BACKGROUND:Psychological birth trauma (PBT) has been proposed as a broader construct encompassing childbirth-related psychological distress, including but not limited to symptoms consistent with post-traumatic stress disorder. Attachment theory suggests that adult attachment dimensions are associated with differences in threat appraisal, affect regulation, and help-seeking; however, their relationship with childbirth-related trauma symptoms and birth satisfaction remains unclear. METHODS:A cross-sectional online survey was completed by 940 postpartum women in Australia (≤24 months postpartum) who had experienced an early-term or full-term (≥37 weeks), vaginal, singleton birth and whose infant did not require neonatal intensive care or special care. Participants completed a demographic questionnaire, the Adult Attachment Questionnaire, City Birth Trauma Scale, and Australian Birth Satisfaction Scale-Revised. Data were analysed in SPSS, with measures scored according to published procedures. Adult attachment anxiety and avoidance were examined as continuous dimensions as the primary analytic approach and via median-split quadrants to derive attachment classifications for secondary analyses. Childbirth-related trauma symptoms were analysed dimensionally, and probable PTSD was identified using a published algorithm. Birth satisfaction was analysed as a continuous outcome. RESULTS:In the primary dimensional analyses, higher attachment anxiety and attachment avoidance were each associated with greater childbirth-related trauma symptom severity and lower birth satisfaction. In secondary exploratory quadrant-based analyses, women with secure attachment classifications reported the lowest trauma symptoms and most favourable birth appraisals, whereas those with attachments classified as disorganised/unresolved reported the highest symptom burden and the least favourable appraisals of stress, self-related attributes, and quality of care. Overall, 14.8% of participants met the published threshold for probable childbirth-related PTSD, with the lowest proportion observed in the secure group and the highest in the disorganised/unresolved group, based on the exploratory quadrant-derived classifications. DISCUSSION:Higher attachment anxiety and avoidance were associated with elevated childbirth-related trauma symptoms and poorer childbirth appraisals within the current sample. Secondary exploratory attachment classification analyses further demonstrated broadly consistent patterns. These findings highlight the potential value of further investigating attachment-informed and trauma-informed approaches within relational maternity care, continuity models of midwifery care, and postnatal psychological support.
BACKGROUND:Nutrition literacy (NL) during pregnancy is critical for maternal and perinatal health. AIMS:To examine the effects of the scenario-based NL mobile application "i-PregMom" on pregnant women's NL and healthy eating behaviors. METHODS:A randomized controlled trial was conducted among 160 pregnant women recruited from three prenatal clinics in northern Taiwan between April 2025 and February 2026. Participants were assigned to either the intervention group or the control group via computer-generated block randomization (1:1). Data collectors and outcome assessors but not participants were blinded. Questionnaires were administered at baseline, 2 weeks later, and 12 weeks after completion of the intervention. Both groups received routine dietary education at 10-14 gestational weeks. The intervention group also had access to i-PregMom. Pregnancy-related NL was assessed using the 22-item, scenario-based Nutrition Literacy Scale, which comprises understanding, analysis, appraisal, and application domains (total score: 0-22). Healthy eating behavior was assessed using a validated 13-item scale (total score: 13-65). RESULTS:In the intervention and control groups, 74 and 75 participants, respectively, completed the 12-week follow-up. Baseline characteristics and scores did not differ between the groups. By the final follow-up, the intervention group had higher mean ± standard deviation NL (20.5 ± 1.6 vs. 18.2 ± 2.1; mean difference = 2.3, 95% confidence interval [CI] = 1.67-2.88; p < .001; Cohen's d = 1.22) and healthier eating behavior (45.6 ± 7.0 vs. 42.2 ± 7.0; mean difference = 3.4, 95% CI = 1.22-5.73; p = .003; Cohen's d = 0.50). CONCLUSION:i-PregMom may serve as a useful adjunct to routine prenatal education by providing continuous, scenario-based support for nutrition-related decision-making and healthy eating. TRIAL REGISTRATION:ClinicalTrials.gov NCT06917703.
