A Correlational Study Of Midwives' Self-Compassion, Psychosocial Health, and Well-Being During the First Wave of COVID-19: What Have We Learned?

INTRODUCTION: During the first wave of the COVID-19 pandemic, midwives worked in a threatening environment and worried about themselves and their families becoming infected. Self-compassion is defined as an attitude of self-kindness that is supported by a balanced attitude toward negative thoughts or feelings and may contribute to the psychosocial health and well-being. The purpose of this study was to describe midwives' self-compassion, psychosocial health, and well-being and the correlation between them. METHODS: This was a descriptive correlational study using a survey administered online during May, 2020. Participants included midwives who worked in labor and delivery units across Israel during the beginning of the COVID-19 pandemic. Measures included a demographic questionnaire; the Self-Compassion Scale Short Form (SCS-SF), which has 12 items in 6 subscales; and the psychosocial health and well-being questionnaire, a short version of the Copenhagen Psychosocial Questionnaire, which has 24 items in 6 subscales. RESULTS: Participants (N = 144) reported a moderate-high level of self-compassion with a mean (SD) SCS-SF score of 3.57 (0.69). The mean (SD) psychosocial well-being score was 30.72 (13.57). The burnout subscale score had the highest mean (46.27), representing a high level of burnout. A minority (11.3%) of midwives considered resigning their midwifery positions. A higher level of self-compassion correlated with better psychosocial well-being (r = -0.466; P < .001). The highest correlation was found between the SCS-SF and the psychosocial health and well-being subscale for depressive symptoms (r = -0.574; P < .001). DISCUSSION: During the first wave of the COVID-19 pandemic, midwives had a moderate-high grade of self-compassion and good psychosocial well-being. Midwives with higher self-compassion had better psychosocial well-being. The findings could inform the development of programs to increase midwives' self-compassion, and psychosocial well-being and the quality of midwifery care, in times of stability and during future pandemics or disasters.

The Effect of Breastfeeding in the First Hour and Rooming-In of Low-Income, Multi-Ethnic Mothers on In-Hospital, One and Three Month High Breastfeeding Intensity.

Despite the known benefits of exclusive breastfeeding, the value of Baby-Friendly Hospital Interventions in increasing breastfeeding rates has been challenged, particularly the interventions of breastfeeding in the first hour of life and rooming-in. This study aimed to measure the association of breastfeeding in the first hour of life and rooming-in with high breastfeeding intensity of low-income, multi-ethnic mothers intending to breastfeed. A prospective, longitudinal cohort study was performed on 149 postpartum mothers who intended to breastfeed their infants. Structured interviews were performed at birth and one and three months. Breastfeeding intensity was defined as the percentage of all feedings that were breast milk, and high breastfeeding intensity was defined as a breastfeeding intensity >80%. The data were analyzed by chi-square, t-test, binary logistic regression analysis, and multivariate logistic regression analysis. Breastfeeding in the first hour was associated with increased high breastfeeding intensity in the hospital (AOR = 11.6, 95% CI = 4.7-28.6) and at one month (AOR = 3.6, 95% CI = 1.6-7.7), but not at three months. Rooming-in was associated with increased high breastfeeding intensity in the hospital (AOR 9.3, 95% CI = 3.6-23.7) and at one month (AOR = 2.4 (1.1-5.3) and three months (AOR 2.7, 95% CI 1.2-6.3). Breastfeeding in the first hour and rooming-in are associated with increasing breastfeeding and should be incorporated into practice.

Exploring midwives' coping and functioning in the labour wards during the Covid-19 pandemic from the Labour Ward Head Nurses' perspective: A qualitative study.

