BACKGROUND & AIMS: :Objectives To explore women's decisional conflict in the pathway of prenatal screening and testing (PreST) in Finland and to evaluate a counseling service. Methods Self-completion surveys were conducted at two medical settings (screening and further testing) of PreST. Decisional Conflict Scale (DCS) was the main measure. Different types of statistical tests were used to compare women's decisional conflict at different medical settings of PreST, and before-after pre-test counseling. Multivariable linear regressions analyzed the influences of the medical settings and other factors on women's decisional conflict. Results Compared to women in population-based screening, women in further testing (before pre-test counseling) were more likely to feel well informed (P < 0.001), had increased values clarity (P < 0.001), but more likely experienced uncertainty (P = 0.040). Besides medical settings, maternal age, gravidity and previous experience of fetal aneuploidy significantly influenced decisional conflict. After counseling, screen-positive women felt better informed (P < 0.001), had increased values clarity (P < 0.001), perceived more support (P < 0.001), and had better decision certainty (P < 0.001) than before counseling. Conclusions Medical settings influence women's decisional conflict during PreST. Individual counseling is effective in improving screen-positive women's decisional conflict. This research adds knowledge and experience on developing decision-making supports across the pathway of PreST.

背景与目标： : 目的探讨芬兰妇女在产前筛查和检测 (prestt) 途径中的决策冲突，并评估咨询服务。方法在prestt的两个医疗机构 (筛查和进一步测试) 进行自我完成调查。决策冲突量表 (DCS) 是主要衡量标准。使用不同类型的统计测试来比较prestt的不同医疗环境以及测试前咨询后的女性决策冲突。多变量线性回归分析了医疗环境和其他因素对女性决策冲突的影响。结果与进行基于人群的筛查的女性相比，接受进一步测试 (在测试前咨询之前) 的女性更有可能感到信息灵通 (p  <  0.001)，值清晰度增加 (p  <  0.001)，但更有可能经历不确定性 (p   =   0.040)。除医疗环境外，孕产妇年龄，妊娠和以前的胎儿非整倍性经历也显着影响决策冲突。咨询后，屏幕阳性的女性比咨询前感觉更好 (p  <  0.001)，增加了价值观的清晰度 (p  <  0.001)，感觉到更多的支持 (p  <  0.001)，并且具有更好的决策确定性 (p  <  0.001)。结论医学环境影响女性在prett期间的决策冲突。个人咨询可有效改善屏幕阳性女性的决策冲突。这项研究增加了在prert整个过程中开发决策支持的知识和经验。

