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10 pages, 398 KB

Open AccessArticle

Educating for Equity: Preparing Student Midwives for Antenatal Care of Vulnerable Pregnant Women—A Pilot Study

by Janice Hill, Tina Werringloer, Ulrike Keim, Maria Meisl and Claudia F. Plappert

Healthcare 2026, 14(7), 952; https://doi.org/10.3390/healthcare14070952 - 5 Apr 2026

Viewed by 407

Abstract

Background: Maternity care for vulnerable pregnant women presents a particular challenge within midwifery practice. In Germany, maternity services lack standardized frameworks to adequately address the specific needs of individuals who have experienced, among other factors, sexualized violence, poverty, female genital mutilation/cutting (FGM/C), or [...] Read more.

Background: Maternity care for vulnerable pregnant women presents a particular challenge within midwifery practice. In Germany, maternity services lack standardized frameworks to adequately address the specific needs of individuals who have experienced, among other factors, sexualized violence, poverty, female genital mutilation/cutting (FGM/C), or discrimination. Limited access to healthcare among these populations contributes to increased maternal and neonatal morbidity and mortality. Emerging evidence indicates that comprehensive medical and psychosocial support provided by midwives can substantially improve obstetric outcomes for marginalized pregnant women. Methods: An elective course, Antenatal Care for Vulnerable Women, was offered in the sixth semester of the Bachelor’s program in Midwifery Science at the University of Tübingen in 2025. The course provided insights into the psychosocial challenges faced by vulnerable pregnant women and prepared students for these specific aspects of midwifery practice. The curriculum incorporated foundational lectures and innovative teaching formats aimed at cultivating constructivist approaches to problem-solving. All sixth-semester midwifery students were asked to assess their knowledge and skills across five vulnerability categories: asylum-seeking, FGM/C, intimate partner violence, trauma, and racism. A pilot pre–posttest analysis using a 6-point Likert scale (1 = very good, 6 = poor) was conducted as hypothesis-generating and curriculum-guiding. The pretest included 38 respondents. The posttest included 11 respondents who attended the course. Results: Students who attended the course demonstrated observable gains in knowledge and skills across all categories, with the greatest improvements in asylum-seeking, median of 5 (IQR 4–5) vs. 2 (2–3); FGM/C, 5 (4–5) vs. 2 (2–3); and racism, 5 (3–5) vs. 2 (2–3). Conclusions: Innovative teaching methods may contribute to preparing midwifery students for targeted care of vulnerable pregnant women. Findings from the pre- and posttests provide preliminary insight into the potential value of experiential learning and may inform the further development of practice-oriented teaching methods. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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20 pages, 570 KB

Open AccessArticle

Influence of a Structured Teaching on Targeted Pelvic Floor Muscle Contraction Ability in Pregnant Women: The pelviTrust Trial

by Konstanze Weinert, Ulrike Keim, Anna-Lena Wawers, Nina Gärtner-Tschacher and Claudia F. Plappert

Healthcare 2026, 14(5), 651; https://doi.org/10.3390/healthcare14050651 - 4 Mar 2026

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Abstract

Background: Pelvic floor muscle dysfunction (PFD) is common during pregnancy. To counteract pregnancy-associated PFD, women require sufficient knowledge and structured guidance on correct pelvic floor muscle (PFM) contraction to improve PFM perception and functional control. Identifying pregnant women who are unable to [...] Read more.

Background: Pelvic floor muscle dysfunction (PFD) is common during pregnancy. To counteract pregnancy-associated PFD, women require sufficient knowledge and structured guidance on correct pelvic floor muscle (PFM) contraction to improve PFM perception and functional control. Identifying pregnant women who are unable to perform correct PFM contraction despite structured teaching may allow early referral for rehabilitative measures. Objective: At measurement stage 1, this study aims to investigate the influence of structured PFM teaching on pregnant women’s ability to perform targeted PFM contraction (tPFMC-A), assess PFM strength, and describe possible early PFD symptoms. Material and Methods: “pelviTrust” is a two-arm randomized, controlled longitudinal study and has been conducted in the Department of Midwifery Science, University of Tuebingen since February 2023. The study sample comprised 221 healthy pregnant women with singleton pregnancy at 18–22 weeks of gestation. The intervention group (IG; n = 113) (69 nulliparous, 40 primiparous and four biparous) completed the validated German Pelvic Floor Questionnaire for Pregnant and Postpartum Women (GPFQppw) and received individualized midwife-led teaching on PFM anatomy, functional activation and PFM-friendly behaviour, followed by visual inspection and vaginal palpation. Objective-targeted PFMC ability (tPFMC-A) and PFM strength (modified Oxford Scale) were compared with self-assessed ability. The control group (n = 101) (61 nulliparous, 38 primiparous, and two biparous) receives routine prenatal and postnatal care and completes the GPFQppw. The present analysis focuses exclusively on the IG at T1. Results: At T1, 88% of the 113 women in the IG believed they could contract their PFM, but only 68% demonstrated a correct tPFMC-A on visual inspection. Following structured teaching with individualized feedback, 97% achieved correct PFM contraction while 2.7% still had deficits. The median PFM strength was three on the modified Oxford Scale (interquartile range: 3–4). Stress urinary incontinence and flatulence were the most frequently reported symptoms. Primiparous and multiparous women reported urinary incontinence and descensus symptoms more often than nulliparous women (p < 0.001). Conclusions: At the first prenatal assessment, pregnant women often overestimate their ability to contract their PFM correctly. A structured, midwife-led PFM teaching improves objectively assessed PFM contraction ability and may be integrated into routine antenatal care to support PFM health in pregnant women. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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26 pages, 650 KB

