complete rupture of the vagina. [ABSTRACT FROM AUTHOR]

Background: Childbirth reserves respect, as emphasized by the World Health Organization in 2018, and the focus towards the need for positive, dignified delivery experiences has become an integral aspect of Respectful Maternity Care (RMC). It is a known fact that RMC is pivotal for favourable birth outcomes and contributes to the satisfaction of maternity care. The absence of RMC negatively affects women's and newborns' rights. The study aimed to explore healthcare providers' perspectives on sustaining RMC actions that mothers previously reported. Methodology: This study was conducted in five hospitals in the Eastern province of Rwanda, involving 5 Focus Group Discussions (FGDs) with midwives and nurses. For interviews, we purposively selected 5-unit managers and five physicians. Additionally, 40 midwives and nurses were recruited for the FGDs. The research utilized the Dream phase of Appreciative Inquiry (AI) for interviews and Focus Groups. Data collection aimed to gain insights into Healthcare Providers' perceptions of how RMC is provided and how to establish and sustain RMC in Rwandan health facilities. Nvivo 12 was employed for organizing codes and creating a codebook, and thematic analysis was applied. Results: Four themes with sub-themes emerged. Namely, 1) Women-centered care, with Compassionate care, Privacy and confidentiality maintenance, Information provision and Liberty in decision making, Effective communication, Family involvement, Cleanliness, and Equality care. 2) Professionalism compliance with Motivated staff, Teamwork, Continuous development, Quality work provision, and Community trust. 3) RMC encounters 4) RMC sustenance. Conclusion and recommendations: The continuous pursuit of high RMC standards in Rwanda involves improving childbirth experiences through utilizing existing resources, ongoing improvement, and sustaining achievements. Key recommended actions in this study for sustaining RMC encompass promoting women-centred care, enhancing healthcare provider attitudes, ensuring professionalism, building community trust, maintaining conducive health facility environments, and involving leadership. [ABSTRACT FROM AUTHOR]

Background: The birth plan is a document expressing a pregnant woman's childbirth preferences, enabling communication of expectations and facilitating discussions among women, their partners, and healthcare providers for key birthing decisions. There has been limited research on the role of birth plans in shared decision-making (SDM). Our study aims to explore how the use of birth plans can contribute to SDM from women's, partners, and healthcare providers' perspectives. Methods: We conducted in-depth interviews with women, their partners, and their healthcare providers. We used a thematic analysis to identify themes and subthemes. Furthermore, we created a grounded theory about the role of birth plans as a tool in SDM. Results: Three main themes were created: "Creating a birth plan", "Getting all on board" and "Birth plans in the daily practice of decision-making". Most women, partners, and healthcare providers agreed that birth plans can facilitate communication and SDM. Women and their partners viewed the birth plan as a tool to prepare for birth. Most healthcare providers mentioned the birth plan as a tool to get to know the women, their partners, and their preferences. Barriers are the attitude of healthcare providers toward birth plans, such as their evident resistance to the birth plan itself or to certain preferences. Another barrier is the assumption women and their partners may have that these plans can accurately predict the childbirth experience, enhancing the chance of a disappointing, negative experience. Some healthcare providers view birth plans as barriers to SDM. Conclusion: The use of a birth plan seems to promote women's, partners', and healthcare providers' involvement in the birth process, and seems suitable to facilitate SDM. Further research is required to explore strategies for overcoming barriers, including healthcare providers' attitudes toward birth plans and the expectations of women and their partners regarding their role. [ABSTRACT FROM AUTHOR]