Background Gestational diabetes mellitus (GDM) healthcare is additionally challenging in the growing group of migrant women (MW) in the Western world, due to language and socioeconomic barriers, and lower healthcare utilisation, resulting in higher perinatal morbidity. Limited awareness among healthcare professionals (HCP) and a lack of care individualisation, compounded by time shortages and understaffing, hamper mutual understanding between caregiver and patient. Aim This qualitative study examines how multidisciplinary care addresses the needs of MW with GDM in southeast Amsterdam, the Netherlands. Combining patient and provider perspectives, it identifies discrepancies in expectations and cultural responsiveness, and makes recommendations for inclusive, culturally tailored practices to improve alignment and health outcomes. Methods Women with GDM from non-Western migrant population attending the outpatient department of a Dutch tertiary obstetric hospital and two community midwifery clinics, along with GDM care providers from the same institutions were recruited. Semi-structured interviews explored MW needs and culturally tailored care. Inductive and deductive coding and exploratory analysis identified recurring themes in patient-provider alignments and misalignments. Findings Interviews with 16 MW and 16 HCP revealed four themes: incomplete GDM understanding, self-management challenges, cultural responsiveness, and recommendations for practice change. Alignments included shared belief in GDM care and overall service satisfaction. Misalignments involved delayed diagnosis explanation, insufficiently tailored diet advice, limited translator use and lack of continuity in care. Conclusion The study highlights persistent challenges in communication, cultural adaptation, and continuity of care, while recognising existing strengths and ongoing efforts towards culturally inclusive and responsive practice. Our findings provide specific directions for improvement of care.
Background The postpartum period is a critical phase for both maternal and infant health. In many healthcare systems, postpartum care is limited to a single six-week visit, often leaving women with inadequate support as they undergo the physiological, psychological, and social adjustments required for motherhood. Aim This scoping review maps the characteristics, delivery approaches, reported outcomes, and evidence gaps of nurse- and midwife-led continuity-of-care interventions that include care or follow-up beyond six weeks postpartum. Methodology Following Arksey and O’Malley’s framework and the Joanna Briggs Institute (JBI) guidance, five electronic databases and gray literature sources were searched for studies published between 2013 and 2025. Eligibility was assessed using the Population, Concept, and Context (PCC) framework. Data were charted according to intervention characteristics, setting, provider, delivery mode, outcome measures, and reported findings. Methodological limitations were appraised using design-appropriate JBI critical appraisal checklists, and the findings were synthesised narratively. Results Fifteen studies met the inclusion criteria, of which ten were randomized controlled trials (RCTs). Interventions were heterogeneous and delivered in hospitals, communities, homes, primary care, and digital settings. Several studies reported reductions in depressive or trauma symptom scores, improved breastfeeding outcomes, and increased contraceptive and service uptake. Evidence of cardiometabolic recovery and long-term quality-of-life outcomes is limited. Small sample sizes temper interpretation in several studies, self-reported outcomes, lack of comparison groups in some non-randomized studies, attrition, and limited feasibility of blinding for behavioral and service-delivery interventions. Conclusion The reported findings suggest that nurse- and midwife-led models may improve continuity and selected maternal outcomes beyond six weeks postpartum. However, heterogeneity and methodological limitations preclude strong conclusions about comparative effectiveness. Extended nursing and midwifery follow-up should be integrated with obstetric, primary care, mental health, and other services, with implementation tailored to local workforce, health system, and financing contexts.
