Nursing Midwifery Commons^™

Internet Use And Decision-Making Processes Among Pregnant Women: A Cross-Sectional Study, Ayça Balmumcu, Endam Çetinkaya Ak, Sabriye Uçan Yamaç

Makara Journal of Health Research

Background: The coronavirus disease 2019 (COVID-19) pandemic restricted access to in-person health services, especially in rural areas. This increased reliance on the internet for health information and decision-making was particularly notable among pregnant women. This study aimed to investigate the role of internet use in decision-making among pregnant women.

Methods: This analytical, cross-sectional study examined 384 pregnant women living in a rural district of Turkey who attended family health centers for prenatal care. Data were collected using the Internet Decision-Making Scale in Pregnancy and a questionnaire assessing internet use patterns during the pandemic.

Results: Pregnant women demonstrated …

Maternal Prenatal Anxiety And Risk Of Preterm Birth And Low Birthweight: Evidence From A Cumulative Meta-Analysis With Stability Thresholds, Bereket Duko, Desta, Biniyam Sahiledengle, Yohannes Tekalegn Efa, Tenaw Tiruye, Lisa Whitehead, Gavin Pereira, Amanuel Tesfay Gebremedhin

Research outputs 2022 to 2026

Background: We conducted cumulative meta-analyses to quantify the degree to which maternal prenatal anxiety impacts preterm birth (PTB) and low birthweight (LBW), and to identify when findings reached stability, enabling confident recommendations for early interventions. Methods: Following PRISMA guidelines, we systematically searched PubMed/MEDLINE, PsycINFO, Scopus, EMBASE, CINAHL (EBSCO), ProQuest, and the Cochrane Library from database inception to May 7, 2025. The methodological quality of included studies was assessed using the Newcastle–Ottawa Scale. Inverse variance weighted random-effects cumulative meta-analysis was performed to pool adjusted odds ratios (AORs) with sequential inclusion of newly published studies. Stability thresholds were computed to assess sufficiency …

Assessing Impact Of Heat Waves On Pregnancy And Lactation Amidst Climate Change: A Scoping Review., Susan Anyango, Grace Nakate

School of Nursing & Midwifery, East Africa

Background: The escalation of heat waves, attributed to climate change, represents a global public health concern, with pregnant
and lactating women identified as particularly vulnerable due to Physiological and hormonal changes.

Aim: To review the existing research on the effects of heat waves on pregnancy and lactation, identifying potential health risks and outcomes.

Methods: A structured search across PubMed, Scopus, Web of Science, and Google Scholar was conducted using terms related
to heat waves, pregnancy, lactation, and climate change. Inclusion criteria focused on peer-reviewed empirical
studies in English.

Results: Heat waves are linked to increased risks of preterm labor, low …

A Historical Analysis Of The Development Of Prenatal Care In The U. S., Kristen Montgomery Phd, Cnm, Aprn, Shelby Greene Bsn, Rn, Lauren Griffin Bsn, Rn, Destiny Lewis Bsn, Rn, Lauryn Lewis Bsn, Rn, Bryleigh Newberry Bsn, Rn, Brittany Scott Bsn, Rn

Epsilon Sigma at-Large Research Conference

Purpose: This paper examines the historical development of prenatal care in the United States, tracing its evolution from informal, home—based management to structured, evidence-based systems that are central to maternal and fetal health.

Aims: The specific aim of this project was to determine how prenatal care evolved in the United States.

Methods: A historical methods approach was used. Historical documents were reviewed using PubMed, CINAHL, and Google Scholar to find relevant resources. Relevant articles were reviewed by the research team and analyzed for components regarding the development of prenatal care. All members of the research team reviewed the articles and …

Dosage Considerations For Aspirin Therapy To Prevent Preeclampsia In Pregnancy, Melissa S. Haraway

All Electronic Theses and Dissertations

Introduction: Preeclampsia remains the leading cause of maternal and neonatal mortality worldwide despite extensive and ongoing research on the subject. The use of aspirin therapy to reduce preeclampsia in pregnancy is widely researched and accepted into practice, however, optimal dosing is still debated. The purpose of this review is to identify which dosage of aspirin therapy offers the most effective reduction in preeclampsia without increasing the risk of postpartum hemorrhage.
Methods: The following databases were searched using the framework methodology by Whittemore and Knafl: CINAHL, PubMed, ScienceDirect, Scopus, ProQuest, and Citations. The search criteria limited articles to five years old …

