Background: Breastfeeding protects against a variety of adverse health outcomes for mothers and babies. Global best practices, known as the Baby-Friendly Hospital Initiative (BFHI), have been developed to support the initiation and exclusivity of breastfeeding during the post-delivery hospital stay. The aims of this study were to explore the literature related to the impact of the BFHI on breastfeeding disparities in the U.S.; compare the impact of exposure to these best practices on exclusive breastfeeding rates in Appalachian and non-Appalachian hospitals; and to understand knowledge, perceptions, and barriers to breastfeeding of postpartum mothers receiving care in a Northeast Tennessee OB/GYN clinic and regional International Board Certified Lactation Consultants’ (IBCLCs®) knowledge, perceptions, and barriers to implementation of the BFHI. Methods: A scoping review was completed to explore literature related to exposure to the BFHI and breastfeeding disparities using the Levac, Colquhoun, and O’Brien methodology. A linear regression analysis of Maternity Practices in Infant Nutrition and Care (mPINC) breastfeeding best practice scores and breastfeeding rates at discharge was conducted comparing this relationship in Appalachian and non-Appalachian hospitals. Finally, a qualitative study was conducted using semi-structured interviews and thematic analysis to gather information from postpartum mothers and regional IBCLCs®. Results: The BFHI has been found to reduce both geographic and racial/ethnic disparities in the U.S., but there are limited studies examining this topic. While there was a significant negative relationship between Appalachian hospitals and exclusive breastfeeding rates at discharge (p=0.0003), there was no significant difference in the relationship between total mPINC scores and exclusive breastfeeding rates at hospital discharge between the two designations (0.4539). Furthermore, both postpartum patients and regional IBCLCs® reported that support, education, and self-efficacy were all necessary to assist mothers on their infant feeding journey. Implications: These findings highlight the need for studies examining the impact of the BFHI on breastfeeding disparities. Research also needs to be conducted to better understand breastfeeding rates in economically distressed, rural areas of the country. Ultimately, risk-stratified interventions supporting the specific needs of a population should be identified or developed to support and empower postpartum mothers to achieve their infant feeding goals.

Pregnant immigrant women are a vulnerable population with respect to access and navigation of maternity care service. They have to deal with the challenges of  navigating a health system in a new country which in most cases is unknown to them while tackling issues such as communication, language, and an unfamiliar healthcare system. Conversely the healthcare professionals are confronted with managing these issues and  providing care within a health institution which was not designed to take on the challenges of providing healthcare to a diverse population.  Both parties continue to search and implement measures within and outside the general healthcare institution with the aspiration of bridging the existing gap.   As a result, the primary aim of this study is to examine immigrant women’s interpretation of maternity care in Sweden and the secondary aim is to explore the views of maternity healthcare professionals on given care to immigrant women. The purpose is to generate and explore new knowledge about an area with limited understanding thus, the research questions are Thus, the research questions are:  How do immigrant women describe their maternity care experience?. How do healthcare professionals describe their experience caring for immigrant women?. An inductive qualitative research was conducted to explore the research problem. Thus, the theory was grounded in data.  Data was collected using semi-structured interviews held with immigrant women who had accessed maternity care in Sweden, had a live birth in the last five years and from healthcare professionals (midwives and doulas).   The result of this study shows that the maternal health needs of immigrant women are compromised due to various factors which centres mainly around communication, language and the health system.  The healthcare professionals also highlighted these same factors and the lack of education and training for them as the most significant underlying systematic problem within health services.

