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Postpartum mothers are susceptible to lumbopelvic pain which may be exacerbated by loading, like carrying their infant in arms and with baby carriers. Nulliparous women carrying infant mannequins may biomechanically mimic mother–infant dyad, but this has not been studied. The purpose of our study was to investigate biomechanical differences of 10 mothers carrying their infants and 10 nulliparous women carrying infant mannequins under 3 gait conditions: carrying nothing, carrying in arms, and carrying in a baby carrier (babywearing). Spatiotemporal gait parameters, peak ground reaction forces and impulses, and lower extremity and trunk kinematics were collected using motion capture and force plates and compared using a mixed 2 × 3 (parity × condition) analysis of variance (α ≤.05). The largest differences occurred between carrying conditions: carrying in arms or babywearing increased vertical and anteroposterior ground reaction forces, trunk extension, ankle dorsiflexion, and hip and knee flexion. Kinematic differences were identified between arms and babywearing conditions. Together this suggests alterations in joint loading for both groups. Our study also contributes a novel understanding of postpartum health by demonstrating alterations in step time, anterior forces, and ankle and knee mechanics, suggesting that during gait, mothers carrying their own infants choose different propulsive strategies than nulliparous women carrying mannequins. [ABSTRACT FROM AUTHOR]

BACKGROUND: Professional societies such as the American College of Obstetricians and Gynecologists (ACOG) promote the idea that postpartum care is an ongoing process where there is adequate opportunity to provide services and support. Nonetheless, in practice, the guidelines ask clinicians to perform more clinical responsibilities than they might be able to do with limited time and resources. METHODS: We conducted an online survey among practicing obstetric clinicians (obstetrician/gynecologists (OB/GYNs), midwives, and family medicine doctors) in California about their priorities and care practices for the first postpartum visit and explored how they prioritize multiple clinical responsibilities within existing time and resources. Between September 2023 and February 2024, 174 out of 229 eligible participants completed the survey, a 76% response rate. From a list of care components, we used descriptive statistics to identify those that were highly prioritized by most clinicians and those that were considered a priority by very few and examined the alignment between prioritized components and recommended care practices. RESULTS: Clinicians were highly invested in the care components that they rated as most important, indicating that they always check these components or assess them when they perceive patient need. Depression and anxiety, breast health/breast feeding issues, vaginal birth complications and family planning counseling were highly ranked components by all clinicians. In contrast, clinicians more often did not assess those care components that infrequently ranked highly among the priority listing, consisting mainly of social drivers of health such as screening and counseling for intimate partner violence, working conditions and food/housing insecurity. In both instances, we found little discordance between priorities and care practices. However, OB/GYNs and midwives differed in some care components that they prioritized highly. CONCLUSIONS: While there is growing understanding of how important professional society recommendations are for maternal-infant health, clinicians face barriers completing all recommendations, especially those components related to social drivers of health. However, what the clinicians do prioritize highly, they are likely to perform. Now that Medi-Cal (Medicaid) insurance is available in California for up to 12 months postpartum, there is a need to understand what care clinicians provide and what gaps remain.

BackgroundPregnant and postpartum women in Sub-Saharan Africa are at high risk of HIV acquisition. We evaluated a person-centered dynamic choice intervention for HIV prevention (DCP) among women attending antenatal and postnatal care.SettingRural Kenya and Uganda.MethodsWomen (aged 15 years or older) at risk of HIV acquisition seen at antenatal and postnatal care clinics were individually randomized to DCP vs. standard of care (SEARCH; NCT04810650). The DCP intervention included structured client choice of product (daily oral pre-exposure prophylaxis or postexposure prophylaxis), service location (clinic or out of facility), and HIV testing modality (self-test or provider-administered), with option to switch over time and person-centered care (phone access to clinician, structured barrier assessment and counseling, and provider training). The primary outcome was biomedical prevention coverage-proportion of 48-week follow-up with self-reported pre-exposure prophylaxis or postexposure prophylaxis use, compared between arms using targeted maximum likelihood estimation.ResultsBetween April and July 2021, we enrolled 400 women (203 intervention and 197 control); 38% were pregnant, 52% were aged 15-24 years, and 94% reported no pre-exposure prophylaxis or postexposure prophylaxis use for ≥6 months before baseline. Among 384/400 participants (96%) with outcome ascertained, DCP increased biomedical prevention coverage 40% (95% CI: 34% to 47%; P < 0.001); the coverage was 70% in intervention vs. 29% in control. DCP also increased coverage during months at risk of HIV (81% in intervention, 43% in control; 38% absolute increase; 95% CI: 31% to 45%; P < 0.001).ConclusionA person-centered dynamic choice intervention that provided flexibility in product, testing, and service location more than doubled biomedical HIV prevention coverage in a high-risk population already routinely offered access to biomedical prevention options.

BackgroundPrior research suggests that physicians' personal experience with breastfeeding may influence their attitudes toward breastfeeding. This phenomenon has not been explored in well-newborn care physician leaders, whose administrative responsibilities often include drafting and approval of hospital breastfeeding and formula supplementation policies.MethodsWe conducted a mixed-methods study, surveying physicians in the Better Outcomes through Research for Newborns (BORN) network. We examined physician attitudes toward recommending breastfeeding and their breastfeeding experience. Qualitative analysis was conducted on responses to the question: "How do you think your breastfeeding experience influences your clinical practice?"ResultsOf 71 participants, most (92%) had a very positive attitude toward breastfeeding with 75% of respondents reporting personal experience with breastfeeding. Of these, 68% had a very positive experience, 25% had a somewhat positive experience, and 6% had a neutral experience. Four themes emerged with respect to the effect of breastfeeding experience on practice: (1) empathy with breastfeeding struggles, (2) increased knowledge and skills, (3) passion for breastfeeding benefits, and (4) application of personal experience in lieu of evidence-based medicine, particularly among those who struggled with breastfeeding.ConclusionsWell-newborn care physician leaders reported positive attitudes about breastfeeding, increased support toward breastfeeding persons, and a perception of improved clinical lactation skills. Those who struggled with breastfeeding reported increased comfort with recommending formula supplementation to their own patients. Medical education about evidence-based breastfeeding support practices and provision of lactation support to physicians has the potential to affect public health through improved care for the patients they serve.

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Background: To further reduce maternal and neonatal mortality, it is essential for mothers and newborns to fully utilize all essential services within the continuum of maternal and newborn care. However, research on maternal and child health services in India has not sufficiently examined geographical disparities in the full utilization of these services and the factors influencing the full utilization, particularly in rural areas. This study aims to address this critical gap. Methods: Utilizing data from 130,312 mothers collected in the National Family Health Survey-5 (2019–21), this study employed spatial analysis to uncover geographical disparities in the full utilization of the continuum of maternal and newborn healthcare services in rural India. Additionally, binary logistic regression was used to identify the factors associated with this utilization. Results: In rural India, 54.3% mothers recieved four or more antenatal care visits, 88.6% received skilled birth attendance, and 75.5% of mothers and 79.8% of newborns received postnatal care within 48 hours of birth. However, only 43.5% mothers-newborn dyads in rural India utilized all four services of the continuum of maternal and newborn healthcare. There were significant geographical disparities in the full utilization of the continuum of maternal and newborn healthcare services. Hotspots were primarily identified in districts of southern states, western Maharashtra, and central Odisha, while cold spots were evident in the northeastern states of Arunachal Pradesh, Meghalaya, Assam, and Nagaland, as well as in the Empowered Action Group states of Bihar, Uttar Pradesh, and Jharkhand. Key determinants influencing the full utilization of the continuum of care in rural India included maternal education, household wealth, parity, health insurance coverage, and exposure to mass media. Specifically, the odds of fully utilizing the continuum of care were significantly lower among women without formal education (adjusted odds ratio = 0.60, 95% CI = 0.56–0.65), those from the poorest wealth quintile (0.65, 0.61–0.69), and mothers with six or more children (0.42, 0.37–0.47), compared to mothers with higher education, those in the richest wealth quintile, and mothers with a single child, respectively. Additionally, mothers from the southern region were more than twice as likely (2.11, 1.99–2.20) to fully utilize the continuum of healthcare services compared to mothers from the northern region. Conclusion: The significant geographical disparities in the full utilization of maternal and newborn healthcare services in rural India highlight the necessity for tailored, region-specific interventions. Future programs should focus on addressing the barriers to care by prioritizing vulnerable groups, including those who are poor, uninsured, less educated, adolescents, and women with high parity. [ABSTRACT FROM AUTHOR]

Background: The postpartum period is a window to engage birthing people in their long-term health and facilitate connections to comprehensive care. However, postpartum systems often fail to transition high-risk patients from obstetric to primary care. Exploring patient experiences can be helpful for optimizing systems of postpartum care. Methods: This is a qualitative study of high-risk pregnant and postpartum individuals. We conducted in-depth interviews with 20 high-risk pregnant or postpartum people. Interviews explored personal experiences of postpartum care planning, coordination of care between providers, and patients' perception of ideal care transitions. We performed thematic analysis using the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change as a framework. COM-B allowed for a formal structure to assess participants' ability to access postpartum care and primary care reengagement after delivery. Results: Participants universally identified difficulty accessing primary care in the postpartum period, with the most frequently reported barriers being lack of knowledge and supportive environments. Insufficient preparation, inadequate prenatal counseling, and lack of standardized care transitions were the most significant barriers to primary care reengagement. Participants who most successfully engaged in primary care had postpartum care plans, coordination between obstetric and primary care, and access to material resources. Conclusions: High-risk postpartum individuals do not receive effective counseling on the importance of primary care engagement after delivery. System-level challenges and lack of care coordination also hinder access to primary care. Future interventions should include prenatal education on the benefits of primary care follow-up, structured postpartum planning, and system-level improvements in obstetric and primary care provider communication. [ABSTRACT FROM AUTHOR]