A Scoping Review Of Maternal Active Smoking During Pregnancy And Low-Birth Weight, Naomi Sondang, Nindi Oktavia, Qorinah Estiningtyas Sakilah Adnani, Lani Gumilang, Hadi Susiarno, Victor Abiola Adepoju

Journal of Asian Midwives (JAM)

Background: Low-birth weight (LBW; < 2.5 kg) infants are at increased risk of early mortality, impaired growth, neuro-developmental delay and chronic disease later in life. Maternal behavior, especially cigarette smoking, remains one of the most modifiable determinants of birth weight. We therefore synthesized recent evidence on the association between active maternal smoking during pregnancy and LBW.
Methods: Following PRISMA guidance, we systematically searched PubMed, Scopus and ScienceDirect for the period January 2020 to 31 January 2025 for English-language observational studies that quantified the relationship between active prenatal smoking and LBW. Risk of bias was appraised, and findings were summarized narratively.
Results: In total 26,650 papers were found and eight eligible studies (four cohort, three cross-sectional, one case-control) from Asia, Europe and the Middle East were included. Across all designs and exposure metrics—self-report, exhaled carbon-monoxide, urinary cotinine, and cord-blood DNA-methylation, active smoking was consistently associated with …

Association Of Covid-19 Status With Maternal And Neonatal Outcomes Among Pregnant Women At Mombasa County Referral Hospital, Kenya, Salome Mghoi Rajab

MSc in Advanced Practice Midwifery

Background: COVID-19 pandemic has raised global concern regarding maternal and neonatal health owing to physiological and immunological changes that may heighten disease severity. Despite the global evidence linking COVID-19 infection with unfavorable pregnancy outcomes, data from Sub-Saharan Africa remain limited. This leaves an essential vacuum in our understanding of how COVID-19 status affects maternal and neonatal outcomes in counties like Mombasa, where health-care system problems may alter risks. Vertical transmission remains a puzzle to be solved.

Aim: To assess the association of COVID-19 status on maternal and neonatal outcomes between March 2020 to March 2022.

Methodology: A …

An Exploration Of The Effect Of Covid Restrictions On Maternity Care In Uganda, Hellen Kyakuwaire, Grace Edwards, Ahmed Mohammed Sarki

Journal of Asian Midwives (JAM)

Background: Uganda responded aggressively to the worldwide spread of COVID-19 by imposing a total lockdown, which forbade movement of the whole population, including pregnant women and other vulnerable groups. This phenomenological study explored pregnant women’s experiences during the total lockdown in Uganda and identified factors that influenced the quality of healthcare for pregnant women during the lockdown.
Methods: Thirty-two newly delivered women were selected across a wide geographical area to represent rural and urban areas. The sample was selected from women who had given birth at the selected health facilities from March 18, 2020, to April 30, 2020. …

Respectful Patient-Provider Communication And Patient Portal Usage In Pregnant People Of Color, Amy H. Goh, Christopher Lee, Chisolum Nkenke, Joyce K. Edmonds

College of Health Professions Faculty Papers

BACKGROUND: Patient-provider communication (PPC) increasingly occurs in online patient portals. Variations in portal usage might worsen communication inequities for pregnant people of color (POC), widening the digital divide. The objective of this study was to examine the relationships between respectful PPC, patient portal usage, and digital health literacy (DHL) in pregnant POC.

METHODS: A multimethod cross-sectional survey design was used. Ordered logistic regression was performed to determine the relationship between PPC and portal use, controlling for trimester prenatal care was initiated, insurance type, age, gestational age, and parity. The moderating effect of Digital Health Literacy Instrument (DHLI) was tested on …

Freestanding Birth Centers-Safety And Efficacy Related To Maternal And Neonatal Outcomes: An Integrative Review, Nicole Lynn Muzik, Casey Renee Workman

All Electronic Theses and Dissertations

Introduction: The goal of this literature review is to determine the safety of community birth by evaluating if low-risk pregnant women at term, who deliver in the community setting, specifically at freestanding birth centers, have comparable or lower maternal and neonatal morbidity and mortality outcomes, than low-risk women who deliver at an in-hospital birthing facility.

