Regional differences in the quality of maternal and neonatal care during the COVID-19 pandemic in Portugal: results from the IMAgiNE EURO study

Objective: To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic. Methods: Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured questionnaire with 40 key WHO standards-based quality measures. Four domains of QMNC were assessed: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region. Results: Out of 1845 participants, one-third (33.7%) had a cesarean. Examples of high-quality care included: low frequencies of lack of early breastfeeding and rooming-in (8.0% and 7.7%, respectively) and informal payment (0.7%); adequate staff professionalism (94.6%); adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstrumental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1%; 19.5% in Lisbon to 28.2% in Algarve). Conclusion: Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal.info:eu-repo/semantics/publishedVersio

Doświadczenia położnych w prowadzeniu porodów u kobiet z prenatalną diagnozą zagrażającą życiu płodu (Midwives' experience of delivering women with Life-Threatening Fetal Diagnosis)

Introduction: Taking care of a woman in the delivery room who is giving birth to a baby affected by a life-limiting foetal condition is a difficult experience for a midwife. Material and methods: In a qualitative study, semi-structured interviews were conducted with 10 midwives who are actively working in delivery rooms at four hospitals in various regions of Poland. The interviews were recorded, and then transcribed and analysed using the content analysis method with the MAXQDA tool. Results: From the experiences of midwives who deliver babies for women after an unfavourable prenatal diagnosis for the baby, two main themes and four sub-themes were identified. Within the first theme, “Impact in the scope of personal experience”, identified sub-themes included “Difficult but positive experiences” and “Confronting one's own emotions”. Within the second theme, “Impact in the scope of interaction with others”, identified sub-themes included “Empathising with the woman” and “Community with other midwives”. Conclusions: Taking care of a woman giving birth to a baby affected by a life-limiting fetal condition is for midwives an experience that is difficult, but ultimately positive and enriching for their personal and professional identity. Midwives need to be prepared through education to effectively deal with the problems which appear in their everyday practice. Psychological support for midwives is insufficient; an opportunity to participate in training courses would enable them to develop their skills related to handling difficult situations, coping with stress, and above all the ability to talk to mothers and fathers of the babies in those situations that are so difficult for the parents.Background: Opieka nad rodzącą na sali porodowej, która rodzi dziecko po diagnozie o letalnym rokowaniu jest trudnym doświadczeniem dla położnej. Metoda: W tym badaniu jakościowym przeprowadzono wywiady półstrukturalne z 10 położnymi aktywnie pracującymi na sali porodowej w czterech szpitalach w różnych regionach Polski. Wywiady zostały nagrane a następnie spisane i przeanalizowane przy użyciu metody analizy treści za pomocą narzędzia MAXQDA. Wyniki: Z doświadczeń położnych, które prowadzą porody u kobiet po niepomyślnej diagnozie prenatalnej dla dziecka, wyodrębniono dwa tematy i cztery podtematy. W pierwszym temacie „Oddziaływanie w obszarze osobistego doświadczenia” wyróżniono podtematy: „doświadczenia trudne ale pozytywne” oraz „konfrontacja z własnymi emocjami”. W drugim temacie „Oddziaływanie w obszarze interakcji z innymi” wyłoniono podtematy: „współodczuwanie” z rodzącą, oraz „community” z innymi położnymi. Wnioski: Opieka nad kobietą rodzącą letalnie chore dziecko jest dla położnych doświadczeniem trudnym, to finalnie, pozytywnym i ubogacającym ich tożsamość osobistą i zawodową. Konieczne jest edukacyjne przygotowanie położnych do skutecznego radzenia sobie z problemami, które pojawiają się w ich codziennej praktyce. Wsparcie psychologiczne dla położnych jest niewystarczające, możliwość uczestnictwa w kursach dokształcających, pozwoliłoby rozwinąć umiejętności radzenia sobie w sytuacjach trudnych, radzenia sobie ze stresem, ale przede wszystkim umiejętności przeprowadzania rozmów z kobietami oraz ojcami dziecka w tak trudnej dla rodziców sytuacji

Parental experiences of prenatal education when preparing for labor and birth of infant with a lethal diagnosis

Abstract Aim The aim of this study was to describe the unique experiences of parents facing a Life Limiting Fetal Conditions (LLFC) diagnosis, who chose to continue with their pregnancy, as they prepare for childbirth through individual and group prenatal education. Design A qualitative study. Methods We employed the phenomenological approach and the Colaizzi strategy to analyse semi‐structured interviews. Thirteen persons were interviewed. The participants were couples (n = 6) and women (n = 7) who received LLFC and were preparing for birth. Results We described three main paths of prenatal education chosen by parents with LLFC: 'Searching for normality' concerned people participating in conventional prenatal classes (AC) who tried to avoid confronting the situation they faced; ‘Searching for communitas’ concerned the participation in special AC selected for the opportunity of sharing experiences; ‘Searching for an individual way’ concerned people who resorted to individual preparation for childbirth, often as a result of delayed planning. Parents should have a choice of various paths of birth preparation, that best meet their preferences

‘Do we need doulas…?’ – Perspectives of maternity care managers on the role of doulas in Poland