Nearly 1 in 5 families with children in the United States are food insecure. Hospitalization of a child can exacerbate food insecurity, both during the hospitali-zation and after discharge. Although some hospitals provide free or subsidized meals during hospitalization, few address food insecurity in the immediate posthospitalization period. To address this gap, we developed an innovative Inpatient Food Pharmacy program. This program offers families of hospitalized children experiencing food insecurity a choice of 1 week of prepared meals, 6 months of monthly produce delivery, or both, after discharge. Our goals were to assess program enrollment, understand family preferences, and evaluate the program's feasibility and acceptability. Among 120 eligible families, 71 (59%) enrolled. Fifty-five families (77%) chose both prepared meals and produce delivery, 13 (18%) chose prepared meals only, and 3 (4%) chose produce delivery only. The program successfully delivered 6972 prepared meals and 348 boxes of produce over 10 months. Follow-up calls reached 41 (58%) of enrolled families, all of whom reported that the program met their acute food needs. Feedback from families and resource navigators suggested the program was acceptable. We aim to advocate for sustainable funding for food delivery for children and families experiencing food insecurity at 3 levels (1) institutionally, through our hospital's community benefit spending, (2) statewide, through a proposed Medicaid Section 1115 waiver providing grocery delivery to Medicaid-insured pregnant and postpartum individuals and their families, and (3) federally, through the Special Supplemental Nutrition Program for Women, Infants, and Children and the Supplemental Nutrition Assistance Program. [ABSTRACT FROM AUTHOR]

Aims: We aim to review the experiences and needs of postpartum Chinese women undergoing 'confinement' or 'doing‐the‐month' a postpartum practice after childbirth. Methods: A meta‐synthesis was reported in alignment with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. Ten electronic databases were searched for eligible primary qualitative or mixed‐methods studies in English and Chinese from their inception until December 2021. Two reviewers independently reviewed the methodological quality of the included studies using the 10‐item Critical Appraisal Skills Program (CASP) qualitative checklist, with discrepancies resolved through discussions. The meta‐synthesis was conducted based on the two‐step approach by Sandelowski and Barroso. Results: Four themes were meta‐synthesized from 13 studies: 'confinement' as an essential practice; physical and psychological stressors during 'confinement'; coping strategies by postpartum women; and needs for family, social, and professional support in enhancing satisfaction with 'confinement'. The review showed that 'confinement' remains a significant practice shaped by socio‐cultural and health constructs. Conclusion: This review suggested re‐evaluating the 'confinement' practice and promoting evidence‐based care to improve maternal well‐being. Nurses and midwives should be cognisant of such postpartum customs and adopt non‐judgemental attitudes as early as the prenatal period to provide culturally sensitive care. Summary statement: What is already known about this topic? 'Confinement' is said to aid physical recovery after childbirth.Studies have shown that this practice can lead to the development of postnatal blues among some postpartum women. What this paper adds? This review delineates how sociocultural factors govern postpartum women's beliefs, behaviours, and experiences during 'confinement', thus allowing healthcare professionals to better understand the influences of postpartum practices on maternal mental health. The implications of this paper: The novel insights herein will aid healthcare professionals in formulating culturally appropriate care to improve postnatal confinement experiences and maternal psychological well‐being. [ABSTRACT FROM AUTHOR]

In the study, we aimed to determine the effect of pregnant women's status of receiving preconception care on their pregnancy stress. This is a descriptive, correlational, and cross-sectional design study, we were conducted with the participation of 409 pregnant women between June-December 2019. The Pregnancy Stress Rating Scale total score mean was found to be 30.72 ± 20.26. Individuals who received medication and vitamins as part of preconceptional care had significantly higher scores (p < 0.05; p < 0.001) compared to those who did not receive them for total pregnancy stress, postpartum social support, infant health, and infant identity-care stress. Similarly, individuals who received medical treatment and regular checkups had significantly higher scores (p < 0.05) compared to those who did not for total pregnancy stress, postpartum social support, infant identity-care, body image and psychological state during pregnancy stress scores. In addition, individuals who maintained a healthy lifestyle had significantly higher scores (p < 0.05; p < 0.001) compared to others for infant health, infant identity-care, and psychological distress during pregnancy. It was determined that women who made preparations for their pregnancy experienced more stress related to their babies (baby's health, baby's identity and care), psychological status in pregnancy, prenatal and postnatal social support, and body image. [ABSTRACT FROM AUTHOR]

Vaccination against measles still stands as a highly impactful public health strategy for mitigating childhood morbidity and mortality. Relatively poor immunization coverage among children has been observed in low and middle-income countries (LMICs). Our study intended to determine socio-demographic factors associated with the 1st dose of measles vaccination among South Asian (SA) and SubSaharan African (SSA) countries children. This was a cross-sectional study. This study utilized demographic and health survey data from 42 low-and middle-income countries (LMICs) in SA and SSA. The children's dataset yielded 255,775 children between the ages of 12 and 59 months. The independent predictors were determined by using crude and adjusted odds ratios with 95% confidence intervals (CI). The prevalence of first-dose measles-immunized children was 55.5% for the selected LMICs. The multivariable analysis for combined regions (SA and SSA) showed that parents with a higher level of education, rich wealth quintile, mothers with media access, mothers with more than four antenatal care (ANC) visits and baby postnatal check-up (PNC) within two months were significantly associated with the first dose of measles vaccination among children. The first dose measles immunization coverage in the selected LMICs was considerably low. To boost the uptake of childhood measles vaccination, public health interventions particularly need to focus on children born to uneducated parents, poor families, and those who have not used health services (ANC and PNC). Financial funding is crucial for establishing mobile vaccination clinics to improve immunization rates among the impoverished. [ABSTRACT FROM AUTHOR]

Breastfeeding improves cognitive ability in childhood, but the long-term impact on socioeconomic outcomes remains unknown. We examined associations between durations of predominant and any breastfeeding and educational attainment, income, and labor force participation in adulthood, and whether these varied by maternal education. Prospective cohort study. We followed 84,255 individuals born 1959–1967 with prospectively collected information on breastfeeding duration and intensity from the Copenhagen Infant Health Nurse Records. Socioeconomic outcome information came from national registers (1980–2020). Linear and Poisson regression were used, and models were adjusted for prenatal and postnatal variables across three levels of maternal education. Durations of being breastfed exhibited associations with all outcomes, with most being more pronounced among mothers with low education. Compared with infants breastfed <1 month, those breastfed ≥5 months had 0.68 (95% confidence interval: 0.60–0.76), 0.55 (0.45–0.65), and 0.65 (0.46–0.84) additional years of education for infants born to mothers with low, medium, or high education, respectively. Moreover, infants breastfed ≥5 months had 4047, 3713, and 1902 US$ higher annual incomes and were 23% less likely to be outside the labor force at age 50 years. These associations were stronger with longer breastfeeding durations and for predominant than any breastfeeding. Prolonged and higher breastfeeding intensity consistently exhibited dose-dependent associations with improved socioeconomic indicators in adulthood. Notably, these relationships were more pronounced among individuals whose mothers had lower educational attainment. Consequently, our findings suggest that breastfeeding may have a lasting positive influence on socioeconomic outcomes, particularly for the most disadvantaged infants. [ABSTRACT FROM AUTHOR]

An increasing number of women are conceiving through assisted reproductive technology; however, few studies have investigated their mental health after successful conception. This study investigated the changes in depressive symptoms in women using assisted reproductive technology and the association between the mode of conception and perinatal depressive symptoms. A longitudinal observational study was conducted from 2015 to 2019, 542 pregnant women completed questionnaires on depressive symptoms at eight timepoints during the prepregnancy, pregnancy and first-year postpartum periods. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. A generalized estimating equation regression model was employed for repeated measures. In the assisted reproductive technology group, depressive symptoms were more prevalent during early pregnancy and at 1 month postpartum than before pregnancy, and more prevalent before pregnancy and at 1 month after childbirth than in the spontaneous conception group. No significant association was identified between the mode of conception and depressive symptoms during the antenatal or postnatal period. The lack of full-time employment and prepregnancy depressive symptoms were associated with antenatal depressive symptoms. Primipara status and depressive symptoms during prepregnancy and pregnancy were associated with depressive symptoms during the first-year postpartum. Assisted reproductive technology was not a risk factor for depressive symptoms during the pregnancy and postpartum periods, whereas primipara status, lack of full-time employment and prepregnancy depressive symptoms were negative predictors. Therefore, targeted mental health interventions should address these specific factors to effectively support maternal mental health. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact of an eHealth educational resource about infant procedural pain management, given during the prenatal period, on feasibility, acceptability, knowledge, self‐efficacy, and involvement. Background: Routine health care requires newborns to have painful procedures (e.g., intramuscular injection). The impacts of untreated pain in neonates are widely recognised but adoption of effective procedural pain management strategies in clinical practice varies. There is clear evidence supporting the effectiveness of parent‐led pain management during procedures (e.g., skin‐to‐skin care) and reputable resources to raise awareness among parents are warranted. Our team co‐created Parenting Pain Away, a website to equip parents with evidence to assist with managing the pain of procedures and empower them to be involved. Methods: A quasi‐experimental evaluation using a pre/post intervention design with low‐risk expectant parents. Results: Of the 41 participants, before intervention exposure participants were familiar or had used skin‐to‐skin care (n = 33), breastfeeding (n = 30) and sucrose (n = 13) as pain management. Most participants (n = 38) desired more information on how to be involved. Providing access to Parenting Pain Away during pregnancy was supported and participants ranked the website above average using the System Usability Scale. Parenting Pain Away did not have a statistically significant influence on outcomes. Participants reported variation in clinical support with parent‐led pain management. Conclusion: A multifaceted approach is recommended to maintain infant procedural pain management. Implications for the Profession and Patient Care: Equipping parents with knowledge related to infant pain management using an eHealth approach satisfied their information desires. The study findings are important considerations for perinatal care providers, policy makers, and families to finally achieve adequate procedural pain management. Reporting Method: This study used the STROBE checklist, adhering to EQUATOR guidelines. Patient and Public Contribution: A stakeholder group (expectant parents, parents, perinatal researchers, clinicians, and administrators) was created to inform the study design and intervention. [ABSTRACT FROM AUTHOR]

