In Switzerland, the right to a home birth is enshrined in law, and the associated costs are reimbursed by the national health insurance system. However, the conditions under which such births should occur remain unregulated at the national level, with no shared criteria for determining eligibility across the country. The aim of this project is to develop national guidelines to define criteria under which pregnant women would be ineligible for a planned home birth. A four-phase process was conducted, combining scientific evidence and expert consensus. It began with a systematic review of international home birth guidelines, conducted across five guideline specific databases and registries, complemented by a manual search. Subsequently, the identified criteria were submitted to expert classification by experienced Swiss home birth midwives through an online survey and three regional Delphi inspired workshops. Finally, the draft guideline was circulated to all members of the Swiss Federation of Midwives (SFM) for national consultation. The systematic search identified 262 records, of which 249 were screened and 42 assessed in full text. Nine guidelines met the inclusion criteria, from which 97 unique ineligibility criteria were extracted. Thirty Swiss clinical midwives participated in the classification phase, resulting in a four category structure distinguishing absolute ineligibility from situations requiring individual assessment. The national consultation generated 433 responses, leading to refinements and clarification of several criteria. The final guidelines comprise 97 criteria, supported by structured decision making pathways. These criteria include both medical conditions (e.g. unmanaged hypertensive disorders) and contextual factors requiring individual assessment (e.g. history of a previous baby >4500 g). This policy initiative has led to the first nationally endorsed home birth guidelines in Switzerland. Built on scientific evidence and clinical consensus, these guidelines provide a harmonized framework to support safety and professional autonomy in midwifery practice.
INTRODUCTION:Perineal preparation during the second stage of labor may influence maternal and neonatal infection risk and healthcare resource utilization. Although povidone-iodine sterilization is traditionally used, microbial flora theory suggests that water cleansing may preserve normal flora without increasing infection while reducing workload and cost. This study compared water cleansing with povidone-iodine sterilization for perineal preparation at Far East Memorial Hospital, Taiwan, from 26 November 2024 to 5 June 2025. METHODS:A randomized controlled trial design was employed, including 143 mothers randomly assigned to either the water cleansing group (n=72) or the povidone-iodine sterilization group (n=71). Outcome measures included maternal and neonatal infection parameters (maternal postpartum temperature, C-reactive protein, REEDA scores, neonatal temperature, and neonatal oral flora colonization), along with cleansing time and medical costs. Data were analyzed using t-tests, chi-squared tests, and generalized estimating equation (GEE). RESULTS:GEE analysis revealed no significant differences between the two groups in maternal and neonatal infection indicators (REEDA, 95% CI: -0.53-0.18, p=0.337; maternal temperature, 95% CI: -0.06-0.21, p=0.278; neonate temperature, 95% CI: -0.12-0.19, p=0.636). The water group had significantly lower average medical costs than the povidone-iodine group (7.49 vs 110.92 TWD, t= -50.22, p<0.001), as well as a shorter cleansing time. Regarding neonatal flora colonization, the water group showed higher rates of normal flora (33.8% vs 15.5%) and lower rates of pathogenic bacteria (5.6% vs 12.7%, χ2=10.88, p=0.028). CONCLUSIONS:Perineal preparation with water was not associated with an increased risk of maternal or neonatal infection or adverse neonatal oral microbial colonization at birth and was associated with lower medical costs. These findings suggest that water may be a safe and cost-effective alternative to povidone-iodine for perineal preparation among women with low-risk pregnancies in hospitals with high episiotomy rates. Further longitudinal studies are needed to determine the effects of intrapartum povidone-iodine exposure on neonatal microbiome development and its potential long-term health consequences. CLINICAL TRIAL REGISTRATION:The study is registered on the official website of ClinicalTrials.gov. IDENTIFIER:NCT06880445.