Breastfeeding offers numerous health benefits to both the mother and infant, yet it is not routinely practiced due to a number of internal and external factors that influence the mother's decision. Guided by the social ecological model, the purpose of this study was to examine the effect of required reporting to The Joint Commission on perinatal measures, a proxy measure for maternity care practices, and those professional effects on breastfeeding initiation and exclusivity for first-time mothers. The hypotheses were that the mandatory reporting, and thus an increase in maternity care practices, would increase the initiation of breastfeeding and exclusive breastfeeding on discharge in first-time mothers. This study was a quantitative retrospective study design that included data collected from the medical records of 1,000 mothers from Southeast Alabama Medical Center who gave birth between 2013 and 2014. The multiple logistic regression analysis indicated that the odds ratio for initiation of breastfeeding was greater among first-time mothers after implementation of mandatory reporting measures (OR = 2.07; p = 0.0007); however, the odds for exclusive breastfeeding on discharge did not show a statistically significant change (OR = 0.94; p = 0.7507). These findings may inform the work of healthcare providers at hospitals, community centers, and public health workers, guiding their maternity care practices to increase the number of first-time mothers who will breastfeed for longer periods of time and improving children's health outcomes.

Bakgrund: De stora medicinska framstegen som åstadkommits inom förlossningsvården genom historien har varit revolutionerande för kvinnor och barn vilket bidragit till en minskad mödra- och barnadödlighet. Barnmorskan är expert på normal graviditet och födsel, och har både förr och nu en avgörande roll för folkhälsans positiva utveckling. Trots denna utveckling minskar antalet normala födslar och parallellt ses en ökning av onödiga interventioner inklusive en ökad andel kejsarsnitt. Syfte: Att klargöra vad som främjar en normal födsel från barnmorskans och kvinnans perspektiv. Metod: Litteraturöversikt med systematisk ansats utfördes genom databassökning i PubMed och CINAHL. Artiklarna kvalitetgranskades genom Caldwells kvalitetsgranskningsmall och dataanalysen utfördes genom en integrerad analys av fem kvantitativa respektive 11 kvalitativa artiklar som svarade på studiens syfte och frågeställningar. Resultat: Studiens resultat klargjorde vad som främjar normal födsel och redovisades genom fyra huvudkategorier. Kategorin stöd identifierade hur kontinuerlig närvaro, empowerment och mödravårdens förlossningsförberedelse främjade det normala. Kategorin omgivning redovisade hur vårdorganisationen och födelserummet antingen kunde främja eller hämma den normala födelseprocessen. Kategorin barnmorskans betydelse redovisades genom hur barnmorskans kompetens, handläggande och egenskaper kunde påverka förloppet. Slutligen visade kategorin kvinnans individuella förutsättningar hur medicinska faktorer, den egna förberedelsen samt copingstrategier underlättade eller hindrade en normal födsel. Slutsats: För att främja normal födsel krävs en genuin tro på den normala födelseprocessen av både barnmorskan och kvinnan. Studien visar på hur barnmorskan självständigt kan främja processen genom sitt förhållningssätt där stöd är avgörande. Ytterligare huvudfynd visar dock på hur vårdorganisationen kan ha en hämmande inverkan. Kontinuitetsmodeller är den mest framgångsrika vårdformen för att främja normal födsel och trots detta är denna vårdform högst begränsad i Sverige. Istället visar studier på hur obstetrikerledda förlossningsenheter med utbredd riskkultur dominerar. Detta är problematisk då studier inklusive denna litteraturöversikt visar hur onödiga interventioner samt kejsarsnitt minskar med kontinuitetsmodeller. / Background: Medical advances throughout history have been revolutionary contributing to a reduction in maternal and child mortality. Midwives are experts in normal pregnancy and birth, having a decisive role in the positive development of public health. Despite this development, the number of normal births are decreasing while there is an increase in unnecessary interventions, including caesarean sections. Aim: To clarify what promotes a normal birth from a midwife and woman's perspective. Method: Literature review with a systematic approach was carried out by database search in PubMed and CINAHL. The articles were quality reviewed using the Caldwell quality framework. The data analysis was performed through an integrated analysis of five quantitative and 11 qualitative articles that answered the aim of the study. Results: The findings clarified factors promoting normal birth and were presented through four main categories: Support identified how continuous presence, empowerment and maternity care's birth preparation promoted normality. Environment reported how care organizations and delivery rooms could either inhibit or promote normal birth. Midwife's importance was reported through how midwife's experience, competence, handling and characteristics could influence the process. Finally woman's individual conditions showed how medical factors, own preparation and coping strategies facilitated or hindered normal birth. Conclusion: To promote normal birth, a genuine belief in normal birth is required by midwives and women. Findings show how midwives independently can promote normal birth through her approach where support was crucial. However, further findings show how care organizations could have an inhibiting impact. Continuity of care models has proven to be the most successful care in promoting normal birth. Despite this, these models are highly limited in Sweden. Instead, studies show how obstetrician-led delivery units with a widespread culture of risk are dominant. This is problematic as studies show how unnecessary interventions and cesarean sections are reduced with continuity of care models.