Background : Weight stigma, the devaluation of individuals based on size/weight, is pervasive throughout medicine and negatively impacts physical and mental wellbeing. Health at Every Size (HAES) promotes people of all body sizes achieving health through weight inclusivity, health enhancement, respectful care, eating for well-being, and life-enhancing movement. While HAES-based interventions have been shown to decrease internalization of weight stigma and improve various health markers, including mental health, no such intervention has been adapted for obstetric care. We aimed to elucidate the perspectives of pregnant and postpartum individuals on weight stigma in obstetric care and elicit feedback and assess interest for the adapted Health at Every Size intervention utilizing a qualitative approach. Methods : We conducted interviews of 20 pregnant and postpartum people with BMI ≥ 30 kg/m2 who reported experiencing stigma. Participants were asked about their obstetric care experiences and to provide feedback on a five-session obstetric-focused HAES intervention prototype. Qualitative description methodology was used to generate the codebook and identify themes. Transcripts were double-coded, and discrepancies were discussed until consensus was reached. Results Identified themes included: 1) Negative experiences related to weight and/or body size during pregnancy, 2) Positive experiences with individual providers, 3) Support and excitement for the weight-inclusive obstetric intervention, and 4) Suggestions for the adapted program and general obstetric care. Conclusion : Individuals in larger bodies report negative experiences related to their weight when engaging in prenatal care. An obstetric intervention focused on optimizing physical and mental well-being through a weight-inclusive lens may be a method for improving obstetric experience of individuals in larger bodies and was well received by all participants.
PROBLEM:Maternal-fetal attachment (MFA) plays a critical role in determining maternal health and influencing child developmental outcomes. However, structured behavioral interventions designed to enhance MFA are seldom included in antenatal care practices. BACKGROUND:MFA forms the foundation of the maternal-child bond. This early relationship is critical for maternal mental health and serves as a precursor to the child's socio-emotional and behavioral development. AIM:This study aimed to determine whether a behavioral communication intervention could enhance maternal-fetal attachment. METHODS:A total of 450 expectant mothers were recruited and randomly assigned to two test groups and one control group in a 3-arm trial (1:1:1). The Maternal-Fetal Attachment Scale (MFAS) and Prenatal Attachment Inventory (PAI) were used to measure MFA at baseline and post-intervention. RESULTS:MFA scores increased across groups over time. Test Group 2, which received additional interactive supportive talk therapy, demonstrated a statistically significant enhancement in MFA measured by the PAI (p < 0.001) versus the control group. However, MFAS score changes for Test Group 2 were not significant (p = 0.064). Test Group 1 showed no significant differences on either scale compared to the control group. DISCUSSION:MFA showed a steady increase throughout pregnancy in the intervention groups, especially in those receiving a blend of psychological and cognitive-behavioral support, demonstrating notably greater improvements beyond natural progression. CONCLUSION:This study emphasizes the benefits of combining supportive talk therapy and behavioral communication therapy to enhance mother-fetal attachment. Strengthening MFA may be crucial for fostering optimal psychological, behavioral, and cognitive development in offspring.
BACKGROUND:This study compared labor characteristics and maternal-neonatal outcomes between pregnant women with diet-controlled (A1) gestational diabetes mellitus (GDM) and normoglycemic women, within a cohort of women undergoing induction of labor (IOL) at term. Furthermore, we aimed to identify risk factors associated with cesarean section (CS) in this specific population. MATERIAL AND METHODS:A total of 686 pregnant women were enrolled and divided into an A1 GDM group (n=256) and a non-GDM control group (n=430). Propensity score matching (PSM) was used to adjust for maternal age, BMI, gravidity, parity, and Bishop score, resulting in 254 matched pairs. Labor induction characteristics, clinical interventions, and maternal and neonatal outcomes were compared. Risk factors for CS were analyzed using univariate and multivariate logistic regression. RESULTS:The A1 GDM group had higher rates of episiotomy and postpartum blood loss, and greater fetal weight (P<0.05), but no significant difference in CS rates (9.8% vs. 11.4%) or most neonatal outcomes. Multivariate analysis showed that advanced maternal age (OR 1.177, 95% CI 1.089-1.272), nulliparity (OR 0.110, 95% CI 0.053-0.231), and lower Bishop score (OR 0.605, 95% CI 0.442-0.828) were independent risk factors for CS, while A1 GDM was not. CONCLUSIONS:In this cohort of women undergoing IOL at term, pregnancy outcomes for those with well-managed A1 GDM were comparable to non-GDM controls. After adjustment for confounders, A1 GDM was not observed to be an independent risk factor for CS, instead, maternal age, parity, and cervical readiness were the primary determinants of delivery mode.