Open AccessArticle

Midwives’ Contribution to the Development of the Mothers’ Bond with Their Newborn

by Raymonde Gagnon, Amélie Garban, Diane St-Laurent, Carl Lacharité and Júlia Perarnau Moles

Healthcare 2026, 14(5), 597; https://doi.org/10.3390/healthcare14050597 - 27 Feb 2026

Viewed by 639

Abstract

Background: The mother’s bond with her newborn is important for the child’s development and their relationship. Midwives are well placed to witness first-hand the beginning of this relationship. Objectives: This study examined, based on mothers’ perceptions, the contribution of midwives to the [...] Read more.

Background: The mother’s bond with her newborn is important for the child’s development and their relationship. Midwives are well placed to witness first-hand the beginning of this relationship. Objectives: This study examined, based on mothers’ perceptions, the contribution of midwives to the development of the bond with their baby from pregnancy to the first postnatal months. Methods: We conducted a descriptive qualitative interpretative study in Quebec, Canada (from 2022 to 2025), with 10 primiparous mothers who were cared for by midwives in a model of continuity of care, and gave birth in a birth center, at home, or in a hospital. Semi-structured retrospective interviews were conducted between two and four months after childbirth, and were complemented by interviews with two midwives. Results: Most participants developed a bond with their baby during pregnancy. They discussed their midwifery care and what they felt were significant elements in the development of their bond with the baby. Midwives encouraged them to develop this bond through their approach and various means: letting them feel the fetus during palpation, talking to it, encouraging mothers to do the same, and reinforcing the bond throughout pregnancy. The birth and first moments after birth were also key moments for promoting contact between mother and baby. Midwives were also creative in promoting bonding in more difficult situations, such as when a transfer to the hospital for delivery was needed. Conclusions: Midwives play an important role in initiating and developing the mother–child bond during pregnancy, especially if they practice within a model of relational continuity. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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12 pages, 324 KB

Open AccessArticle

Castor Oil for Induction of Labor: A Safe and Effective Method: A Large Retrospective Cohort Study in a University Hospital Setting

by Peter Jakubowski, Dorothée Hoffmann, Birgitt Schönfisch, Harald Abele, Jürgen Andress and Kristina Bettecken

Healthcare 2026, 14(4), 496; https://doi.org/10.3390/healthcare14040496 - 14 Feb 2026

Viewed by 2061

Abstract

Background/Objectives: Castor oil has long been used as a traditional method for inducing labor, but evidence regarding its safety and effectiveness remains limited. This study aimed to assess the efficacy and safety of castor oil for labor induction in a large cohort within [...] Read more.

Background/Objectives: Castor oil has long been used as a traditional method for inducing labor, but evidence regarding its safety and effectiveness remains limited. This study aimed to assess the efficacy and safety of castor oil for labor induction in a large cohort within a high-risk university hospital setting. Methods: A retrospective analysis was conducted on women who underwent labor induction between January 2017 and June 2018 at the Department for Women’s Health, University Hospital Tübingen. Outcomes of women induced primarily with castor oil-based induction cocktail and their offspring were compared with those induced using standard methods (prostaglandins, oxytocin, ripening balloon). Primary outcomes included induction-to-delivery time, need for additional induction methods, mode of delivery, and maternal/fetal complications. Results: A total of 1015 women were included; 824 (82.1%) received castor oil, and 191 (18.8%) underwent standard induction. The mean induction-to-delivery interval was 26.9 h in the castor oil group versus 19.0 h in the standard group. Additional induction was required in 50.5% of the castor oil group compared to 37.2% of the standard group. No significant differences were observed between groups regarding delivery mode or maternal/fetal complications. Conclusions: Castor oil appears to be a safe but slightly less effective option for inducing labor close to the calculated due date, even in a high-risk population. Large-scale prospective randomized trials are warranted to further evaluate its role in clinical practice. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

13 pages, 227 KB

Open AccessArticle

Women’s Perceptions on Newborn Care Practices, Knowledge Sources, Benefits, and Challenges in Rural Northern Jordan: A Qualitative Study

by Mahmoud H. Alrabab’a, Roqia S. Maabreh, Dalal B. Yehia, Anwar M. Eyadat, Abdallah Ashour, Salam Bani Hani, Amira A. Mohammad, Naser A. Alsharairi, Yazan Alkhsealat, Hanan Abusbaitan and Wael T. Alali

Healthcare 2026, 14(1), 52; https://doi.org/10.3390/healthcare14010052 - 24 Dec 2025

Viewed by 1047

Abstract

Background/Aim: Communities all across the world celebrate the birth of babies through distinct customs and traditional practices. While some of these traditions may bring comfort and cultural continuity, others may not be in line with medical recommendations and could pose major health [...] Read more.