Bakgrund: Obstetriskt våld inom förlossningsvården är ett dilemma både nationellt och internationellt som kan komma att påverka kvinnors syn på förlossningen negativt. Varje kvinna har självbestämmanderätt över sin kropp samt rätt till att vara delaktig i sin vård och få sina önskemål kring förlossningen i möjligaste mån uppfyllda. Barnmorskan har en viktig roll att stödja och skapa trygghet hos kvinnan under förlossningen och har en stor påverkan på hur kvinnan kommer att uppleva sin förlossning. Syfte: Syftet med denna studie är att utifrån instagraminlägg beskriva kvinnors upplevelser av obstetriskt våld under förlossningen. Metod: Netnografiskt inspirerad metod baserad på 107 publicerade inlägg från ett instagramkonto. Kvalitativ innehållsanalys tillämpades. Resultat: Resultatet består av tre kategorier och åtta subkategorier. Bristande information och samtycke; skalpelektod, oxytoxininfusion, studentnärvaro. Fysiskt och psykiskt våld; påtvingade positioner, fysiska och psykiska övergrepp, kränkande kommentarer. Bristande bemötande och negativa attityder; hotfulla kommentarer av vårdpersonal, bristande tilltro till den födande. Kvinnor upplevde bristande information och samtycke, de kände sig utsatta för fysiska övergrepp i form av fasthållning. De upplevde sig överkörda och kände sig misstrodda av vårdpersonalen. Dessa händelser kan alla tolkas som obstetriskt våld. Slutsats: Obstetriskt våld under förlossning kan yttra sig på olika sätt och kan tillämpas omedvetet från vårdpersonal. Som barnmorska är det viktigt att ha kunskap och kännedom om begreppet för att kunna förebygga uppkomsten av detta. Barnmorskan bör skapa trygghet och autonomi hos kvinnan och sträva efter att skapa en mer positiv förlossningsupplevelse. Klinisk tillämpbarhet: Resultatet i denna studie kan ge ökad kunskap och medvetenhet om hur vårdpersonalens bemötande och handlingar kan komma att påverka kvinnans förlossningsupplevelse. Ökad kunskap och medvetenhet om obstetriskt våld under förlossningen kan resultera i att barnmorskan omsätter denna kunskap och anammar ett mer professionellt förhållningssätt gentemot den födande kvinnan. Detta genom att tydligare informera om varför undersökningar och interventioner utförs samt genom att alltid inhämta kvinnans samtycke. / Background: Obstetric violence in maternity care is a dilemma both nationally and internationally, which may negatively affect women's view of childbirth. Every woman has the right to selfdetermination over her body, to be involved in her care and to have her wishes regarding childbirth metas far as possible. The midwife has an important role in supporting and creating security for the woman during childbirth and has a major influence on how the woman will experience her delivery. Aim: The aim of this study is to describe women’s experiences of obstetric violence during childbirth bases on Instagram posts. Methods: Netnographic inspired method based on 107 published posts on an Instagram account. Qualitative content analysis was applied. Results: The result consists of three categories and eight subcategories. Lack of information and consent; scalp electrode, oxytocin infusion, students attendance. Physical and psychological violence; forced positions, physical and psychological abuse,offensive comments. Lack of treatment and negative attitudes; threatening comments by healthcare staff, lack of trust in the birthing woman. Women experienced a lack of information and consent, they felt exposed to physical abuse in form of restraint. They felt trampled on and humiliated and felt distrustedby the healthcare staff. These events can all be interpreted as obstetric violence. Conclusion: Obstetric violence during childbirth can manifest itself in different ways and can be applied unconsciously by healthcare professionals. As a midwife, it is important to have knowledge and awareness with the concept in order to be able to prevent the occurrence of this. The midwife should create security and autonomy in order to create a more positive birth experience for the women. Clinical implications: The results of this study can provide increased knowledge and awareness of how the care staff's treatment and actions can affect the experience of the woman who gives birth. Increased knowledge and awareness of obstetric violence during childbirth can result in the midwife putting this knowledge into practice and adopting a more professional approach towards the woman who gives birth. This by more clearly informing about why examinations and medical actions are carried out and by always obtaining the woman's consent.