AIM: The aim of this study is to explore midwives' coping and functioning in the labour wards during the Covid-19 pandemic from the Labour Ward Head Nurses' perspective. BACKGROUND: The World Health Organization announced the Covid-19 outbreak to be a pandemic in March 2020. Midwives worldwide were affected by this outbreak, working in risky environments, confronting the anxiety and fear of childbearing women. METHODS: A qualitative study using thematic analysis was conducted using semi-structured interviews done over the telephone. Thirteen Labour Ward Head Nurses were interviewed, and the texts were analysed. The study took place in April 2020 during the first Covid-19 lockdown in Israel. RESULTS: Three main themes were generated in the coding process: (a) stress, fear and anxiety, (b) joint efforts and (c) frustration. CONCLUSION: Our study illustrates the difficulties that arose at the beginning of the pandemic, a new and unfamiliar chaotic period. Midwives' managers can use the current research to learn about actions that may assist in improving staff resilience and cohesion during times of crisis. IMPLICATIONS FOR NURSING MANAGEMENT: Understanding the psychological impact of the Covid-19 pandemic among health care professionals is crucial for guiding policies and interventions to maintain staff's psychological well-being.

Spiritual Interventions Used by Jewish Women to Facilitate the Family Continuum: A Qualitative Study.

Introduction: Spiritual interventions (SI) are used by patients and their families as a means to promote health. The family continuum (FC), which includes finding a partner/spouse, getting married, becoming pregnant, and having a safe pregnancy/birth, is an important concept for the Jewish culture as well as other cultures that have a traditional family-centered approach. There is a dearth of professional literature pertaining to SI to promote the FC. Although patients may use SI, this information is not routinely collected in a health history. The purpose of the study was to describe the experience of Jewish women's use of SI to promote the FC. Methods: This ethnographic study included interviews of Jewish women pertaining to FC, a text review, and field study. Coding of the text, site visits, and interviews were performed and reviewed to identify categories and themes and were refined until saturation was achieved. Results: Fifty-three observant and non-observant Jewish women participated in the study. Women expressed that SI were the means for them playing an active role in fulfilling the FC, and included intermediaries to God, self-improvement, and folk/spiritual remedies. The examples of SI included: visits to holy sites and spiritual leaders for blessings and advice, prayers, psalms, doing good deeds, eating special foods, wearing amulets, and performing certain SI with predesignated repetitions. Women attributed these SI to attaining an FC. Women who achieved each FC milestone without difficulty tended to use less SI, whereas women's SI usage increased the longer a milestone was not achieved. Conclusions: Jewish women are using many SI to promote the FC. Health care should be delivered in a culturally competent manner, which includes the incorporation of safe cultural practices. Obtaining a cultural assessment as part of the medical history could assist the health care professional in integrating safe SI into patient care.

Why do Thoracic Radiologists Need to Know About Cultural Competence (and What Is it Anyway)?

Thoracic radiologists meet patients when performing procedures such as transthoracic computed tomography-guided biopsy and during shared decision-making required for lung cancer screening. Both patients and thoracic radiologists are influenced by their cultures, which affect their health care interactions. While culture may relate to religion or ethnicity of individuals, it also includes multiple additional characteristics such as gender, socioeconomic status, sexual orientation, education, occupation, age, disability, and more. Patients from different cultures undergo similar medical procedures; however, care must be tailored according to the cultural and linguistic needs of each patient. Cultural competence allows all patients, from the same or different culture as the thoracic radiologist, to receive care that is tailored to the patient's cultural and linguistic needs. Cultural competence includes concepts such as cultural awareness, linguistic competence, and health literacy as well as avoiding bias and stereotyping. Culturally competent care requires appropriate services for interpretation, relating to spoken language, and translation, related to written reports and documents. The implications of not providing adequate interpretation and translation services include the inability to take an accurate health history and patient inability to understand the informed consent forms. Thoracic radiologic services should have culturally competent practices in place at every step of the care, starting from the first phone call when patients are making an appointment. This will allow patients to receive care that is culturally and linguistically appropriate and lead to better satisfaction and outcomes.

Breastfeeding Intensity and Exclusivity of Early Term Infants at Birth and 1 Month.

