Search Results (243)

Background/Objective: In Spain, 99% of births occur in hospital settings, and planned home birth is neither funded nor regulated by the Public Health System. Despite growing interest in this birth option, qualitative evidence exploring the experiences of women who opt for a planned home birth after a previous hospital birth remains scarce, particularly in contexts where this practice is not integrated into the healthcare system. This study aimed to explore the perceptions and experiences of Spanish women who opted for a planned home birth following a previous hospital birth, focusing on the reasons that motivated this decision and the care received during the process. Methods: A qualitative descriptive design was employed. Semi-structured interviews were conducted between July and December 2025 with 19 women who had experienced a planned home birth in Spain after a previous hospital birth. Data were analysed using inductive thematic analysis following Braun and Clarke’s approach. The study adhered to the Standards for Reporting Qualitative Research (SRQR). Results: Three main themes emerged: (1) motives related to choosing a planned home birth, including negative hospital experiences characterised by loss of autonomy, medicalisation of birth without consent, and fragmented care; (2) seeking a physiological and humanised birth, reflecting women’s desire for empowerment, control, and a transformative experience, alongside barriers such as lack of professional support and financial burden; and (3) the need to increase visibility and establish regulation, highlighting demands for professional training, dissemination strategies, and integration of planned home birth into the Public Health System to ensure equitable access. Conclusions: Women who opted for a planned home birth after a hospital experience reported highly positive and empowering outcomes. However, the absence of regulation, professional support, and public funding creates significant inequalities. Integrating planned home birth into the Public Health System, educating healthcare professionals, and developing strategies to increase the visibility of planned home births are essential to guarantee women’s right to choose where they give birth. Full article

Background/Objectives: In Japan, hospital births predominate, with home births comprising only 0.1% of deliveries. This study assessed how documented practices for planned home births attended by independent midwives align with national guidelines and WHO intrapartum care recommendations, and assess maternal and neonatal differences before and after the COVID-19 pandemic. Methods: Records of 430 low-risk pregnant women who received continuous care at a private midwifery home over 25 years were reviewed. After excluding 8 maternal and 22 neonatal transfers, 400 records were analyzed. Descriptive statistics were compared with WHO recommendations and between the pre-pandemic (1999–2019) and post-pandemic (2020–2024) periods. Results: All women experienced spontaneous singleton cephalic labors with intermittent fetal heart rate auscultation. The mean gestational age was 277.3 days and the median labor duration was 303.5 min. Labor onset was spontaneous in 83.5% of cases. Nearly half of the women had no perineal lacerations. Postpartum blood loss ≥500 mL occurred in 14.1% of cases. Family presence was nearly universal. Neonates had a mean birth weight of 3129.0 g and high Apgar scores. Skin-to-skin contact occurred in 52.9%; exclusive breastfeeding reached 93.8% at 1 month. Post-pandemic births showed higher maternal age and higher neonatal birth weight, although these differences should be interpreted cautiously due to the small post-pandemic sample. Conclusions: Independent midwives provided evidence-based, physiologically oriented care, partially aligning with selected WHO intrapartum recommendations during planned home births. Midwife-led home births may support positive childbirth experiences and favorable maternal/neonatal outcomes for low-risk women. Post-pandemic shifts underscore the need for continued monitoring and flexible, community-based perinatal support, while recognizing the limitations of retrospective, single-site data. Full article

Endocrine-disrupting chemical (EDC) exposure from plastics and everyday products is widespread and linked to infertility. We conducted a 3-month uncontrolled feasibility pilot study among five idiopathically infertile couples to assess whether an intensive lifestyle intervention was associated with within-person changes in urinary EDC biomarkers and exploratory changes in reproductive parameters. The intervention was embedded in a film project (“The Plastic Detox”) and integrated personalized education, product substitutions, at-home urine biomonitoring, sperm testing, and weekly coaching. Urine and semen samples were collected at baseline, 6 weeks, and 12 weeks. Linear mixed-effects models were used to estimate biomarker changes. BPA was designated a priori as the primary biomarker endpoint. Directional reductions were observed in urinary bisphenol A (BPA), mono-n-butyl phthalate (MBP), and monobenzyl phthalate (MBzP) over the intervention period. Within-person reductions in products containing ingredients of concern were associated with lower BPA levels. Descriptive upward trends of semen parameters were observed, with the majority of the subfertile men testing >40 million motile sperm/ejaculate after the intervention. Participants had increased environmental health literacy, were more motivated to reduce exposures, and reported improved wellness endpoints. Four couples achieved pregnancy and live birth during follow-up; given the uncontrolled design and small sample size, these outcomes are presented descriptively. Overall, this pilot study demonstrates feasibility and measurable biomarker change, supporting evaluation in larger, controlled trials. Full article