Methods: The authors of this integrative review retrieved original research articles from computerized databases (Nursing and Allied Health, PubMed, and CINAHL), as well as online journal hand searching, followed by cited reference searching. A total of 48 articles underwent a full-text review, and a total …

A Brief History Of Antenatal Colostrum Expression, And Where To From Here, Therese A. O’Sullivan, Connie N. Ihlein

Research outputs 2022 to 2026

The practice of antenatal colostrum expression (ACE), or the extraction of colostrum from the breasts during pregnancy, has an interesting history and continues to evolve. This narrative review aims to describe how perception and practices of ACE have changed over time, summarise the evidence on ACE in maternal and infant care, and highlight areas for future research. The literature demonstrates that ACE is safe for low-risk women when done from around 36 weeks’ gestation. Women should be reassured that the skill of hand expressing is a valuable tool post-birth, regardless of whether they are able to collect colostrum antenatally or …

Emotional Safety In Maternity Care: An Evolutionary Concept Analysis, Elliesha O'Reilly, Kate Buchanan, Sara Bayes

Research outputs 2022 to 2026

Background: Safety in maternity care is a priority, and a broadened view of safety (e.g., emotional, psychological, cultural) is evident in scientific literature and in lay discourse. ‘Emotional safety’ is being referred to with increasing frequency in this context; however, there is a lack of clarity in its use and meaning. Aim: The aim of this concept analysis was to examine the concept of emotional safety in maternity care. Methods: The evolutionary approach was used for this concept analysis. Data sources: This concept analysis was literature-based, with a systematic search conducted of CINAHL, MIDIRS, and MEDLINE databases. Ten articles published …

To Be Soft Again: A Phenomenological Study Of Uncertainty And Resilience In Childbearing During The Covid-19 Pandemic, Marcianna Nosek

Nursing and Health Professions Faculty Research and Publications

Background:

During the COVID-19 pandemic, uncertainty was exacerbated in experiences of pregnancy and childbirth as people navigated through uncharted territory. Building resilience may be one effective way to cope. However, for those who carry a heavier burden in upholding others, a societal expectation of “toughness” and the ability to endure may lead to an appearance of resilience, while on the inside, well-being may be compromised.

Objectives:

This study is part of a larger phenomenological study that explored the broad research question: What is the lived experience of childbearing during the COVID-19 pandemic? Specific themes of uncertainty and resilience are reported …

Enhancing Respiratory Health With Post-Yoga Exercises During Pregnancy, Hiromi Ito-Kaneko, Masayuki Uehara

Journal of Asian Midwives (JAM)

Pregnancy results in enlarged uterus and diaphragm elevation, which may cause shallow breathing. These changes often cause nocturnal dyspnea, chest discomfort, and difficulty breathing, especially late pregnancy. Training of pregnant women for extending their exhalation reduces suffocation during movement, increasing comfort during pregnancy. In prenatal yoga, deep breathing is practiced and has a relaxing effect.
The purpose of this study is to determine whether yoga exercises during pregnancy improves exhalation length.
We enrolled 152 pregnant women and used a chronograph to measure their exhalation length pre- and post-yoga exercises and compared exhaled breath length by gestational age group. The pre-yoga …

Vaccine Decision-Making Among Pregnant Women: A Protocol For A Cross-Sectional Mixed-Method Study In Brazil, Ghana, Kenya And Pakistan, Jessica Schue, Prachi Singh, Berhaun Fesshaye, Emily Miller, Shanelle Quinn, Ruth Karron, Renato Souza, Maria Laura Costa, Ferdinand Okwaro, Marleen Temmerman

Centre of Excellence in Women and Child Health

Maternal immunization is a critical strategy to prevent both maternal and infant morbidity and mortality from several infectious diseases. When the first COVID-19 vaccines became available during the pandemic, there was mixed messaging and confusion amongst the broader public and among those associated with health care systems about the recommendations for COVID-19 vaccinations in pregnancy in many countries. A multi-country, mixed-methods study is being undertaken to describe how vaccine decision-making occurs amongst pregnant and postpartum women, with a focus on COVID-19 vaccines. The study is being conducted in Brazil, Ghana, Kenya, and Pakistan. In each country, participants are being recruited …