Objective: To examine breastfeeding exclusivity and intensity of early term (ET) infants, born at 37-38 weeks, and term infants, born at 39-41 weeks, during the postpartum hospitalization and the first month of life. Materials and Methods: This was a prospective cohort study of 358 mothers of ET and term infants during the first 72 hours after birth and at 1 month of age. Logistic analysis was used to calculate unadjusted and adjusted odds ratios (aORs) and control for confounding variables. Results: ET infants had significantly lower breastfeeding in the first hour (aOR = 0.43, 95% confidence interval [CI] = 0.21-0.87), lower exclusive breastfeeding in the hospital and at 1 month (aOR = 0.46, 95% CI = 0.27-0.71 and aOR = 0.40, 95% CI = 0.22-0.71), and lower rates of high breastfeeding intensity in the hospital and at 1 month (aOR = 0.39, 95% CI = 0.22-0.71 and aOR = 0.33, 95% CI = 0.15-0.72), after controlling for confounding variables. ET infants had more emergency room (ER) visits in the first month (OR = 7.6, 95% CI = 1.01-60.6), and all ET infants who had ER visits were exclusively breastfed. Conclusions: ET infants had lower breastfeeding in the hospital and at 1 month. They should be regarded as a group at risk for breastfeeding challenges and infant morbidity.

Nurses' professional stigma and attitudes towards postpartum women with severe mental illness.

AIMS AND OBJECTIVES: To examine professional stigma and attitudes of parenthood towards postpartum women with severe mental illness and the association between postpartum nurses' attitudes and nursing interventions that promote motherhood. BACKGROUND: Stigma and attitudes towards parenthood of women with severe mental illness may influence nurses' clinical practices. DESIGN: Cross-sectional, mixed methods. METHODS: The Stigma among Health Professionals towards People with Severe Mental Illness, Attitudes towards Parenthood among People with Severe Mental Illness and Nursing Interventions that Promote Becoming a Mother Questionnaires were used in the study, as well as qualitative analysis. RESULTS: Sixty-one postpartum nurses participated in the study. Increased stigma was associated with an increase in negative attitudes towards parenthood among people with severe mental illness, in general, and towards their parenthood skills, in particular. Postpartum nurses reported a decrease in nursing interventions and a therapeutic nurse-client relationship that fosters mother's empowerment. Themes that emerged from the qualitative analysis were postpartum nurse's perceptions of inadequacy, difficulty of postpartum nurses taking responsibility for managing women with severe mental illness and a paternalistic approach to these women, rather than empowerment, regarding infant care. CONCLUSION: Nurses providing care to postpartum women with severe mental illness and their infants may provide fewer routine postpartum interventions due to professional stigma and negative attitudes concerning parenting skills. Nurses should provide individualised, tailored care that allows women with severe mental illness to become a mother to the best of her ability. RELEVANCE TO CLINICAL PRACTICE: Not all women with severe mental illness are capable of caring for themselves and/or their baby. Nurses should provide individualised, tailored care that allows the women with severe mental illness to become a mother to the best of her ability.

Association between severities of striae gravidarum and Obstetric Anal Sphincter Injuries (OASIS).