Background/Aim: Communities all across the world celebrate the birth of babies through distinct customs and traditional practices. While some of these traditions may bring comfort and cultural continuity, others may not be in line with medical recommendations and could pose major health risks to the newborn. This study examined rural Jordanian women’s perceptions on practices, knowledge sources, benefits, and challenges around caring for newborns in the northern region. Materials and Methods: In this qualitative descriptive study design, twelve women (aged 22 to 60 years) from the Kufr Som village in Northern Jordan, took part in in-depth semi-structured interviews in August 2025. The interviews focused on identifying caregiving practices, knowledge sources, and perceived benefits or challenges related to newborn care. The responses were verbatim transcribed from audio recordings for thematic analysis. Results: Nine themes emerged. “Thermal protection,” “bathing care,” “umbilical cord care,” and “feeding rites” are four themes that encapsulate the common practices women follow when caring for a newborn. The two themes that capture the sources of knowledge and direction for learning newborn care practices are “transmission of knowledge across generations” and “social influence”. The themes “spiritual safeguarding” and “perceived health protection” highlight the benefits of traditional practices, whereas “conflicts between tradition and modern care” underscores their challenges. Conclusions: Newborn care practices are deeply rooted in Northern Jordanian culture. Evidence-based strategies are needed to augment existing practices in order to improve neonatal care outcomes. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

18 pages, 531 KB

Open AccessArticle

Exploring Empowerment in Group Antenatal Care: Insights from an Insider and Outsider Perspective

by Florence Talrich, Astrid Van Damme, Marlies Rijnders, Hilde Bastiaens and Katrien Beeckman

Healthcare 2025, 13(15), 1930; https://doi.org/10.3390/healthcare13151930 - 7 Aug 2025

Cited by 1 | Viewed by 1607

Abstract

Background: Empowerment during pregnancy is linked to improved maternal and infant health outcomes and greater maternal well-being. Group Antenatal Care (GANC), a participant-centered model of care, promotes empowerment, active engagement, and the deconstruction of hierarchy between participants and care providers. It combines health [...] Read more.

Background: Empowerment during pregnancy is linked to improved maternal and infant health outcomes and greater maternal well-being. Group Antenatal Care (GANC), a participant-centered model of care, promotes empowerment, active engagement, and the deconstruction of hierarchy between participants and care providers. It combines health assessment, interactive learning, and community building. While empowerment is a core concept of GANC, the ways it manifests and the elements that facilitate it remain unclear. Method: We conducted a generic qualitative study across four organizations in Brussels, using multiple data collection methods. This included interviews with 13 participants and 21 observations of GANC sessions, combining both the insider and outsider perspective. An adapted version of the Pregnancy-Related Empowerment Scale (PRES) guided the interviews guide and thematic analysis. Results: We identified seven themes that capture how empowerment occurs in GANC: peer connectedness, provider connectedness, skillful decision-making, responsibility, sense of control, taking action, and gaining voice. Several aspects of GANC contribute to empowerment, particularly the role of facilitators. Conclusions: This study highlights how GANC enhances empowerment during pregnancy through interpersonal, internal, and external processes. Important components within GANC that support this process include the group-based format and the interactive nature of the discussions. The presence of skillful GANC facilitators is an essential prerequisite. In a diverse and often vulnerable context like Brussels, strengthening empowerment through GANC presents challenges but is especially crucial. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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20 pages, 333 KB

Open AccessArticle

Interprofessional Collaboration in Obstetric and Midwifery Care—Multigroup Comparison of Midwives’ and Physicians’ Perspective

by Anja Alexandra Schulz and Markus Antonius Wirtz

Healthcare 2025, 13(15), 1798; https://doi.org/10.3390/healthcare13151798 - 24 Jul 2025

Cited by 3 | Viewed by 3685

Abstract

Background: Interprofessional collaboration (IPC) is considered fundamental for integrated, high-quality woman-centered care. This study analyzes concordance/differences in the perspectives of midwives and physicians on IPC and Equitable Communication (EC) in prenatal/postpartum (PPC) and birth care (BC). Methods: The short form of [...] Read more.