Abstract Aim The purpose of this study was to analyse perinatal care managers' perspectives on the role of doulas in Poland and to consider how managers' perspectives might affect the opportunities for doulas to practice in individual hospitals. Design This is a qualitative descriptive study. Method The total of 17 hospitals was selected for the study. Semi‐structured interviews were conducted with 11 manager staff members. Results Three groups of facilities were identified: ‘0’ (n = 6) – refused to give interviews, ‘A’ (n = 8) – marginal experience in working with doulas, and ‘B’ (n = 3) – regular experience in working with doulas. The hospitals from Group A showed indifference towards working with doulas. Group B declared a positive attitude towards such cooperation. Attitudes towards doulas vary among executives and are related to the frequency of doula‐assisted births. Our results indicate factors that may influence the attitude of medical staff towards doulas and which may contribute to improve future initiatives meant to facilitate collaboration between midwives and doulas. Patient or Public Contribution This study explored the lived experiences of perinatal care managers

'Ten poród jest trudny, ale piękny' - doświadczenia rodziców związane z urodzeniem dziecka z diagnozą o śmiertelnym rokowaniu

Introduction: The experience of childbirth, during which parents welcome and say goodbye to their child at the same time, is an unimaginably difficult/traumatic experience. This study aims to explore parents' experiences following the birth of a terminally ill baby. Material and methods: Semi-structured, in-depth interviews were conducted in this qualitative study. The interviews were developed using content analysis, by coding and constructing themes in iterative, collaborative meetings, using the MAXQDA tool. Thirteen parents took part in the study: nine women following a prenatal diagnosis with a lethal prognosis for their child and four fathers of those children. Results: Content analysis revealed two main themes and two sub-themes. The first theme is “Embracing bad news during pregnancy” and the second theme is “This birth is difficult but beautiful”, within which the following sub-themes were identified: “Joy of meeting the baby” and “Saying goodbye to your child is important”. Conclusions: For parents who were preparing for childbirth after prenatal diagnosis with a lethal prognosis for their child, the experience of childbirth had positive implications. Meeting their newborn child was an important moment for them, an affirmation of their parenthood. Parents emphasised that the time to say goodbye to their child was a celebration of their brief parenthood.Background: Doświadczenie porodu podczas którego rodzice witają i jednocześnie żegnają swoje dziecko, jest niewyobrażalnie trudnym/traumatycznym doświadczeniem. Zbadanie doświadczeń rodziców, wynikających z narodzin letalnie chorego dziecka. Metoda: W tym badaniu jakościowym przeprowadzono półstrukturalne wywiady pogłębione. Wywiady zostały opracowane przy użyciu analizy treści, poprzez kodowanie i konstruowanie tematów w trakcie iteracyjnych, zespołowych spotkań, za pomocą narzędzia MAXQDA. W badaniu wiło udział 13 rodziców, dziewięć kobiet po prenatalnej diagnozie o letalnym rokowaniu dla dziecka i czterech ojców dziecka. Wyniki: Analiza treści ujawniła dwa główne tematy i dwa podtematy. Pierwszy temat: „Oswojenie trudnych informacji w okresie ciąży”, w ramach drugiego tematu: „ Ten poród jest trudny ale piękny”, wyodrębniono podtematy: „radość ze spotkania z dzieckiem” i podtemat: „ czas pożegnania jest ważny”. Wnioski: Dla rodziców, którzy przygotowywali się do porodu po prenatalnej diagnozie o letalnym rokowaniu dla dziecka, doświadczenie porodu miało pozytywne implikacje. Spotkanie z nowonarodzonym dzieckiem było dla nich ważnym momentem, potwierdzeniem ich rodzicielstwa. Rodzice podkreślali, że czas pożegnania z dzieckiem był celebrowaniem ich krótkiego rodzicielstwa

The Experience of Women Giving Birth after Cesarean Section—A Longitudinal Observational Study

Natural childbirth after a previous cesarean section is a debated issue despite scientific research and international recommendations. This study aimed to examine the experiences of women giving birth after a previous cesarean section, their preferences, and changes in attitudes towards childbirth after labor. This longitudinal study involved 288 pregnant women who had a previous cesarean section and completed a web-based questionnaire before and after labor, including information about their obstetric history, birth beliefs, and preferred mode of delivery. Among women who preferred a vaginal birth, nearly 80% tried it and 49.78% finished delivery by this mode. Among women declaring a preference for an elective cesarean section, 30% attempted a vaginal birth. Choosing a hospital where staff supported their decision (regardless of the decision) was the most helpful factor in preparing for labor after a cesarean section (63.19%). Women’s birth preferences changed after labor, with women who had a vaginal birth after a cesarean section preferring this mode of delivery in their next pregnancy (89.34%). The mode of birth did not always follow the women’s preferences, with some women who preferred a natural childbirth undergoing an elective cesarean section for medical reasons. A variety of changes were noticeable among women giving birth after a cesarean section, with a large proportion preferring natural birth in their next pregnancy. Hospitals should support women’s birth preferences after a cesarean section (if medically appropriate), providing comprehensive counseling, resources, and emotional support to ensure informed decisions and positive birth experiences

Rates of instrumental vaginal birth and cesarean and quality of maternal and newborn health care in private versus public facilities: Results of the study in 16 countries

Lazzerini M, Valente EP, Covi B, et al. Rates of instrumental vaginal birth and cesarean and quality of maternal and newborn health care in private versus public facilities: Results of the study in 16 countries. International Journal of Gynecology & Obstetrics. 2022;159(S1):22-38