Background: The existence of a valid instrument to evaluate the attitude of mothers towards compliance with medical ethics during childbirth can lead to appropriate interventions to create a positive attitude. The purpose of this study is to determine the construct validity of the MEAVDQ (Medical Ethics Attitude in Vaginal Delivery Questionnaire). Methods: The study was carried out with 350 women. The main research instrument was MEAVDQ. This 59-item questionnaire comprises three parts A, B, J. Part A is concerned with the first principles. Part B deals with the second and third principles and part J addresses the fourth principle of medical ethics. Structural Equations Modeling (SEM) was used to determine the construct validity of MEAVDQ. Results: The results of SEM revealed that there was a positive correlation between structures A and B. The relationship between structures B and J was also positive and significant. On the other hand, there was a direct and indirect relationship between structures A and J. One-unit increase in structure A led to 0.16 (95% CI: 0.01, 0.33) direct increase in structure J. Also, one-unit increase score increases in structure A caused 0.39 indirect rise (95% CI: 0.26, 0.53) in structure J with the mediating role of the structure B. Conclusions: It can be suggested to midwifery policy maker and midwives that respect for the first principle of medical ethics and autonomy is the most important principle of medical ethics in childbirth. By respecting the autonomy of mothers, a positive birth experience can be created for them. [ABSTRACT FROM AUTHOR]

Background: Experiencing childbirth as traumatic is common and can have long-lasting negative consequences for women's mental health. However, fostering a sense of social identity has been shown to protect psychological wellbeing and mental health during life transitions, such as entering parenthood. This study therefore investigated the relationship between traumatic childbirth and first-time mothers' social identity and their psychological wellbeing, and more specifically whether strength of identity as a first-time mother protected psychological wellbeing following traumatic childbirth. Method: Women over the age of 18 who were living in the UK and had given birth to their first child in the past nine months were recruited to the study from clinical and community settings. They completed digital self-report questionnaires about their birth experience, social identity, mental health, and psychological wellbeing. Women who perceived themselves to have had a traumatic birth (the trauma group; N = 84) were compared to women who did not perceive themselves to have had a traumatic birth (the control group, N = 39). T-tests and chi square tests assessed preliminary group differences before multivariate analyses of covariance controlled for covariates. Post-hoc tests identified the direction of differences. Multiple regression and moderation analyses analysed interaction effects. Results: The trauma group had significantly lower psychological wellbeing (mean = 41.5, 95% CI [39.4–43.7], p =.008, partial η2 = 0.059), compared to the control group (mean = 48.4, 95% CI [45.3–51.5]), but the two groups did not differ in the strength of their first-time mother identity, which was high across both groups. Strength of identity did not moderate the relationship between traumatic childbirth and psychological wellbeing. Giving birth by caesarean section independently reduced the strength of the first-time mother identity (p =.017, partial η2 = 0.049). All analyses controlled for emotional and practical support, perceptions of healthcare staff, and mode of birth. Conclusions: Having a traumatic birth was associated with lower psychological wellbeing, and the strength of first-time mother identity does not appear to moderate this relationship. Factors such as mode of birth may be more important. Further research, including longitudinal designs, is needed to understand the relationship between these constructs and identify more effective ways of protecting first-time mothers' mental health. [ABSTRACT FROM AUTHOR]