Background: Interprofessional collaboration (IPC) is considered fundamental for integrated, high-quality woman-centered care. This study analyzes concordance/differences in the perspectives of midwives and physicians on IPC and Equitable Communication (EC) in prenatal/postpartum (PPC) and birth care (BC). Methods: The short form of the ICS Scale (ICS-R with eight items) adapted for the midwifery context, and the EC scale (three items) were completed by 293 midwives and 215 physicians in Germany. Profession- and the setting-specific differences were analyzed using t-tests and ANOVA with repeated measurements. Confirmatory factor analysis with nested model comparisons test the fairness of the scales. Results: Midwives’ ratings of all IPC aspects were systematically lower than physicians’ in both care settings (variance component professional group: η²_p = 0.227/ 0.318), esp. for EC (d = 1.22–1.41). Both groups rated EC higher in BC. The setting effect was less pronounced among physicians for the ICS-R items than among midwives. Violations of test fairness reveal validity deficiencies when using the aggregated EC sum score for group comparisons. Conclusions: Fundamental professional differences were found in the IPC assessment between physicians and midwives. The results enhance the understanding of IPC dynamics and provide starting points for action to leverage IPC’s potential for woman-centered care. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

25 pages, 802 KB

Open AccessArticle

Pregnancy Care in Times of Cannabis Legalization: Self-Rated Knowledge, Risk Perception and Communication Practices of Midwives in Germany

by Julia Wollscheid, Matthias Burke, Theresa Kimmel, Tobias Kaufmann, Anil Batra and Annette Binder

Healthcare 2025, 13(11), 1228; https://doi.org/10.3390/healthcare13111228 - 23 May 2025

Cited by 1 | Viewed by 1353

Abstract

Background/Objectives: The legalization of recreational cannabis in Germany in 2024 has increased the relevance of cannabis use in maternal healthcare. Although prenatal cannabis exposure is associated with potential risks to fetal development, the topic remains underrepresented in midwifery research and education. Germany, midwives [...] Read more.

Background/Objectives: The legalization of recreational cannabis in Germany in 2024 has increased the relevance of cannabis use in maternal healthcare. Although prenatal cannabis exposure is associated with potential risks to fetal development, the topic remains underrepresented in midwifery research and education. Germany, midwives play a key role in prenatal care. This study investigates midwives’ self-rated knowledge, perceived risks, and the frequency of screening and counseling on cannabis use during pregnancy. Methods: This study presents a secondary analysis of cross-sectional survey data collected from midwives and physicians in Germany (N = 284) between May and October 2024. Statistical analyses included descriptive statistics, Wilcoxon signed-rank tests, chi-square tests, Spearman’s rank correlations, and multiple linear regression models. Results: Midwives rated their knowledge about cannabis-related risks during pregnancy as moderate. While most reported that substance use was addressed in initial training, only continuing education and older age were associated with higher self-rated knowledge. Knowledge was positively correlated with risk perception and communication frequency. Overall, risk perception was high—particularly regarding fetal outcomes—though cannabis was perceived as less harmful than alcohol and addressed less often. Fewer than half of the midwives routinely screened for cannabis use, and only 22% always provided counseling. Conclusions: To strengthen midwives’ preparedness, both the integration of cannabis-specific content into initial training and the expansion of continuing education may be beneficial. Clear, evidence-based, and non-stigmatizing communication strategies are essential to support maternal and fetal health in a changing legal and cultural landscape. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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20 pages, 257 KB

Open AccessArticle

Care Providers’ and Parents’ Experiences with Implementing the Conversational Health Literacy Assessment Tool (CHAT)-Maternity-Care in the Netherlands: A Mixed Methods Study

by Evi M. E. Vlassak, Judit K. J. Keulen, Elina Miteniece, Rianneke de Ritter, Marijke J. C. Hendrix and Marianne J. Nieuwenhuijze

Healthcare 2025, 13(10), 1173; https://doi.org/10.3390/healthcare13101173 - 17 May 2025

Viewed by 1285

Abstract

Background/Objectives: Care providers’ understanding of patients’ health literacy is crucial to tailoring care and reducing health inequalities. This study explores the experiences, facilitators, and barriers encountered by maternity care providers when implementing CHAT-maternity-care: a conversational tool that supports care providers in estimating (expectant) [...] Read more.

Background/Objectives: Care providers’ understanding of patients’ health literacy is crucial to tailoring care and reducing health inequalities. This study explores the experiences, facilitators, and barriers encountered by maternity care providers when implementing CHAT-maternity-care: a conversational tool that supports care providers in estimating (expectant) parents’ health literacy. As a secondary objective, the study also examines the experiences of (expectant) parents. Methods: Maternity care providers used CHAT-maternity-care after finalizing an e-learning. Implementation was evaluated among maternity care providers with a questionnaire and in-depth focus group meetings and among (expectant) parents with semi-structured interviews. Results: Providers experienced that using CHAT-maternity-care enhanced their health literacy insight, improved health literacy awareness, and fostered easier, more comprehensive and structured estimation of parents’ health literacy. Key facilitators for implementing CHAT-maternity-care as perceived by providers were the perceived value of health literacy insights; the tool’s relevance, user-friendliness, and familiarity; and social factors. The main barriers were time constraints, the tool’s novelty, and social factors. (Expectant) parents were positive and open to having conversations based on CHAT-maternity-care. Questions based on CHAT-maternity-care were perceived as beneficial by parents in uncovering previously unaddressed concerns. Conclusions: CHAT-maternity-care is mostly well received and assessed as helpful to improving health literacy insights. The findings underscore the importance of education, peer support, and organizational alignment for broader adoption and implementation of CHAT-maternity-care. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

