Pretest-post-test evaluation with lay midwives in remote Guatemala after educational activities about COVID-19.

INTRODUCTION: Guatemalan lay midwives are well-respected community leaders in a country that lacks the institutional capacity to meet healthcare needs related to pregnancy, newborns, and COVID-19. Thus, Guatemalan lay midwives, who attend the majority of births in their country and who attend most births at home, are in an optimal position to offer frontline support to pregnant women and newborns regarding the global pandemic. The primary objective of this program of study was to dispel myths about COVID-19 and to provide culturally relevant educational activities to low-literacy Guatemalan lay midwives about issues related to the virus, such as signs and symptoms, risks to the mother and fetus, which patients are most vulnerable, appropriate responses, benefits and side-effects of the vaccine, timing of the vaccine, how the virus interacts with breastfeeding, and breastfeeding recommendations. METHODS: In a partnership among the Guatemalan Ministry of Health, expert faculty at the University of Utah College of Nursing, and Madre y Niño, a non-profit organization from the US, evidence-based educational activities about COVID-19 were offered orally in the native language of participants. Two hundred and ten lay midwives attended educational sessions at 11 locations throughout the remote Peten department. Educational activities included repetition, storytelling, and role plays. A pretest-post-test evaluation of 10 questions with 24 correct answers was used to determine if the educational activities changed lay midwife knowledge about COVID-19. Participants were given essential birth supplies and laminated COVID Reminder Cards, which were designed to increase visual literacy, to encourage knowledge retention after the educational sessions. RESULTS: Participants showed a significant increase in knowledge scores (possible 0-24) from prescores 7.09 (standard deviation (SD)=3.06) to 15.20 (SD=4.61), Student's t-test p<0.001. In addition, a significantly higher proportion of participants mistakenly thought COVID-19 passed through breast milk on the pretest (70.1%) compared to post-test (8.4%) (McNemar test, p<0.001). Regarding breastfeeding, 12.6% of participants knew on the pretest that women with COVID-19 who breastfeed should wear a mask and wash their hands compared to 74.3% of participants who knew these recommendations on the post-test (Wilcoxon signed-rank test, p<0.001). Finally, 2% of participants knew on the pretest that pregnant women with COVID-19 should take a low-dose aspirin compared to 67% of participants on the post-test (χ² (1)=194.7, p<0.001). CONCLUSION: These essential primary care providers misunderstood many critical issues related to COVID-19, pregnancy, and newborns. Culturally relevant educational activities provided orally in the native language of participants dispelled myths about the virus and significantly improved lay midwife knowledge. Providing evidence-based educational activities in a culturally relevant format is critical to protecting remote, vulnerable populations, such as pregnant Guatemalan women and newborns, during a global pandemic.

Investigation of Predictors of Newborn Screening Refusal in a Large Birth Cohort in North Dakota, USA.

Objectives The objective of this study was to identify maternal and provider predictors of newborn screening (NBS) refusal in North Dakota between 2011 and 2014. Methods Records of 40,440 live resident births occurring in North Dakota between 2011 and 2014 were obtained from the North Dakota Department of Health and included in the study. Factor-specific percentages of NBS refusals and 95% confidence intervals were computed for each predictor. Since the outcome is rare, multivariable Firth logistic regression was used to investigate maternal and provider predictors of NBS refusal. Model goodness-of-fit test was evaluated using the Hosmer-Lemeshow test. All analyses were conducted in SAS 9.4. Results Of the 40,440 live births, 135 (0.33%) were NBS refusals. 97% of the refusals were to white women, 94% were homebirths, and 93% utilized state non-credentialed birth attendants. The odds of NBS refusals were significantly higher among non-credentialed birth attendants (p < 0.0001), homebirths (p < 0.0001), and among those that refused Hepatitis B vaccination (HBV) at birth (p = 0.047). On the other hand, odds of NBS refusals were significantly (p < 0.0001) lower among women that had more prenatal visits. Conclusions for Practice This study provides preliminary evidence of association between NBS refusal and provider type, home births, and HBV refusal. Additional studies of obstetric providers, home births and women are needed to improve our understanding of the reasons for NBS refusal to better deliver preventive services to newborns.

mHealth intervention to improve the continuum of maternal and perinatal care in rural Guatemala: a pragmatic, randomized controlled feasibility trial.