Background Childbirth is a complex event where the quality of care may profoundly be linked to women’s experiences and subsequent psychological wellbeing. Adverse childbirth experiences can be associated with to childbirth-related post-traumatic stress disorder. Conversely, positive care experiences, specifically supportive interactions and respectful treatment, may act as a protective factor associated with maternal resilience. Aim This study aimed to investigate how medical events during childbirth, including birth complications and interventions, align with the quality of childbirth care. It evaluated the relationship between positive (person-centred care) and negative (mistreatment) care-related factors on perceived threat and subsequent childbirth-related post-traumatic stress symptoms (CB-PTSS). Methods This cross-sectional analysis utilised data from 683 mothers/birthing people collected at 8-weeks postpartum as part of a large German prospective cohort study, RESPECTPARENTS (N=1300).Structural Equation Modelling (SEM) was employed to examine the direct and indirect paths connecting predictor variables (birth complications and interventions) to outcome variables of perceived threat and childbirth-related post-traumatic stress symptoms using positive care-related factors (person-centred care) and negative care-related interaction (mistreatment) as potential mediating variables. Results Results confirmed that birth complications demonstrated a significant positive association with higher perceived threat (β = 0.152, 95% CI [0.062, 0.238], p < .001) and CB-PTSS (β = 0.158, 95% CI [0.083, 0.236], p < .001). Person-centred care was inversely related to perceived threat (β = -0.107, 95% CI [-0.196, -0.014], p = .022) and lower CB-PTSS (β = -0.255, 95% CI [-0.336, -0.173], p < .001). Mistreatment during childbirth significantly mediated the relationship between birth interventions and CB-PTSS (β = 0.032, 95% CI [0.015, 0.062], p = 0.004), though the magnitude of this indirect effect was small (β = 0.032, 95% CI [0.015, 0.062], p = 0.004). Discussion This study confirms that birth complications are associated with higher perceived threat and CB-PTSS. Critically, the mediation finding highlights that negative experiences of care during childbirth may be an important factor in to trauma development. Beyond the mediation pathway, the direct protective effect of positive care-related factors on perceived threat and CB-PTSS is particularly noteworthy. This underscores that the subjective experience of care during childbirth is a key associated risk factor for birth trauma, independent of obstetric procedures. Conclusion These findings highlight the necessity of person-centered, trauma-informed childbirth care supported by empowering healthcare policies. By demonstrating that care-related factors are directly associated with perceived threat and CB-PTSS risk, this study underscores the critical responsibility of healthcare professionals in shaping psychological outcomes through respectful practice.
BACKGROUND:Hyperemesis gravidarum (HG) affects 0.3-2% of pregnancies, while nausea and vomiting in pregnancy (NVP) affects up to 70-80% worldwide. Although physical complications are well recognised, the psychological burden and role of care experiences are less clearly defined. AIM:To synthesise evidence on psychological morbidity in HG and NVP, alongside women's experiences of care. METHODS:Mixed-methods systematic review of peer reviewed studies (2010-2025). CINAHL, Embase, MEDLINE, and PsycINFO were searched in line with PRISMA. Study quality was appraised using Joanna Briggs Institute tools. Quantitative data was synthesised narratively, qualitative data thematically, and findings integrated using a convergent segregated approach. RESULTS:Results: Sixty four international studies were included, comprising 56 quantitative studies, six qualitative studies and two mixed-methods studies. Depression and anxiety were the most frequently assessed outcomes and were generally higher in HG compared with controls, with some persistence beyond pregnancy. Greater symptom severity in HG and NVP was associated with higher depression and anxiety. Large cohort studies reported increased risks of anxiety and depression, including postnatal and longer term risk. Additional outcomes included stress, psychological distress, post-traumatic stress symptoms, suicidal ideation, and reduced mental health related quality of life. Qualitative studies identified four themes: psychological burden and trauma, invalidation and unmet care needs, disruption to daily life, identity and relationships, and support and coping. Women reported dismissal and lack of validation, while valuing specialist services and psychological support. Integrated findings indicated psychological morbidity was associated with both symptom severity and care experiences. CONCLUSION:HG and severe NVP are associated with substantial psychological burden that extends beyond symptom scores alone. Integrating quantitative and qualitative evidence highlights the importance of considering both psychological outcomes and women's experiences of care when assessing the impact of these conditions.
