Abstract available through the Annals of Behavioral Medicine.

Thesis (M. (Nursing)) -- University of Limpopo, 2022 / Background Despite all the interventions that have been developed previously preterm labour remain to be the leading cause of perinatal morbidity and mortality worldwide. Preterm labour occurs before 37 weeks of gestation under two obstetric circumstances namely, ‗spontaneous preterm labour‘ and ‗indicated preterm labour‘. The aim of the study was to develop the strategies to enhance prevention of preterm labour in selected hospitals in Capricorn District, Limpopo Province. Research Method A sequential explanatory mixed method was adopted, the study was conducted in three phases, namely, quantitative study, qualitative study, and development of strategies. Self-developed questionnaires with 50 item questions each for mothers and registered midwives were administered. Both questionnaires were pre-tested prior to being administered to the respondents of the main study. The sample size of mothers was 77 mothers and 62 registered midwives. Data collected from the respondents were analysed using Statistical Package for Social Science (SPSS) version 25 with the help of the statistician. Tables, pie charts and bar graphs were drawn to present the results. The results of quantitative phase were utilized to formulate the Interview Guides that were used to explore the knowledge and practise of registered midwives and obstetricians regarding preterm labour. Interviews were conducted with 20 mothers, 6 registered midwives and 4 obstetricians until data saturation was reached. Data were analysed qualitatively using Tesch‘s Open-Coding method. v Quantitative Results The quantitative results for midwives revealed that about 60% of the mothers who had preterm labour were teenagers. Most of the respondents had ‗spontaneous preterm labour‘ and did not have any comorbidities while few had ‗indicated preterm labour‘ and were induced. All 62(100%) of the midwives showed that the facility does not offer an Outreach Programme on the prevention of preterm labour. Themes and Sub-Themes Results Themes and sub-themes were coded manually. Results that emerged from the integration and comparison of quantitative and qualitative results revealed that the mothers who went into preterm labour spontaneously had little information or no health education regarding preterm labour. Developed strategies The following strategies were developed based on the identified factors that might hinders the prevention of preterm labour and after exploring the knowledge and practice of midwives and obstetricians in the selected hospitals, Capricorn District, Limpopo Province. Strategies includes strengthening of BANC Plus, staff establishment, laboratory turnaround time, outreach programmes and improvement of counselling and support services. Recommendations of the Study The recommendation of the study is divided into three groups which includes recommendations for midwives at the PHC and hospital, recommendations for the obstetricians at the hospital and the recommendations for the Department of Health. The midwives to visit schools and community centres at least twice in a month to give information to the woman of childbearing age and reinforce health education on each Antenatal Care visit. The obstetricians to screen all mothers who are at risk of preterm labour for infections, follow up the results and treat the mothers accordingly. The Department of Health should hire enough staff so that quality care can be vi rendered to the pregnant woman at the PHC and hospital. The Department of Health should develop the electronic database, to register all mothers who have a history of preterm labour, so that when they are pregnant the database system will also help to identify them at the PHC, and they would then be referred to the hospital in time. If the developed strategies to enhance prevention of preterm labour may be adopted and adhered to by the midwives and obstetricians, these may help in reduction of high figures of preterm labour in the selected hospitals.

Environmental exposure levels are often sufficiently disparate between populations such that there is little or no overlap, complicating our ability to ascertain the full dose-response curve and as such create informed regulatory policy.I reviewed the literature on methods available to address non- and partially-overlapping exposure distributions, drawing from both epidemiology as well as other relevant disciplines to describe the universe of proposed solutions. I also used the case study of maternal PCB-153 exposure and birthweight, utilizing real-world and simulated data to explore our ability to ascertain “true” dose-response curves from observational data given the limited cohort-specific exposure ranges. I investigated the importance of controlled and uncontrolled confounding as well as the impact of sample size on our ability to ascertain a “true” underlying dose-response curve. Pooling and meta-analysis were useful to increase the heterogeneity of exposure distributions despite imperfect confounding control and heterogenous confounding structures across cohorts. The analyses also serve as continued evidence of the challenges of making population-wide inferences from study samples with restricted exposure ranges as well as the danger of pooling multisite data without sufficiently accounting for heterogeneity in both exposure level and distribution of confounders. These results highlight the limitations of using both individual studies and systematic reviews of environmental chemicals, and emphasize the need for pooling and meta-analysis to widen exposure distributions that in turn permit us to accurately capture the negative effects of these environmental chemicals.