BACKGROUND & AIMS: BACKGROUND:Though effective treatment programs for severely malnourished children are available, mortality rate among children with acute malnutrition continue to rise and little is known about its long-term outcomes and potential predictors of its in-hospital and post-discharge mortality. The aim of this study was to assess the survival status and predictors for mortality in severely malnourished children admitted to Minia University Maternity and Children Hospital. METHODS:A retrospective cohort study which included 135 children under 5 years of age who were admitted to the nutrition rehabilitation ward with severe acute malnutrition (SAM) during the period from January to December 2018. Data were collected from the inpatient's hospital records and the children's parents/guardians were interviewed using a detailed structured questionnaire that inquired about demographic and socioeconomic variables. The logistic and Cox regressions were used to assess the factors associated with the SAM's mortality. RESULTS:A total of 135 children were enrolled into the study. Death rate during hospitalization was 9.6%. The survival rate at the end of the fourth week of admission was 82.4%. There were 6.7% post-discharge deaths among 104 alive discharged children which occurred within 8 weeks after discharge. The adjusted HRs (95% CIs) for total SAM deaths were 1.57 (1.10-2.99) in children < 12 vs ≥ 12 months old; 4.79 (2.23-6.10) in those with WAZ < -3SD, 2.99 (1.16-4.66) in those with edema at admission and 3.44 (1.07-9.86) in children with complications. The respective ORs (95%CIs) for in-hospital SAM deaths in the same groups of children were 2.64 (1.22-6.43), 8.10 (2.16-11.67), 3.04 (1.70-6.06) and 3.71 (1.59-6.78). The main predictor for the SAM's post-discharge mortality was illiteracy of mothers; the adjusted HR (95%CI) was 7.10 (1.58-31.93; p = 0.01). CONCLUSIONS:Age, WAZ, edema and complications at admission were predictors for both in-hospital and total SAM mortality, while mother's education contributed to the early post-discharge mortality. The identification of predictors for mortality is an important preliminary step for interventions aiming to reduce morbidity and mortality.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Although the overall rate of caesarean deliveries in India remains low, rates are higher in private than in public facilities. In a household survey in Delhi, for instance, more than half of women delivering in private facilities reported a caesarean section. Evidence suggests that not all caesarean sections are clinically necessary and may even increase morbidity. We present providers' perspectives of the reasons behind the high rates of caesarean births in private facilities, and possible solutions to counter the trend. METHODS:Fourteen in-depth interviews were conducted with high-end private sector obstetricians and other allied providers in Delhi and its neighbouring cities, Gurgaon and Ghaziabad. RESULTS:Respondents were of the common view that private sector caesarean rates were unreasonably high and perceived time and doctors' convenience as the foremost reasons. Financial incentives had an indirect effect on decision-making. Obstetricians felt that they must maintain high patient loads to be commercially successful. Many alluded to their busy working lives, which made it challenging for them to monitor every delivery individually. Besides fearing for patient safety in these situations, they were fearful of legal action if anything went wrong. A lack of context specific guidelines and inadequate support from junior staff and nurses exacerbated these problems. Maternal demand also played a role, as the consumer-provider relationship in private healthcare incentivised obstetricians to fulfil patient demands for caesarean section. Suggested solutions included more support, from either well-trained midwives and junior staff or using a 'shared practice' model; guidelines introduced by an Indian body; increased regulation within the sector and public disclosure of providers' caesarean rates. CONCLUSIONS:Commercial interests contribute indirectly to high caesarean rates, as solo obstetricians juggle the need to maintain high patient loads with inadequate support staff. Perceptions amongst providers and consumers of caesarean section as the 'safe' option have re-defined caesareans as the new 'normal', even for low-risk deliveries. At the policy level, guidelines and public disclosures, strong initiatives to develop professional midwifery, and increasing public awareness, could bring about a sustainable reduction in the present high rates.

背景与目标：

BACKGROUND & AIMS: :Vitamin A is essential for mother and child; however, vitamin A deficiency (VAD) remains a public health issue in various countries, affecting around 19 million pregnant women. In Brazil, the scarcity and inconsistency of data have prevented the prevalence and epidemiological status of VAD from being established. This study aimed to analyze vitamin A nutritional status in women receiving prenatal care at a reference center in northeastern Brazil. A cross-sectional study was conducted with a sample of 676 women. Serum retinol was measured by high-performance liquid chromatography. Subclinical infection was detected by measuring C-reactive protein (CRP). The World Health Organization criteria were used in the prevalence analysis, VAD classification level, and CRP effect evaluation. The prevalence of VAD (serum retinol <0.70 μmol/L) was 6.2% (95% confidence interval 4.5⁻8.3). In the univariate analysis, the variables significantly associated with VAD (p < 0.05) were having <12 years of schooling, being in the third trimester of pregnancy, and anemia. In the final multivariate model, the variables that remained significantly associated (p < 0.05) were being in the third trimester of pregnancy and anemia. VAD constituted a mild public health problem in this sample of pregnant women and was associated with the third trimester of pregnancy and maternal anemia.