Problem Continuity of care (CoC) improves maternal health, yet midwifery students encounter obstacles in digital communication, including a lack of standardised instruction. Background Digital technology is essential for facilitating CoC, but students lack sufficient exposure to telehealth protocols to foster meaningful clinical partnerships. Question What are the digital communication needs of midwifery students, and how might a mobile application be implemented to enhance continuity of care practices? Methods A mixed-methods exploratory sequential design was used. Phase 1 involved Focus Group Discussions (FGDs) with 40 midwifery students in West Java, Indonesia. Phase 2 utilised a survey of 97 students to confirm the communication model through Confirmatory Factor Analysis (CFA). Findings Qualitative analysis revealed eight themes, including Communicator, Channel, and Effect. The quantitative validation of the communication model questionnaire exhibited robust reliability across all aspects (Cronbach's alpha reaching 0.977), affirming its validity and reliability for application in Indonesian midwifery education. Significant quantitative results indicated that the Message dimension had the highest mean score (5.45), whereas the Communicator dimension had the lowest (5.07). Discussion The components of the application-based digital communication model can be used by clinical educators in CoC-oriented learning activities to help midwifery students develop digital communication competencies. However, this framework is still exploratory and has not been implemented or tested in a real-life clinical setting. Conclusion The principal contribution of this study is a newly validated digital communication model framework. The application-based digital communication model has produced a valid and reliable questionnaire incorporating these quantitatively validated components, so that it can be used for the implementation of the application-based digital communication model in midwifery education in Indonesia.
BACKGROUND:Pregnancy and childbirth are significant life events that can affect women's mental health and maternal functioning. Psychological flexibility, defined as the ability to adapt to changing situations and maintain balance under stress, plays a crucial role in this process. This study aimed to examine the effects of psychological flexibility and pregnancy stress on the perception of traumatic birth and breastfeeding success among primiparous pregnant women in the latent phase. METHODS:This cross-sectional study was carried out between January 2021 and June 2022 at a training and research hospital in eastern Türkiye. The study sample consisted of 310 primiparous pregnant women, selected through simple random sampling among eligible participants admitted in the latent phase of labor. Data were collected using the Personal Information Form, Psychological Flexibility Scale, Pregnancy Stress Rating Scale, Traumatic Birth Perception Scale, and LATCH Breastfeeding Assessment Tool. Data were analyzed using descriptive statistics, Pearson correlation analysis, and path analysis based on structural equation modeling (SEM). RESULTS:The study found a significant negative correlation between psychological flexibility and traumatic birth perception (r = -.183, p < .001) and was positively correlated with breastfeeding success (r = .208, p < .001). Pregnancy stress was positively correlated with the perception of traumatic birth (r = .472, p < .001) and negatively correlated with breastfeeding success (r = -.263, p < .001). Path analysis demonstrated that psychological flexibility had a significant negative effect on traumatic birth perception (β = -.159, p = .001) and a significant positive effect on breastfeeding success (β = .214, p < .001). Pregnancy stress had a significant positive effect on traumatic birth perception (β = .468, p < .001) and a significant negative effect on breastfeeding success (β = -.257, p < .001). CONCLUSION:Increased psychological flexibility was associated with a lower perception of traumatic birth and higher breastfeeding success. Conversely, higher pregnancy stress was linked to higher traumatic birth perception and lower breastfeeding success. These findings highlight the importance of integrating psychological flexibility-based interventions into prenatal education and midwifery care to promote maternal mental health and breastfeeding outcomes. In addition, future studies could explore intervention programs designed to enhance psychological flexibility among pregnant women to prevent traumatic birth experiences and improve postpartum adaptation.