This study was done with the objective of designing and applying a nutrition education program based on a test of improved practices for pregnant women and women of childbearing age in the rural communities of Ibarra canton: La Riconada and Cuambo. For this, information was collected on knowledge, attitudes, and practices (KAP) regarding the eating habits of pregnant women. These results were used to identify content and recommendations to reinforce and/or instruct about eating during pregnancy. Nutrition education was based on the methodology of the improved practices test, which consisted of testing the recommendations in families' homes before recommending them and recording information on their acceptability. The results indicate that pregnant women in the two communities don't eat all the food groups every day. They need to increase the consumption of foods rich in calcium and iron, as well as foods that supply energy, protein, and fats. The pregnant women don't eat additional foods to cover these recommendations during the pregnancy. Despite the knowledge they have and the lessons they received, there are women who don't eat greens, vegetables, and fruits because they don't like them, and those who do eat them don't meet the established nutritional recommendations. The women prefer to eat artificial drinks with unboiled water, and they do not look after personal hygiene. The test of improved practices has been useful for observing if they really put in practice the knowledge about eating during pregnancy, and at the same time it helped design the educational proposal that served as a guide to help improve eating practices of pregnant women in the two rural communities, considering their motivations and recommendations.

[pt] O presente trabalho tem como objetivo de analisar de que forma o lúpus interfere na experiência de gravidez dessas mulheres. O mesmo é classificado como uma doença crônica multissistêmica de natureza autoimune conhecida pela sua imprevisibilidade, apresentando períodos de remissões e recaídas. A gestação para mulheres com lúpus é considerada como de alto risco e necessitam de um planejamento sistemático, pois estas podem apresentar recorrentes abortos e a ativação da doença durante o período gestacional. Ao discutirmos sobre gestantes com lúpus, iremos dar ênfase as suas experiências em relação à patologia, a saúde sexual e reprodutiva, e a maternidade, onde estas são perpassadas pelas relações familiares. Nessa perspectiva configuram-se como objetivos específicos deste trabalho: 1) Discutir os sentidos da maternidade para mulheres gestantes com doença autoimune convivendo com lúpus; 2) Verificar como as relações familiares se expressam no que se refere ao cuidado e apoio de mulheres com lúpus; 3) Discutir como as gestantes com lúpus convivem com sua patologia. O percurso metodológico deste trabalho buscou compreender sob essas perspectivas o cotidiano de cinco mulheres na vivência desse cenário. Como procedimentos de investigação, utilizamos entrevistas semiestruturadas que foram realizadas individualmente por meio de plataforma virtual. Os resultados apontam para a importância das relações familiares quando dissertamos sobre gestantes e lúpus. Ademais, pensarmos o medo existente em relação aos desdobramentos da gestação e a maternidade, e também a relevância das associações e grupos de mulheres que convivem com lúpus para a convivência com a patologia. Destacamos a imprescindibilidade do planejamento e execução de políticas públicas e a ampliação dos estudos sobre o lúpus. / [en] The present work aims to analyze how lupus interferes in the pregnancy experience of these women. It is classified as a chronic multisystem disease of an autoimmune nature known for its unpredictability, periods of remissions and relapses. Pregnancy for women with lupus is considered to be at high risk and elements of systematic planning, as they may present with recurrent abortions and the activation of the disease during the gestational period. When discussing pregnant women with lupus, we will emphasize how their experiences in relation to pathology, sexual and reproductive health, and motherhood, where these are permeated by family relationships. In this perspective, the specific objectives of this work are configured: 1) Discuss the meanings of motherhood for pregnant women with autoimmune disease living with lupus; 2) Check how family relationships are expressed in terms of the care and support of women with lupus; 3) Discuss how pregnant women with lupus live with their pathology. The methodological path of this work sought to understand these perspectives in the daily lives of five women in the experience of this scenario. As investigation procedures, we use semistructured changes that were carried out through a virtual platform. The results point to the importance of family relationships when we talk about pregnant women and lupus. In addition, we think about the existing fear in relation to the consequences of pregnancy and motherhood, and also the descent of women and groups of women who live with lupus to live with the pathology. We highlight the indispensability of planning and implementing public policies and the expansion of studies on lupus.

