bmcpregnancychildbirth.biomedcentral.com

2 months ago | bmcpregnancychildbirth.biomedcentral.com | Cassandra Yuill |Mairi Harkness |Helen Cheyne |Mónica Ferreira |Eloise Price |Amarnath Bhide | +12 more

In the United Kingdom, induction of labour rates are rapidly rising, and around a third of pregnant women undergo the procedure. The first stage, cervical ripening, traditionally carried out in hospital, is increasingly offered outpatient – or ‘at home’. The current induction of labour rates place considerable demand on maternity services and impact women’s experiences of care, and at home cervical ripening has been suggested as potential solution for alleviating these. However, there is a lack of evidence on both women’s and birth partners’ experiences and acceptability of at home cervical ripening informing its practice. We undertook a qualitative study of women and their birth partners’ experiences of cervical ripening at home and in hospital. Semi-structured interviews explored experiences, acceptability and consequences of cervical ripening. We identified six key themes: ‘Information and choice’; ‘Physical and sensorial environments’; ‘Pain’; ‘Uncertainty’; ‘Care during induction’; ‘Lasting effects’. Women and birth partners experienced limited choice about cervical ripening. Many reported that shared hospital spaces contributed to negative experiences, while home environments were comforting. Women were unprepared for cervical ripening-associated pain, and delays and uncertainty during induction caused anxiety. Supportive care contributed to more positive experiences; however, some reported difficult or traumatic experiences related to induction. Most participants were positive about home cervical ripening, yet our study highlights the lack of information and genuine choice regarding cervical ripening and induction. Privacy, presence of birth partners and supportive care contributed to more positive experiences among women. Home cervical ripening may be acceptable to some women and birth partners in the context of informed choice and personalised care.

Jan 20, 2025 | bmcpregnancychildbirth.biomedcentral.com | Jennifer Leason |Brittany Barker |Yufei Zheng |Harriet MacMillan |Brandi Anne Berry |Erik Mohns | +5 more

Indigenous Peoples comprise the youngest and fastest growing demographic in Canada, with many living in urban-suburban areas. Given higher fertility rates, younger overall ages and higher adolescent pregnancy rates, perinatal research is needed—to inform policymaking and programming throughout pregnancy and childhood. Yet such data remain scarce in British Columbia (BC), Canada. This study therefore aimed to describe the experiences of young, urban, Indigenous mothers-to-be who enrolled in a larger BC early prevention trial designed to reach families experiencing socioeconomic disadvantage. This descriptive study utilized baseline data from a trial that enrolled first-time mothers-to-be who met indicators of socioeconomic disadvantage and who were residing in select urban-suburban areas. These indicators included being young (19 years or younger) or having limited income, low access to education, and being single (aged 20−24 years). We described and compared survey data on girls (n = 109; aged 14−19 years) and young women (n = 91; aged 20−24 years) using Chi-square or Student’s t-tests. Of the 739 trial participants, 200 or 27% identified as Indigenous and met trial eligibility criteria: limited income (92.9%), limited access to education (67.0%), and/or being single (90.9%). Beyond this, participants reported associated adversities including: unstable housing (63.3%), psychological distress (29.3%), severe anxiety or depression (48.5%), experiences of childhood maltreatment (59.4%) and intimate partner violence (39.5%). Compared to girls, young women reported higher income and educational attainment (p < 0.001), more unstable housing (p = 0.02) and more childhood maltreatment (p = 0.014). Many had recently received primary healthcare (75%), but few had received income assistance (34%). Most (80.5%) reported experiencing four or more adversities. We present data illustrating that a high proportion of pregnant Indigenous girls and young women engaged with public health and consented to long-term research participation—despite experiencing cumulative adversities. The trial socioeconomic screening criteria were successful in reaching this population. Girls and young women reported relatively similar experiences—beyond expected developmental differences in income and education—suggesting that adolescent maternal age may not necessarily infer risk. Our findings underscore the need for Indigenous community-led services that address avoidable adversities starting in early pregnancy.