Background: Preterm newborns face many health problems due to their incomplete intrauterine development and the immaturity of their systems. One of these problems concerns nutrition. This study aimed to determine the effect of online kangaroo care (KC) training provided post‐discharge on breastfeeding self‐efficacy in mothers with preterm infants. Methods: This research was conducted as an experimental study with a randomised control group. Two groups were formed: kangaroo care and control. The sample of the study consisted of 68 mothers of preterm infants. The mothers in the KC group were given online KC training after discharge from the hospital. The mothers were asked to perform KC regularly, at least once a day, for 20 min, 7 days a week. The Breastfeeding Self‐Efficacy Scale was administered to the mothers before and after training. Results: The results of the study revealed that the difference between the pre‐test and post‐test breastfeeding self‐efficacy scores was statistically significantly higher among the mothers who received online KC training compared with the controls (p < 0.001). Conclusion: According to the results of our research carried out in this context, the mothers who received online KC training had increased breastfeeding self‐efficacy compared to those in the control group. [ABSTRACT FROM AUTHOR]

Background: Parents' low health literacy (HL) has negative impacts on child health. Parental interventions may improve parents' HL and thus impact child health positively. Objectives: This study aimed to gain knowledge about associations between parents' comprehensive HL (CHL) and child health after an extended postnatal home visiting program in Swedish multicultural, disadvantaged settings compared to parents receiving regular child healthcare (CHC). Materials and Methods: This quasi‐experimental study used a case–control sampling method to recruit first‐time parents through two CHC centres in Stockholm (2017–2020). Participants (N = 151) were interviewed twice through structured questionnaires when their child was <2 months and 15–18 months old. HLS‐EU‐Q16 assessed parents' CHL. Children's medical records (0–18 months) were reviewed regarding breastfeeding, children's exposure to smoking, language development and healthcare utilisation. Data were analysed with regression models and non‐parametric tests. Results: No significant association was found between parents' CHL and child health. However, significantly fewer unplanned visits to the CHC centre were observed among children (0–18 months) in the intervention group irrespective of CHL, compared with children to parents with improved CHL in the comparison group (F = 3.856, p = 0.011). Conclusions: Postnatal home visiting interventions practicing proportional universalism and family‐centred care may reduce unplanned visits within CHC in disadvantaged settings despite parents' CHL. Further studies with long‐term follow‐up are suggested to explore associations between parents' CHL and child health. Trial Registration: As a clinical study (not a clinical trial) with appropriate ethical permission with participants' consents, this study was retrospectively registered (18 February 2020) in the ISRCTN registry (ISRCTN10336603). [ABSTRACT FROM AUTHOR]

Background: Two‐thirds of pregnancy‐related deaths occur from 1 day to 1 year after birth, and medical complications frequently occur after birth. Postpartum health concerns are often urgent, requiring timely medical care, which may contribute to a reliance on acute care. One approach to improving postpartum health is to investigate birthing parents' accounts of acute care use in the months after birth, which is what we did in this study. Methods: This mixed‐methods study included questionnaire responses, semi‐structured interviews, and chart review of 18 English‐speaking individuals who used acute care in the 90 days after birth in the southeastern United States. Interviews were conducted remotely, recorded, and professionally transcribed. Qualitative data were inductively coded to iteratively develop categories and themes with respect to contributors and barriers to postpartum acute care use. Results: Birthing parents engaged in complex decision‐making processes to decide where and when to seek postpartum acute care in response to their urgent health concerns. Many described fear and uncertainty about their postpartum health. Most participants contacted a healthcare practitioner before using acute care, followed their guidance, and were treated or otherwise reassured at the acute care visit. Discussion: These findings suggest multilevel opportunities for strengthening healthcare systems, including better‐preparing individuals for the postpartum period and structuring care to accommodate birthing parents and include their support systems. The insights from this study can inform multilevel strategies for strengthening healthcare so that birthing parents are safe and well postpartum. [ABSTRACT FROM AUTHOR]

Background: Kangaroo care is an effective intervention to increase survival and improve the health and development of preterm infants. Despite this, implementation of kangaroo care globally remains low. The objectives of this review were to: (a) synthesize evidence on parents' and healthcare practitioners' perceptions, experiences, knowledge of, and attitudes toward kangaroo care of preterm babies in hospital settings; and (b) establish parents' satisfaction with kangaroo care. Methods: Studies of any design were included if they focused on parents' or healthcare practitioners' perceptions, experiences, knowledge of, and attitudes to kangaroo care of preterm babies, or reported parents' satisfaction, and were conducted in hospital settings. The search of seven electronic databases, African Journals Online, World Health Organization regional databases, and a gray literature search was conducted in April/May 2020, and updated in January 2024. Study selection was undertaken by two independent reviewers. Quality assessment using the Mixed Method Appraisal Tool and data extraction were completed by one reviewer with a 10% check by a second reviewer. Data were synthesized narratively using a parallel results convergent integrated design. Results: Thirty‐seven studies, 19 quantitative, 16 qualitative, and 2 mixed methods, were included. The findings suggested that while healthcare practitioners generally demonstrated knowledge about kangaroo care, there was a notable minority with insufficient understanding among those who received training. Parents' knowledge, particularly among fathers, was limited. Both healthcare practitioners and parents appeared to have positive attitudes to kangaroo care. Little is known about parental satisfaction with kangaroo care. Conclusions: Most healthcare practitioners were knowledgeable about kangaroo care, but parents had limited knowledge. This review findings suggest a need to enhance parental knowledge of kangaroo care before neonatal unit admission, and training is needed for HCPs to implement kangaroo care consistently. [ABSTRACT FROM AUTHOR]

Background: In the United States, 35% of all pregnancy‐related deaths occur between 24 h and 6 weeks after delivery, yet the first outpatient visit is not typically scheduled until 6 weeks postpartum. Thus, the ability to independently navigate this period is critical to maternal well‐being and safety. However, previous research suggests that many women feel unprepared to manage the challenges they encounter during this time, and there is a current need to synthesize the existing evidence. Therefore, the purpose of this integrative review is to describe parent‐identified gaps in preparation for the postpartum period in the United States. Methods: Using the Integrative Review framework by Whittemore and Knafl, a systematic search of Medline, CINAHL, PsychInfo, Web of Science, and a hand‐search was conducted for peer‐reviewed articles published in English between 1995 and 2023. Results were reported according to PRISMA 2020 guidelines. Studies that met eligibility criteria were synthesized in a literature matrix. Results: Twenty‐two studies met inclusion criteria. Four themes were identified: Mental Health Concerns, Physical Concerns, Infant Feeding and Care Concerns, and General Concerns and Recommendations. Many women, regardless of parity, reported feeling unprepared for numerous postpartum experiences, including depression, anxiety, physical recovery, breastfeeding, and infant care. Parents reported difficulty differentiating normal postpartum symptoms from complications. Hospital discharge teaching was viewed as simultaneously overwhelming and inadequate. Parent recommendations included the need for earlier and more comprehensive postpartum preparation during pregnancy, delivered in multiple formats and settings. Parents also reported the need for earlier postpartum visits and improved outpatient support. Conclusions: Our findings indicate that many parents in the United States feel unprepared to navigate a wide variety of emotional, physical, breastfeeding, and infant‐care experiences. Future research should explore innovative educational approaches to postpartum preparation during pregnancy as well as outpatient programs to bridge the current gaps in postpartum care. [ABSTRACT FROM AUTHOR]

Contraception, and the opportunity and ability to decide the timing, number, and spacing of one's pregnancies, is not just critical for maternal and infant health, but necessary for the attainment of basic reproductive rights. Short inter‐pregnancy intervals have significant consequences for both maternal and newborn mortality, including preterm birth and maternal anemia, and they are a key cause of preventable deaths worldwide. Addressing the unmet need for contraception could have widespread implications for health equity and access. Integrating comprehensive contraceptive services into various health settings including antenatal care, postpartum care, and child immunization visits is vital. Contraceptive counseling should be holistic, and should involve shared decision‐making and patient autonomy. Contraceptive counseling is particularly important in the post‐pregnancy period, where loss to follow‐up may be high, and for adolescents and other vulnerable populations who are often overlooked in these discussions. Addressing the unmet need for contraception requires collaboration and teamwork among healthcare professionals, particularly midwives and physicians, who have the opportunity to amplify one another's efforts, share best practices, advocate for broader contraceptive services, and strengthen training among midwifery and medical trainees. Members of FIGO and ICM have worked together to produce this joint statement, identifying priorities within contraceptive provision and underlining key collaborative strategies to address the unmet need for contraception. [ABSTRACT FROM AUTHOR]