背景与目标： : 维生素a对母亲和儿童至关重要; 然而，维生素a缺乏症 (VAD) 仍然是各国的公共卫生问题，影响了大约1900万名孕妇。在巴西，数据的匮乏和不一致阻碍了VAD的流行和流行病学状况的确立。这项研究旨在分析巴西东北部参考中心接受产前护理的妇女的维生素a营养状况。对676名妇女进行了横断面研究。通过高效液相色谱法测定血清视黄醇。通过测定C反应蛋白 (CRP) 检测亚临床感染。在患病率分析，VAD分类水平和CRP效果评估中使用了世界卫生组织标准。VAD (血清视黄醇 <0.70 μ mol/L) 的患病率为6.2% (95% 置信区间4.5 8.3)。在单变量分析中，与VAD显着相关的变量 (p < 0.05) 是教育 <12年，妊娠晚期和贫血。在最终的多变量模型中，仍然显着相关的变量 (p < 0.05) 是在妊娠和贫血的第三个月。在该孕妇样本中，VAD构成了轻度的公共卫生问题，并与妊娠晚期和孕产妇贫血有关。

BACKGROUND & AIMS: BACKGROUND:Few investigations have considered evaluating the effects of certain combinations of ward routines like swaddling of the baby and separation of mother and baby on infant variables such as neonatal weight loss. AIMS:To study the effect of different ward routines in respect to proximity to mother and type of infant apparel, on breastfeeding parameters (amount of ingested milk, volume of supplements, number of breastfeeds, total duration of breastfeeding time) day 4 after birth as well as recovery from neonatal weight loss and infant's weight on day 5. STUDY DESIGN AND SUBJECTS:In a randomized trial with factorial design four treatment groups including 176 mother-infant dyads were studied 25-120 min after birth. Randomized treatments focused on care routines administered to the infants after delivery and later in the maternity ward as well as to the type of clothing the infants received. Group 1 infants were placed skin-to-skin with their mothers after delivery, and had rooming-in while in the maternity ward. Group 2 infants were dressed and placed in their mothers' arms after delivery, and roomed-in with mothers in the maternity ward. Group 3 infants were kept in the nursery both after birth and while their mothers were in the maternity ward. Group 4 infants were kept in the nursery after birth, but roomed-in with their mothers in the maternity ward. Equal numbers of infants were either swaddled or clothed in baby attire. Breastfeeding parameters were documented during day 4 after birth. Infant's weight was measured daily. RESULTS:Babies who were kept in the nursery received significantly more formula and significantly less breast-milk, than did babies who roomed-in with their mothers. Swaddling did not influence the breastfeeding parameters measured. However, swaddled babies who had experienced a 2-h separation period after birth and then were reunited with their mothers tended to have a delayed recovery of weight loss compared to those infants who were exposed to the same treatment but dressed in clothes. Furthermore, swaddled babies who were kept in the nursery and received breast-milk supplements had a significantly delayed recovery of weight loss after birth when compared to those infants ingesting only breast-milk. On day 5, regression analyses of predicted weight gain in the exclusively breastfed infants indicated a significant increase per 100 ml breast-milk (59 g), compared to the predicted weight gain on day 5 per 100 ml supplements in the swaddled babies (14 g) (P=0.001). CONCLUSION:Supplements given to the infants in the nursery had a negative influence on the amount of milk ingested. In addition, supplement feeding or a short separation after birth when combined with swaddling was shown to have a negative consequence to infant weight gain.

背景与目标：

BACKGROUND & AIMS: :Survival and quality of life are improved for very preterm babies when delivery occurs in a maternity unit with on-site neonatal intensive care (level III unit). We investigated the impact of distance on the probability of delivering in such a unit for births before 32 weeks of gestation from 9 European regions with diverse perinatal health systems (the MOSAIC cohort). We analysed distances between women's homes, and the nearest level III in population quartiles, adjusting for maternal and pregnancy characteristics. Living farther away from a level III reduced access to specialised care everywhere; in some regions women residing in the fourth quartile were half as likely to deliver in level III units as those in the first. To improve regionalized perinatal care the spatial location of level III units should be taken into account.

