Background Continuous intrapartum support is associated with improved childbirth experiences and clinical outcomes and is central to the WHO Labor Care Guide. Although related to practical support, "being with" a laboring woman is not identical to doing tasks; "being with" is described as a professional ideal and the cornerstone of woman-centered care. Presence in this sense goes beyond physical proximity and includes emotional attunement that aims to help the woman feel safe, seen, and involved. How this is understood and practiced in real clinical settings is less well described. We aimed to explore Swedish midwives' experiences of providing continuous support during the active phase of labor.Method (Design/Setting) This qualitative study was nested within PICRINO, a multicenter randomized trial evaluating the WHO Labor Care Guide. We conducted five focus groups with midwives from Swedish hospitals of varying size (approximate to 1000-4000 births/year) and context (urban and non-urban). The data were analyzed using reflexive thematic analysis to generate themes from the midwives' accounts.Results Six themes were identified, forming one overarching theme: "The heartbeat of midwifery: continuous support during active labor through presence, rhythm, and attunement," and five themes: (1) Presence as the steady pulse, (2) Trust and alliance as foundation, (3) Anchoring and guiding presence, (4) Attunement to the birthing woman, and (5) Navigating structural constraints. Support involved remaining in the room, creating calm, building trust over hours, reframing pain as progress, and adjusting to the woman's changing needs. Continuous support was described as a way to follow the rhythm of the woman and the birth process, central to midwifery practice and professional identity, and an expectation so deeply embedded that it is often unspoken.Discussion Swedish midwives' presence during active labor shapes what they do and what women receive, underscoring continuous support as the heartbeat of midwifery practice. Their narratives reveal that this continuous, attuned, uninterrupted presence enables expertise to be expressed through simple, well-timed acts that help women endure, orient, and remain present during childbirth. When support is sustained, small gestures carry meaning. When support is interrupted, the nature and impact of midwifery care can shift.
ABSTRACT Background Postpartum depressive symptoms (PPDS) are common yet under‐recognized in routine maternal care, particularly in low‐ and middle‐income settings where screening and maternal mental health services remain poorly integrated. We explored midwives' and public health nurses' (PHNs) understanding of PPDS and how they identify, support, and refer mothers in postnatal and child welfare services in Ghana. Methods We conducted a qualitative study using in‐depth interviews with 33 midwives and PHNs in postnatal and child welfare clinics at three public facilities in Ho Municipality, Ghana, between September and November 2024. Interviews explored understanding of PPDS, identification and support practices, referral experiences, and barriers to care. Data were analyzed inductively using Braun and Clarke's thematic analysis. Results Clinical boundaries between PPDS and expected postpartum emotional changes were unclear, with providers relying on emotional and behavioral changes rather than standardized screening. Recognition relied on provider observation because mothers were perceived to rarely disclose distress owing to stigma, expectations of maternal strength, and fear of judgment. Care was largely relational within weakly integrated maternal mental health systems. The lack of access to standardized screening tools, limited training, inadequate privacy, poor documentation, and inconsistent referral pathways hindered identification and follow‐up. Conclusion Midwives and PHNs play a central role in identifying and supporting mothers with PPDS, but their ability is constrained by clinical uncertainty, limited maternal disclosure, and weak integration of maternal mental health into routine care. Strengthening routine screening, provider training, confidential consultation spaces, and referral pathways could improve the identification and management of PPDS.
