Effects of midwife-led maternity services on postpartum wellbeing and clinical outcomes in primiparous women under China’s one-child policy

Background: The Midwife-led maternity services have been implemented in China in response to the high rates of primiparous women and Caesarean Sections (CS) which may be related to China’s one-child policy. However, few studies in China have been reported on the effectiveness of Midwife-led Care at Delivery (MCD) and the Continuity of Midwife-led Care (CMC) on postpartum wellbeing and other clinical outcomes. Therefore, evidence-based clinical validation is needed to develop an optimal maternity service for childbearing women in China. Methods: A concurrent cohort study design was conducted with 1730 pregnant women recruited from 9 hospitals in Shanghai. Among the 1730 participants at baseline, 1568 participants completed the follow-up questionnaire, with a follow-up rate of 90.6%. Results: Compared with the routine Obstetrician-led Maternity Care (OMC), Midwife-led Care at Delivery (MCD) was associated with CS rate (OR were 0.16; 95%CI: 0.11 to 0.25) and a higher total score of postpartum wellbeing (βwere 2.70; 95%CI: 0.70 to 4.70) when adjusting for the baseline differences and other confounders during delivery or postpartum period. Moreover, continuity of Midwife-led Care (CMC) was associated with CS rate (OR were 0.30; 95%CI: 0.23 to 0.41), as well as increased rate of breastfeeding within the first 24 h (OR were 2.49; 95% CI: 1.47 to 4.23), higher postpartum satisfaction (β = 4.52; 95% CI: 1.60 to 12.68), lower anxiety (βwere 0.66; 95% CI: 0.16 to 1.17), increased self-control (βwere 0.39; 95% CI: 0.02 to 0.76) and a higher total score of postpartum wellbeing (βwere 3.14; 95% CI: 1.54 to 4.75). Conclusion: CMC is the optimal service for low-risk primiparous women under China’s one-child policy, and is worthwhile for a general implementation across China

Determinants of breast-feeding within the first 6 months post-partum in rural Vietnam

Objective: This study explored the determinants of breast-feeding practices within the first 6 months post-partum among women residing in rural Vietnam.Methods: The study was conducted in Quang Xuong district, in the Thanh Hoa Province of Vietnam. In the first phase, 463 women were prospectively studied at weeks 1, 16 and 24 post-partum. During the second phase, 16 focus group discussions were undertaken to obtain complementary information.Results: Exclusive breast-feeding dropped from 83.6% at week 1 to 43.6% at week 16 and by week 24, no infant was exclusively breast-fed. A logistic regression analysis found 'mother's education level', 'mother's decision-making on breast-feeding', 'mother's comfort to breast-feed in public places', 'father's occupation', 'feeding preference of father' and 'having sufficient food for the family' significantly influenced the exclusive breast-feeding practice. Qualitative data provided in-depth information on factors relating to mother, infant, close relatives and providers.Conclusion: Providing appropriate training and supportive supervision on breast-feeding counselling to health workers and supporting working mothers to exclusively breast-feed their infants through community mobilization were recommended to improve breast-feeding in rural Vietnam