Objective Rates of completion of the gold standard 2-hour oral glucose tolerance test (OGTT) for impaired glucose intolerance postpartum in patients with gestational diabetes mellitus (GDM) are consistently less than 50%. Screening tests performed prior to hospital discharge, including fasting blood glucose (FBG) to detect persistent hyperglycemia, have been investigated. We lack evidence, however, on whether implementation of routine postpartum FBG impacts the likelihood of obtaining the routine 2-hour OGTT. We sought to retrospectively compare the rates of completion of the 2-hour OGTT pre- and postimplementation of a routine FBG screen. Study Design We performed a single-center retrospective cohort study comparing the completion of the 2-hour OGTT pre- and postimplementation of a routine FBG screen. Our primary outcome was the completion of the postpartum OGTT. Bivariate analyses assessed associations between demographic and preinduction clinical characteristics by pre- and post-implementation groups, as well as OGTT completion. Multivariable logistic regression was used to control for possible confounders. A sensitivity analysis was performed to account for the overlap with the coronavirus disease 2019pandemic. Results In total, 468 patients met the inclusion and exclusion criteria. In our post-intervention group, 64% of patients completed a postpartum FBG. For our primary outcome, completion of the 2-hour OGTT significantly decreased in our postintervention group from 37.1 to 25.9% (p = 0.009), adjusted odds ratio (aOR): 0.62, confidence interval (CI): 0.41–0.92. This difference was no longer statistically significant when excluding patients during the pandemic, from 40.3 to 33.1% (p = 0.228), aOR: 0.76, CI: 0.455–1.27. Conclusion Implementation of a routine FBG was associated with a negative impact on patients completing a 2-hour OGTT. The difference was no longer significant when excluding patients who would have obtained the OGTT during the pandemic, which may have been due to the smaller cohort. Future work should investigate patient perceptions of the FBG and its impact on their decision-making around the OGTT. Key Points Screening for postpartum glucose intolerance is imperative for gestational diabetics. A fasting blood glucose is recommended as a postpartum screen for hyperglycemia in GDM patients. Implementation of an FBG was associated with a decrease in completion of the gold standard OGTT. [ABSTRACT FROM AUTHOR]

Background: A divergent fracture pattern is seen in patients living with type 1 diabetes (T1D). These patients are at risk for fractures at unusual distal sites over and above the fractures occurring at major osteoporotic sites. Avascular necrosis (AVN) involving the talus has not been reported previously in T1D. Case Presentation: We hereby report an exceptional case of a 24-year old patient of T1D, who reported to us 3 months post-partum with swelling and pain over her right ankle. In the third trimester of her pregnancy, she encountered trivial trauma to her right ankle. One month after delivery, she developed fragility fractures over her left 2nd to 4th metatarsal heads. On further workup, she was found to have low bone mass and avascular necrosis of right talus on magnetic resonance imaging. On follow up 1 year later, she continued to have low bone mass although her bone mineral density (BMD) increased at the lumbar spine and hip. She was diagnosed with right talar AVN due to fragility fracture sustained in the third trimester with low bone mass consequent to T1D. A possible role of pregnancy- and lactation-related osteoporosis was considered in view of the chronological association with pregnancy. Conclusion: Our case highlights the fragile skeletal health of patients living with T1D making a case for greater scrutiny of declining bone health in these patients. [ABSTRACT FROM AUTHOR]

Background: Skin-to-skin care (SSC) is an evidence-based care method for preterm-born infants. Staff may hesitate to initiate early SSC, the first or second week of life, for the most extremely preterm infants; 1 reason could be nurses' attitudes. Purpose: The aim was to investigate the attitudes and experiences of neonatal nurses regarding early SSC for the most extremely preterm infants, born at gestational week (GW) 22-23, using an exploratory and descriptive approach. Methods: A web-based survey was sent to all nurses across the 6 Swedish units routinely caring for the most extremely preterm infants. Descriptive statistics and qualitative content analysis were used to analyze the data. Results: The response rate was 258 out of 547 (47%). This study reveals a spectrum of attitudes and experiences among nurses, ranging from viewing early SSC as an integral aspect of infant care to deeming it very challenging or simply not feasible. The outcomes are presented in 2 categories, describing both facilitators and challenges associated with early SSC. Noteworthy, facilitators include well-implemented guidelines that support early SSC. Conversely, challenges encompass knowledge gaps and the scarcity of scientific evidence demonstrating the safety of all SSC, including early, for the most extremely preterm infants. Implications for practice and research: This study underscores the importance of spreading knowledge, and has clinical adapted guidelines about the practical aspects of SSC for infants born at 22-23 GW. Future research is required to clarify safety aspects pertaining to SSC for the most extremely preterm infants. [ABSTRACT FROM AUTHOR]

Background: Nonmedical opioid misuse has reached epidemic proportions. In this study, we sought to understand the challenges that healthcare providers experience in providing care to pregnant and postpartum women reporting nonmedical opioid use. Methods: Two methodological tools were used to understand better the experiences of frontline workers working with OUD patients in Indiana, including the Secondary Traumatic Stress Scale and a qualitative feedback form about what they wish their colleagues understood about their jobs and what resources they need to do their jobs. Results: In total, twenty-three individuals participated in the survey research. Quantitative results indicate that 37.53% of the surveyed frontline healthcare workers experience vicarious trauma. Qualitative results suggest that a source of Secondary Traumatic Stress is a lack of preparedness to treat illness amidst an unequal distribution of societal resources. Conclusion: Though these results are drawn from a small sample of healthcare workers, they are aligned with documented secondary traumatic stress rates among other healthcare professionals. Using these data, healthcare organizations, non-governmental organization leaders, policymakers, and members of advocacy and activist boards can identify mechanisms for improving the quality of work and care in OUD intervention and prevention efforts. [ABSTRACT FROM AUTHOR]

Objective: Studies evaluating the ability to diagnose and accurately predict the severity of micrognathia prenatally have yielded inconsistent results. This review aimed to evaluate reliability of prenatal diagnostic imaging in the diagnosis and characterization of micrognathia. Design: Systematic review and meta-analysis. Setting: Studies with a prenatal diagnosis of micrognathia via ultrasound with a confirmatory postnatal examination were included. Prenatal severity was defined with and without mandibular measurements. Extent of airway obstruction at birth was defined by level of intervention required. Meta-analyses of proportions and relative risk were performed. Patients: A total of 16 studies with 2753 neonates were included. Main Outcome Measures: Primary outcome was the efficacy of characterizing the degree of micrognathia on prenatal imaging as it relates to respiratory obstruction at birth. Secondary outcome was the accuracy of prenatal diagnosis with the utilization of mandibular measurements versus without. Results: Performing meta-analysis of proportions, the proportion of missed prenatal diagnoses of micrognathia made without mandibular measurements was 11.62% (95%CI 2.58-25.94). Utilizing mandibular measurements, the proportion of cases missed were statistically lower (0.20% [95%CI 0.00-0.70]). Patients determined to have severe micrognathia by prenatal imaging did not have a statistically significant increase in risk for more severe respiratory obstruction at birth (RR 3.13 [95%CI 0.59-16.55], P =.180). Conclusion: The proportion micrognathia cases missed when prenatal diagnosis was made without mandibular measurements was over 1 in 10, with mandibular measures improving accuracy. This study highlights the need for a uniform objective criterion to improve prenatal diagnosis and planning for postnatal care. [ABSTRACT FROM AUTHOR]

Research on justifications has shown their significance in advice-giving, decision-making and children disputes. However, the majority of studies gloss over practical functions of justifications in patient-physician interactions as they are often expected and pursued by patients and in turn, are adopted by physicians to support their stance and authority. This study, through conversation analysis (CA), aims to explore a) what are pragmatic functions of justifications in patient-physician interaction? b) how and when do physicians unfold their justifications for treatment recommendations? c) how do physicians deal with different responses based on their epistemic and deontic domains?. A total of 32 video-recordings between postpartum women and physicians are collected and studied. Four pragmatic functions of justifications drawn upon by physicians are explored: justifications as face-saving, reassurance, risk discussion and clarification-seeking. Despite physicians' attempts to justify their positions as less challenged by patients, this is not the entire picture as they demonstrate their desire to resolve patients' concerns and coordinate their viewpoints to achieve the best practice that facilitates patients' well-being. [ABSTRACT FROM AUTHOR]

Background: Family planning (FP) is part of Ethiopia's essential health service package. However, integrating FP into other health care services is a relatively new concept. Integrated service can minimize missed opportunities and allow health workers to provide FP services and Reproductive, Maternal, Newborn, Child, Adolescent, and Nutrition (RMNCAH-N) services simultaneously. Thus, the objective of this study was to assess the levels of FP integration into maternal and child health (MCH) services at primary health care service delivery units in Ethiopia. Methods: This was a facility-based cross-sectional study conducted from July to October 2022. We conducted a nationally representative survey of primary health care (PHC) facilities selected from seven regions and two-city administrations in Ethiopia to assess the current level of FP integration across four service delivery units (antenatal care unit, postnatal care unit, post-abortion care unit, and immunization unit) of the facilities. We collected data from selected health facilities through interview with health facility managers, healthcare providers in the selected service units, clients seeking health services, and extraction of data from facility records. We employed descriptive analysis, and categorized the degree of FP integration according to the FP information and services provided in the selected service delivery units. Results: This national FP integration survey included 122 health facilities (39 primary hospitals, 42 health centers, and 41 health posts) from seven regions and two city administrations. The study found a huge discrepancy regarding FP counselling given at ANC, PNC, PAC, and immunization service delivery units as reported by health care providers and clients. The proportion of PNC and immunization clients who received FP counselling was higher at health post compared to hospitals and health centers. Moreover, the proportion of PAC clients who received FP information was higher in primary hospitals compared to health centers. Conclusion: Data from facility records and provider interviews showed significant FP integration within ANC, PNC, and immunization units of PHC facilities. However, client exit interviews indicated low FP counselling integration. Facility records revealed few PNC and PAC clients received contraceptives in the past year. The study found high FP counselling and provision of at least one short- or long-acting contraceptive at PNC and PAC units. No facility offered contraceptives at immunization units, indicating missed FP integration opportunities. [ABSTRACT FROM AUTHOR]