Objective To translate, culturally adapt, and validate the Italian versions of the Expectancy subscale of the Childbirth Self-Efficacy Inventory and the Childbirth Attitudes Questionnaire for use among Italian-speaking pregnant women. Design A cross-sectional methodological study involving cross-cultural translation, cultural adaptation, and psychometric validation. Setting The study was conducted at the Department of Obstetrics and Gynaecology of a large university hospital in north-eastern Italy. The institution manages approximately 3000 births per year and offers antenatal classes led by midwives. Participants A convenience sample of 115 pregnant women was recruited. The majority of participants were primigravidae and in their third trimester at the time of survey completion. Methods The instruments were translated and culturally adapted in accordance with established cross-cultural guidelines. Face and content validity were assessed by a panel comprising five pregnant women and five midwives. Following item refinement, the final Italian versions (CAQ-Ita and CBSEI-Efficacy-SS-Ita) were administered via an online questionnaire. Psychometric evaluation was subsequently conducted, including assessments of internal consistency and Rasch analysis to examine item fit. Results One item from each scale was removed following content validation. The CAQ-Ita and CBSEI-Efficacy-SS-Ita demonstrated high internal consistency (α = 0.85 and 0.93, respectively). Rasch analysis supported overall model fit and unidimensionality, although two CAQ items exhibited suboptimal fit. The majority of participants reported mild to moderate fear of childbirth and moderate levels of self-efficacy. Conclusion The instruments demonstrated robust psychometric properties and are suitable for assessing fear of childbirth and childbirth self-efficacy among Italian-speaking pregnant women. Their use may support screening and the development of tailored antenatal interventions within midwifery care.
OBJECTIVE:To develop and evaluate the psychometric properties of the Fear of Physical Activity During Pregnancy Scale (FPAPS) among Chinese pregnant women. DESIGN:A methodological study. METHODS:The study was conducted in three phases. Phase I involved item generation informed by the fear-avoidance model, a literature review, and semi-structured interviews. Phase II refined the item pool through expert consultation and pilot testing. Phase III evaluated the scale in a cross-sectional sample of 507 pregnant women. The sample was divided into two non-overlapping subsamples for item analysis and exploratory factor analysis (n = 230) and confirmatory factor analysis (n = 277). Content validity, structural validity, hypotheses testing for construct validity, internal consistency, two-week test-retest reliability, and floor and ceiling effects were evaluated. RESULTS:The final FPAPS comprised seven items and showed a unidimensional structure. Exploratory factor analysis explained 50.5% of the variance, and a revised confirmatory factor analysis model showed acceptable fit. The S-CVI/Ave for the final scale was 1.000. Average variance extracted was 0.578, composite reliability was 0.900, Cronbach's alpha was 0.863, McDonald's omega was 0.870, and the two-week test-retest intraclass correlation coefficient was 0.706. No floor or ceiling effects were observed. Higher FPAPS scores were associated with lower total physical activity, moderate-intensity activity, vigorous-intensity activity, moderate-to-vigorous physical activity, and exercise/sports activity. Women without pre-pregnancy physical activity habits and primiparous women reported higher FPAPS scores. CONCLUSION:The FPAPS is a brief, pregnancy-specific scale with acceptable initial psychometric properties for assessing fear-related cognitions about physical activity during pregnancy among Chinese pregnant women.