A Survey Of Students’ Experiences Of Returning To Midwifery Studies After Maternity Leave: A Pilot Survey, Liz Mcneill, Elaine Jefford, Michelle Gray, Dianne Bloxsome, Terri Downer, Jessie Johnson-Cash, Lyn Ebert

Research outputs 2022 to 2026

Aim: To identify the barriers and facilitators having an impact on the progression and completion of studies for students who give birth during their midwifery program. Background: Balancing the demands of pregnancy and new motherhood with the rigorous academic requirements of a tertiary-level midwifery program is challenging for students wishing to progress and complete their studies. Understanding the barriers and facilitators students face when resuming midwifery studies following birth can assist universities in providing educational environments that support students in achieving their midwifery education. Design: Social media online Qualtrics survey with closed and open questions. Method: Participants were Australian midwifery …

Factors Associated With Anaemia Among Pregnant Women In Rwanda: An Analysis Of The Rwanda Demographic And Health Survey Of 2020, Lilian Nuwabaine, Joseph Kawuki, Livingstone Kamoga, Quraish Sserwanja, Ghislaine Gatasi, Linet M Mutisya, John Baptist Asiimwe

School of Nursing & Midwifery, East Africa

Background: Anaemia in pregnancy is associated with several adverse outcomes for mothers and newborns, as well as their families. In this study, we assessed the prevalence of anaemia and the associated factors among pregnant women in Rwanda.

Methods: Secondary data from the 2020 Rwanda Demographic and Health Survey (RDHS) was used. Multistage stratified sampling was used to select 435 pregnant women included in the study. Anaemia among pregnant women was defined as a haemoglobin value/dL. Multivariable logistic regression was used to assess the associated factors with anaemia in pregnancy, using SPSS (version 26).

Results: Of the 435 pregnant …

Ensnared Care: How Restrictive Healthcare Laws Impact Mothers, Mckenzie Richards

School of Public Policy Capstones

Do restrictive healthcare policies impact whether expectant mothers receive adequate prenatal care? Could such policies also affect access to alternative birthing options for delivery? Through a literature review and a two-way fixed effects model using panel data, this study investigates two categories of state-level restrictive healthcare policies: scope of practice laws and certificate of need laws. The literature demonstrates the detriments of scope of practice care on access to care and maternal health. However, the statistical models presented on scope of practice find no relationship between scope of practice laws and adequate prenatal care or alternative birthing options. Though the …

Study Protocol For A Stepped-Wedge Cluster (Nested) Randomized Controlled Trial Of Antenatal Colostrum Expression (Ace) Instruction In First-Time Mothers: The Ace Study, Cassandra Cuffe, Roslyn Giglia, Matthew N. Cooper, Julie Hill, Desiree Silva, Anita M. Moorhead, Valerie Verhasselt, Joshua R. Lewis, Deborah Ireson, Jill R. Demirci, Talea Cotte, Kathryn Webb, Frances Patey, Therese A. O’Sullivan

Research outputs 2022 to 2026

Background: Although many mothers initiate breastfeeding, supplementation with human-milk substitutes (formula) during the birth hospitalization is common and has been associated with early breastfeeding cessation. Colostrum hand expressed in the last few weeks before birth, known as antenatal colostrum expression (ACE), can be used instead of human-milk substitutes. However, evidence is lacking on the efficacy of ACE on breastfeeding outcomes and in non-diabetic mothers. Methods and Planned Analysis: This multicenter stepped-wedge cluster (nested) randomized controlled trial aims to recruit 945 nulliparous pregnant individuals. The trial is conducted in two phases. During Phase 1, control group participants are under standard care. …

Age, Body Mass Index, Physical Activity And Quality Of Life In Turkish Pregnant Woman With And Without A Diagnosis Of Gestational Diabetes Mellitus: A Comparative Study, Yaren Nur Tayyar, Hatice Kahyaoglu Sut

Makara Journal of Health Research

Background: This study aimed to examine and compare the age, body mass index (BMI), physical activity (PA), and quality of life (QOL) of third-trimester Turkish pregnant women with and without a diagnosis of gestational diabetes mellitus (GDM).

Methods: A comparative study was conducted in the obstetrics clinic of a university hospital in Turkey, and it included 210 women (GDM women = 105 and non-GDM women = 105). Personal Information Form, International Physical Activity Questionnaire-Short Form (IPAQ), and World Health Organization Quality of Life-Short Form-Turkish (WHOQOL-Bref-TR) were used.