INTRODUCTION:Quality of obstetric care comprises both provision and experience of care, yet patient experiences have received less attention. Person-centered care seeks to tackle this gap by attributing equal significance to clinical outcomes and care experiences. Individual experiences vary despite similar treatments because subjective appraisals differ. Understanding this process can help to enhance person-centered care in obstetrics. The study's aim is to explore how birthing persons perceive and make sense of obstetric care experiences. METHODS:The qualitative study adopted a grounded theory approach according to Corbin and Strauss, utilizing 12 narrative interviews with mothers who gave birth in a hospital a maximum 12 months prior. They were recruited through iterative theoretical sampling through the project Instagram channel between March and August 2023. The iterative process of data collection, analysis and constant comparison resulted in a theoretical model explaining how parturients experience obstetric situations. RESULTS:During analysis, sense of coherence (SoC) emerged as core category shaping how parturients perceive and make sense of obstetric situations: negative experiences related to low manifestations of SoC and positive experiences to high SoC. A subsequent literature review linked these empirical findings to Antonovsky's SoC which was contextually adapted to the perception of obstetric situations shaped by comprehensibility, perceived manageability and contextual framing factors. CONCLUSIONS:Recognizing how parturients construct meaning through their situational SoC, may offer a basis for reflections on interaction with them. Though not allowing for direct generalization, the findings may offer a theoretical concept for further research targeting situational SoC during care processes or piloting feasible measures for real-time assessment.
INTRODUCTION:Pregnancy is a critical period of heightened vulnerability to mental health challenges. Peer support and mindfulness have individually shown promise as non-pharmacological perinatal mental health strategies, yet their combined potential remains underexplored. This study evaluated the feasibility of a novel intervention integrating peer support with a mindfulness application. METHODS:A quasi-experimental pre-post feasibility design was conducted between April 2024 and January 2025 at an antenatal clinic in a public hospital in New South Wales, Australia, using convenience sampling across two sequential recruitment phases. The 4-week intervention combined mutual peer support sessions with guided mindfulness practice via the Headspace app, enrolling pregnant women at elevated risk of anxiety and depression (priority group) and those from the general pregnant population. Validated self-report measures (DASS-21, FFMQ-15, MSPSS) and salivary cortisol samples were collected pre- and post-intervention. Wilcoxon signed-rank and Mann-Whitney U tests examined within- and between-group changes; open-ended post-intervention survey responses were analyzed using content analysis. RESULTS:Thirteen pregnant women participated, achieving a 100% retention rate despite recruitment challenges. A statistically significant reduction in stress was observed in the general group compared to the priority group (median [IQR]: 22 [14-30] vs 8 [2-20]; p<0.050). No significant pre-to-post changes were found in anxiety, depression, mindfulness, or perceived social support in either group (p>0.05). Qualitative findings highlighted that the intervention fostered emotional support, connectedness, and mindfulness engagement, with participants expressing willingness to recommend the program. CONCLUSIONS:Combining peer support with a mindfulness application appears feasible and acceptable for pregnant women and warrants evaluation in adequately powered randomized controlled trials.
INTRODUCTION:Multiple sclerosis (MS) is a chronic neurological disease that frequently affects women during their reproductive years and may influence fertility intentions and family planning decisions. This study aimed to identify factors associated with reproductive choices among women with MS and to examine the role of psychological, social, and disease-related variables in fertility decision-making. METHODS:A cross-sectional study was conducted in Greece between August 2023 and December 2024, involving 103 women aged 18-50 years with neurologist-confirmed MS (mean age: 38.05 ± 7.01 years). Participants were recruited from the Naval Hospital of Athens and the Greek Multiple Sclerosis Society. Structured questionnaires assessed social support, psychological wellbeing, relationship dynamics, repro-ductive motivation, and quality of life. Associations between clinical, psychosocial, and demographic var-iables and childbearing were examined using univariate analyses and binary logistic regression. RESULTS:In univariate analyses, childbearing was associated with relapsing-remitting MS compared with progressive disease forms (73.9% vs 0%, p=0.001), marital status (all unmarried women were childless, p=0.001), fingolimod exposure (all users were childless, p=0.008), higher mental health scores (p=0.035), greater health-related distress (p=0.006), and stronger fatalistic motivation for parenthood (p=0.005). However, in multivariable logistic regression, none of these variables independently predicted childbearing status (all p>0.05). CONCLUSIONS:These findings suggest that reproductive decision-making among women with MS may involve multiple disease-related, psychological, and relationship-related considerations. Further studies with larger sample sizes are needed to confirm these associations.