This study co-designed and developed multimodal educational games in collaboration with parents and teachers to engage girls in STEM from early childhood onward. Recent studies examine the supportive and complementary role of digital educational technology, such as multimodal games, in engaging girls in STEM education during primary and secondary schooling. Different skills, such as computational thinking, mathematical and scientific skills, can be developed via simulations, models, narrative-rich videos, and digital games. However, there is limited research on how parents and teachers perceive how multimodal games can engage children, especially girls in STEM, in early years learning environments, both at home and in formal educational classroom play-based learning contexts. Employing a multi-case study approach, the study conducted focus group discussions (N = 10) with 15 parents and 15 teachers of children from birth to 8 years of age. The theoretical framework underpinning Bronfenbrenner’s socioecological lens guided the thematic data analysis, particularly acknowledging theoretical ideas that a young girl’s natural learning environment comprises parents, siblings, peers, and early childhood professionals (e.g., educators) who play an essential role in the development of a child’s early STEM engagement. Findings indicate the essential role of the pedagogue (both parents and educators), with multimodal technologies (games) acting as the third teacher, being critical in scaffolding girls’ early STEM education by capitalising on multimodal learning environments. Implications pertain to designing hands-on, multimodal games that enable children to engage seamlessly with science and mathematics concepts through a variety of design features, including problem-solving, doing, constructing, role-play, and gamification. Full article

Background/Objectives: Neonatal hypothermia remains a significant contributor to neonatal mortality and morbidity mainly in low and middle-income countries, such as those in sub-Saharan Africa. The objective of this systematic review and meta-analysis is to assess the prevalence of neonatal hypothermia and its risk factors in sub-Saharan Africa. Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis statement (PRISMA) guideline was used to search databases (PubMed, Scopus, Cocrane library and Google Scholar) for studies reporting both the prevalence and factors associated with neonatal hypothermia in sub-Saharan Africa. We have included cross-sectional, cohort and descriptive studies published between 1 June 2014 and 31 May 2024. The Joanna Briggs Institute (JBI) quality appraisal checklist was used for the appraisal of studies. Subgroup analysis was conducted by country, study design and population. A total of 21 articles with 12,803 participants from 9 countries were included in the analysis. Results: The pooled prevalence of neonatal hypothermia was 55.39% (95% CI: 48.52, 62.25). Preterm birth (odds ratio (OR): 3.49; 95% CI: 1.98–6.16), low birth weight (OR: 3.56; 95% CI: 2.36–5.39), no skin-to-skin contact (OR: 1.31; 95% CI: 0.55–3.13), lack of resuscitation (OR: 2.56; 95% CI: 1.75–3.76), delayed initiation of breast feeding (OR: 2.38; 95% CI: 1.57–3.61), admission during cold season (OR: 1.80; 95% CI: 1.33–2.44), home delivery (OR: 1.94; 95% CI: 1.51–2.50) and early bathing (OR: 3.03; 95% CI: 0.98–9.38) were the factors significantly associated with neonatal hypothermia. Conclusions: The observed high prevalence of hypothermia was associated with physiological, behavioral and environmental factors. Full article