Poor pregnancy outcomes such as prematurity, low birth weight and infant mortality are societal indicators of a nation’s health status. These indicators have remained at exceptionally high rates in the United States despite the levels of resources and technology. In the quest to understand that discrepancy, among the ranges of theories and models for explaining poor pregnancy outcomes an emerging concept is coming to attention: social capital. In order to test whether maternal social capital has an impact on pregnancy outcome, women in a Healthy Start program were surveyed over a 13-month period to assess their social capital levels and then their pregnancy outcomes. What emerged was that maternal social capital can predict up to 47% of the variance in pregnancy outcome. That is a powerful research result considering that previously there has been no literature tracing a link between maternal social capital and pregnancy outcome. In this study, maternal risk factors adversely affect up to 30% of the variance in pregnancy outcomes. Previous research has focused on maternal risk factors as the primary reason for high rates of preterm delivery, low birth weight, and infant mortality in the United States. However, this research found that in the sample of women at risk for adverse pregnancy outcomes, maternal risk factors had a very strong influence on maternal social capital (R-square=65%) while their effects on pregnancy outcomes were about half of their effects on social capital. This result suggests that social capital mediates the effects of maternal risk factors on pregnancy outcomes. It appears that one of the reasons that the high rates of adverse pregnancy outcomes in the United States have remained a mystery is that maternal social capital has not been taken into account.

El objetivo general de este estudio fue determinar el nivel de conocimiento sobre caries de infancia temprana en gestantes atendidas en la clínica Inmaculada en el distrito de Sullana, durante los meses de julio, agosto y setiembre del año 2023. Fue un estudio de tipo cuantitativo, básico, transversal y prospectivo. Se apoyó en una muestra de 145 gestantes que fueron atendidas en la clínica Inmaculada en el distrito de Sullana. Se tuvo como resultados: Se describe el nivel de conocimiento de las gestantes sobre caries de infancia temprana refiriendo que la mayor frecuencia es del 60% que corresponde al nivel regular, el 20.7% que corresponde al nivel malo y el 19.3% que corresponde al nivel bueno. Se identificó que el 72.4% de las madres gestantes tienen de dos a más hijos mientras que el 27.6% tienen un solo hijo. El grupo etario con mayor frecuencia pertenece a las gestantes comprendidas entre 31 a 40 años representando el 52.4%. Según el grado de instrucción, el nivel superior representa el 66.9% de las madres gestantes y de esta cantidad el 39.3% tuvieron conocimiento de nivel regular. El 75.2% de las madres gestantes que participaron del estudio representan al sector urbano, de las cuales el 46.2% presentan un nivel regular de conocimiento acerca de caries de infancia temprana. / The general objective of this study was to determine the level of knowledge about early childhood caries in pregnant women treated at the Inmaculada clinic in the district of Sullana, during the months of July, August and September of 2023. It was a quantitative, basic study, transversal and prospective. It was based on a sample of 145 pregnant women who were treated at the Inmaculada clinic in the district of Sullana. The results were: The level of knowledge of pregnant women about early childhood caries is described, stating that the highest frequency is 60%, which corresponds to the regular level, 20.7%, which corresponds to the bad level, and 19.3%, which corresponds to the Well. It was identified that 72.4% of pregnant mothers have two or more children while 27.6% have only one child. The most frequent age group belongs to pregnant women between 31 and 40 years old, representing 52.4%. According to the level of education, the higher level represents 66.9% of pregnant mothers and of this amount, 39.3% had regular level knowledge. 75.2% of the pregnant mothers who participated in the study represent the urban sector, of which 46.2% have a regular level of knowledge about early childhood caries.