Results: The age and BMI of GDM women were higher …

Impact Of The Maternity Care Changes Of The Covid-19 Pandemic On Pregnant Women And Their Birth Partners: An Integrative Literature Review, Rebekah Kemp

Master of Science in Nursing Final Projects

Introduction: In March 2020, the novel coronavirus originating out of Wuhan in China and spreading rapidly worldwide, became known as the COVID-19 pandemic. Patients with pre-existing conditions, such as the elderly and pregnant women, are among those most vulnerable to severe infection due to COVID-19. Increased pulmonary expansion in the respiratory tract make pregnant women more susceptible to viral respiratory infections and exacerbation of illnesses like COVID-19. Another major concern correlated with the pandemic and pregnancy is its effect on pregnant women’s mental health. Unique physiological and psychological changes place pregnant women at an increased risk for experiencing mental health …

Adherence To Screening And Management Guidelines Of Maternal Group B Streptococcus Colonization In Pregnancy, Sabine Pangerl, Deborah Sundin, Sadie Geraghty

Research outputs 2022 to 2026

Aims: To investigate Group B Streptococcus (GBS) colonization in pregnancy; adherence to antenatal GBS screening and adherence to the intrapartum antibiotics protocol within two models of care (midwifery and non-midwifery led). Design: This retrospective quantitative study has employed a descriptive design using administrative health data. Methods: Data from five maternity hospitals in metropolitan and regional Western Australia that included 22,417 pregnant women who gave birth between 2015 and 2019 were examined, applying descriptive statistics using secondary data analysis. Results: The study revealed an overall GBS colonization rate of 21.7% with similar rates in the different cohorts. A lower adherence to …

No One Should Have To Give Birth Alone: An Analysis Of The Efficacy Of Community-Based Doula Programs Serving Ethnic Minorities In San Francisco, Maria Margaret Nelson

Master's Projects and Capstones

Adverse birth outcomes for both the parent and the child disproportionately affect people of color. Evidence demonstrates that one of the ways to mitigate these negative consequences is through the utilization of a doula, a trained birth companion that is not a medical provider but whose role it is to physically and emotionally support the patient through pregnancy, birth, and postpartum. Community-based doula programs, where the doula is of the same cultural background as the client, are particularly effective in improving birth outcomes in communities of color by providing culturally competent care and helping to navigate a healthcare system that …

Implicit Bias Training For Perinatal Nursing, Racheal Lakine-Harden

Dissertations

Problem: Maternal and fetal morbidity and mortality is a rising health care crisis in the United States. Black women are disproportionately affected. Clinician implicit bias and medical racism have been named as factors in this crisis. Recommendations to address this public health peril include; educating and raising awareness among front-line perinatal nursing staff on implicit bias and its consequences for Black women. The purpose of this project is to evaluate the impact of implicit bias training on nurses’ awareness of implicit bias, attitudes, and beliefs about disparities, and the likelihood to engage in behaviors to reduce or address racial bias …

Implementation Of Quantitative Blood Loss Tool To Detect Postpartum Hemorrhage After Vaginal Delivery, Rachael Williams

Dissertations

Problem Maternal deaths and comorbidities related to postpartum hemorrhage (PPH) continue to be high despite being quite preventable. The delay in recognition and treatment of PPH due to the use of imprecise estimated blood loss (EBL) instead of precise measurement using quantitative blood loss (QBL) attributes to this issue.

Methods For this quality improvement (QI) project, a descriptive, observational design was used to gather quantitative data regarding QBL implementation instead of EBL as well as the number of PPH’s identified. A pilot cohort of staff nurses participated by documenting QBL two hours after each delivery. The nurses were given an …

Perinatal Care In Western Uganda: Prevalence And Factors Associated With Appropriate Care Among Women Attending Three District Hospitals, Mercy Muwema, Dan K. Kaye, Grace Edwards, Gorrette Nalwadda, Joanita Nangendo, Jaffer Okiring, Wilson Mwanja, Elizabeth N. Ekong, Joan N. Kalyango, Joaniter I. Nankabirwa

School of Nursing & Midwifery, East Africa

Background: Perinatal mortality remains high globally and remains an important indicator of the quality of a health care system. To reduce this mortality, it is important to provide the recommended care during the perinatal period. We assessed the prevalence and factors associated with appropriate perinatal care (antenatal, intrapartum, and postpartum) in Bunyoro region, Uganda. Results from this study provide valuable information on the perinatal care services and highlight areas of improvement for better perinatal outcomes.