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

Introduction: A woman’s health and her child’s development are greatly affected by the responsiveness and support of the health system throughout the postpartum period. While various scholars have analysed the qualities of continuity of care and their effects during that phase, this article aims to reveal women’s experiences of postpartum care by analysing the impact of continuity of care through home visiting (HVCoC) versus standard care. Methods: Semi-structured interviews have been conducted in a qualitative study with 19 mothers of children under 1 year of age, who meet at least one criterion, such as living in poverty, being under 18 while giving birth, lacking permanent housing, residing in crisis centres due to domestic violence, or giving birth for the first time. All participants of the study have received either standard care or continuity of care through home visiting within the HVCoC model project. Results: The study has shown that women’s postpartum care experiences depend on the service delivery model. The standard care model, compared with the HVCoC model, has led to negative experiences for women across three dimensions: Relational, informational, and management continuity of care. Conclusions: While existing research has concluded that adequate postpartum support is related to the continuity of care model, this study’s findings reveal how different care organisation models affect the value women receive from their healthcare. Decision makers should develop postnatal care services that ensure continuity of care throughout pregnancy and the postpartum period by providing access to the same healthcare specialist for ongoing care. Full article

The closure of rural maternity units in hospitals across the United States contributes to health inequities; however, little is known about the effects of reopening maternity services in this context. We conducted a mixed-methods study to characterize labor and delivery outcomes and patient experiences associated with the reopening of a rural Level 1 Maternity Care Center (MCC) at a critical access hospital. We compared clinical outcomes and distance to care for patients who gave birth at the rural MCC in the three years after its opening with outcomes from a similar low-risk and geographically located sample who gave birth at a large suburban academic medical center in the same hospital system in the three years before the MCC reopened. We also conducted in-depth interviews with patients who gave birth at the MCC. Labor and delivery outcomes were similar across both groups, with significantly more care provided by family physicians and midwives and lower neonatal intensive care unit use at the MCC. The opening of the MCC halved the distance patients traveled to give birth, and patients reported high rates of satisfaction. Rural maternity care centers can improve access to quality care closer to home using a resource-appropriate model. Full article

Background: BTB and CNC homology 1 (Bach1) are transcriptional regulators involved in the oxidative response and inflammation. Although its biological functions are well characterized, the clinical impact of Bach1 gene polymorphisms (rs2300301, rs1153285, and rs2070401) on respiratory outcomes in preterm infants remains unclear. Methods: This multicenter study included 212 Japanese preterm infants born at <32 weeks of gestation with birth weights <1250 g. Three Bach1 single-nucleotide polymorphisms (SNPs; rs2300301, rs1153285, and rs2070401) were genotyped using TaqMan polymerase chain reaction (PCR). The requirements for home oxygen therapy (HOT) were compared across genotypes. Logistic regression analyses were performed after adjusting for the gestational age, sex, birth weight, and histological chorioamnionitis status. Results: Infants requiring HOT had a significantly lower gestational age (26 ± 1.7 weeks vs. 27 ± 2.2 weeks, p = 0.015) and lower birth weight (774 ± 235 g vs. 818 ± 233 g, p = 0.043) than those who did not. Histological chorioamnionitis was more prevalent in the HOT group (p = 0.022). rs2300301 was associated with HOT in univariate analysis (OR = 1.78, 95% CI: 1.20–2.04, p = 0.015). However, this association did not remain statistically significant after adjustment for gestational age, sex, birth weight, and histological chorioamnionitis (OR = 2.48, 95% CI: 0.90–6.80, p = 0.079). The rs1153285 and rs2070401 SNPs were not significantly associated with HOT expression. Conclusions: Our findings suggest a potential association between the Bach1 rs2300301 polymorphism and prolonged oxygen requirement in preterm infants. Although the adjusted analysis did not confirm the statistical significance, this SNP may serve as a candidate genetic marker for respiratory morbidity. Further studies are required to validate these findings. Full article