Background: Neonatal mortality has decreased in Angola; however, it remains high. Quality maternal and child health (MCH) care is key to improving neonatal survival. In Angola, however, the association between neonatal mortality and MCH care has not yet been investigated. Therefore, this study aimed to identify the association between neonatal mortality and MCH services in Angola. Methods: We used the Angola Demographic Health Survey 2015–16, which is the latest nationally representative dataset of Angola. The associations between early/late neonatal death and MCH care utilization were identified by a multivariable logistic regression analysis, adjusted by the sex of the child, type of residence, wealth index, caesarian section, size of the child at birth and delivery assisted by skilled birth attendant. The individual sample weight, sample strata for sampling errors/design, and cluster number were incorporated in a descriptive and logistic regression analysis to account for the unequal probability sampling in different strata. Results: The early and late neonatal mortality rates were 22 and 2 per 1000 live births, respectively. We found that having none, one, two or three tetanus injections before the last pregnancy compared to five or more injections, and no postnatal health check for children before discharge were associated with the occurrence of late neonatal death. During the first 2 days after childbirth, no observation of breastfeeding, no counseling on breastfeeding, no counseling on newborn danger signs, no measurement of child body temperature, and no examination of the cord as well as not checking child health before discharge were associated with early neonatal death. Conclusions: Doses of maternal tetanus vaccination and postnatal child health check before discharge were modifiable factors associated to late neonatal death. Further studies to improve MCH care coverage are needed. [ABSTRACT FROM AUTHOR]

Background: We examined the effectiveness of a community-based intervention package that targeted pregnant women for increasing utilization of maternal health services. The intervention package was implemented in Suhum Municipality, Ghana, from March 2019 to April 2022. The package consisted of: (i) maternal health education by female and male peers; (ii) training existing health workers on maternal health; and (iii) strengthening the local community health management committees. Methods: A cross-sectional household survey was conducted in May 2022. We sampled four groups of women: (i) intervention at baseline; (ii) intervention at follow-up; (iii) control at baseline; and (iv) control at follow-up. Three outcome variables were set, i.e., the proportions of women having utilized: (i) at least four antenatal care (ANC) services; (ii) facility-based delivery (FBD) services; and (iii) post-partum care (PPC) services. To estimate the effectiveness of the intervention package in increasing the service coverages, both crude and adjusted difference-in-differences (DID) estimates were calculated. Significance levels were set at the values of 0.10, 0.05, and 0.01, since the aforementioned service coverages had already been too high to have room for an increase at the significance level of 0.05. Results: The proportion of women completing at least four ANC services displayed significant DID in both crude and adjusted analyses. The proportions of women utilizing facility-based delivery services and post-partum care services did not display significant DID. Conclusions: Of the three outcome variables set, only the proportion of women having utilized at least four ANC services significantly increased in the intervention group, compared with the control group. Ghana has been in the transition process of shifting the minimum number of ANC visits from four to eight. Thus, nationwide scaling up of the intervention package is expected to help the transition be smooth by increasing the number of ANC visits. [ABSTRACT FROM AUTHOR]

Background and Purpose Recent changes to medical recommendations for exercise in pregnancy and postpartum have expanded to include recreational athletes. While women are transitioning into motherhood at the height of their athletic careers, there is limited guidance on musculoskeletal training from pregnancy through safe return to activity. The lack of education and support in this population may lead to increased prevalence of symptoms and delay of treatment, ultimately hindering athletic performance. The purpose of this case series is to assess pelvic floor symptoms through implementing a new pre- and postnatal exercise training paradigm in a group of women aiming to return to recreational athletics. Study Design Case series Methods Six recreationally athletic women between 25-35 years of age were referred to physical therapy during pregnancy to participate in this protocol. The women completed a standardized pregnancy and postpartum rehabilitation plan focused on core and pelvic floor control in addition to specific strength and mobility training. Results Pain, urinary dysfunction, and pelvic floor muscle strength were assessed at six weeks postpartum and at discharge. Meaningful improvement was noted in pain, urinary dysfunction, and muscle strength by the time of discharge. Conclusion The decrease in symptoms and improvements in measures of musculoskeletal health suggests that a physical therapist guided rehabilitation protocol may be useful as part of the standard of care to reduce prevalence of pain and dysfunction, particularly in the recreational athlete population. Improving understanding of exercise training in this population may minimize musculoskeletal symptoms and encourage additional research to improve the standard of care for this group of patients. Level of Evidence Level 4 [ABSTRACT FROM AUTHOR]

Stillbirth can lead to complex and varied psychological outcomes for parents. Many choose to have another pregnancy following a stillbirth; however, little is known about the experience of parenting and bonding with the subsequent baby. Couples, who were the biological parents of a stillborn baby and at least one subsequent live baby aged under five, were recruited and interviewed individually. Data were analysed using interpretative phrenomenological analysis. Twelve individual interviews (of six couples) were conducted and four themes with nine subthemes were developed. Theme 1 " Back to the starting line: pregnancy as a means to an end " captured parents' desire to bring a live baby home with pregnancy being experienced alongside fear, trauma, and grief. Theme 2 " Reality hits " encapsulated the experience of arriving home and feeling overwhelmed by the demands of a new-born baby. Theme 3 " Being a living and loss parent " captured the experience of being a parent to both a living and non-living baby with conflicting emotions. Theme 4 " Protection: ' I need him there next to me, so I know he's alive '" represented the fear some parents felt when parenting their live baby and included parents' strategies to manage this anxiety. This study presents novel insight into the complexities of being a parent to a stillborn baby in tandem with a live baby, with difficulties arising in bonding, and managing emotional distress linked to trauma and grief. Potential implications for care includes a need for increased training for professionals providing postnatal care. [ABSTRACT FROM AUTHOR]

Background: The maternity continuum of care includes attending at least four antenatal care (ANC) visits, delivering in a health facility, and receiving postnatal care. However, in many developing nations, including Ethiopia, completion of this continuum is low, contributing to high maternal mortality. So far, no studies have assessed this issue in the study area. Objective: To assess the completion of maternity continuum of care and associated factors among women who gave birth in the last 6 months in Kena district, southern, Ethiopia, 2023. Design: Cross-sectional study using quantitative data collection method. Methods: The study was conducted among 592 women in southern Ethiopia from April to June 2023. A study participants were selected by a simple random sampling technique. Data were collected using a structured, pretested, interviewer-administered questionnaire. Then, data were entered into EpiData 3.1 and analyzed using statistical package for social science software (SPSS version 26). Logistic regression was used to identify factors related to the maternity continuum of care, with statistical significance set at p < 0.05. Results: The mean age of the enrolled women was 28.78 ± 4.6 years. Of these, 11.8% (95% confidence interval (CI): 9%–14%) of women completed the entire maternity continuum care. Women with secondary education and above (adjusted odds ratio (AOR) = 5, 95% CI: 2.5–11), autonomy in healthcare decision-making (AOR = 2.4, 95% CI: 1.3–4.6), having information on maternal health (AOR = 2.4, 95% CI: 1.3–4.6) Early initiation of ANC (AOR = 4, 95% CI: 2.27–7.1) and birth preparedness (AOR = 2.7, 95% CI: 1.5–5) were significantly associated with completion. Conclusions: Completion of the maternity continuum of care in study area is very low. Targeted interventions should promote women's autonomy in healthcare decision-making, early ANC initiation, and birth preparedness to improve outcomes. Plain language summary: Maternity continuum of care and associated factors Why was this study done? In Ethiopia, many women do not get the care they need during pregnancy and after childbirth, especially in rural areas. This lack of care increases health risks for mothers. This study looked at how many women in the Kena district, a rural area, completed all their maternity care. It also explored the factors that helped women complete their care. What did the researchers do? The study team worked with 592 women who had given birth in the last six months. They used a questionnaire to gather information on the types of care these women received during pregnancy and after childbirth. The team also analyzed factors mentioned in other studies that could influence whether women complete their maternity care. What did the researchers find? Only 11.8% of the women completed all recommended maternity care. Women were more likely to complete their care if they had a higher level of education, could make their own healthcare decisions, started antenatal care (ANC) early, and were prepared for birth complications. What do these results mean? The findings show that most women in the Kena district do not complete their maternity care. To improve this, there needs to be more focus on helping women make decisions about their health, encouraging early antenatal care visits, and preparing for potential birth complications. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion To evaluate the effect of couplet care on parent–infant closeness among preterm infants.A comparison study in a Level III neonatal intensive care unit (NICU) before and after the introduction of couplet care, including stabilising infants in the delivery unit for early skin‐to‐skin contact, providing mothers' postpartum care in the infant's room and providing the father's bed in the infant's room. The study included parents of preterm infants born below 35 weeks.Parents of 40 and 66 infants were included before and after couplet care was introduced, respectively. In the linear regression model, the first skin‐to‐skin contact happened significantly earlier after the introduction than before: mean 4.0 vs. 24.0 h after birth and mean difference −18.5 (95% confidence interval −34.8 to −2.1). A larger proportion of infants received their first skin‐to‐skin contact within 2 h after birth after the introduction than before (45.5% vs. 8.6%; odds ratio 13.8 [3.6–62.8]). At least one parent was present in the infant's NICU room longer after the introduction than before (mean 21.2 vs. 10.8 h per day; mean difference 10.8 [9.1–12.4]).Couplet care significantly increased parent–infant closeness during the first weeks of life. [ABSTRACT FROM AUTHOR]