INTRODUCTION:Freedom of movement and upright positions during labor are recommended in maternity care, yet organizational routines may constrain women's mobility, autonomy, and shared decision-making. This study examined how a woman-centered antenatal intervention on mobility during labor operated and under which conditions its effects were enabled or constrained. METHODS:A convergent mixed-methods study was conducted in community-based childbirth preparation programs in Portugal. Quantitative data were collected from low-risk nulliparous women at baseline (n=56), post-intervention (n=38), and postpartum (n=30), assessing emancipated decision-making, decision satisfaction, childbirth self-efficacy, birth beliefs, and childbirth experience. Semi-structured interviews were conducted with eight women and four nurse-midwives. Data were analyzed separately and integrated through joint display analysis and meta-inferences. RESULTS:Satisfaction with decision-making improved significantly (3.66 vs 3.70, p<0.001), natural birth beliefs increased (4.14 vs 4.41, p<0.001), and medical birth beliefs decreased (3.74 vs 3.51, p=0.032). No significant antenatal changes were found in emancipated decision-making or childbirth self-efficacy. Women who remained mobile during labor reported higher overall childbirth experience (p=0.005), participation (p=0.011), own performance (p=0.011), and professional support (p=0.015). Qualitative findings showed acceptability and feasibility, highlighting experiential learning, bodily awareness, reflective preparation, and nurse-midwife facilitation as key mechanisms. Integrated findings suggested that antenatal measures primarily captured preparedness for action, whereas agency became more visible when women enacted mobility during labor. CONCLUSIONS:The intervention may strengthen women's preparedness to act regarding mobility during labor, but enacted agency appears to depend on intrapartum relational and organizational conditions.
INTRODUCTION:Despite rising awareness of occupational health, preconception health remains overlooked, particularly in demanding healthcare environments. The pilot study aimed to examine the associations between working conditions, workplace-related risks and the reproductive health of nurses and midwives. METHODS:A cross-sectional pilot study was conducted in Slovenia in 2022, including 41 participants. Associations between occupational factors and reproductive health outcomes were analyzed using descriptive statistics, the Mann-Whitney U test and the likelihood-ratio χ² test (G²), based on Kullback-Leibler divergence. RESULTS:Findings suggest possible associations between factors such as single shift work, overtime, lifting and work stress and reproductive problems. Discrimination by patients, relatives and colleagues was significantly associated with sexual desire, frequency of sexual activity and general sexual behavior. Among participants, 34.2% reported menstrual problems, 29.2% conception difficulties and 44.7% reproductive diagnoses. Post hoc effect size analysis revealed six large and two medium effect sizes, indicating potential clinical relevance beyond mere statistical significance. CONCLUSIONS:These preliminary findings indicate that certain occupational and psychosocial stressors may be linked to adverse reproductive outcomes among healthcare professionals. Addressing these risks through targeted preventive strategies could help protect the reproductive health of female healthcare professionals, most of whom are of reproductive age.