24 pages, 754 KB

Open AccessArticle

A Retrospective Observational Study on Post-Pandemic Effects of Endogenous and Exogenous Factors on Prematurity in Pregnant Women Under 18 Years of Age

by Florin Țovîrnac, Alina Mihaela Călin, Eva Maria Elkan, Nicoleta Andreea Țovîrnac, Valentin Marian Antohi and Alexandru Nechifor

Healthcare 2025, 13(2), 197; https://doi.org/10.3390/healthcare13020197 - 19 Jan 2025

Viewed by 2400

Abstract

Background/Objectives: This research investigates the impact of exogenous and endogenous factors on fetal health in pregnant women under the age of 18, with a special focus on the influence of educational level, adherence to vices (smoking and alcohol), comorbidities (diabetes and hypertension), and [...] Read more.

Background/Objectives: This research investigates the impact of exogenous and endogenous factors on fetal health in pregnant women under the age of 18, with a special focus on the influence of educational level, adherence to vices (smoking and alcohol), comorbidities (diabetes and hypertension), and poor sanitary conditions. Methods: The study uses retrospective data collected from a medical institution in the Southeast region of Romania, including a sample of 3639 births during the post-pandemic period (2022–2023). This period was considered to be a reference period for the study because, as a result of measures to combat the spread of COVID-19 disease in the pandemic, there was an increase in the birth rate among patients under 18 years of age. The APGAR clinical score was evaluated at 5, 10, and 20 min after birth and measured on an inverted scale to reflect the increased risk to fetal health. Results: The results indicate that lack of education is a significant exogenous factor associated with an increased risk of preterm births and a lower APGAR score. Additionally, adherence to vices is more pronounced among pregnant women with low educational levels and smoking and alcohol consumption negatively impact fetal health. Regarding comorbidities, diabetes did not significantly affect the short-term APGAR score, while hypertension had a complex effect, though medical interventions mitigated the associated risks. Conclusions: The conclusions of the research emphasize the need for appropriate educational and medical interventions to reduce the risks associated with preterm births and newborn health in adolescent pregnancies, especially in disadvantaged environments. The study suggests future research directions to expand the analysis to other geographical regions and for long-term monitoring of newborn health. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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16 pages, 1494 KB

Open AccessArticle

Prenatal Maternal Psychological Stress (PMPS) and Its Effect on the Maternal and Neonatal Outcome: A Retrospective Cohort Study

by Joana Kathleen Aldinger, Harald Abele and Angela Kranz

Healthcare 2024, 12(23), 2431; https://doi.org/10.3390/healthcare12232431 - 3 Dec 2024

Cited by 6 | Viewed by 8184

Abstract

Background/Objectives: Prenatal psychology studies show that stress, depression, and psychological stress during pregnancy can have a significant impact on maternal and fetal health and are highly prevalent. The aim of the study was to compare maternal and neonatal short-term outcomes in pregnant women* [...] Read more.

Background/Objectives: Prenatal psychology studies show that stress, depression, and psychological stress during pregnancy can have a significant impact on maternal and fetal health and are highly prevalent. The aim of the study was to compare maternal and neonatal short-term outcomes in pregnant women* (the asterisk (*) is used at the appropriate places in this text to indicate that all genders are included) with a history of prenatal maternal psychological stress (PMPS) with those of pregnant women* not exposed to PMPS to determine differences and identify risk factors. Methods: Statistical tests for differences and relative risks between the groups were carried out with the perinatal data of University Hospital Tübingen from 2022 using IBM SPSS. Results: The study shows that PMPS has significant negative effects on various parameters, including the rate of premature births, preeclampsia, induction of birth, birth duration, and fetal asphyxia, as well as the birth weight of the children and their Apgar values (an assessment of newborn health scored shortly after birth). In addition, the risk of PMPS increases in women* with stillbirths and two or more previous miscarriages. However, the practical relevance must be critically scrutinized and confirmed by bigger studies. Conclusions: PMPS has a significant impact on the maternal and neonatal birth outcomes and must be identified as a risk factor in pregnancy. There is still a need for further research with larger samples, more balanced groups, and multivariate regression models to generate detailed, more transferable results and a deeper insight into the significant effects of PMPS and the role midwives can play in helping it. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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14 pages, 645 KB

Open AccessArticle

Psychometric Evaluation of Women’s Knowledge of Healthcare Rights and Perception of Resource Scarcity during Maternity

by Claudia Susana Silva-Fernández, María de la Calle, María A. Suta, Silvia M. Arribas, Eva Garrosa and David Ramiro-Cortijo

Healthcare 2024, 12(20), 2045; https://doi.org/10.3390/healthcare12202045 - 15 Oct 2024

Cited by 2 | Viewed by 1858

Abstract

Background/Objectives: Resources to cope with maternity and women’s participation are essential modulators of maternal well-being. Therefore, it is relevant that the psychosocial factors of woman be monitored during maternity to promote adequate healthcare. This study involved the design and the validation of [...] Read more.