ABSTRACT Introduction Despite evidence supporting comprehensive treatment for perinatal substance use disorder (SUD), access and engagement in these programs remain limited due to structural barriers, stigma, and bias. Pregnant people with SUD thus often enter birth hospitalization after negative—or absent—healthcare experiences. Although prior research has described patients' perspectives on interactions with healthcare clinicians during hospitalization and clinicians' perspectives on SUD treatment barriers, less is known about clinicians' experiences caring for this population during labor and birth in the inpatient setting. Methods We conducted semi‐structured interviews with healthcare clinicians caring for pregnant patients with SUD during labor and delivery at a tertiary care center in New England. Interviews were transcribed, de‐identified, coded using ATLAS.ti, and analyzed thematically. Results Thirteen clinicians participated. Four themes emerged: caring for pregnant patients with SUD was perceived as uniquely challenging because of increased resource needs and behavioral concerns; clinicians expressed concern about patients' ability to parent safely; clinicians described apprehension and wariness around the emotional experience of providing care; and conversely, some found caring for this population uniquely rewarding and inspiring. Conclusions Caring for pregnant people with SUD is an emotionally charged experience that may trigger clinician bias. By viewing these patients as fundamentally different from others, clinicians contribute to the experience of stigma, mistrust of healthcare systems, and avoidance of care among patients. Efforts to reduce clinician bias and promote respectful, equitable maternity care are critical to improving patient experiences and outcomes.
ABSTRACT Introduction Severe anemia may be life‐threatening and is associated with adverse maternal outcomes; however, there is a paucity of literature on socio‐cultural practices that may influence anemia in pregnancy. Women in many African societies value cultural practices in the perinatal period. These practices are known to influence the prevention, detection, and management of anemia in pregnancy. Aim To explore the socio‐cultural practices and beliefs that influence anemia in pregnancy among women in Cape Coast, Ghana. Methods A qualitative descriptive exploratory study design was used, consisting of semi‐structured face‐to‐face interviews with 32 puerperal women. Interviews were audio‐recorded and transcribed verbatim. A hybrid thematic analysis was undertaken, incorporating a deductive, theoretical (top‐down) process and an inductive, data‐driven (bottom‐up) approach. The theoretical domains framework was used to develop the interview questions and to guide the deductive analysis. Results Women believed certain traditional medicines would influence pregnancy outcomes; however, they perceived that they had limited autonomy concerning their antenatal attendance, food choices, and preferences. Partners were reported to make decisions about the location and timing of the initial antenatal visit and to manage the money for transportation and out‐of‐pocket healthcare‐related expenses. Family members were reported to prohibit women from consuming foods believed to impact pregnancy adversely. Family support played a crucial role, while practical community support was generally lacking. Conclusion Socio‐cultural factors may influence anemia in pregnancy management. This study highlights the need for empowerment of women, and for education of partners and other family members about anemia in pregnancy. There is also a need to understand women's socio‐cultural backgrounds and familial power dynamics when providing care.
ABSTRACT Background Breastfeeding rates and duration have been linked to a variety of factors, including mode of birth and maternal psychopathology. Although the research on mode of birth has focused primarily on caesarean sections and produced conflicting results, the research on psychopathology has primarily been undertaken in postnatal women. Furthermore, no study has explored whether mode of birth may moderate the relationship between maternal psychopathology and breastfeeding rates and duration. Aims To evaluate the impact of mode of birth (caesarean section, spontaneous vaginal birth, instrumental birth) and antenatal maternal psychopathology (depression and anxiety symptoms) on breastfeeding in a sample of new mothers. Design A longitudinal study design was employed to collect data during pregnancy, at 10 weeks post‐partum, and at 10‐months post‐partum. Methods Participants were 488 women booked in to give birth at a Private Hospital in North Sydney, Australia. Participants completed self‐report questionnaires relating to maternal depression, anxiety, and breastfeeding during pregnancy and at 10‐weeks and 9‐months post‐partum. Details about mode of birth and breastfeeding during the immediate postnatal stay were extracted from hospital records. Results Older maternal age and primiparity were associated with lower breastfeeding rates and duration at hospital discharge, 10‐weeks and 9‐months post‐partum. No associations were observed between mode of delivery or antenatal depression/anxiety symptoms and breastfeeding. Conclusion For Australian women who give birth in the private system, risk factors for poorer breastfeeding outcomes include older age and primiparity. Women who present with these characteristics may benefit from targeted breastfeeding support.