Background: Telehealth, including video consultation (VC), has become prevalent during the COVID-19 pandemic. However, the experience and concern of women using VC for postpartum care has yet to be adequately studied but is crucial for their adoption. The study aimed to assess the experience and attitude of postpartum mothers (PPM) towards using VC as a novel model of care delivery and the factors that could potentially affect their adoption. Method: Data were gathered from PPM participating in VC using Zoom platform for postpartum care using mixed method. In-depth interviews (IDI) of twenty-five PPM were audio-recorded, transcribed verbatim and audited for accuracy. Thematic analysis was conducted to identify themes relating to perceived threat, usefulness, ease of use, and attitudes toward using VC in postpartum care. The themes are reported based on the "Health Information Technology Acceptance Model" framework. Preliminary quantitative data on the acceptability of VC were collected using structured surveys. Results: PPMs valued convenience, accessibility, and personalised care VC offered to address their immediate postpartum concerns. They perceived VC as suitable for seeking medical opinions, improving confidence in parent crafting, and providing better care access. They recognised the lack of physical examination as a major limitation in VC and proposed a hybrid postpartum care model, combining VC and in-person consultation to cater to individual needs and preferences. PPMs alluded to trust in the care providers, flexibility in VC appointment timings and enhanced interface of remote platforms as enablers for VC adoption. Preliminary quantitative data shows that PPMs found VC saved time (100%), energy (98%), and money (90%) and was appropriate (94%), easy to use (96%), acceptable (96%) for postpartum care. Conclusion: PPMs favoured combining VC and in-person consultation to mitigate their concerns and personalise their care needs. [ABSTRACT FROM AUTHOR]

Background: Maternal recognition of neonatal danger signs following birth is a strong predictor of care-seeking for newborn illness, which increases the odds of newborn survival. However, research suggests that maternal knowledge of newborn danger signs is low. Similarly, maternal knowledge of optimal newborn care practices has also been shown to be low. Since both issues are typically addressed during antenatal care, this study sought to determine whether group antenatal care (G-ANC) could lead to improvements in maternal recognition of danger signs and knowledge of healthy newborn practices, as well as boosting postnatal care utilization. Methods: This cluster randomized controlled trial of G-ANC compared to routine individual antenatal care (I-ANC) was conducted at 14 health facilities in Ghana, West Africa, from July 2019 to July 2023. Facilities were randomized to intervention or control, and pregnant participants at each facility were recruited into groups and followed for the duration of their pregnancies. 1761 participants were recruited: 877 into G-ANC; 884 into I-ANC. Data collection occurred at enrollment (T0), 34 weeks' gestation to 3 weeks postdelivery (T1) and 6–12 weeks postpartum (T2). Comparisons were made across groups and over time using logistic regression adjusted for clustering. Results: Overall, knowledge of newborn danger signs was significantly higher for women in G-ANC, both in aggregate (13-point scale) and for many of the individual items over time. Likewise, knowledge of what is needed to keep a newborn healthy was higher among women in G-ANC compared to I-ANC over time for the aggregate (7-point scale) and for many of the individual items. Women in G-ANC were less likely to report postnatal visits for themselves and their babies within 2 days of delivery than women in I-ANC, and there was no difference between groups regarding postnatal visits at one week or 6 weeks after birth. Conclusion: This study illustrates that group ANC significantly improves knowledge of newborn danger signs and healthy newborn practices when compared to routine care, suggesting that the impact of G-ANC extends beyond impacts on maternal health. Further research elucidating care pathways for ill newborns and maternal behaviors around healthy newborn practices is warranted. Trial registration: : ClinicalTrials.gov Identifier: NCT04033003, Registered: July 25, 2019 Protocol Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9508671/. [ABSTRACT FROM AUTHOR]

Background: This study investigated the prevalence and predictors of episiotomy among puerperal women accessing postnatal care in the Kumasi Metropolis. Methods: A cross-sectional survey was conducted among 1750 postnatal mothers who had spontaneous vaginal using a questionnaire. Descriptive statistics were conducted to show the rate of episiotomy. Chi-square and binary logistic regression analyses were conducted using Jamovi software version 2.5.3. Results: The prevalence of episiotomy among the study population was 49.7% compared to the 10% of all deliveries recommended by World Health Organisation (WHO). Among those who had an episiotomy, 88.5% gave consent, and 77.6% required repairs. In the bivariate analysis educational status, age, perineal tearing, marital status, household monthly income, spontaneous vaginal deliveries and previous episiotomy had a significant association with episiotomy risk. In the multivariate analysis, married women, lower education levels, moderate household incomes, grand multiparous women, spontaneous vaginal delivery (SVD), instrumental deliveries, longer second stages of labour, and attending more antenatal care (ANC) sessions were all associated with a reduced likelihood of episiotomy. Higher one-minute Apgar scores and anemia also lowered the odds. Conversely, hypertensives, women with four or more previous vaginal deliveries, and those with a history of episiotomy were more likely to undergo the procedure. Conclusion: Episiotomies conducted was high, indicating potential overuse compared to WHO's recommendations. Antenatal attendance and timing should be prioritised to improve maternal preparation and outcomes. Policy interventions to reduce unnecessary episiotomies are needed. Midwifery education must also emphasise the importance of respectful maternity care. [ABSTRACT FROM AUTHOR]

Background: Cord care is one component of essential newborn care that reduces newborn morbidity and mortality. Poor cord care practice leads to a large amount of neonatal death due to infection. In Ethiopia, many women give birth at home, where neonates are exposed to unclean cord care practices or application of different traditional substances. Despite the severity of the problem, studies related to postnatal cord care practice are scarce. Hence, this study is aimed to assess umbilical cord care practices and associated factors in the postnatal period in Arba Minch town. Objective: To assess postnatal cord care practices and associated factors among mothers who gave birth in the last six months in Arba Minch Town, southern Ethiopia, 2019. Methods: Cross-sectional study design was conducted and using simple random sampling method 423 mothers who gave birth with in the last six months in Arba Minch town from November 11 to December 02, 2019, were selected. Data was collected using structured questionnaire administered by the interviewer. EpiData version 4.4 was used for data entry and SPSS version 25 was used for data analysis. Variables with p ≤ 0.25 in bivarible logistic regressions were considered as potential candidates for multivariable logistic regression analysis to control confounders. Adjusted Odds Ratio with 95% confidence interval was applied in multivariable logistic regression models, to identify variable, which has significant association. Results: The overall proportion of women who had good postnatal cord care was 67.1%. The maternal age group of 25 to 29 years (AOR = 2.51; 95% CI: 1.35–4.68), maternal educational status of secondary school and above (AOR = 4.19; 95% CI: 2.05–8.54), mothers with good knowledge of cord care (AOR = 1.77; 95% CI: 1.03–3.05), and health facility delivery (AOR = 2.60; 95%CI: 1.05–6.41) were independent factors associated with good cord care. Conclusions: The proportion of good cord-care practice reported in this study was relatively worthy. Maternal age group of 25–29 years, maternal educational status of secondary school and above, having good knowledge of cord care, and delivering at health facility were factors that increased good postnatal cord care practice. Therefore, investing in improving these factors would positively affect maternal postnatal cord care practice. In order to reduce neonatal morbidity and mortality, routine counseling of cord care practice to mothers would attain good knowledge about postnatal cord care practices. Community health education would also increase awareness and practice of postnatal cord care. [ABSTRACT FROM AUTHOR]

Our study delves into postpartum depression (PPD) extending observation up to six months postpartum, addressing the gap in long-term follow-ups and uncover critical intervention points. Through a continuous three-wave cohort study involving 3174 of 10,730 invited postpartum women, we utilized machine learning to predict PPD risk, incorporating self-reported surveys and health records from October 2021 to Jan 2023. PPD prevalence slightly decreased from 30.9 % to 29.1 % over six months. The Random Forest model emerged as the most effective, identifying key predictors of PPD at different stages. The top three factors at first month were newborn's birth weight, maternal weight before delivery and before pregnancy. The EPDS scores of last time, newborn's birth weight and maternal weight before pregnancy and before delivery were main predictors for EPDS scores at third and sixth months postpartum. The study faces limitations such as potential selection bias due to the convenience sampling method and the reliance on self-reported measures, which may introduce reporting bias. Furthermore, the high attrition rate could affect the representativeness of the sample and the generalizability of the findings. There is a slight decrease in PPD rates over six months, yet the prevalence remains high. This underscores the need for early and ongoing mental health support for new mothers. Our study highlights the efficacy of machine learning in enhancing PPD risk assessment and tailoring intervention strategies, paving the way for more personalized healthcare approaches in postpartum care. • Extensive follow-up reveals PPD trends up to six months postpartum, emphasizing continuous monitoring necessity. • Machine learning utilized in a three-wave cohort study identifies PPD risk predictors. • Key predictors for PPD include newborn's birth weight and maternal pre-delivery weight, highlighting intervention targets. • PPD prevalence demostrates a slight decline over six months, maintaining a significant impact. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Quality maternity care is known to improve a range of maternal and neonatal outcomes. The Lancet Series on Midwifery's Quality Maternal and Newborn Care (QMNC) Framework is a high‐level synthesis of the global evidence on quality maternity care. Initial qualitative work demonstrated the Framework's adaptability in evaluating service user and provider perceptions of the quality of maternity care. However, evaluating services at scale requires a survey instrument. This paper reports the validation of the QMNC Framework index (QMNCFi), a five‐part survey for the evaluation of maternity care across diverse settings.International online English language survey of women who had given birth in the previous year in Australia, Ghana, India and the United Kingdom (UK). It was distributed through service user networks (UK and Australia) and at postnatal clinics (Ghana and India). All forms were completed online. Test–retest was conducted to assess reliability.Five hundred and forty mothers completed the survey (Australia 136; Ghana 131; India 153; UK 120). Construct validity: Cronbach's α in 12 of the survey's 13 sections ranged from 0.795 to 0.986; for the remaining section the alpha was 0.594. Reliability: 55 participants completed the QMNCFi a second time. Intraclass correlation coefficient results ranged from 0.657 to 0.939 across the 13 sections. Field researchers in Ghana and India reported that the survey was easily understood and completed.This survey has shown that, across diverse contexts, the QMNCFi is a valid, reliable, and comprehensive tool for measuring service user perceptions of the quality of care over time. [ABSTRACT FROM AUTHOR]

