Mental health of midwives during the COVID-19 pandemic: A scoping review.

AIM: A summary of studies focusing on the mental health of midwives during the COVID-19 pandemic has not yet been conducted. This review aims to comprehensively understand the current state of midwives' mental health in the context of the COVID-19 pandemic and to provide valuable insights to guide future research. METHODS: This study was based on a framework for conducting scoping reviews. The protocol was registered before conducting this review and procedures were carried out according to that protocol. Article searches were conducted in four databases from December 2019 to December 2023. From 921 articles selected according to pre-registered protocol criteria, the analysis finally included 14 studies. RESULTS: A total of 13 studies were cross-sectional and one was longitudinal, with pre-pandemic data. More than 80% of the studies began data collection within approximately 1 year after the pandemic was declared by the World Health Organization (by February 2021). Half of the studies were conducted in Asia. Burnout and turnover intentions were investigated in several studies but used different measures. Only two studies were aimed at positive aspects such as job satisfaction and well-being. CONCLUSIONS: Most research on midwives' mental health during the COVID-19 pandemic has focused on negative aspects such as burnout and turnover intentions. However, most results were cross-sectional, with studies in the early stages of the pandemic, so continued follow-up is needed.

A breast milk production model for achieving exclusive breastfeeding in low-risk primiparas who had vaginal births at 4 months postpartum: A prospective cohort study.

BACKGROUND: This study aimed to investigate the thresholds of milk production for predicting the achievement of exclusive breastfeeding (EBF) at 4 months postpartum. METHODS: The inclusion criteria were singleton, low-risk primiparas, non-cesarean section, and healthy mothers and infants. Temporary feeding of artificial milk in the past was included. Women who could be judged to have intentionally used artificial milk were excluded from the analysis. Measurements of the 24-h milk production by test weights were obtained at early postpartum (days 3-4) and at 1 month postpartum. To predict the achievement of EBF at 4 months postpartum, the area under the receiver operating characteristic (ROC) curve was calculated for early postpartum and 1 month milk production. RESULTS: There were 80 eligible participants analyzed. ROC analysis of milk production for achieving EBF at 4 months revealed an area under the curve (AUC) of 0.736 (95% CI: [0.625, 0.848]) for early postpartum and an AUC of 0.854 (95% CI: [0.772, 0.936]) for 1 month postpartum. The proposed thresholds are 102 g/day (higher sensitivity) and 161 g/day (higher specificity) at early postpartum, and 527 g/day (higher sensitivity) at 1 month postpartum. CONCLUSIONS: In low-risk primiparas, the milk production models at early postpartum and 1 month postpartum showed a high accuracy for predicting the achievement of EBF at 4 months postpartum. The present study indicates that even when formula milk is temporarily used, it is still possible to reach the goal of achieving EBF.

A longitudinal study of the association of epidural anesthesia and low-dose synthetic oxytocin regimens with breast milk supply and breastfeeding rates.

Breastfeeding is known to improve maternal and child health. However, epidural anesthesia (EDA) and synthetic oxytocin (synOT) are suggested to have negative effects on breastfeeding. In this study, we aimed to determine the effects of intrapartum synOT and EDA on breast milk supply, breastfeeding rates, and maternal salivary oxytocin levels. Women were recruited during pregnancy or after birth at a single hospital. Data were collected at 3 days postpartum (T1), 1 month postpartum (T2), and 4 months postpartum (T3) on 83 low-risk primiparous women who planned to breastfeed for at least 12 weeks postpartum to avoid dropouts from early discontinuance of breastfeeding. Women with cesarean section, twin pregnancy, premature neonates, and an Apgar score of < 7 at 5 min were excluded. Participants recorded their 24-h milk supply by test weights at 3 days and 1 month postpartum. Additionally, they filled out questionnaires assessing their breastfeeding level and lactogenesis stage II initiation. Salivary oxytocin levels were obtained at 3 days postpartum. Women who delivered using EDA had lower salivary oxytocin levels (P = .055, d = .442), breast milk supply in early postpartum (P = .025, d = .520) and at 1 month postpartum (P = .036, d = .483), and breastfeeding rates at 4 months postpartum (P = .037, V = .236) than women who did not deliver using EDA. There was no association between breastfeeding and the use of intrapartum synOT. In conclusion, this study showed that women who delivered using EDA had lower breast milk supply in the early postpartum period and breastfeeding rates at 4 months postpartum. It also revealed that using synOT at low doses during labor did not affect breastfeeding. Thus, women who deliver using EDA need support for increased breast milk supply in the early postpartum period.Trial registration: UMIN000037783 (Clinical Trials Registry of University Hospital Information Network).

Women's experiences and perceptions of women-centered care and respectful care during facility-based childbirth: A meta-synthesis.

AIM: The World Health Organization has recommended intrapartum care for a positive childbirth experience through respectful care based on women-centered care. This study aimed to explore women's experiences of facility-based childbirth to gain insights into their perceptions of women-centered care, including humanized childbirth and respectful maternity care during intrapartum care. METHODS: Used the Joanna Briggs Institute method as the framework for this meta-synthesis, we searched the PubMed, EMBASE, CINAHL, PsycINFO, and LILCAS databases, and included qualitative studies and interviews of women's experiences and perceptions of women-centered care during facility-based childbirth published from 1990 to 2020 in English. Study quality was assessed using the Critical Appraisal Skills Programme checklist. NVivo software was used for data extraction and synthesis. RESULTS: There were 22 studies from 19 countries that met the established inclusion criteria. Five categories of experiences of facility-based childbirth and perceptions of women-centered care from the synthesized voices of women were generated: (i) value of women through childbirth; (ii) overwhelmed by unpleasant childbearing experiences; (iii) a sense of being respected and valued; (iv) a sense of being disrespected and abused; and (v) inadequate systems and resources. Our meta-synthesis indicated that respectful and helpful interaction between women and healthcare providers produced positive perceptions among women. CONCLUSIONS: This study emphasizes the importance of respectful interactions and intrapersonal experiences. Strong systems and positive environments lead to positive interactions between women and healthcare providers. Future studies need to consider cultural and economic differences in women-centered care and respectful care for childbirth in different contexts.