INTRODUCTION:Preterm birth (PTB), defined as delivery before 37 weeks of gestation, is a major cause of neonatal mortality and morbidity worldwide. Its multifactorial etiology remains incompletely understood, and Cyprus reports among the highest PTB rates in Europe, highlighting the need for population-specific evidence. This study aimed to investigate the sociodemographic, behavioral, and obstetric history factors of PTB in Cyprus and to examine whether these factors differed according to the degree of prematurity. METHODS:A matched case-control study was conducted at a tertiary referral hospital in Cyprus, designated as the national center for maternal and neonatal care. Eligible participants were women delivering between January 2019 and December 2022. Conditional logistic regression was conducted to determine the significant associations between sociodemographic, behavioral and obstetric history with PTB. Subgroup analysis of extreme to very (<32 weeks) vs moderate to late PTB (32 to <37 weeks) was also conducted. RESULTS:Participants were 978 women (489 cases <37 weeks, 489 controls ≥37 weeks). Maternal age increased PTB odds (AOR=1.21; 95% CI: 1.06-1.38), as did previous gynecological surgeries (AOR=1.74; 95% CI: 1.30-2.34), cesarean section (AOR=1.87; 95% CI: 1.28-2.73), and miscarriage (AOR=1.44; 95% CI: 1.03-2.00). Primiparous women had reduced odds versus nulliparous (AOR=0.71; 95% CI: 0.52-0.98). In subgroup analysis, higher BMI (AOR=0.96; 95% CI: 0.92-0.99), prior cesarean (AOR=0.54; 95% CI: 0.30-0.99), and asylum seeker status (AOR=0.19; 95% CI: 0.05-0.67) were linked to lower odds of extreme PTB. CONCLUSIONS:Future prospective studies are needed to further investigate and confirm the observed associations between sociodemographic, behavioral, and obstetric factors with PTB and degree of prematurity.
INTRODUCTION:Evidence on the use, safety, and decision-making related to medication, vaccination, and complementary and alternative medicine during pregnancy and breastfeeding, remains limited. This uncertainty may influence women's health behaviors and perceptions during these stages. The aim of this study is to identify the needs related to the use of medication, vaccination, and alternative medicine during pregnancy and breastfeeding in Catalonia. METHODS:A descriptive cross-sectional survey was conducted among 889 pregnant and recently postpartum women attending public Sexual and Reproductive Health Care Services in Catalonia (2024-2025). The questionnaire assessed use, opinions, information sources, and decision-making regarding medication, vaccination, and alternative therapies during pregnancy and breastfeeding. RESULTS:More than half of the participants reported health conditions requiring medication during pregnancy. Most women (84.6%) relied on healthcare professionals' prescriptions and recommendations, and about half felt safe and confident when using medication. Vaccination during pregnancy was widely accepted, with over 80% agreeing with it. Alternative therapy use was limited, with osteopathy being the most common. During breastfeeding, medication use remained cautious and largely guided by professional advice. CONCLUSIONS:Pregnant and breastfeeding women generally adopt a cautious approach to medication and rely heavily on healthcare professionals for decision-making. Trust and shared decision-making play a key role in adherence and perceived safety, highlighting the importance of clear, evidence-based guidance to support maternal and infant health.
INTRODUCTION:Exclusive breastfeeding (EBF) is a cornerstone for infant development and maternal health, offering nutritional, emotional, and public health benefits. Despite its importance, global EBF rates remain below targets, with barriers varying by socioeconomic context. In Argentina, while 91.7% of infants start breastfeeding, only 44.6% sustain EBF at six months. METHODS:A qualitative study was conducted using 32 focus groups involving 231 mothers from four Argentine urban areas with varying EBF prevalence. Participants were segmented by maternal experience, education level, and breastfeeding continuity. Thematic analysis was performed using MAXQDA and Atlas.ti, identifying key facilitators and barriers to EBF. RESULTS:Key facilitators included prenatal breastfeeding education, postpartum support, conducive workplace policies, and strengthened mother-infant bonding. Barriers encompassed physical pain, psychological distress, delivery complications, workplace tensions, and sociocultural pressures such as the perception of insufficient milk supply. Digital platforms emerged as vital tools for information exchange and support, particularly for primipara mothers, although insufficient public policies limit their impact on sustaining EBF. CONCLUSIONS:Access to education, professional guidance, and digital support platforms significantly contributes to EBF success. However, persistent challenges, including family dynamics, cultural stigmas, and work-related tensions, undermine EBF continuity. Comprehensive public policies promoting shared responsibility among families, employers, and society are critical to sustaining EBF practices. Targeted interventions addressing these multifaceted challenges can enhance maternal and child health outcomes globally.