BACKGROUND/OBJECTIVE: Guatemala's indigenous Maya population has one of the highest perinatal and maternal mortality rates in Latin America. In this population most births are delivered at home by traditional birth attendants (TBAs), who have limited support and linkages to public hospitals. The goal of this study was to characterize the detection of maternal and perinatal complications and rates of facility-level referral by TBAs, and to evaluate the impact of a mHealth decision support system on these rates. METHODS: A pragmatic one-year feasibility trial of an mHealth decisions support system was conducted in rural Maya communities in collaboration with TBAs. TBAs were individually randomized in an unblinded fashion to either early-access or later-access to the mHealth system. TBAs in the early-access arm used the mHealth system throughout the study. TBAs in the later-access arm provided usual care until crossing over uni-directionally to the mHealth system at the study midpoint. The primary study outcome was the monthly rate of referral to facility-level care, adjusted for birth volume. RESULTS: Forty-four TBAs were randomized, 23 to the early-access arm and 21 to the later-access arm. Outcomes were analyzed for 799 pregnancies (early-access 425, later-access 374). Monthly referral rates to facility-level care were significantly higher among the early-access arm (median 33 referrals per 100 births, IQR 22-58) compared to the later-access arm (median 20 per 100, IQR 0-30) (p = 0.03). At the study midpoint, the later-access arm began using the mHealth platform and its referral rates increased (median 34 referrals per 100 births, IQR 5-50) with no significant difference from the early-access arm (p = 0.58). Rates of complications were similar in both arms, except for hypertensive disorders of pregnancy, which were significantly higher among TBAs in the early-access arm (RR 3.3, 95% CI 1.10-9.86). CONCLUSIONS: Referral rates were higher when TBAs had access to the mHealth platform. The introduction of mHealth supportive technologies for TBAs is feasible and can improve detection of complications and timely referral to facility-care within challenging healthcare delivery contexts. TRIAL REGISTRATION: Clinicaltrials.gov NCT02348840 .

Mãos que acolhem vidas: as parteiras tradicionais no cuidado durante o nascimento em uma comunidade nordestina / Hands that hold lives: traditional midwives in the care during birth in a northeastern community

Este é um estudo etnográfico, que teve como objetivos conhecer a experiência das parteiras tradicionais no cuidado à mulher durante o processo de nascimento em domicílio em uma comunidade rural e refletir sobre o significado cultural que a experiência das parteiras oferece ao processo de nascimento. Adotou-se a conceituação de cultura de Geertz. A coleta de dados foi realizada por meio de entrevistas, utilizando-se a história oral de vida como referencial metodológico. Os dados foram analisados e apresentados na forma de narrativa. Em seus relatos, as parteiras tradicionais contribuíram com uma maneira de cuidar, fundamentada no significado da experiência vivida em uma perspectiva sensível, amorosa e acolhedora, respeitando o ritmo de cada mulher, compreendendo o ser humano em sua dimensão de totalidade. Em Serra Encantada, local de realização do estudo, ser parteira é ser lavadeira de menino e a relação que se estabelece é de comadrio e amizade. O cuidado à mulher, durante o processo de nascimento, constitui um ritual envolto em crenças e valores, rico em símbolos e significados. Essa é uma prática regida também pelos desígnios de Deus. Enfim, perceber a existência de um cuidado humanizado, convida a todos para refletir, aprender e compartilhar a sabedoria desse cuidado que contribui para o nascimento de novos padrões de consciência, compatíveis com atitudes simples, sensíveis e mais harmônicas em busca de um viver pautado pelo amor, respeito e solidariedade. Este trabalho contribui também, para a melhoria da qualidade da experiência da mulher em relação ao processo de nascimento.

This is an ethnographic study which had the objective to know the experience of the lay midwifes care for women during home delivery in a rural community and to make reflections about the cultural meaning that their experience offers to childbirth process. Geertz concept of culture was adopted. The data collection were carried out by means of interview, and oral history was the methodology proposed. The data were presented in a narrative format. In their reports, the lay midwives contributed with their especial manner of caring, based on their lived experience in a sensible perspective, loving and sheltering, respecting the rhythm of each woman and understanding the human being in the total dimension. At Serra Encantada, the place where this study was carried out being a midwife means baby washer and the relationship established is of godmother and friendship. The women care during childbirth is a ritual, which involves beliefs and values, rich in meanings and symbols. God rules this practice. This way of caring is an invitation to the reflection and learning about humanized care during labor and delivery. They bring about new patterns of actions compatibles with simple, sensible and harmonious attitudes, in search of respectful and solidary living. This work has also contributed to visualize references for quality care of women during childbirth process in order to enrich women's experiences.