Background/Objectives: Resources to cope with maternity and women’s participation are essential modulators of maternal well-being. Therefore, it is relevant that the psychosocial factors of woman be monitored during maternity to promote adequate healthcare. This study involved the design and the validation of two new tools that identify women’s knowledge of healthcare rights (MatCODE) and perception of resource scarcity (MatER) during pregnancy, labor and early postpartum; Methods: The content validity was carried out using the Aiken’s V coefficient and the content validity index (CVI-i) based on five experts. In addition, for the face validity, the pilot cohort was considered the INFLESZ scale. Finally, the questionnaires were applied to 185 women, which allowed to assess the construct validation by factorial and Rasch analysis. The divergent validity was also studied with validated psychological questionnaires; Results: MatCODE and MatER questionnaires received CVI-i and Aiken’s V > 0.80 values, and the INFLESZ demonstrated acceptable semantic understanding. The analysis confirms the unidimensionality of the questionnaires, with fit values for MatCODE of RMSEA = 0.113 [0.105; 0.122] and for MatER of RMSEA = 0.067 [0.063; 0.072]. The divergent validity showed significant and consistent correlations with the constructs assessed. For MatCODE, ω = 0.95 and α = 0.94, and for MatER, ω = 0.79 and α = 0.78; Conclusions: MatCODE and MatER are useful new tools for monitoring maternal healthcare, with adequate psychometric characteristics in the Spanish context. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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Review

Jump to: Research, Other

17 pages, 347 KB

Open AccessReview

Aromatherapy for Labour Pain Management: Umbrella Review

by Nicole Breuninger, Harald Abele and Joachim Graf

Healthcare 2026, 14(5), 573; https://doi.org/10.3390/healthcare14050573 - 25 Feb 2026

Viewed by 861

Abstract

Background/Objectives: Aromatherapy is widely used in midwifery, with pain relief during labour being a common objective. This umbrella review consolidates evidence from systematic reviews and meta-analyses on its efficacy for this purpose. Methods: Following PRISMA guidelines, nine systematic reviews and meta-analyses [...] Read more.

Background/Objectives: Aromatherapy is widely used in midwifery, with pain relief during labour being a common objective. This umbrella review consolidates evidence from systematic reviews and meta-analyses on its efficacy for this purpose. Methods: Following PRISMA guidelines, nine systematic reviews and meta-analyses published between 2011 and 2023 were included, encompassing 127 primary studies. Populations, interventions, comparators, and outcomes were systematically extracted, and methodological quality was assessed using AMSTAR 2. Results: Lavender and rose were the most commonly used essential oils. Application methods included inhalation, massage, and bathing. Across reviews, aromatherapy showed statistically significant effects on labour pain reduction, particularly during the early stages of labour. However, high heterogeneity, low methodological quality of many reviews, and inconsistent reporting limit the overall strength of the evidence. No adverse effects were reported. Conclusions: The study results suggest that aromatherapy could be an effective, non-invasive intervention for labour pain. However, due to the low methodological quality of the studies and the correspondingly low strength of evidence, these results cannot yet be applied to the general population. This means that no general recommendation for use can be made at this time. Available reviews did not identify an increase in adverse maternal or neonatal outcomes, but safety monitoring and reporting were often limited by low review quality and inconsistent methods. Future high-quality randomized trials and evidence-based clinical guidelines are needed. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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16 pages, 313 KB

Open AccessReview

How Self-Determined Are Reproductive Decisions? Sociological Aspects of Pregnancy, Birth, and Breastfeeding: Implications for Midwifery Practice—A Narrative Review

by Joachim Graf, Konstanze Weinert, Harald Abele and Angela Kranz

Healthcare 2025, 13(13), 1540; https://doi.org/10.3390/healthcare13131540 - 27 Jun 2025

Cited by 2 | Viewed by 1707

Abstract

Pregnancy and birth are biological processes shaped by social factors, requiring sociological approaches to explain reproductive behaviour. This narrative review outlines the importance of health sociology against the background that health and illness behaviour is influenced by the social environment. The aim of [...] Read more.