INTRODUCTION:Early labor care is complex because of women's individual needs. To consider varying experiences and distinguish between parturients who are well at home and those who require increased support, the GebStart-tool was developed. It intends to advise primiparous women during early labor, enhance the quality of care, and improve perinatal outcomes. The aim of this study was to assess the potential benefits and risks of applying the GebStart-tool. METHODS:Applying the preliminary version of the GebStart-tool, we compared labor and birth data from n=303 study participants with spontaneous onset of labor with baseline data of n=1635 births that occurred in the six months preceding the study across six centers. Descriptive statistics and odds ratios were calculated. RESULTS:GebStart-study participants had significantly lower odds for labor augmentation with oxytocin (OR=0.65; 95% CI: 0.51-0.84, p<0.001), epidural analgesia (OR=0.56; 95% CI: 0.43-0.72, p<0.001), and cesarean section (OR=0.52; 95% CI: 0.36-0.76, p<0.001) compared to baseline data. In contrast, the odds for opioid administration (OR=1.37; 95% CI: 1.02-1.83, p=0.028) and a spontaneous vaginal birth (OR=1.33; 95% CI: 1.02-1.72, p=0.028) were significantly higher. Apgar scores at one minute and arterial umbilical cord pH did not differ substantially between groups. CONCLUSIONS:Compared to baseline data, GebStart-study participants had a higher chance of fewer intrapartal interventions and a spontaneous vaginal birth. Therefore, using the GebStart-tool seems promising for improving labor and birth outcomes. In a future larger study, the effectiveness of applying the final version of the GebStart-tool should be investigated.CLINICAL TRIAL REGISTRATION: The study was registered in the Swiss National Clinical Trials Portal and the German Clinical Trial Register.IDENTIFIERS: SNCTP000004555 and DRKS00025572.
INTRODUCTION Caul birth, in which an infant is born with part of the amniotic sac covering the head or body, is a rare phenomenon with limited research on its prevalence, predictors, and outcomes in contemporary midwifery and obstetric practice. Although it has historically been attributed cultural and symbolic significance, it remains underexplored in research. The aim of this retrospective cohort study was to investigate the prevalence of caul birth, its predictors, and associated neonatal and maternal outcomes in a Swedish hospital setting. METHODS A retrospective cohort study including all births at a Swedish hospital in 2023 (n=1382) was conducted. Data were obtained from medical records. Women with caul birth were compared with those undergoing amniotomy during labor (n=377). Multivariable logistic regression was used to identify predictors and maternal and neonatal outcomes associated with caul birth. RESULTS Caul birth occurred in 1.5% (n=21) of births and was associated with maternal overweight according to BMI (AOR=3.42; 95% CI: 1.10-10.64), spontaneous onset of labor (AOR=18.21; 95% CI: 2.31-143.50), and multiparity (AOR=11.11; 95% CI: 1.34-92.10). Epidural analgesia (AOR=0.10; 95% CI: 0.02-0.44) and longer duration from hospital admission to birth (AOR=0.63; 95% CI: 0.48-0.84) were associated with decreased odds of caul birth. No adverse neonatal outcomes were observed. CONCLUSIONS Caul birth was rare but associated with spontaneous, low-intervention labor and reassuring maternal and neonatal outcomes. These findings align with current recommendations against routine amniotomy in uncomplicated labor, although larger studies are needed.
