Developing an Evaluation Model for Maternity Care: A Mixed-Method Study from Iran

Background: Maternity care is an integral part of primary health care (PHC) systems worldwide. This study aimed to develop a new model for evaluating the maternity health program (MHP) in Iran. Methods: In this mixed-methods study, first, the challenges of MHP were surveyed through systematic review and expert interviews. Next, to identify the existing shortcomings in MHP evaluation system, the SWOT technique, cross-sectional study and comparative analyses were used. Finally, the Delphi technique was used to reach consensus on developed evaluation standards. Results: The final developed evaluation model contains five dimensions including reproductive health/family planning, maternity health, health records, evaluation, and resources management. Overall, this model has 32 standards and 289 measures. The scores obtained for the sum of the measures in two importance and applicability criteria were 8.24 and 7.85, which these scores are estimated to be equal to 91.55 and 87.22 percent of the highest possible scores, respectively. Conclusion: Considering the comprehensiveness of the obtained model, it is hoped that it could lead to performance improvement of the PHC centers in the area of maternity health.

Psychological impacts of the COVID-19 pandemic on one-month postpartum mothers in a metropolitan area of Japan

Background The coronavirus disease 2019 (COVID-19) pandemic has recently become the most important issue in the world. Very few reports in Japan have examined the impact of the COVID-19 pandemic on peripartum mental health. We examined the status of postpartum mental health before and during COVID-19 pandemic from a consecutive database in a metropolitan area of Japan. Methods The subjects were women who had completed a maternity health check-up at a core regional hospital in Yokohama during the period from April 1, 2017, to December 31, 2020. We collected the subjects’ scores for the Edinburgh Postnatal Depression Scale (EPDS) and the Mother-to-Infant Bonding Scale (MIBS) at 1 month postpartum. The subjects were divided into four groups (three Before COVID-19 groups and a During COVID-19 group). MANOVA and post-hoc tests were used to determine mental health changes in the postpartum period among the four groups. Results The Before and During COVID-19 groups contained 2844 and 1095 mothers, respectively. There were no significant difference in the total scores of the EPDS and MIBS among the four groups. However, the EPDS items related to anxiety factors were significantly higher and the EPDS items related to anhedonia and depression factors (excluding thoughts of self-harm) were significantly lower in the During COVID-19 group. Conclusion The EPDS scores changed in connection with the COVID-19 pandemic. Anxiety, which represent hypervigilance, was significantly higher and anhedonia and depression were significantly lower in the During COVID-19 group. Our results may reflect COVID-19-related health concerns and a lack of social support caused by the COVID-19 pandemic.

Childbirth violence-based negative health consequences: a qualitative study in Iranian women

Background Violation of mothers' rights during childbirth is a global problem that often silently torments women in many parts of the world. The aim of this study was to explore negative health consequences due to childbirth violence based on mothers' perceptions and experiences. Methods To achieve rich data, an exploratory qualitative study was carried out in 2019 on 26 women with childbirth violence experience who had given birth in hospitals of Ilam, Iran. Data were collected using semi‑structure in‑depth interviews (IDIs) and a purposive sampling. Participants were asked about their experiences and perceptions of negative health consequences due to childbirth violence. Data were analyzed by conventional content analysis based on Graneheim and Lundman approach. MAXQDA (v.18) software was used for better data management. Results Final codes were classified into 9 sub-categories and 3 main categories including maternal and newborn injuries, weakening of family ties, sense of distrust and hatred. These findings emerged the theme: negative health consequences. Conclusions This study broke the silence of abused mothers during childbirth and expressed the perspective of mothers who suffered childbirth violence as a routine phenomenon in maternal care, and a serious threat to the health of mothers, newborns and families. Findings of this study can be a warning for maternity health system, monitoring and support structures as well as health policy-makers to seriously plan to prevent and eliminate this problem.

Midwifery Trained Registered Nurses' Perceptions of Their Role in the Labor Unit

Introduction: A Midwifery Trained Registered Nurse (MTRN) is a member of the multi-professional maternity health care team in Sri Lanka. Her contribution to the maternity care team is poorly understood, often undermined, and undefined. In the context of low- and middle-income settings where traditional midwives play a crucial role in domiciliary care, the MTRNs role as a member of the multi-professional hospital-based maternity care team has not been well-described. Objective: The study aimed to describe MTRNs' perceptions of their role in the Labor Unit within the multi-professional maternity health care team at five tertiary care hospitals in the Capitol Province of Sri Lanka. Materials and Methods: A descriptive cross-sectional study was conducted among 186 MTRNs working in labor rooms in the study setting. All MTRNs in the selected hospitals were invited and included in the sample. A postal survey was carried out using a pre-evaluated, pretested self-administered questionnaire, and descriptive statistics were derived. Results: All respondents were females, aged 27 to 60 years (mean ±SD 40 ±8.3 years). The majority (66%)was less than 45 years old. Almost all (>96%) MTRNs perceived 12 tasks of the listed tasks as their primary responsibility. Regarding other tasks, they perceived a high degree of overlap between their role and those of the doctors and midwives. Although almost all MTRNs rated the level of interprofessional collaboration from registered nurses (RNs) and doctors as average to good, nearly half (49%) of them rated support from midwives ranging from very poor to average. Conclusion: A high degree of perceived overlap between MTRNs' tasks with those of the other members of the maternity care team can cause role confusion, conflicts, and poor patient care. MTRNs' role in the Labor Unit within the multi-professional maternity health care team was controversial. Clarifying the MTRNs scope of practice will help improve interprofessional understanding of roles and responsibilities and collaboration.