Pregnancy and birth are biological processes shaped by social factors, requiring sociological approaches to explain reproductive behaviour. This narrative review outlines the importance of health sociology against the background that health and illness behaviour is influenced by the social environment. The aim of this paper is to summarize the current state of research on the influence of social systems and social milieu behaviour on reproduction, pregnancy, and childbirth in order to make it easier for midwives and doctors to take these factors into account in their everyday clinical and outpatient work. First, the paper lays out the basics of how health and illness are socially constructed, looking at it from both a structural and action-oriented perspective. It then goes on to explain what this means for pregnancy and childbirth as social processes, how women’s health is related to the social construction of gender roles, that breastfeeding is also a social process, and what conclusions can be drawn for the work of midwives. Pregnancy and birth are social processes based on norms and role attributions: “Decisions” regarding one’s own reproductivity are usually only “self-determined” to a limited extent and tend to occur in the context of social norms and milieu-specific role expectations. The promotion of women’s health depends on how milieu-specific norms and logics of action are understood. For all the professions involved in obstetrics, this results in the need for a critical examination of the sociological aspects of health. This implies the necessity for all obstetric professions to critically examine aspects of the sociology of health in order to provide women and their families with appropriate, evidence-based and client-centred care in the context of pregnancy, birth and the postpartum period, against the background of constant social change. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

26 pages, 550 KB

Open AccessReview

Pregnant Women’s Knowledge of Pelvic Floor and Related Dysfunctions: A Scoping Review

by Konstanze Weinert and Claudia F. Plappert

Healthcare 2025, 13(8), 847; https://doi.org/10.3390/healthcare13080847 - 8 Apr 2025

Cited by 2 | Viewed by 4605

Abstract

Pregnancy and childbirth can have far-reaching effects on women’s pelvic floor health. It is important to educate pregnant women about pelvic floor health and potential birth-related pelvic floor (PF) changes as part of continuous midwifery care. This scoping review aims to identify the [...] Read more.

Pregnancy and childbirth can have far-reaching effects on women’s pelvic floor health. It is important to educate pregnant women about pelvic floor health and potential birth-related pelvic floor (PF) changes as part of continuous midwifery care. This scoping review aims to identify the current state of research on knowledge and knowledge gaps in pregnant women regarding the PF and PF dysfunction (PFD) in order to derive conclusions and recommendations for midwifery care and midwifery science. This review follows the Arksey and O’Malley framework and the PRISMA Statement. The literature search was conducted on databases PubMed, CINAHL, and Web of Science using various search terms and defined inclusion criteria. Eleven articles were included. The results show a considerable context-related knowledge deficit among pregnant women, with a high prevalence of PFDs such as urinary incontinence (UI), fecal incontinence (FI), or prolapse symptoms (POP). All contributions emphasize the importance of improved specific education and health advice regarding the PF and PFD for pregnant women to close knowledge gaps and promote sustainable PF health. Demands are made on the professional group ‘midwife’, which emphasize the importance of specific and target group-appropriate educational concepts on the subject of the PF and PFD. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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26 pages, 1339 KB

Open AccessReview

Challenges and Choices in Breastfeeding Healthy, Sick and Preterm Babies: Review

by Susanne H. Bauer, Harald Abele and Joachim Graf

Healthcare 2024, 12(23), 2418; https://doi.org/10.3390/healthcare12232418 - 2 Dec 2024

Cited by 6 | Viewed by 7594

Abstract

Although breastfeeding is associated with many health-related benefits for both mothers and children, the WHO recommendation for exclusive breastfeeding is not achieved by the majority in any WHO region. This paper aims to present the current state of research on challenges and choices [...] Read more.

Although breastfeeding is associated with many health-related benefits for both mothers and children, the WHO recommendation for exclusive breastfeeding is not achieved by the majority in any WHO region. This paper aims to present the current state of research on challenges and choices in breastfeeding healthy, sick and preterm babies. The research was organized as a systematic search in PubMed and the study was performed as a narrative review after applying the PRISMA protocol. Finally, n = 57 studies were included. Both barriers and support factors emerge as a complex interaction of individual, group and societal factors, the precise understanding of which is relevant to increasing breastfeeding rates in the future. Knowledge as well as practical skills proved to be generally helpful, whereas the lack of breastfeeding support for mothers, who are often separated from their premature babies in hospital, was identified as a key risk factor for this subgroup. Appropriate training for healthcare professionals can improve the situation as a result. After discharge, workplace-related barriers are of major concern to allow further breastfeeding when maternity leave ends. Thus, the promotion of breastfeeding must be perceived as a task for society as a whole. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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13 pages, 569 KB

Open AccessReview

The Impact of Artificial Intelligence (AI) on Midwifery Education: A Scoping Review

by Angela Kranz and Harald Abele

Healthcare 2024, 12(11), 1082; https://doi.org/10.3390/healthcare12111082 - 24 May 2024

Cited by 17 | Viewed by 5563

Abstract

As in other healthcare professions, artificial intelligence will influence midwifery education. To prepare midwifes for a future where AI plays a significant role in healthcare, educational requirements need to be adapted. This scoping review aims to outline the current state of research regarding [...] Read more.