INTRODUCTION:eHealth is a resource that provides continuity of care from midwives and maternal education, allowing for the personalization of information and the selection of resources tailored to individual needs. However, for many available digital tools, information on their quality and usability is lacking. The objective of this study was to explore the perceptions of users of the EMAeHealth digital app, which was designed and developed by midwives, regarding its acceptance, usability, strengths, and weaknesses for implementation. METHODS:This was an exploratory sequential mixed-methods study. Semi-structured individual interviews were conducted between January and March 2024. Participants were selected by purposive sampling. Subsequently, an ad hoc survey was created based on these results to be filled in anonymously. RESULTS:The acceptance rate of the EMAeHealth app was 64%. In the qualitative analysis, there were two categories: 1) 'What makes this app stand out?', including accessibility, quantity, quality, good organization of information, and credibility of the source; 2) 'Remaining potential', describes the improvement recommendations that were most strongly agreed with, both in the interviews and in the survey with 106 women, which were related to personalization, inclusion of a chat box with the midwife, and connection of the app with the health records services, with ratings 4.38 ± 0.83, 4.28 ± 1.00 and 4.16 ± 1.10 out of 5 points, respectively. CONCLUSIONS:A digital tool would expand the availability of information, personalization, and resources offered in maternal education, increasing its reach and effectiveness. However, it is necessary to carry out further work on the individualization of information and its adaptation to each woman's health situation and stage of life.
Introduction Termination of pregnancy for fetal anomaly is associated with profound psychological distress for parents and can be emotionally demanding for healthcare professionals. Evidence on professionals' knowledge, practices, and support needs in Italy remains limited. We aimed to examine Italian healthcare professionals' knowledge of legal aspects, bereavement care practices, and emotional experiences related to care in the context of termination of pregnancy (ToP) for fetal anomaly, and to explore factors associated with supportive behaviors. Methods A cross-sectional web-based survey was conducted among healthcare professionals between September 2022 and December 2023. The survey included sociodemographic and professional characteristics, knowledge of Italian law, bereavement care practices, and professionals' emotional experiences. Results A total of 552 respondents participated of which 84.8% were midwives; 99.4% correctly identified when termination of pregnancy can be performed, while 19.5% were aware that no legally fixed gestational threshold exists; younger and less experienced respondents showed lower levels of legal knowledge (p<0.001). Feelings of inadequacy were reported by 51.4% of respondents, and 71.2% reported the need for debriefing after assisting with a termination of pregnancy. The presence of a shared emotional support protocol was significantly associated with supportive behaviors (p <= 0.003). Routine use of memory boxes was reported by 53.0% of respondents, whereas follow-up care was least consistently ensured (37.4%); 97.2% recognized the need for lactation management after termination of pregnancy for fetal anomaly. Conclusions The RESPeC-ToP Study highlights gaps in legal knowledge and uneven implementation of key bereavement care components. Training and shared emotional support protocols emerge as actionable strategies to standardize supportive practices and strengthen both quality of care and staff support within maternity services.
INTRODUCTION This study aimed to explore how birth care professionals promote health behavior for pregnant women in vulnerable circumstances. METHODS A questionnaire was distributed online from February to June 2023 among all primary care midwifery practices (n=144) and obstetric units (n=15) in the West and Southwest regions of the Netherlands. Descriptive statistics were used to present the results. RESULTS The questionnaire was completed by 106 birth care professionals (67%). Almost all respondents (95%) found it important to discuss health behavior with pregnant women in vulnerable circumstances, and 89% reported doing so with all or the majority of women in vulnerable circumstances. Discussing partners' health behavior with the partners themselves was less frequently reported as important (84%), and only 40% of respondents reported discussing this with all or most partners. Most respondents reported they provided personalized information about smoking, alcohol intake, drug use, healthy diet, folic acid, use of medication, and being overweight. Only 32% reported providing information about chronic stress. Most respondents agreed that it is important to give attention to the identity of pregnant women in vulnerable circumstances (83%) and to their autonomy (91%) when discussing health behavior, but lack of time is a barrier to discussing this. Only 30% of the respondents found it difficult to discuss health behavior with pregnant women in vulnerable circumstances. Still, 57% of the respondents indicated that they (might) need additional knowledge, and 53% indicated that they did not have sufficient education in this area. CONCLUSIONS Birth care professionals recognize the importance of discussing health behaviors with pregnant women in vulnerable circumstances. However, future research should explore how birth care professionals can be better educated to discuss health behavior, including chronic stress, with pregnant women and their partners in a timeefficient manner.