Bakgrund Cirka fem procent av alla gravida kvinnor i världen konsumerar en eller flera beroendeframkallande substanser idag. Ett växande bekymmer är den snabba ökningen av opioidmissbruk under graviditet, vilket inte bara har en negativ inverkan på kvinnan utan även kan leda till olika skador på fostret. Individer med substansbrukssyndrom upplever frekvent stigmatisering relaterat till sitt beroende. Kvinnor representerar omkring 30 procent av alla personer som erhåller vård för narkotikarelaterade problem i Sverige, och dödsfallen bland dessa kvinnor ökar betydligt. Personcentrerad vård skall utgå från att se personen bakom diagnosen eller sjukdomen och erbjuda ett empatiskt förhållningssätt. Trots detta utgör den otillräckliga vården ett hinder för kvinnor med substansmissbruk under graviditet. Syfte Beskriva hur gravida kvinnor med substansbrukssyndrom upplever mötet med vården. Metod Detta arbete är en icke-systematisk litteraturöversikt med tio vetenskapliga originalartiklar, som genom en integrerad dataanalys presenteras i resultatet. Databaserna PubMed och CINAHL användes för att få fram artiklar kopplade till det valda ämnet. Klassificering och kvalitetsbedömning gjordes med hjälp av Sophiahemmet Högskolas modifierade bedömningsunderlag. Resultat Resultatet har sammanställts i fem huvudkategorier: Upplevelser av bemötande, Upplevelser av stigmatisering, Upplevelser av behandling, Att söka vård och Identifierade behov: Kunskap och kommunikation. Resultatet påvisar att gravida kvinnor med substansbrukssyndrom upplever att mötet med vården präglas av stigmatisering, otillräcklig behandling och kunskapsbrist. Slutsats Denna litteraturöversikt belyser hur gravida kvinnor med substansbrukssyndrom upplever mötet med vården. Resultatet indikerar att mötet mellan dessa gravida kvinnor och vården ofta är präglat av stigmatisering och diskriminering på grund av deras aktiva bruk av substanser. Många erhåller otillräcklig smärtlindring under förlossning. Resultatet belyser även behovet av ökad kunskap och förbättrad kommunikation inom hälso- och sjukvården. Positiva upplevelser var inte enbart relaterade till vårdpersonalens specialisering, utan snarare till närvarande och fördomsfria vårdgivare som ingav känslan av trygghet. / Background  Approximately five percent of all pregnant women worldwide are currently consuming one or more addictive substances. A growing concern is the rapid increase in opioid abuse during pregnancies, which not only negatively affects the woman but can also lead to various harms to the fetus. Individuals with substance use disorder often experience stigmatization related to their addiction even in the context of healthcare visits. Women constitute about 30 percent of all individuals receiving care for drug-related problems in Sweden, and fatalities among these women are increasing significantly. Person-centered care should recognize the person behind the diagnosis or illness and offer an empathetic approach. Despite this, the inadequate care becomes a barrier for women with substance use during pregnancy.  Aim To describe how pregnant women with substance use disorder experience encounters with healthcare.  Method  This is a non-systematic literature review with ten scientific original articles, which were selected and presented in the results, through an integrated data analysis. The databases PubMed and CINAHL were used to retrieve articles related to the chosen topic. Classification and quality assessment were performed using Sophiahemmet University’s modified assessment criteria model.  Results  The results obtained after the analysis of the ten scientific articles have been compiled into five main categories: Experiences of reception, Experiences of stigmatization, Experiences of treatment, Seeking care, and Identified needs: Knowledge and communication. The results indicate that pregnant women with substance use disorders perceive encounters with healthcare characterized by stigmatization, inadequate treatment and lack of knowledge.  Conclusions  This literature review emphasizes how pregnant women with substance use disorders experience encounters with healthcare. The results indicate that the interaction between these pregnant women and healthcare is often characterized by stigma and discrimination due to their active substance use. A significant number of these women do not receive sufficient pain relief during childbirth. The findings underscore the necessity for increased knowledge and improved communication within healthcare. Positive experiences were not solely related to the specialization of healthcare professionals but rather to the presence of a nonjudgmental healthcare provider who instilled a sense of security.

Yes / Pregnant women seeking asylum in the United Kingdom appear particularly vulnerable, having complex health and social care needs and could benefit from a woman centred approach to midwifery care. This article is the second of three parts and reports on the findings from one objective of a wider doctorate study. It focuses on exploring midwifery students' perceptions of how to approach the care of pregnant women seeking asylum. Although the design of the study is explored in article one, in this context, the data was subject to critical discourse analysis to meet this objective. Key words and phrases were highlighted which appeared to reveal power and ideology implicit in the language used when discussing midwifery care of the pregnant woman seeking asylum. Dominant discourses were identified which appeared to influence the way in which care was approached and the possible sources of these discourses critically analysed. The findings suggest an underpinning ideology around following policies and guidelines to meet the physical needs of the woman at the expense of her other holistic needs. Despite learning to adopt a woman centred approach in theory, once in practice some students appear to be socialised into (re)producing these dominant medical and managerial discourses with “midwifery discourse” being marginalised. In addition, some students appeared to have difficulty understanding how to adopt a woman centred approach and the importance of considering the woman's context and its impact on care. These findings have implications for midwifery educators and this article identifies that the recent Nursing and Midwifery Council requirement for students to undertake a caseloading activity could provide the opportunity for them to adopt a consistent woman centred approach in practice, rejecting dominant medical and managerial discourses. However, these discourses appear to influence midwives caring for women more widely and will be difficult to challenge.

Yes / Asylum-seeking and refugee (AS&R) women living in the UK often have complex health and social care needs, with poor underlying mental and physical health and an increased risk of negative pregnancy outcomes. Despite this, AS&R women are less likely to attend for timely maternity care and when they do, care may be poor, with staff not understanding their specific needs and displaying poor attitudes. This article discusses the Maternity Stream of the City of Sanctuary and how this charity aims to work with statutory and voluntary sector maternity-related services and groups to develop services that are inclusive for AS&R women and meet their specific needs. Volunteer AS&R women are central to the activities of the Maternity Stream and this article discusses how they engage with midwives and other maternity workers to facilitate the development of services that may ultimately improve pregnancy outcomes for AS&R women.