As in other healthcare professions, artificial intelligence will influence midwifery education. To prepare midwifes for a future where AI plays a significant role in healthcare, educational requirements need to be adapted. This scoping review aims to outline the current state of research regarding the impact of AI on midwifery education. The review follows the framework of Arksey and O’Malley and the PRISMA-ScR. Two databases (Academic Search Premier and PubMed) were searched for different search strings, following defined inclusion criteria, and six articles were included. The results indicate that midwifery practice and education is faced with several challenges as well as opportunities when integrating AI. All articles see the urgent need to implement AI technologies into midwifery education for midwives to actively participate in AI initiatives and research. Midwifery educators need to be trained and supported to use and teach AI technologies in midwifery. In conclusion, the integration of AI in midwifery education is still at an early stage. There is a need for multidisciplinary research. The analysed literature indicates that midwifery curricula should integrate AI at different levels for graduates to be prepared for their future in healthcare. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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29 pages, 780 KB

Open AccessSystematic Review

Postpartum Health in Mothers of Preterm Infants in the NICU: Needs, Service Utilization, and Care Gaps—A Systematic Review

by Tabea Mina Stein, Marie-Jeannine Riefert, Harald Abele, Cornelia Wiechers and Claudia F. Plappert

Healthcare 2026, 14(5), 668; https://doi.org/10.3390/healthcare14050668 - 6 Mar 2026

Cited by 1 | Viewed by 1341

Abstract

Background/Objectives: Mothers of preterm infants face complex postpartum challenges, yet their needs are often overlooked in neonatal care. This review synthesizes evidence on maternal health needs, service utilization, perceived adequacy, and barriers to care. Methods: A systematic search of PubMed, CINAHL, and PsycINFO [...] Read more.

Background/Objectives: Mothers of preterm infants face complex postpartum challenges, yet their needs are often overlooked in neonatal care. This review synthesizes evidence on maternal health needs, service utilization, perceived adequacy, and barriers to care. Methods: A systematic search of PubMed, CINAHL, and PsycINFO identified 16 peer-reviewed studies published between 2007 and 2025 on mothers of preterm infants. A narrative synthesis integrated quantitative and qualitative findings from NICU settings. Results: Across 16 included studies, all reported psychological and emotional needs, with anxiety, distress, and fear for infant survival frequently highlighted. Informational needs were identified in 11 studies, particularly regarding infant care and postpartum guidance. Physical needs were reported in 10 studies, including fatigue and pain affecting NICU engagement. Nursing support and lactation services were consistently accessed, whereas psychosocial services and postpartum follow-up were reported in fewer than half of the studies. Perceived adequacy depended on empathetic, individualized communication, while structural and contextual barriers, such as transportation, financial burden, and NICU policies, limited maternal engagement. Despite available services, gaps in emotional, informational, and practical support persisted. Conclusions: Mothers of preterm infants experience substantial postpartum health needs that are insufficiently addressed within current NICU-centered care structures. Integrating maternal-focused, continuous, and psychosocially informed postpartum care into neonatal services is essential to reduce care gaps and support maternal well-being during NICU hospitalization. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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15 pages, 258 KB

Open AccessCommentary

Midwifery Leadership in a Changing World—Why Is This So Challenging? A Reflective Commentary

by Marie Lewis

Healthcare 2025, 13(19), 2473; https://doi.org/10.3390/healthcare13192473 - 29 Sep 2025

Viewed by 3156

Abstract

Background: Midwifery leadership is central to delivering safe, high-quality maternity care. Yet despite sustained investment in leadership development and governance frameworks, UK national reviews consistently identify leadership as a weakness. Understanding why this persists is vital to achieving meaningful improvement. Objective: This paper [...] Read more.

Background: Midwifery leadership is central to delivering safe, high-quality maternity care. Yet despite sustained investment in leadership development and governance frameworks, UK national reviews consistently identify leadership as a weakness. Understanding why this persists is vital to achieving meaningful improvement. Objective: This paper offers a reflective commentary on the challenges of midwifery leadership in the UK, drawing on national evidence, leadership theory, and professional experience. Methods: A reflective commentary approach was adopted, informed by over 30 years of practice across clinical, academic, and national improvement roles. The discussion integrates insights from national maternity inquiries, academic literature, international comparisons, and leadership theories including compassionate, courageous, and adaptive leadership. Findings: Structural and cultural barriers—including workforce shortages, rising clinical complexity, tensions between midwifery- and medically led models of care, and punitive governance systems—limit the effectiveness of midwifery leadership. These conditions erode psychological safety, fuel attrition, and constrain succession planning. Reflection on professional experience highlights the impact of these dynamics on leaders’ ability to act with confidence and influence. Evidence also points to the value of relational, values-based behaviours—compassion, courage, adaptability, and systems thinking—in enhancing resilience and outcomes. International examples show that supportive policy environments and greater autonomy enable midwifery leadership to thrive. Conclusions: Midwifery leadership requires both individual capability and structural support. Practical priorities include dismantling punitive cultures, embedding Safety-II approaches, investing in leadership development, and enabling professional autonomy. Without such systemic reform, the ambitions of the NHS Long Term Plan will remain at risk, regardless of individual leaders’ skills. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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