Factors affecting Maternal-care during labour at maternity centres of Karachi, Pakistan: Exploratory study

Each year around 529,000 women die worldwide due to harmful consequences of childbirth in developing countries. Thus, this study aimed to explore barriers and facilitators that influence the provision of quality care during labor at maternity centers of Karachi, Pakistan. The qualitative exploratory study design was used to explore such factors from public and private maternity health facilities of Karachi, Pakistan. In-depth interviews were conducted through purposive sampling by using validated semi-structured interview guide. Data was analyzed using content analysis manually. Among major barriers; unhygenic environment, lack of basic equipment, supplies and medicine, unprofessional attitude of staff, physical infrastructre and shotrage of staff were explored. Among facilitators; Caring and supportive attitude of healthcare personnel during labor were identified. Continuous...

A Qualitative Study on the Breastfeeding Experiences of Young Mothers

Background: Breastfeeding practice for young mothers could be problematic, especially when supports are absent. Evidence reported that young mothers have risks of experiencing mental health problems and of behavioural problems in their children. Data showed that 36 per 1,000 childbirth occurred among Indonesian female adolescents aged 15-19 during 2018. Nevertheless, the breastfeeding experience of young mothers has not been well studied, particularly in the Indonesian context. Therefore, to develop professional caring and supporting relationships, it is important to address this knowledge gap.Purpose: This study aimed to explore the experiences of breastfeeding practices among Indonesian young mothers.Methods: A qualitative exploratory study was employed, and one-to-one in-depth interviews were conducted on 18 young mothers between May until August 2019. Data analysis was guided by Colaizzi’s thematic approach.Results: Four key themes emerged from the qualitative data, i.e., formal support of breastfeeding, the role of family, partner and peers, culture and judgement, and future aspirations and healthcare. Indonesian young mothers sought formal information on breastfeeding from healthcare providers. However, there was a lack of translation into practices due to lack of supports from partners, cultural beliefs, and parents' interference, which consequently led to the failure of breastfeeding. Indonesian young mothers were suggesting that breastfeeding information should also be provided to their circle of supports, such as partners and close relatives. Conclusion: Indonesian young mothers experienced complex situations through their journey of breastfeeding practices. A tailored maternity health service involving partners, parents, and communities into culture-sensitive programme intervention is needed to provide professional caring, and reliable supportive sources of breastfeeding for young mothers.

Understanding forgotten exposures towards achieving Sustainable Development Goal 3: the case of herbal medicine use in Tanzania

Background: In most sub-Sahara African countries, herbal medicines are widely used during pregnancy or delivery for various motives despite their unclear pharmacology and potential toxicity. All risky exposures, including use of herbs during pregnancy or delivery should be restricted in order to facilitate achieving Sustainable Development Goal (SDG) 3, which states: “ensure healthy lives and promote wellbeing for all including reduction of morbidity and mortality among mothers and newborns”. Thus, this study assessed use of herbal medicines during pregnancy or delivery and determined factors associated with the practice in Tabora, Tanzania.Methods: This cross-sectional quantitative study gathered information from 340 women who delivered a live-born baby in the preceding two years. Using a two-stage-sampling technique, we selected and interviewed women attending reproductive, maternal and child health clinics in public health facilities in Tabora, central Tanzania. We compared proportions using chi-square test and performed Poisson regression analysis to determine independent correlates of herbal use.Results: Of 340 recruited women, 208 [61.2 %; 95% confidence interval (CI): 55.4, 66.3%] used herbal medicines during pregnancy or delivery. Major reasons for use included shortening of labour duration, 81 (38.9%) and reducing labour pain, 58 (27.9%). The independent predictors of herbal use were number of antenatal visits and the stance of maternity health care providers on the use of herbs. Women who made less than four visits had 24% higher prevalence ratio of using herbal medicines as compared to those who made at least four visits [adjusted Prevalence Ratio (aPR):1.24; 95%CI: 1.02, 1.50, p=0.03]. Furthermore, the adjusted prevalence ratio of using herbs was 35% higher among women who were not discouraged by health care providers against using herbs versus those who were discouraged (aPR: 1.35; 95%CI: 1.13, 1.60, p=0.01). Conclusions: Use of herbal medicines during pregnancy or delivery among women in Tanzania is high. This calls for comprehensive investigations on the effects of using herbs during pregnancy or delivery as a step towards understanding some of the challenges in achieving SDG 3. Additionally, maternity health care providers ought to strengthen provision of health education messages during antenatal visits on the undesirable effects of using herbs.