OBJECTIVES: to examine the association between the severities of Striae Gravidarum (SG) and Obstetric Anal Sphincter Injuries (OASIS) and to measure the symptoms regarding urinary incontinence, fecal/flatus incontinence, and dyspareunia, at 6 and 12 months postpartum. DESIGN: this is a cohort study. SETTING: four university teaching medical centers in Israel, two in the north and two in the center of the country. PARTICIPANTS: women with OASIS were interviewed and assessed for SG. OASIS was divided into 4 groups: 3A, 3B, 3C and 4. Inclusion criteria were:OASIS diagnosis, non-instrumental vaginal childbirth, birth between 37 and 42 gestational weeks, singleton newborn, neonatal birth weight of Severity scoring of SG severity scoring, using Atwal's Numerical Scoring System,observed 4 body sites; Abdomen, Breasts, Hips, and Buttocks., Total severity score (TSS) for all sites range between 0 and 24 and categorized: 0-3: no SG (NSG) and 4 and over: SG. The Pelvic Floor Symptom Bother Questionnaire (PFBQ),a validated, structured questionnaire, was used for the 6 and 12 month follow-up assessments, with nine items regarding pelvic floor dysfunction (urinary and bowel impairment uterine prolapse and sexual function). MEASUREMENTS AND FINDINGS: eighty women who had OASIS were enlisted, interviewed and assessed for SG. The average score for women with some SG was 6.10 (SD = 4.12). There were 58 (72.5%) women with OASIS level 3A; 12 (15%) had 3B; 4 (5.0%) had 3C and 6 (7.5%) had 4th degree anal injuries, respectively. Forty two (52.5%) of the women had SG and 38 (47.5%) had no SG. There was no association between SG severity and OASIS (3A, 3B, 3C+4th) χ2 (6) = 8.4014; p = 0.2. As there were only 10 women with OASIS of 3C and 4, we re-analyzed the association between SG severity and OASIS severity of 3A and 3B. There was a significant association between SG severity and OASIS severity (3A, 3B) χ2 (3) = 9.306; p = 0.025. ADDITIONAL FINDINGS: women with SG were younger (mean = 26.74, SD = 3.57) than women without SG (mean = 29.29, SD = 4.40) (t(78) = 2.86, p = .005). Three symptoms had a significant reduction in the bother degree between 6 and 12 months: urinary incontinence (p = 0.017), flatus incontinence (p = 0.031) and sexuality (p = 0.016). KEY CONCLUSIONS: the innovation of this research is the association between SG severity and OASIS severity (3A, 3B), added information regarding OASIS risk factors.

Obstetric anal sphincter injuries and the role of the midwife.

Obstetric anal sphincter injuries (OASIS) can have a very negative impact on women's health and quality of life. Literature exists concerning the role of the surgeon and physiotherapist after OASIS, but there is a dearth of literature pertaining to the role of the midwife in the management of women following an obstetric anal sphincter injury. This article examines the midwife's role and describes a new service instituted at Hadassah-Hebrew University medical centre, Jerusalem, utilised in the early postpartum period while the woman is still in hospital, entitled Special Services for Perineal Trauma.

The effect of a cultural competence educational intervention for first-year nursing students in Israel.

PURPOSE: To evaluate the effectiveness of an educational intervention to increase general cultural competence of first-year nursing students. DESIGN: This was a quasi-experimental study that used a convenience sample with an experimental group and a control group and pre- and posttesting. The sample comprised 146 first-year nursing students enrolled in the Introduction to Nursing course divided into an intervention group (n = 58) of students from one school and a control group (n = 88) including students from two schools. The intervention group received a 2-hour faculty lecture on cultural competence, and students prepared and delivered a student group presentation about a cultural group in Israel, basing the presentation on Campinha-Bacote's five constructs. A demographic data instrument and Campinha-Bacote's Inventory for Assessing the Process of Cultural Competence Among Healthcare Professional-Revised© were used for pre- and posttesting. FINDINGS: Students who received the educational intervention increased scores significantly (68 ± 6 to 73 ± 6, p = .000), students who did not receive the educational intervention had no significant increase (67 ± 6 to 66 ± 6). DISCUSSION/CONCLUSIONS: Introducing the topic of cultural competence for nursing students in the first-year Introduction to Nursing course as an integrative learning strategy revealed significant increases in cultural competence scores. IMPLICATIONS FOR PRACTICE: Recommendations are to include evidence-based cultural competence teaching strategies into the nursing curriculum.

Stressful childbirth situations: a qualitative study of midwives.

INTRODUCTION: This study aimed to explore clinical life-threatening childbirth situations, which midwives perceive as extremely stressful, and to identify how midwives cope with those experiences. METHODS: Participants were 18 midwives employed in 6 labor and delivery units in Israeli hospitals. Individual semistructured, in-depth interviews were conducted wherein participants were asked to describe an extremely stressful situation that they had experienced, their significant feelings associated with the event, their coping strategies, and their support systems. RESULTS: Thematic content analysis revealed 2 themes, with each consisting of 4 categories. The first theme focused on reactions to stressful childbirth situations and their impact on midwives. Categories were: functioning professionally in an unexpected reality, emotional reactions, physical reactions, and long-term effects. The second theme related to coping with stressful situations, focusing on coping difficulties, and suggestions for change. Categories were: midwives' coping difficulties, their colleagues' reactions, their feelings about supervisory staff support, and their suggestions for meeting expressed needs. DISCUSSION: Stressful childbirth situations can have a long-term impact on midwives' professional and personal identities. Midwives need to feel supported and valued in order to deal with emotional stress. Incorporating clinical supervision by experienced midwives can serve as a supportive framework for other midwives.