Background: This study evaluated early childhood comorbidities of cerebral palsy (CP) in low birth weight (LBW) children and assessed the impact of maternal bio-psychosocial factors on CP risk in preterm infants of varying birth weights (BWs). Methods: Data from 15,181 preterm infants (2009–2013) and 151,810 controls were analyzed using Taiwan's National Health Insurance Research Database. CP prevalence and LBW-associated comorbidities were examined, and odds ratios (ORs) were calculated. Results: This study confirmed increasing prematurity and LBW rates in Taiwan, with LBW infants showing higher CP prevalence. Significant maternal risk factors included age extremes (<20 and >40 years). LBW infants exhibited higher risks for respiratory, circulatory, nervous system, and psycho-developmental comorbidities compared with controls, with the lowest BW having even higher ORs. Maternal factors such as family income, the number of hospital admissions, and length of hospital stay were remarkably correlated with BW and subsequent complications. Each additional gestational week crucially reduced the risk of complications in premature infants. Conclusions: LBW infants are at a higher risk for CP and various comorbidities, with maternal bio-psychosocial factors playing a critical role. Addressing these factors in prenatal care and interventions is essential to improve outcomes for premature infants. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) is the most common form of violence against women. Postpartum IPV refers to any type of IPV that occurs up to one year after childbirth and has many adverse impacts on mothers and their children. Considering the lack of sufficient information on the prevalence and factors related to IPV after childbirth in Iran, this study aimed to evaluate the frequency and severity of IPV, its different forms, and psychosocial factors related to IPV, as well as to explore how IPV is perceived among mothers one year after childbirth. Methods: An explanatory sequential mixed-methods design was used to conduct this study in two phases. The first phase is a cross-sectional study that will be performed on postpartum mothers who have a one-year-old child referred to health care centers in the southern region of Tehran, Iran, with the aim of determining the prevalence of IPV and its related factors. The second phase is a qualitative conventional content analysis study with the purpose of exploring women's experiences and perceptions of IPV and its preventive or protective factors. Purposive sampling will be used. Based on the results of the quantitative phase, mothers who are at the two ends of the IPV spectrum (based on their total Conflict Tactics Scale (CTS-2) scores) will be selected, and in-depth and semistructured interviews will be conducted with them. Finally, the researchers will provide an interpretation of the quantitative results using qualitative data. Discussion: This is the first study that uses a mixed methods approach to explain different dimensions of IPV, its related factors, and mothers' perceptions of it. By providing a better understanding of this phenomenon, it is hoped that the results of this research will be used by policymakers and officials of educational and cultural systems to plan and provide effective interventions, enact laws, and present educational and cultural programs to prevent IPV after childbirth. Ethical code: IR.TUMS.FNM.REC1400.200. Plain English summary: Intimate partner violence is the most common form of violence against women, with a higher prevalence in Asian and Eastern Mediterranean countries, including Iran. The period after childbirth is a stressful and anxiety-provoking event due to the increased physical, psychological, social, and economic needs of parents, leading to intimate partner violence. Studies show that women who experience violence after childbirth face many physical, sexual, and emotional problems. Additionally, it will have a negative impact on their baby. Many factors can lead to intimate partner violence, among which psychological factors are among the most important. Therefore, we decided to perform a study in two phases with the aim of determining the prevalence and factors related to intimate partner violence. In the first phase, we will study Iranian women who have a one-year child living in southern Tehran city and ask them to complete questionnaires related to intimate partner violence. In the second phase, we will conduct an interview with women who have experienced violence after childbirth to obtain more information about the factors involved. [ABSTRACT FROM AUTHOR]

Aim: The centralization of Finnish maternity services can mean longer journeys when women are in labor. The aim of this study was to describe women's experiences of having an unplanned out-of-hospital delivery (OHD) and to produce a deeper understanding of how to support them when this happens. Design: Qualitative descriptive study design with narrative inquiry method. Methods: Individual interviews were carried out with 15 women who had an unplanned OHD and the data were analyzed using a narrative method. Results: Three narratives described the women's experiences of an unplanned OHD with a common plot being their sense of control. In the first narrative, a sense of control was maintained; in the second, the sense of control fluctuated; and the third narrative centered on a loss of control. All the narratives were related to the women's experiences of what was happening to their body, the people around them during delivery, and the situation after the childbirth. Conclusion: Having an unplanned OHD forced women to reconsider their preconceptions and expectations of childbirth and focus on how to handle the situation at hand. A key factor was the sense of control they felt while giving birth, which should be considered a core principle in maternity care practices, from antenatal care to delivery. [ABSTRACT FROM AUTHOR]