Background/Objectives: Histological chorioamnionitis (HCAM) is a risk factor of chronic lung disease (CLD) in preterm neonates. Funisitis, an indicator of fetal inflammatory response, has been linked to adverse neonatal outcomes, but its impact on respiratory outcomes in extremely preterm neonates remains uncertain. In this study, we investigated whether HCAM with funisitis is associated with poorer respiratory outcomes when compared with HCAM alone in preterm (gestational age 22–36 weeks) neonates. Methods: This was a retrospective cohort study. We divided very low-birth weight (VLBW) preterm neonates with placenta histopathology examinations into three groups—normal, isolated HCAM, and HCAM with funisitis. Perinatal characteristics, radiographic findings, morbidities, and respiratory outcomes were compared. Results: Among 244 VLBW neonates, 25 (10.2%) had HCAM with funisitis, 88 (36.1%) had isolated HCAM, and the remaining 131 were in the normal group. Neonates with HCAM and funisitis had a significantly lower gestational age (26.44 ± 2.1 weeks) but a higher incidence of clinical chorioamnionitis (40.0%) than those with isolated HCAM (12.5%) or normal placentas (6.9%). Moreover, the incidence of cystic–interstitial lung changes before 2 weeks of postnatal age was higher in the HCAM with funisitis group (56.5%) than in the isolated HCAM group (25.0%), and the normal group (4.4%). CLD occurred in 66.7%, 37.7%, and 1.3% of these groups, respectively, and the need for home oxygen at follow-up was 26.1%, 13.7%, and 6.4%. Both isolated HCAM and HCAM with funisitis protected against severe respiratory distress syndrome. However, extremely preterm birth and funisitis had a more adverse impact on CLD development than HCAM alone (adjusted odds ratio 15.259 vs. 3.841). Conclusions: Funisitis independently predicts poor respiratory outcomes in extremely preterm infants. The long-term clinical impacts of funisitis in preterm infants should be further investigated. Full article

Background/Objectives: Prolonged hospitalization of clinically stable preterm infants may lead to nosocomial infections, interfere with breastfeeding, and hinder parent-infant bonding. We evaluated the impact of an early discharge program with hospital-at-home (HaH) on hospital stay and clinical outcomes among preterm infants. Methods: A retrospective case–control study was conducted in a tertiary neonatal unit (Spain). Fifty infants managed with HaH (2016–2020) were compared with ninety-six controls receiving conventional in-hospital care. Baseline characteristics, growth, and clinical events up to 12 months were collected. Analyses included bivariate comparisons and multiple linear regression for length of stay, adjusted for gestational age, birth weight, sex, and parental factors. Results: Baseline characteristics were comparable between groups. Discharge weight was lower in HaH infants (1865 vs. 2130 g; p < 0.001), but no differences were observed at 6 or 12 months. Length of stay was shorter in HaH infants (26.3 vs. 33.8 days; p = 0.081), and the multivariable model showed an independent 5.5-day reduction (β −5.53; 95% CI −10.96 to −0.11; p = 0.046). Exclusive breastfeeding was more frequent (74% vs. 59%; p = 0.08) and significantly longer in HaH infants (141.9 vs. 81.1 days; p = 0.024). No increases were found in complications at discharge, emergency visits (28% vs. 32%; p = 0.7), or readmissions (18% vs. 31%; p = 0.2). Conclusions: Among clinically stable preterm infants, early discharge with HaH was associated with a shorter hospital stay and longer exclusive breastfeeding duration, without evidence of increased morbidity or healthcare use; however, causal inference cannot be established due to the observational design. These findings support the implementation of nurse-led HaH programs as a safe, family-centered strategy for neonatal care. Full article

Background/Objectives: Parents achieving recommended eicosapentaenoic (EPA) and docosahexaenoic (DHA) acid intake can improve the health of parents and their children. Evidence links higher DHA intake to lower preterm birth (PTB) risk. With parental intake poorly defined, the objective is to characterize EPA and DHA intake by parents with children in households in a diverse, urban city. Methods: Parents with ≥1 child in the household completed a validated seven-question food frequency questionnaire to assess consumption of foods contributing most to EPA and DHA intake in American diets during the cross-sectional Voices of Child Health in Chicago Panel Survey (May–July 2022). Female respondents reported prior PTB. Home/residence information was linked to the Childhood Opportunity Index (COI). Multivariable linear regression and survey-weighted models evaluated parental characteristics associated with EPA+DHA intake. Pairwise comparisons estimated intake differences (mean (SE)) among groups. Results: Chicago parents (n = 1057) reported lower-than-recommended EPA+DHA intake and mothers consumed less compared to fathers (difference: 27.1 (11.4) mg/d; p = 0.02). Prior PTB was associated with lower EPA+DHA intake, yet DHA-containing supplement use, which occurred in ~25% of parents, was associated with higher intake (p < 0.05). Lower household income and a lower COI were associated with lower intake while parental race and ethnicity categories were also associated with intake (all p < 0.05); intake differed for mothers and fathers based on Black race and Hispanic ethnicity categories. Conclusions: The findings suggest that efforts aimed at improving parental EPA+DHA intake to improve the health of families should account for multidimensional influences on household food choices. Full article