Introduction: Appropriate perinatal care provision and utilization is crucial to improve maternal and newborn survival and potentially meet Sustainable Development Goal 3. Ensuring availability of healthcare infrastructure as well as skilled personnel can potentially help improve maternal and neonatal outcomes globally as well as in resource-limited settings. Methods: A systematic review on effectiveness of perinatal care regionalization was updated, and a new review on facility-based interventions to improve postnatal care coverage and outcomes was conducted. The interventions were identified through literature reviews and included transport, mHealth, telemedicine, maternal education, capacity building, and incentive packages. Search was conducted in relevant databases and meta-analysis conducted on Review Manager 5.4. We conducted subgroup analysis for evidence from low- and middle-income countries (LMICs). Results: Implementation of regionalization programs significantly decreased maternal mortality in LMICs (OR: 0.43; 95% CI: 0.34–0.55, 2 studies), stillbirth overall (OR: 0.70; 95% CI: 0.54–0.89, 5 studies), perinatal mortality overall (OR: 0.54; 95% CI: 0.5–0.58, 2 studies), and LMICs (OR: 0.54; 95% CI: 0.50–0.58, 1 study). Transport-related interventions significantly decreased maternal mortality overall (OR: 0.55; 95% CI: 0.40–0.74, 1 study), neonatal mortality (RR: 0.76; 95% CI: 0.66–0.88, 1 study), perinatal mortality (RR: 0.86; 95% CI: 0.77–0.95, 1 study), and improved postnatal care coverage (OR: 6.89; 95% CI: 5.15–9.21, 1 study) in LMICs. Adding maternity homes/units significantly decreased stillbirth (OR: 0.75; 95% CI: 0.61–0.93, 1 study) in LMICs. Incentives for postnatal care significantly improved infant mortality (RR: 0.79; 95% CI: 0.65–0.96, 1 study), stillbirth (OR: 0.60; 95% CI: 0.44–0.83, 1 study), and postnatal care coverage (RR: 1.13; 95% CI: 1.03–1.25, 1 study) in LMICs. Telemedicine improved postnatal care coverage significantly in LMICs (RR: 2.54; 95% CI: 1.22–5.28, 3 studies) and decreased maternal mortality (OR: 0.46; 95% CI: 0.21–0.98, 1 study) and infant mortality (OR: 0.65; 95% CI: 0.45–0.95) in LMICs. Maternal education significantly decreased neonatal mortality (RR: 0.75; 95% CI: 0.66–0.84, 2 studies), perinatal mortality (RR: 0.86; 95% CI: 0.77–0.95, 1 study), infant mortality (RR: 0.79; 95% CI: 0.65–0.96, 1 study), and stillbirth (RR: 0.61; 95% CI: 0.45–0.82, 1 study). Capacity-building interventions significantly decreased maternal mortality in LMICs (OR: 0.37; 95% CI: 0.29–0.46, 5 studies), neonatal mortality overall (OR: 0.72; 95% CI: 0.53–0.98, 4 studies) and in LMICs (OR: 0.63; 95% CI: 0.54–0.74, 3 studies, and RR: 0.61; 95% CI: 0.48–0.79, 3 studies), perinatal mortality (OR: 0.53; 95% CI: 0.45–0.62, 2 studies, and RR: 0.86; 95% CI: 0.77–0.95, 1 study), infant mortality (OR: 0.50; 95% CI: 0.43–0.59, 1 study, and RR: 0.79; 95% CI: 0.65–0.96, 1 study), under-5 mortality (RR: 0.79; 95% CI: 0.66–0.94, 1 study), and stillbirth in LMICs (OR: 0.71; 95% CI: 0.62–0.82, 4 studies), and preterm birth overall (OR: 0.39; 95% CI: 0.19–0.81, 1 study). Conclusion: Perinatal regionalization and facility-based interventions have a positive impact on maternal and neonatal outcomes and calls for implementation in high burden settings but a better understanding of optimal interventions is needed through comprehensive trials in diverse settings. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy and later is associated with an increased risk of type 2 diabetes and other metabolic disorders. Consistent and evidence based postnatal care is key to improving maternal long-term health. We therefore aimed to review and compare recommendations of national and international clinical practice guidelines (CPG) for postnatal care after GDM and identify any evidence gaps in recommendations needing further research. Methods: We searched five databases and forty professional organization websites for CPGs providing recommendations for postnatal care after GDM. CPGs which had full versions in English, endorsed, prepared, or authorized by a professional body, and published between 2013 and 2023 were eligible for inclusion. Two reviewers independently screened the articles, extracted the recommendations, and appraised the included CPGs using the Appraisal of Guidelines, Research, and Evaluation (AGREE) II tool. Results: Twenty-six CPGs from 22 countries were included. Twelve CPGs (46%) were appraised as low quality with the lowest scoring domains being rigor of development and editorial independence. We found little high certainty evidence for most recommendations and few recommendations were made for maternal mental health and postpartum metabolic screening. Evidence gaps pertained to postpartum glucose screening, including frequency, tests, and ways to improve uptake, evaluation of effective uptake of lifestyle interventions, and ongoing long-term follow up care. Conclusions: Most of the postnatal care recommendations in GDM guidelines are not based on high certainty evidence. Further efforts are needed to improve the global evidence base for postnatal care after GDM to improve long-term maternal health. Protocol Registration: This review was registered in PROSEPRO (CRD42023454900). [ABSTRACT FROM AUTHOR]

Background: Postnatal care (PNC) is the care of a newborn and mother for up to six weeks from one hour of placenta birth. The postnatal period is one of the most hazardous stages for mothers and their baby's health. The PNC is influenced by several maternal, family, biological, and socio-economic factors and it is necessary to identify the most significant factors of PNC. Therefore, the authors focus on determining the significant determinants of postnatal care in Bangladesh. Methods and materials: This study is based on a secondary dataset extracted from the Bangladesh Demographic and Health Survey (BDHS)-2017/18. Descriptive statistics, chi-square test, and multilevel logistic regression have been used to determine the contributing factors of PNC. Results: The rate of postnatal care was highest in Sylhet (73.7%) and lowest in Dhaka (57.1%). Female babies had 10.1% less odds of having postnatal care than male babies. Findings depict that the children with 1–3 siblings have 1. 82 times more odds (odds ratio (OR):1.82, 95% confidence interval (CI):0.03–3.21) of PNC than babies without any siblings. Children who suffered from fever recently had 1.25 times (OR = 1.25, 95% CI:1.09–1.45) more odds of taking PNC than their counterparts. Children of working mothers had 1.33 times (OR:1.33, 95% CI:1.14–1.56) more odds of having PNC than children of non-working mothers. Conclusion: The sex of a child, birth order number, place of residence, region, receiving Bacillus Calmette-Guérin (BCG) vaccine, number of antenatal care visits, having fever recently, number of household members, media exposure, and household facilities are significantly linked with PNC in Bangladesh. To ensure the good health of a child, it is necessary to focus on the targeted groups and put emphasis on the identified variables. The authors believe that the findings will be helpful to the policymakers of Bangladesh to lessen childhood morbidities which will be helpful in achieving the target of the Sustainable Development Goals (SDGs) for reducing preventable maternal and under-five deaths by 2030. [ABSTRACT FROM AUTHOR]

Postnatal care immediately after birth is a crucial component to save lives of mothers and the newborns. A paucity of evidence indicated that women's unwillingness to receive care after birth is a remained challenge in resource-limited settings in general and in Ethiopia in particular. This study aimed to assess the utilization of postnatal care within 48 h after birth and its determinants in northwest Ethiopia. A community-based cross-sectional study was conducted from October to November 2020. A total of 811 women who had birth within the last one year were involved in the study. Both random and fixed effects were reported using an adjusted odds ratio with a 95% confidence interval and p value of 0.05. The study revealed that 13.3% (95% CI 10.9–15.7%) of women attended postnatal care visits within 48 h after birth. Attending secondary and above education (AOR = 2.39; 95% CI 1.18, 4.84); health extension workers home visiting during pregnancy (AOR = 1.74; 95% CI 1.08, 2.82); birth order (AOR = 2.07; 95% CI 1.03, 4.14); place of delivery (AOR = 7.49; 95% CI 3.73, 15.06); and short distance to health facility (AOR = 4.19; 95% CI 1.64, 10.70) were significantly associated with postnatal care utilization within 48 h after birth. Postnatal care utilization within 48 h is low in rural northwest Ethiopia compared to findings from most resource-limited settings. The existing health system should consider multilevel intervention strategies focusing on maternal health education, engaging community health workers in health promotion, and ensuring physical accessibility of healthcare facilities to be more effective in improving postnatal care utilization within 48 h. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Adverse childhood experiences (ACEs) are known contributors to lifelong mental health challenges. Despite studies linking ACEs to increased risk of adverse postpartum mental health outcomes, a systematic review on the occurrence of postpartum post‐traumatic stress disorder (PTSD) in women with ACEs is lacking.A systematic search was conducted in seven databases to retrieve studies from inception to January 31, 2024. A random‐effects model was used to quantify weighted estimates of postpartum PTSD incidence. Statistical analysis was conducted using R software.Seven studies were included in the system review. One study was identified as an outlier and excluded from the meta‐analysis. Among the six remaining studies, 1186 women exposed to ACEs were identified, with 249 of them experiencing postpartum PTSD. The estimated incidence of postpartum PTSD among women exposed to ACEs was 22.6% (95% confidence interval [CI] 16.1%–29.8%). Subgroup analysis revealed significant variations in incidence depending on study settings (p < 0.01) and PTSD assessment methods (p < 0.01). Due to multicollinearity among the primary variables, a meta‐regression to identify factors influencing study heterogeneity was not conducted.The incidence of postpartum PTSD was 22.6% in women with ACEs, higher than that observed in the general obstetric population. This finding suggests the need to provide comprehensive postpartum care for these women. [ABSTRACT FROM AUTHOR]