背景与目标： : 当在现场新生儿重症监护病房 (III级病房) 分娩时，早产婴儿的存活率和生活质量得到改善。我们调查了距离对妊娠32周前分娩的可能性的影响，该分娩来自9个具有不同围产期卫生系统的欧洲地区 (MOSAIC队列)。我们分析了女性家庭之间的距离，以及人口四分位数中最接近的III级，并根据孕产妇和怀孕特征进行了调整。远离三级生活减少了各地获得专业护理的机会; 在某些地区，居住在第四个四分位数的妇女在三级单位分娩的可能性是第一个的一半。为了改善区域围产期护理，应考虑三级单位的空间位置。

BACKGROUND & AIMS: :The American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM) asked ACNM member midwives and ACOG Fellows with successful and sustainable collaborative practices between obstetricians and midwives to describe their care models in jointly written articles. This review analyzes 12 of the 60 articles submitted. Five main themes were identified: impetus for new collaboration, basic foundations of collaborative care, commitment to successful partnership, care integration, and health professions education in an interprofessional practice environment. The analysis provides evidence of the extent to which committed clinicians are working together to provide excellent, women-centered maternity care.

背景与目标： : 美国妇产科学院 (ACOG) 和美国助产士护士学院 (ACNM) 要求ACNM成员助产士和ACOG研究员在产科医生和助产士之间成功和可持续的合作实践，以共同撰写的文章描述他们的护理模式。这篇综述分析了提交的60篇文章中的12篇。确定了五个主要主题: 新合作的动力，协作护理的基本基础，对成功伙伴关系的承诺，护理整合以及在跨专业实践环境中的卫生专业教育。该分析提供了证据，证明有奉献精神的临床医生在多大程度上共同努力，以妇女为中心提供出色的产妇护理。

BACKGROUND & AIMS: :Since 2008, Greece suffers a severe economic crisis. Adverse health outcomes have been reported, but studies on perinatal health are sparse. We aimed to examine the impact of economic crisis on perinatal parameters during early and established crisis periods. Birth records of 14 923 neonates, born in a public maternity hospital from 2005-2014, were reviewed for maternal (age, delivery mode) and neonatal (gender, birthweight, gestational age) variables. Univariable analysis tested the association of study variables with time-periods 2005-2007, 2009-2011 and 2012-2014. Multivariable logistic regression analysis identified factors independently associated with low birthweight (LBW) (<2500 g), prematurity (<37 weeks) and caesarean section (CS). During 2012-2014, compared to 2005-2007, LBW rate increased from 8.4 to 10.5% (RR 1.16; 95%CI 1.01-1.33); prematurity from 9.7 to 11.2% (RR 1.09; 95%CI 0.96-1.24), comprising mainly late-preterm neonates; CS from 43.2 to 54.8% (RR 1.21; 95%CI 1.16-1.26). Maternal age ≥30 years was risk factor for LBW, prematurity and CS; LBW was additional risk factor for CS. However, LBW and CSs increased during the study period, independently of maternal age. In conclusion, impaired perinatal parameters, manifested by increasing maternal age, LBW, prematurity and CS rate, were observed during the years of economic decline, with possible adverse consequences for later health.

背景与目标： : 自2008年以来，希腊遭受了严重的经济危机。已经报道了不良的健康结果，但是关于围产期健康的研究很少。我们旨在研究经济危机在早期和既定危机时期对围产期参数的影响。回顾了2005-2014年在公立妇产医院出生的14名923新生儿的出生记录，以了解孕产妇 (年龄，分娩方式) 和新生儿 (性别，出生体重，胎龄) 变量。单变量分析测试了研究变量与时间段2005-2007，2009-2011和2012-2014的关联。多因素logistic回归分析确定了与低出生体重 (LBW) (<2500g)，早产 (<37周) 和剖腹产 (CS) 独立相关的因素。在2012-2014期间，与2005-2007相比，LBW率从8.4增加到10.5% (RR 1.16; 95% CI 1.01-1.33); 早产儿从9.7到11.2% (RR 1.09; 95% CI 0.96-1.24)，主要包括早产新生儿; 从43.2到54.8% 的CS (RR 1.21; 95% CI 1.16-1.26)。孕妇年龄 ≥ 30岁是LBW、早产和CS的危险因素; LBW是CS的额外危险因素。然而，在研究期间，LBW和CSs增加，与产妇年龄无关。总之，在经济衰退期间，观察到围产期参数受损，表现为孕产妇年龄，LBW，早产和CS率的增加，可能对以后的健康产生不利影响。