yes / This article examines the effects of role redesign on the work and professional boundaries of midwives employed in the National Health Service. It outlines midwives' views and experiences of attempts to change their skills and professional boundaries and, using the concept of closure, considers the implications for the midwifery profession. The findings show that role redesign is changing midwives' work and that the traditional emotional, social and caring skills associated with a midwife are being undermined by the growth in technical work. Importantly, midwives attempts to use closure have met with limited success and aspects of their work which they enjoy are being delegated to maternity support workers, while midwives' roles expand to include work traditionally performed by doctors. Midwives' concerns about the implications of work redesign for maternity care and their professional boundaries reflect the uncertainty surrounding the profession about the future role and skills of a midwife.

Postnatal care is an area for serious concern, with readmission of women and infants following discharge having increased significantly over the past decade. A reduction in average postnatal stays together with care delivered by many members of a fragmented multidisciplinary team disallowing full timely assessments of health needs, are reasons cited for this. There is a disjuncture between process, policy and health outcomes in maternity and neonatal outcomes. While there is evidence indicating what needs to be done to reduce mortality and morbidity and improve outcomes, more is required in relation to how this is done; central to this is innovation. Currently, the NHS does not have sufficient useful data on the extent to which frontline workers are delivering needed interventions, or their short and long-term impacts. Unscheduled maternity and neonatal admissions are supposedly a key indicator of the quality of maternity care. An understanding of why these incidents occur could generate significant cost reductions at a time of severe austerity and enhance the quality of care and safety for women and their infants.

No / Pregnant asylum-seeking and refugee women are a particularly vulnerable group in society, who may be possibly living alone in poverty in inappropriate accommodation (Dunne, 2007) and experiencing hostile attitudes (Hynes and sale, 2010). They may have poor physical and mental health, placing them at an increased risk of poor pregnancy outcomes (National Institute for Health and Care Excellence (NICE), 2010). Despite this, they are less likely to attend for timely maternity care. This article discusses the evaluation to date of an ongoing befriending project located in Northern england, targeting pregnant asylum-seeking and refugee women and helping to address difficulties that they may face. Volunteer befrienders, who themselves are asylum-seeking and refugee mothers, receive training to provide support and guidance to clients. Preliminary data suggest that befriending has advantages for both client and volunteer: clients appear to develop a trusting relationship with their befriender which facilitates self-confidence and helps overcome social isolation; and the volunteers feel that they are undertaking a worthwhile role and often move onto paid employment. Befriending may be a useful resource for midwives and ultimately improve pregnancy outcomes for asylum-seeking and refugee women.

Yes / Pregnant women seeking asylum in the UK may be particularly vulnerable with poor underlying health, more complex pregnancies and an increased risk of maternal and perinatal mortality. Studies have shown that some women seeking asylum have poor experiences of maternity care. This is despite the implementation of NICE guidelines to improve care for women with complex social factors. This article reports on a phenomenological study undertaken in West Yorkshire, aiming to explore the maternity care experiences of local pregnant asylum seeking women, to inform service development. Six women were interviewed over a three-month period. The findings focused more broadly on their experiences of living in the UK whilst being an asylum seeker and pregnant rather than focusing on maternity care, although this was included. Five key themes emerged: ‘pre-booking challenges’, ‘inappropriate accommodation’, ‘being pregnant and dispersed’, ‘being alone and pregnant’ and ‘not being asked or listened to’. These findings could be used as the basis for training midwives to understand how the difficulties women experience can impact on their health and social needs.

yes