Aim: The aim of the research was to find significant factors that influence women's satisfaction with childbirth. Design: A cross-sectional study design was chosen. Methods: The Czech version of the Birth Satisfaction Scale - Revised, supplemented with demographic questions and questions related to the process of childbirth, was used for data collection. The online questionnaire was completed by 870 women who met the inclusion criteria for the study. Results: Several statistically significant results were found: women's satisfaction with childbirth increases with increasing age (p < 0.05), secondary / multipara women are more satisfied with the experience of childbirth than primipara women (p < 0.05), and the experience of spontaneous vaginal birth leads to higher satisfaction than operative birth (p < 0.05). The term of delivery, place, and perception of pain during delivery also influence women's satisfaction with birth (p < 0.05). Conclusion: The midwife's duty in caring for the woman is not only to ensure safety but also to promote the emergence of a positive and satisfying experience. Situations such as acute operative delivery or preterm birth are unavoidable in obstetrics. However, respectful care and emotional support provided during labor can develop women's ability to perceive control over the situation, cope with labor pain and prevent negative experiences. [ABSTRACT FROM AUTHOR]

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Physical activity during pregnancy is established to derive clinically meaningful improvements in pregnancy, childbirth, and postpartum health outcomes. Evidence-based pre-screening tools have been developed to support the implementation of physical activity programmes, and enhance communication between health care providers, exercise professionals and pregnant women. The Get Active Questionnaire for Pregnancy (GAQ-P) and the Health Care Provider Consultation Form for Prenatal Physical Activity (HCPCF) empower pregnant women to identify whether they require additional counselling from their obstetric health care provider in terms of physical activity. However, these tools are not available in Polish. This work details the process taken to translate the GAQ-P and HCPCF into Polish. Material and Methods: We followed the translation process outlined by the Translation and Cultural Adaptation International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines between August 2022 and August 2023. We formed an expert group that included representatives of the Polish Society of Sports Medicine, The Polish Society of Gynaecologists and Obstetricians, practitioners, and scientists in physical activity during pregnancy. We implemented 9 of the 10 steps recommended by ISOPR in the translation process. At the Cognitive Debriefing stage, we collected opinions on the Polish version of GAQ-P and HCPCF from 70 stakeholders on the clarity and cultural appropriateness of the translation. Results and Conclusions: Target users have positively evaluated the Polish version of GAQ-P and HCPCF. Thanks to the ISPOR methodology, we obtained a trustworthy, evidence-based screening tools, which can reduce the barriers for most women to be physically active during pregnancy. [ABSTRACT FROM AUTHOR]

INTRODUCTION Childbirth and parenting classes are very important because they potentially help couples to make the right decisions during pregnancy, childbirth, and the postpartum period, which has a direct effect on the health of the mother and neonate. However, in Cyprus, the culture of childbirth and parenting classes has not been previously explored. METHODS An ethnographic study design was adopted, specifically non-participant observation was undertaken of 19 classes. Semi-structured telephone interviews were employed to collect data in addition to field notes and a reflective diary. Inductive content analysis was undertaken to analyze the data. RESULTS Four main thematic categories emerged from data analysis: 1) Views and opinions about the course, 2) Important perinatal topics, 3) Usefulness and reasons for attending the classes, and 4) The journey of learning. The importance of antenatal classes has not been given sufficient attention in Cyprus. CONCLUSIONS There is a clear need for a standardized curriculum within the current configuration of national maternity healthcare in Cyprus. Policymakers must implement a standardized curriculum, integrating diverse pedagogical methods to provide indepth information for expectant parents and parents. While emphasizing the crucial role of midwives in perinatal education, this study also advocates for collaboration with other healthcare professionals emphasizing the imperative need for a comprehensive, standardized approach to perinatal education within the national healthcare system of Cyprus. [ABSTRACT FROM AUTHOR]