Methods: A cross sectional survey was conducted among postpartum mothers attending care at three district hospitals in Bunyoro. Following consent, a questionnaire was …

Opioid Use Disorder And Infant Health Outcomes: A Literature Review, Shayln Russell-Fritch

Epsilon Sigma at-Large Research Conference

Introduction and background

Opioid use disorder (OUD) is an epidemic in the U.S. OUD affects both the mother’s and infant’s health. Substance-exposed infants suffer from decreased health outcomes relative to non-exposed infants.

Purpose

The aim is to identify infant health outcomes when pregnant women are prescribed medication-assisted treatment (MAT) for OUD. Among pregnant women with OUD in the U.S., is medication-assisted therapy as compared to no therapy associated with decreased negative infant health outcomes?

Literature review

Five studies on OUD and infant outcomes in the U.S. were reviewed. CINAHL and PubMed were searched using terms opioid use disorder, pregnancy, and …

Comparing An Evidence-Based Screening Tool To Standard Substance Abuse Screening Questions In Identifying Pregnant Women At Risk For Substance Abuse, Nicole Y. Romero

Doctor of Nursing Practice Scholarly Projects

The purpose of the study project was to compare a nonspecific substance screening questionnaire with a well validated, evidence-based substance screening tool designed specifically for the pregnant population Evidence has shown use of an evidence-based screening tool improves maternal and fetal outcomes and reduces the risk of missed cases, stereotyping, and stigma. This study project utilized the social learning theory model, which defines human behavior as a reciprocal, continuous interaction among cognitive, behavioral, and environmental determinants. A pilot observational study project was conducted within a focal organization in a specified women’s health clinic over a 12-week period comparing their currently …

Placental Lesions And Differential Expression Of Pro-And Anti-Angiogenic Growth Mediators And Oxidative Dna Damage Marker In Placentae Of Ghanaian Suboptimal And Optimal Health Status Pregnant Women Who Later Developed Preeclampsia, Enoch Odame Anto, David Antony Coall, Emmanuel Akomanin Asiamah, Osei Owusu Afriyie, Otchere Addai-Mensah, Yaw Amo Wiafe, W. K. B. A. Owiredu, Christian Obirikorang, Max Efui Annani-Akollor, Nicholas Akinwale Titiloye, Eric Adua, Emmanuel Acheampong, Evans Asamoah Adu, Stephen Opoku, Agartha Odame Anto, Augustine Tawiah, Youxin Wang, Wei Wang

Research outputs 2022 to 2026

Background Angiogenic growth mediators (AGMs) and oxidative stress (OS) both play essential roles in normal placental vascular development and as such, placental alterations in these factors contribute to pre-eclampsia (PE). Suboptimal health status (SHS), an intermediate between health and disease, has been associated with imbalanced AGMs and OS biomarkers. Thus, SHS pregnant women may be at increased risk of developing PE and may present abnormal placental alteration and expression of AGMs and OS compared to optimal health status (OHS) pregnant women. We examined the histopathological morphology, immunohistochemical expression of AGMs antibodies and oxidative DNA damage marker in the placentae of …

Predictors Of Fear Of Childbirth And Depressive Symptoms Among Pregnant Women: A Cross-Sectional Survey In Pwani Region, Tanzania, Agnes Fredrick Massae, Margareta Larsson, Sebalda Leshabari, Columba Mbekenga, Andrea Barnabas Pembe, Agneta Skoog Svanberg

School of Nursing & Midwifery, East Africa

Background: Many women experience fear of childbirth (FoB) and depressive symptoms (DS) during pregnancy, but little is known about FoB among Tanzanian women. The current study aimed to assess the prevalence of FoB and DS among pregnant women and determine predictors of each and both, focusing on sociodemographic and obstetric predictors.

Methods: A cross-sectional study was conducted at six health facilities in two districts in Tanzania between 2018 and 2019. In total, 694 pregnant women with gestational age between 32 and 40weeks and expecting vaginal delivery were consecutively recruited and assessed for FoB and DS. We collected data …