INTRODUCTION Traumatic birth experiences are increasingly recognized as a significant issue in maternity care. While many studies focus on the perspectives of birthing persons, little is known about how healthcare providers perceive the causes of traumatic births and possible strategies to prevent them. This study explores obstetric care providers' perceptions of factors contributing to traumatic birth experiences and their suggestions for improving trauma sensitive obstetric care. METHODS A convergent parallel mixed methods design was used. An online survey among obstetric care providers in Germany was conducted between October 2024 and February 2025 (n=102). Quantitative data were analyzed descriptively and using logistic regression models. In addition, four expert interviews were conducted and analyzed using qualitative content analysis. Findings from both strands were integrated during interpretation. RESULTS Most respondents defined traumatic birth experiences primarily through loss of control (85.3%) and negative emotions (75.5%). Lack of communication and information was identified as the most important contributing factor (97.1%), followed by lack of emotional support (89.2%). Emotional support was rated as the most important preventive measure (mean=4.86; SD=0.51). The main barriers to trauma sensitive care were lack of time (mean=4.52; SD=0.81) and staff shortages (mean=4.35; SD=0.83). Interview findings highlighted structural challenges, the importance of reflective practice among caregivers, and the need for systematic training in trauma sensitive communication. CONCLUSIONS The findings highlight the need to strengthen trauma sensitive approaches in obstetric care through improved communication, emotional support, and shared decision making. In addition to structural improvements such as adequate staffing, regular training and reflective practice among providers may help reduce traumatic birth experiences.
INTRODUCTION Acupressure, the application of firm pressure to specific acupoints, has been associated with benefits during the perinatal period, including reducing nausea, alleviating pain, inducing labor, supporting lactation and decreasing anxiety. While research has explored its effectiveness, little is known about midwives' knowledge and views regarding acupressure and its integration into practice. This study aimed to explore midwives' knowledge, perspectives and factors influencing their use of acupressure during the perinatal period. METHODS A quantitative, cross-sectional survey design was employed using a selfadministered online and paper-based questionnaire. This was a total population study utilizing a non-probability sampling technique where the entire population of 240 midwife members of the Malta Midwives Association (MMA) was included. Eligible participants included practicing members in any maternity care setting across the Maltese Islands and these were invited to complete the survey. After conducting a pilot study, data collection took place between July and September 2024, where a total of 94 responses were received. Quantitative data were analyzed using descriptive and inferential statistics, while open-ended responses underwent thematic analysis. RESULTS While midwives demonstrated a strong interest in acupressure, their hesitation to practice stemmed primarily from insufficient training (20.7%; n=87), education (19.5%; n=82) and a lack of evidence-based guidelines (16.7%; n=70). Less than half of the respondents reported practicing acupressure (12.8%; n=12), with most expressing uncertainty about the location of various acupoints and acupoints contraindicated before 37 weeks of gestation (61.7% to 87.2% across all acupoints). Findings from thematic analysis highlighted that increased maternal interest in natural approaches, creates a corresponding need for enhanced midwifery expertise in acupressure. CONCLUSIONS The findings revealed midwives' lack of adequate knowledge, education and training in using acupressure during the perinatal period. These themes mirrored the quantitative findings, reinforcing that interest in acupressure is present among Maltese midwives but is constrained by gaps in knowledge, training and policy support.