Jan 8, 2025 | bmcpregnancychildbirth.biomedcentral.com | Susan Heaney |Clare Collins |Megan Rollo |Leanne Brown |Ellen Payne

Women and people diagnosed with diabetes in pregnancy, are recommended to have frequent monitoring and careful management for optimal pregnancy outcomes. This health care management should be supported by a multidisciplinary healthcare team. For individuals living in rural areas, there are increased barriers to healthcare access, with subsequent worse health outcomes compared to those in metropolitan regions. Despite this, there remains a lack of research into the experiences of healthcare delivery for rural women and people with diabetes in pregnancy. Survey invitations were sent via the National Diabetes Services Scheme email list. The survey included multiple choice and open-ended questions. Responses from the open-ended question asking participants the changes they would want made to their care delivery were interpreted using qualitative content analysis. Responses were separated into metropolitan and rural categories using the Modified Monash Model criteria. There were 668 survey responses, with 409 responding to the open-ended qualitative survey question/s. 71.6% of respondents were metropolitan and 27.6% lived rurally. A total of 31 codes were established from the open-ended responses, with the five overarching themes of ‘quality of care’, ‘practice & communication’, ‘individual’s experience’, ‘access’ and ‘burden of care’ identified. The most frequently occurring codes irrespective of location included education or information (n = 45), frequency and timeliness of care (n = 42), no changes (n = 42) and improved health professional communication (n = 40). Local care options was the only code with more rural quotes compared to metropolitan. The most frequently occurring codes had strong representation from metropolitan and rural respondents, indicating that those with previous diabetes in pregnancy had similar priorities for changes in their healthcare delivery regardless of location. Rural respondents identifying local care options as a priority for change is likely indicative of the rural healthcare landscape with limited access to care options. Recommendations from this study supported by previous research include focusing on improving health professional communication both with women and people with diabetes in pregnancy and with other relevant professionals. Recommendations for rural locations should focus on improving local care options whilst considering resource limitation, such as telehealth clinics.

Nov 28, 2024 | bmcpregnancychildbirth.biomedcentral.com | Alison Chisholm |Sheila Greenfield |James Hodgkinson |Layla Lavallee |Paul D. Leeson |Lucy H Mackillop | +9 more

The COVID-19 pandemic accelerated the adoption of remote care, or telemedicine, in many clinical areas including maternity care. One component of remote care, the use of self-monitoring of blood pressure in pregnancy, could form a key component in post-pandemic care pathways. The BUMP trials evaluated a self-monitoring of blood pressure intervention in addition to usual care, testing whether it improved detection or control of hypertension for pregnant people at risk of hypertension or with hypertension during pregnancy. This paper reports the qualitative evaluation which aimed to understand how the intervention worked, the perspectives of participants in the trials, and, crucially, those who declined to participate. The BUMP trials were conducted between November 2018 and May 2020. Thirty-nine in-depth qualitative interviews were carried out with a diverse sample of pregnant women invited to participate in the BUMP trials across five maternity units in England. Self-monitoring of blood pressure in the BUMP trials was reassuring, acceptable, and convenient and sometimes alerted women to raised BP. While empowering, taking a series of self-monitored readings also introduced uncertainty and new responsibility. Some declined to participate due to a range of concerns. In the intervention arm, the performance of the BUMP intervention may have been impacted by women’s selective or delayed reporting of raised readings and repeated testing in pursuit of normal BP readings. In the usual care arm, more women were already self-monitoring their blood pressure than expected. The BUMP trials did not find that among pregnant individuals at higher risk of preeclampsia, blood pressure self-monitoring with telemonitoring led to significantly earlier clinic-based detection of hypertension nor improved management of blood pressure. The findings from this study help us understand the role that self-monitoring of blood pressure can play in maternity care pathways. As maternity services consider the balance between face-to-face and remote consultations in the aftermath of the COVID-19 pandemic, these findings contribute to the evidence base needed to identify optimal, effective, and equitable approaches to self-monitoring of blood pressure.

Nov 24, 2024 | bmcpregnancychildbirth.biomedcentral.com | Friedrich-Alexander-Universität Erlangen-Nürnberg |Friedrich-Alexander- Erlangen-Nürnberg

This work aimed to analyze pregnancy app features, expert guidance and content trustworthiness, commercialization, and their user perception. For this purpose, we reviewed app descriptions, performed in-depth searches, and used NLP on user reviews. This section will discuss key findings in the respective areas, derive overall implications, provide insights for clinical practice, limitations of this work, and lastly provide links for future research.