Context Methods Findings Conclusions Policy Points This study examines exposure to out‐of‐pocket (OOP) costs related to childbirth and postpartum care for those with a Medicaid‐insured birth compared with those with a commercially insured birth and subsequent financial outcomes at 12 months postpartum. We find that Medicaid is highly protective against health care costs for childbirth and postpartum care relative to commercial insurance, particularly for birthing people with low income. We find persistent medical debt and worry at 12 months postpartum for Medicaid recipients who reported OOP childbirth expenses. This study examines exposure to out‐of‐pocket (OOP) costs related to childbirth and postpartum care for those with a Medicaid‐insured birth compared with those with a commercially insured birth and subsequent financial outcomes at 12 months postpartum. We find that Medicaid is highly protective against health care costs for childbirth and postpartum care relative to commercial insurance, particularly for birthing people with low income. We find persistent medical debt and worry at 12 months postpartum for Medicaid recipients who reported OOP childbirth expenses.Out‐of‐pocket (OOP) costs related to childbirth and postpartum care may cause financial hardship, depending on type of insurance and income.We estimated OOP spending on childbirth and postpartum care and financial strain 1 year after birth, comparing Medicaid‐insured births with commercially insured births. The Postpartum Assessment of Health Survey followed up with respondents to the Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System after a 2020 birth in six states and New York City. The survey included questions on health care costs and financial well‐being. Our analytic sample consisted of 4,453 postpartum people, 1,544 with a Medicaid‐insured birth and 2,909 with a commercially insured birth.We observe significant financial hardship from childbirth that persists into the postpartum year, with significant differences by insurance and income. We find Medicaid is highly financially protective relative to commercial insurance; 81.4% of Medicaid‐insured births were free to the patient, compared with 15.7% of commercially insured births (p < 0.001). Six of ten commercially insured births (59%) cost over $1,000 OOP. Among respondents reporting OOP costs for childbirth, we found that Medicaid enrollees are more likely to have borrowed money from friends or family to pay for childbirth (8% vs. 1%, p < 0.001) and one in five had not made any payments 1 year postpartum (26% vs. 5% of commercially insured births, p < 0.001). Among the commercially insured, those with incomes under 200% of the federal poverty level (FPL) fared worse financially than those above 200% FPL on a number of indicators, including debt in collection (33% vs. 13%, p < 0.001) and financial worry (55% vs. 34%, p < 0.001).The cost of childbirth and postpartum health care results in significant and persistent financial hardship, particularly for families with lower income with commercial insurance. Medicaid offers greater protection for families with low income by offering reduced cost sharing for childbirth and postpartum health care, but even minimal cost sharing in Medicaid causes financial strain. [ABSTRACT FROM AUTHOR]

Background:Methods:Results:Conclusions:Black birthing people in the United States are disproportionately impacted by maternal mortality and more frequently report physical and verbal mistreatment during intrapartum care. Birth plans for prenatal and postpartum care promote autonomy and agency but have not been used as tools to address disparities in perinatal care.We reviewed the literature on the use of birth plans and communication in the pregnancy care setting. We provide an expert analysis and a recommendation for a comprehensive birth plan that incorporates patient preferences and individualizes patient risks as a communication tool.In this expert opinion we outline how an equity birth plan can address social determinants of health, promote respectful communication and prioritize attention to patient narratives. This instrument can be used to address systemic problems that result in health inequities on a community, provider and institutional level.A birth plan with attention to equity serves as a new paradigm for care which can empower patients and reduce racial inequities in perinatal and postpartum outcomes. [ABSTRACT FROM AUTHOR]

Background: Lack of sunlight exposure is the primary reason for the worldwide epidemic of vitamin D deficiency. There was a meta-analysis conducted under the title of Knowledge and Practice of Mothers towards sunshine exposure of their children in Ethiopia. However, studies conducted on factors associated with sunlight exposure practice among infants showed non-conclusive and inconsistent findings. Hence, this systematic review and meta-analysis were conducted to estimate the pooled prevalence of good sunlight exposure practice and its associated factors among infants in Ethiopia. Methods: All articles were systematically searched by PubMed, Hinari, Global Health and CINAHL, Epistemonikos, African Journal of Online (AJOL), Google Scholar and Google. All studies, until the end of May 30, 2023, were included in this review. Pure qualitative studies and studies in which the outcome was not reported were excluded from the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was used. Meta-analysis was conducted by using STATA 17 software. Forest plots were used to present the pooled prevalence of good sunlight exposure practices. A random effect model was used to compute the pooled prevalence, while subgroup analysis was performed to identify the possible source of heterogeneity. Publication bias was assessed by begg's and Egger's tests. We use Trim and fill analysis was used to treat the publication bias. Results: This review involved 14 studies and 6,121 participants. The pooled prevalence of good sunlight exposure practice among infants in Ethiopia was 53.46% (95%CI: 45.98, 60.95). Mothers had PNC follow-up [OR = 2.22 (95% CI: 1.31, 3.47)], mothers with secondary and above educational status [OR = 4.17, (95% CI: 1.73, 10.06)], employed mothers [OR = 3.72, (95% CI: 2.71, 5.11)], urban residence [OR = 2.67, (95% CI: 1.17, 6.08)] and not fear of sunlight exposure [OR = 4.08, (95% CI: 1.44, 16.00)] were positively associated with good sunlight exposure practice. Conclusions: The pooled prevalence of good sunlight exposure practices among infants in Ethiopia is low. Had postnatal care follow-up, being urban residents, mother's employment status, mother's educational status and not fear of sunlight exposure were independent factors of good sunlight exposure practice among infants. Therefore, health professionals create awareness for mothers to increase postnatal follow-up, and the importance of health education especially for rural residents. [ABSTRACT FROM AUTHOR]

This randomized controlled study aims to investigate the effect of acupressure on pain and postpartum comfort following a cesarean section. The study was conducted with 60 women who underwent cesarean delivery. The participants were randomly assigned to either the intervention or control group. In the intervention group, acupressure was applied to the LI4, SP6, and P6 points for 15 minutes at the 2nd and 4th hours after the cesarean section. In the control group, acupressure was not applied and only routine nursing care was given. Data was collected using a personal information form, Visual Analog Scale (VAS), and Postpartum Comfort Questionnaire (PCQ). Acupressure application was applied to the intervention group at the 2nd and 4th hour after cesarean section. All data collection forms were filled out by women in the intervention group before starting acupressure application at 2 hours after cesarean section. VAS was filled out again after acupressure application at 2 hours. VAS was filled out before and after acupressure application at 4 hours after cesarean section. PSQ was filled out in both groups before discharge. In the study, the intervention group's 2nd (3.03 ± 1.24, p <.001) and 4th (4.06 ± 1.22, p <.001) hour posttest VAS scores were lower and PCQ posttest scores (140.6 ± 9.01, p <.001) were higher than the control group. The results indicate that acupressure intervention applied to points LI4, SP6, and P6 was a useful nonpharmacological treatment for postpartum pain and comfort for the study group. [ABSTRACT FROM AUTHOR]

Objective: To understand obstetric provider perspectives on child protective services (CPS)-mandated reporting requirements and how they affect care for pregnant and postpartum patients with opioid use disorder (OUD). Methods: Key informant interviews were conducted virtually with obstetricians, nurse practitioners, and social workers caring for obstetric patients (n = 12). Providers were asked about their experience as mandated reporters working with patients with OUD. Transcripts were independently coded by two staff, and content analysis was used to identify themes. Results: Our analysis resulted in six thematic areas, including CPS-mandated strengths, concerns related to CPS reporting requirements, implementation of mandates, supporting patients after CPS report, communication between stakeholders, and the impact on care. Providers noted that the fear of CPS involvement causes some patients to delay or not engage in care. Other patients are hesitant to accept medications for OUD for fear of CPS involvement. The inconsistencies in how reporting mandates are applied and how CPS handles cases make communication about the policies challenging for providers and create anxiety for patients. Conclusions: The results of this study indicate that mandated reporting requirements and the potential for CPS involvement are perceived to have minimal positive effects on perinatal individuals with OUD and may negatively affect patients and their care. Clinicaltrials.gov number: NCT04240392. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: The postpartum period is critically important for comprehensive obstetric care; however, most women are neglected during this important period. Objective: This study was carried out to determine the burden of postpartum morbidities and associated factors among the urban vulnerable population in Gautam Buddha district, Uttar Pradesh. Methods: A cross-sectional study was conducted among 150 postpartum women in urban slums of Gautam Buddha district. A semi-structured questionnaire was used along with a physical examination and assessment of anemia by Sahli's hemoglobinometer. Results: A total of 106 (70.7%) mothers reported at least one of the postpartum morbidities (PPMs). The most frequently reported morbidity was anemia (55.3%) followed by backache (29.3%). Almost a third (39, 36.8%) of all women, who suffered from PPM, did not seek any treatment for the same. Univariate analysis revealed that morbidities were higher among women with low literacy (Odds Ratio, OR: 5.63, 95% CI: 2.508–13.54, p = 0.000), low socioeconomic status (OR: 0.317, 95% CI: 0.151–0.657, p = 0.002), and inadequate antenatal care (OR: 0.108, 95% CI: 0.044–0.246, p = 0.0001). Similarly, young mothers (OR: 2.599, 95% CI: 1.332–5.14), less educated (OR = 3.603, 95% CI: 1.838–7.203, p = 0.000), those from lower economic status (OR: 0.247, 95% CI: 0.119–0.497, p = 0.001), with inadequate antenatal care (OR: 0.112, 95% CI: 0.052–0.232, p = 0.005), and low iron folic acid intake (OR: 0.371, 95% CI: 0.184–0.732, p = 0.004) showed higher prevalence of anemia. Conclusion: The role of education and adequate antenatal care are highlighted in the study. Antenatal visits should be utilized as opportunities to increase awareness regarding various aspects of care during the postnatal period. Maintaining more comprehensive support and involvement between health care providers and the mothers is needed to prevent many of these postpartum morbidities. [ABSTRACT FROM AUTHOR]