INTRODUCTION:Women admitted to the hospital early in labor face an increased intrapartum intervention rate, possibly resulting in negative obstetric outcomes. It is well documented that women receiving midwife-led care receive fewer unnecessary medical interventions. However, the impact of midwife-led care during early labor remains poorly understood. The aim of this study was to evaluate the effect of midwife-led care compared to obstetrician-led care regarding medical interventions during early labor. METHODS:A systematic review of literature published until June 2024 was performed in PubMed, CINAHL Complete, Web of Science Core Collection, and the Cochrane Library following Cochrane guidelines. PICO criteria included the keywords pregnant women, midwife-led care, obstetrician-led care and medical interventions during early labor. Quality was assessed using the RoB 2-tool and the ROBINS-I-tool. Data were extracted by using a purposively designed extraction template and then analyzed descriptively. RESULTS:Of 1057 identified studies, four studies were eligible and included in this review, including two randomized controlled trials and two observational studies. The results regarding birth mode are not entirely clear. Most studies reported that women who receive midwife-led care during the early stages of labor are more likely to have a vaginal birth and less likely to require a cesarean section. However, one study could not find a statistically significant difference regarding birth mode and care model received in early labor. Another study showed increased use of labor augmentation among women receiving obstetrician-led care. CONCLUSIONS:There remains a lack of knowledge about the role of midwife-led care during early labor and its impact on early labor interventions and subsequent birth outcomes. More attention should be focused on early labor care to improve outcomes for laboring women and their partners. Recognizing the potential benefits of midwife-led care during this phase could lead to initiatives aimed at promoting such care across various settings.
INTRODUCTION The latent phase of labor is a critical stage of childbirth, yet access to continuous, needs-based care during this phase remains limited in Germany. Structural challenges in the healthcare system, including a reduced number of obstetric facilities and insufficient financial support for outpatient services, further restrict options for women and midwives. METHODS This study aimed to explore the resources available to midwives and the barriers they encounter when providing care and counseling during the latent phase of labor. A qualitative research design was employed. Thirteen semi-structured interviews with midwives were conducted between June 2024 and March 2025. Data were analyzed using qualitative content analysis. RESULTS Four main categories emerged: 1) the physiology of the latent phase, 2) decision-making criteria for the location of care, 3) structural conditions in the hospital, and 4) aspects of care improvement. Midwives reported a lack of outpatient options, uncertainties in defining the latent phase, and tensions between guideline recommendations and women's subjective needs. Structural barriers, such as staff shortages, limited space, and financial disincentives, were highlighted. At the same time, midwives expressed an openness to innovative concepts, including midwife-led outpatient care, designated rooms within clinics, and improved prenatal education. CONCLUSIONS Midwives in Germany perceive current support for childbearing women during the latent phase as insufficient. To ensure needs-based care, structural and financial reforms are required, alongside expanded counseling and educational opportunities. Strengthening midwife-led concepts, improving antenatal education, and adapting reimbursement structures, could reduce unnecessary interventions and enhance woman-centered care.
INTRODUCTION:Pain and anxiety are common during labor. Evidence on non-pharmacological tools like the peanut ball from public hospital settings in Honduras is limited. This study evaluated its efficacy in reducing pain and anxiety. METHODS:A parallel-group, randomized, single-blind clinical trial was conducted at Hospital Escuela, Honduras, February to July 2025. Nulliparous women in active labor (cervical dilation ≥4 cm) were assigned to an intervention group (standard care + intermittent peanut ball use, n=83) or to a control group (standard care alone, n=80). Primary outcomes were pain and anxiety (Visual Analog Scales). Secondary outcomes included labor duration and oxytocin use. Pre-planned subgroup (no oxytocin) and adjusted analyses were performed. RESULTS:No significant between-group differences were found in pain (p=0.45), anxiety (p=0.62), or maternal well-being. The active phase duration was shorter in the intervention group, mean=162 minutes (SD=78), compared with the control, mean=252 minutes (SD=138) (mean difference= -90.0 min, 95% CI: -172.37-7.7; p=0.03). This effect persisted in the subgroup without oxytocin (p=0.012) and after adjustment. Oxytocin use was higher in the intervention group (67.5% vs 38.8%; risk ratio, RR=1.74; 95% CI: 1.25-2.42; p=0.001). Cesarean birth and other outcomes were similar. CONCLUSIONS:The peanut ball shortened active labor but did not reduce maternal pain, anxiety, or oxytocin use within our setting. CLINICAL TRIAL REGISTRATION:The study is registered on the official website of ClinicalTrials.gov. IDENTIFIER:NCT06811584.