Introduction: Women with polycystic ovary syndrome (PCOS) have more pregnancy complications like gestational diabetes, hypertension, and preterm labor than other women. Metformin has been used in an attempt to improve pregnancy outcomes. Our study aims to explore childbirth experiences in women with PCOS compared with a reference population. It also explores the potential influence of metformin, obesity, pregnancy complications, and the duration and mode of birth on childbirth experiences. Material and methods: This study is a cohort study combining data from two randomized trials conducted in Norway, Sweden and Iceland. The PregMet2 study (ClinicalTrials.gov, NCT01587378) investigated the use of metformin vs. placebo in pregnant women with PCOS. The Labour Progression Study (ClinicalTrials.gov, NCT02221427) compared the WHO partograph to Zhang's guidelines for progression of labor and were used as the reference population. A total of 365 women with PCOS and 3604 reference women were included. Both studies used the Childbirth Experience Questionnaire (CEQ). Main outcome measures were total CEQ score and four domain scores. The CEQ scores were compared using Mann–Whitney U test for women in Robson group 1 with PCOS (n = 131) and reference women (n = 3604). CEQ scores were also compared between metformin‐treated (n = 180) and placebo‐treated (n = 185) women with PCOS, and for different subgroups of women with PCOS. Results: There was no difference in total CEQ score between women with PCOS and reference women—Wilcoxon–Mann–Whitney (WMW)‐odds 0.96 (95% confidence interval [CI] 0.78–1.17). We detected no difference in CEQ scores between the metformin‐ and placebo‐treated women with PCOS (WMW‐odds 1.13, 95% CI 0.89–1.43). Complications in pregnancy did not affect CEQ (WMW‐odds 1, 95% CI 0.76–1.31). Higher body mass index (WMW‐odds 0.75, 95% CI 0.58–0.96), longer duration of labor (WMW‐odds 0.69, 95% CI 0.49–0.96), and cesarean section (WMW‐odds 0.29, 95% CI 0.2–0.42) were associated with lower CEQ scores in women with PCOS. Conclusions: Women with PCOS experience childbirth similarly to the reference women. Metformin did not influence childbirth experience in women with PCOS, neither did pregnancy complications. Obesity, long duration of labor or cesarean section had a negative impact on childbirth experience. [ABSTRACT FROM AUTHOR]

Life expectancy at birth is considered a parameter of the social development, health system, or economic development of a country. We aimed to investigate the effects of GDP per capita (as the economic factor), health care expenditure, the number of medical doctors (as social factors), and CO2 emissions (as the environmental factor) on life expectancy. We used panel data analysis for 13 Eastern European countries over the 2000–2020 period. After performing the analysis, we used a cross-country fixed-effects panel (GLS with SUR weights). According to our model, a one percent increase in health expenditure (as % of GDP) increases life expectancy at birth by 0.376 years, whereas each additional medical doctor per 10,000 inhabitants increases life expectancy at birth by 0.088 years on average. At the same time, each additional 10,000 USD per capita each year would increase life expectancy at birth by 1.8 years on average. If CO2 emissions increase by 1 metric ton per capita, life expectancy at birth would decrease by 0.24 years, suggesting that higher carbon emissions are capable of reducing longevity. Every European country has to make special efforts to increase the life expectancy of its inhabitants by applying economic and health policies focused on the well-being of the population. [ABSTRACT FROM AUTHOR]

To determine the usefulness of combining two methodologies (OSCE and escape room) in a scenario simulation to evaluate a subject, and determine the evaluation of the students of this experience. An observational cross-sectional study was carried out with students enrolled in a sexual and reproductive health-care course as a part of their nursing degree. The students had to solve four clinical cases based on the contents of the teaching practices of the subject by solving clues that led them to carry out procedures and techniques and provide care in scenario simulators. Students evaluated the experience using the GAMEX (Gameful Experience in Gamification) scale. Mean differences were estimated with their respective 95% confidence intervals. A total of 124 students participated. Of these, 63.7% (79) solved the clinical cases with their knowledge and skills. Most (80.6%, 100) students stated that they completely remembered and applied the knowledge of the topic during the game. Almost all (98.4%, 122) would recommend this experience. The dimensions with the best rating on the GAMEX scale were "fun", with an average score of 4.7 points (0.49), followed by "critical thinking", with 4.2 (0.59). Women presented statistically better scores than men (mean difference: 1.58; 95% CI: 0.55, 2.61). The OSCE combined with an escape room using scenario simulations may be a useful tool to evaluate the subject. In addition, the students were satisfied, had fun, and recommended the experience. This study was not registered. [ABSTRACT FROM AUTHOR]