The phenomenon of counterurbanization, understood as the migration of urban residents to rural areas beyond the suburbanization zone, includes both permanent relocation to the countryside and seasonal migration. The aim of the study is to identify the relationship between newcomers or people temporarily staying in rural areas and their permanent residents, with particular emphasis on the impact of the former group on the local community. The research was conducted in 2023 in 18 villages from different regions of Poland. It was assumed that the villages studied were located outside the zones of strong influence of large urban centers, including outside metropolitan areas. Surveys and in-depth interviews were conducted aimed at both permanent residents of the villages living there from birth and newcomers. The group of newcomers was divided into two categories—new residents who settled in the village in the last few years and owners of second homes who stay in the village temporarily. It can be generally stated that the newcomers from the city, when organizing their life in the countryside, are more active and more frequently initiate contact with the permanent residents than this takes place in the opposite direction. The purpose of the contact is to acquire information, useful for settling down or maintaining the estate, as well as for daily functioning in the countryside. The interactions between the representatives of the two groups considered are usually short-lived and momentary, and they take place usually in the central square of the village, in the street, or in a shop. Conversations concern daily life in the village and private matters. Encounters at home or in other places, which might be conducive to deeper exchange of knowledge and experiences and which might establish conditions for undertaking joint initiatives, are much rarer. Full article

Background: Exposure to indoor air pollution (IAP), including particulate matter of size 2.5 µm/m³ (PM_2.5) and carbon monoxide (CO) resulting from the combustion of biomass fuels in homes, is an important risk factor associated with growth and developmental delays in neonates. We investigated the association between exposure to HAP and adverse birth outcomes in a birth cohort study of 594 pregnant females in Sri Lanka. Methods: Pregnant females between the ages of 18 and 40 years were enrolled in their first trimester and followed until delivery. Baseline assessments of fuel used for cooking were used to categorize the females into high-exposure (wood and kerosene) or low-exposure (liquid petroleum gas and electricity) groups. Indoor air quality measurements of PM_2.5 (n = 303) and CO (n = 258) were conducted in a subgroup of households. The outcomes at birth included the neonates’ appearance, pulse, grimace, activity, respiration (APGAR) score, Brazelton Neonatal Behavioural Assessment Scale (BNBAS) score, and birth weight. Linear and logistic regressions were used to evaluate the association between household air pollution (HAP) and birth outcomes. Results: Of the 526 neonates assessed at delivery, 55.7% were born to mothers with high HAP exposure and 44.3% with low HAP exposure, respectively. The results of the linear regression found an inverse association between higher exposure to HAP and birthweight in the adjusted and unadjusted models; the birth weight of children in the high-exposure group was lower by 107 g compared to that of the low-exposure group after adjusting for other variables (β = −106.8; 95% confidence intervals: −197.6, −16.0). Exposure status was not associated with birth length, gestational age, or the APGAR score; however, the BNBAS motor score was significantly lower in the neonates of the high-exposure group (6.41 vs. 6.55, p = 0.04), though it was not significant when adjusted for other variables. No correlation was found between the measured indoor PM_2.5 levels and birth weight, birth length, gestational age, APGAR score, or BNBAS score. Conclusions: Exposure to IAP due to emissions from combustion products from biomass fuels adversely affects birth weight. These effects may be more pronounced in vulnerable populations in settings where primary healthcare for pregnant women is limited. Full article

The violent dispossession of land in South Africa disrupted more than just homes—it severed Black South Africans from a sacred, ancestral connection to land as a source of identity, belonging, and spiritual dwelling. This article examines how forced removals displaced not only bodies but also histories, memories, and the deep-rooted sense of ikhaya (home). Rooted in the concept of endleleni (being on the road/along the road), this study explores how amaXhosa navigate the in-between journey of landlessness and homecoming. Using indigenous storytelling methodology, it reveals how land is not merely for shelter or sustenance but is intricately tied to birth, the umbilical cord, and death, making its reclamation a fight for existence itself. Full article