BACKGROUND:In China, the implementation of evidence-based skin-to-skin contact for ≥ 90 min after birth remains suboptimal. Although midwives play a pivotal role in facilitating skin-to-skin contact, the factors influencing their implementation of this practice have not been systematically examined. OBJECTIVE:To investigate the status of skin-to-skin contact implementation among midwives and identify key factors influencing its implementation, guided by Normalisation Process Theory. METHODS:A cross-sectional design with stratified sampling was used to recruit 342 midwives from 16 cities and districts in China between April and September 2025. Data were analysed using descriptive statistics, univariate analysis and binary logistic regression. RESULTS:Substantial gaps were observed in the implementation of skin-to-skin contact, with only 21.9% of midwives routinely completing skin-to-skin contact for ≥ 90 min. Binary logistic regression identified four independent predictors of skin-to-skin contact implementation: hospital nature (OR = 5.572, 95%CI = 1.994-15.574, P = 0.001), whether midwives had knowledge of skin-to-skin contact (OR = 2.751, 95%CI = 1.177-6.433, P = 0.020), coherence (OR = 1.277, 95%CI = 1.083-1.506, P = 0.001), collective action (OR = 1.198, 95%CI = 1.082-1.327, P = 0.001). CONCLUSION:The implementation rate of skin-to-skin contact among midwives remains suboptimal. To improve SSC implementation, future interventions should adopt a whole-system approach. This requires both strengthening midwives' conceptual understanding and commitment to SSC through targeted education, and enhancing collective action within teams through optimised resource allocation and streamlined clinical workflows.
Background Autistic people represent a substantial and probably under-recognised population within reproductive and maternity services. Maternity care nevertheless continues to rely on neurotypical assumptions about communication, sensory tolerance, pain expression, emotional display, and help-seeking. Aim To map the scope, distribution, and thematic content of literature on autistic people’s experiences and support needs across pregnancy, childbirth, postpartum care, and infant feeding, and to identify implications for maternity service design and midwifery practice. Methods A mapping review was conducted using a systematic literature search. The search returned 73 relevant records. After title and abstract screening and focused relevance assessment, 25 papers were included in the final evidence map. Studies were categorized by design, perinatal stage, and thematic focus, and were synthesised narratively. Results The final map comprised 7 reviews or evidence syntheses, 9 qualitative studies, 4 survey studies, 2 cohort or comparative quantitative studies, and 3 practice-focused or contextual papers. The literature clustered most significantly around pregnancy and childbirth. Across study designs, the most consistent findings concerned sensory overload, communication barriers, poor fit between autistic needs and routine maternity care, unmet support needs, and dissatisfaction with standard care environments. Evidence on clinical outcomes and midwives’ own experiences remained limited. Conclusion Avoidable distress commonly arises from the interaction between autistic sensory and communication needs and inflexible maternity systems. Accessible care requires predictable and multimodal communication, consent-based touch, sensory adjustment, continuity where possible, tailored postnatal and feeding support, and co-designed pathways. Research should now evaluate implementation, sustainability, and outcomes in routine maternity services with autistic people as partners.
PURPOSE:This study aimed to examine the effects of regular kangaroo care (KC) on sleep-wake cycles, growth, physiological stability, and maternal breast milk cortisol and melatonin levels in premature infants. DESIGN:This study was a parallel group, single-blind, pre-test-post-test, randomised controlled trial (RCT). METHODS:This randomized controlled study was conducted in a neonatal intensive care unit (NICU) in Türkiye between September 2024 and September 2025 Thirty-six premature infants were randomized to intervention (n = 28) or control (n = 28). Infants in the intervention group received KC for three consecutive days, twice daily (10:00 a.m. and 10:00 p.m.) for 60 min per session. Data were collected using the Infant Information Form, Physiological Parameters Monitoring Chart, and Premature Infant Sleep-Wake Cycles Tracking Chart. Sleep-wake cycles were monitored using a Bispectral Index device. Breast milk cortisol and melatonin levels were measured at baseline and on day three using the competitive ELISA method. The study was registered at ClinicalTrials.gov (NCT06589349). RESULTS:Regular KC had a statistically significant effect on BIS values, heart rate, respiratory rate, oxygen saturation, and body temperature (p < 0.05). No statistically significant effects were observed on infant body weight or on maternal breast milk cortisol and melatonin levels (p > 0.05). CONCLUSION:The findings indicate that regular KC is associated with improved regulation of the sleep-wake cycle and enhanced physiological stability in premature infants. No significant changes were observed in maternal breast milk cortisol or melatonin levels following KC.