Background: Approximately 10% of newborns require assistance at delivery, and heart rate (HR) is the primary vital sign providers use to guide resuscitation methods. In 2016, the American Heart Association (AHA) suggested electrocardiogram in the delivery room (DR-ECG) to measure heart rate during resuscitation. This study aimed to compare the frequency of resuscitation methods used before and after implementation of the AHA recommendations. Methods: This longitudinal retrospective cohort study compared a pre-implementation (2015) cohort with two post-implementation cohorts (2017, 2021) at our Level IV neonatal intensive care unit. Results: An initial increase in chest compressions at birth associated with the introduction of DR-ECG monitoring was mitigated by focused educational interventions on effective ventilation. Implementation was accompanied by no changes in neonatal mortality. Conclusions: Investigation of neonatal outcomes during the ongoing incorporation of DR-ECG may help our understanding of human and system factors, identify ways to optimize resuscitation team performance, and assess the impact of targeted training initiatives on clinical outcomes. [ABSTRACT FROM AUTHOR]

Postpartum hemorrhage (PPH) represents a significant threat to maternal health, particularly in developing countries, where it remains a leading cause of maternal mortality. Unfortunately, only 60% of pregnant women at high risk for PPH are identified, leaving 40% undetected until they experience PPH. To address this critical issue and ensure timely intervention, leveraging rapidly advancing technology with machine learning (ML) methodologies for maternal health prediction is imperative. This review synthesizes findings from 43 selected research articles, highlighting the predominant ML techniques employed in PPH prediction. Among these, logistic regression (LR), extreme gradient boosting (XGB), random forest (RF), and decision tree (DT) emerge as the most frequently utilized methods. By harnessing the power of ML, we aim to foster technological advancements in the healthcare sector, with a particular focus on maternal health and ultimately contribute to the reduction of maternal mortality rates worldwide. [ABSTRACT FROM AUTHOR]

Aneurysmal subarachnoid hemorrhage (aSAH) can be prevented by early detection and treatment of intracranial aneurysms in high-risk individuals. We investigated whether individuals at high risk of aSAH in the general population can be identified by developing an aSAH prediction model with electronic health records (EHR) data. To assess the aSAH model's relative performance, we additionally developed prediction models for acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) and compared the discriminative performance of the models. We included individuals aged ≥35 years without history of stroke from a Dutch routine care database (years 2007–2020) and defined outcomes aSAH, AIS and ICH using International Classification of Diseases (ICD) codes. Potential predictors included sociodemographic data, diagnoses, medications, and blood measurements. We cross-validated a Cox proportional hazards model with an elastic net penalty on derivation cohorts and reported the c-statistic and 10-year calibration on validation cohorts. We examined 1,040,855 individuals (mean age 54.6 years, 50.9% women) for a total of 10,173,170 person-years (median 11 years). 17,465 stroke events occurred during follow-up: 723 aSAH, 14,659 AIS, and 2,083 ICH. The aSAH model's c-statistic was 0.61 (95%CI 0.57–0.65), which was lower than the c-statistic of the AIS (0.77, 95%CI 0.77–0.78) and ICH models (0.77, 95%CI 0.75–0.78). All models were well-calibrated. The aSAH model identified 19 predictors, of which the 10 strongest included age, female sex, population density, socioeconomic status, oral contraceptive use, gastroenterological complaints, obstructive airway medication, epilepsy, childbirth complications, and smoking. Discriminative performance of the aSAH prediction model was moderate, while it was good for the AIS and ICH models. We conclude that it is currently not feasible to accurately identify individuals at increased risk for aSAH using EHR data. [ABSTRACT FROM AUTHOR]