Cultural competence and ethnic attitudes of midwives concerning Jewish couples.

OBJECTIVE: To examine nurse-midwives' general cultural competence and ethnic attitudes toward Jewish couples of varying degrees of religious identification during the birth process and the relationship between background data, ethnic attitudes, and cultural competence. DESIGN: Descriptive, correlational study. SETTING: Academic tertiary care health facility. PARTICIPANTS: Thirty staff nurse-midwives employed at a university hospital in Israel. METHODS: Participants completed Campinha-Bacote's Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals-Revised, Ethnic Attitude Scale-Adapted, and a midwifery demographic survey. RESULTS: General cultural competence scores were consistent with previous studies of nurses who did not receive formal cultural education. Midwives' ethnic attitude differed significantly among Secular, Traditional, Religious, and Ultra-Orthodox Jewish patient scenarios. The most positive attitudes and lowest bias scores occurred for midwives when the patient scenarios were similar to or congruent with their religious identification. CONCLUSIONS: The results of this study indicate a need to establish educational and practice content with clinical experiences to improve midwives' cultural competence and ethnic attitudes toward women and their families with dissimilar cultural backgrounds. These results have global implications for nursing/midwifery care considering patients' varying degrees of religious adherence.

Cultural competence of healthcare professionals caring for breastfeeding mothers in urban areas.

OBJECTIVE: Breastfeeding is strongly influenced by cultural considerations. Therefore, culturally competent healthcare professionals can provide more appropriate breastfeeding support and information. The purpose of this study was to measure the general cultural competence of healthcare professionals caring for breastfeeding mothers in an urban area. METHODS: Healthcare professionals involved in the care of breastfeeding mothers in New York, NY were surveyed utilizing Campinha-Bacote's Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R) and a demographic data instrument. RESULTS: Of 141 surveyed healthcare professionals, 128 completed the questionnaire. There were 18 physicians, 69 nurses, and 41 other allied health professionals in this sample. Of those surveyed, 76% reported a majority of their clients' cultural background differed from their own, 56% had studied cultural diversity in school, and 68% had attended a continuing education class on the subject. The mean score on the IAPCC-R was 68 +/- 9, which is culturally aware on Campinha-Bacote's continuum of culturally incompetent, culturally aware, culturally competent, and culturally proficient. There was no statistical difference in IAPCC-R scores whether or not the respondents had attended courses in school or worked with a more diverse population. Professionals who had attended continuing education courses on cultural diversity had significantly higher total scores (69 +/- 9 vs. 65 +/- 7, P = 0.021) and scores for cultural skill (14 +/- 2 vs. 13 +/- 2, P = 0.002) and desire (17 +/- 2 vs. 16 +/- 2, P = 0.011). Twenty-three percent of the participants achieved a score of cultural competence. They were more likely to have attended continuing education courses on cultural diversity (31% vs. 7%, P = 0.0003). CONCLUSIONS: The majority (77%) of healthcare professionals caring for breastfeeding mothers in urban areas did not achieve a score of cultural competence.

Jewish laws, customs, and practice in labor, delivery, and postpartum care.

Many communities throughout the world, especially in the United States and Israel, contain large populations of religiously observant Jews. The purpose of this article is to provide a comprehensive, descriptive guide to specific laws, customs, and practices of traditionally, religious observant Jews for the culturally sensitive management of labor, delivery, and postpartum. Discussion includes intimacy issues between husband and wife, dietary laws, Sabbath observance, as well as practices concerning prayer, communication trends, modesty issues, and labor and birth customs. Health care professionals can tailor their practice by integrating their knowledge of specific cultures into their management plan.