BACKGROUND & AIMS: BACKGROUND:To explore the benefits, barriers and disadvantages of implementing an electronic record system (ERS). The extent that the system has become 'normalised' into routine practice was also explored. METHODS:Qualitative semi-structured interviews were conducted with 19 members of NHS staff who represented a variety of staff groups (doctors, midwives of different grades, health care assistants) and wards within a maternity unit at a NHS teaching hospital. Interviews were conducted during the first year of the phased implementation of ERS and were analysed thematically. The four mechanisms of Normalisation Process Theory (NPT) (coherence, cognitive participation, collective action and reflexive monitoring) were adapted for use within the study and provided a theoretical framework to interpret the study's findings. RESULTS:Coherence (participants' understanding of why the ERS has been implemented) was mixed - whilst those involved in ERS implementation anticipated advantages such as improved access to information; the majority were unclear why the ERS was introduced. Participants' willingness to engage with and invest time into the ERS (cognitive participation) depended on the amount of training and support they received and their willingness to change from paper to electronic records. Collective action (the extent the ERS was used) may be influenced by whether participants perceived there to be benefits associated with the system. Whilst some individuals reported benefits such as improved legibility of records, others felt benefits were yet to emerge. The parallel use of paper and the lack of integration of electronic systems within and between the trust and other healthcare organisations hindered ERS use. When appraising the ERS (reflexive monitoring) participants perceived the system to negatively impact the patient-clinician relationship, time and patient safety. CONCLUSIONS:Despite expectations that the ERS would have a number of advantages, its implementation was perceived to have a range of disadvantages and only a limited number of 'clinical benefits'. The study highlights the complexity of implementing electronic systems and the associated longevity before they can become 'embedded' into routine practice. Through the identification of barriers to the employment of electronic systems this process could be streamlined with the avoidance of any potential detriment to clinical services.

背景与目标：

BACKGROUND & AIMS: :In an attempt to evaluate the contributory factors to the high frequency of referred cases in obstructed labour at the State's referral hospital, a questionnaire-based survey of 396 maternity care-providers from 66 randomly selected peripheral delivery units in Ogun State, Nigeria was conducted over a 2-month period, to evaluate their knowledge and use of the partograph. The majority of the personnel were nurses/midwives (45.5%) and community health extension workers (CHEW) (42.7%). Of the 216 personnel (54.5%) who were aware of the partograph, 36 (16.7%), 119 (55.5%) and 61 (28.2%) demonstrated poor, fair and good levels of knowledge, respectively. No junior CHEW had a satisfactory knowledge of the partograph. Only 39 (9.8%) of all the personnel routinely employed the partograph for labour management and almost half of these individuals had a poor level of knowledge. Efforts to limit the frequency of referred cases of established obstructed labour to the State's referral hospital should include training of care-providers at the peripheral delivery units, especially junior personnel in the effective use of the partograph, in addition to employing quality assurance measures to check inappropriate use.

背景与目标： : 为了评估该州转诊医院分娩受阻的高频率转诊病例的促成因素，对尼日利亚奥贡州66个随机选择的外围分娩单位的396名产妇护理提供者进行了基于问卷的调查，历时2个月，评估他们对partograph的了解和使用。大多数人员是护士/助产士 (45.5%) 和社区卫生推广人员 (CHEW) (42.7%)。在了解情况的216名人员 (54.5% 名) 中，分别有36名 (16.7% 名)，119名 (55.5% 名) 和61名 (28.2% 名) 表现出较差，公平和良好的知识水平。没有一个小咀嚼对partograph有令人满意的了解。在所有人员中，只有39 (9.8%) 人通常使用partograph进行劳动管理，其中几乎一半的人知识水平很差。努力限制将既定的受阻劳动案件转诊到国家转诊医院的频率，除了采用质量保证措施检查不当使用外，还应包括培训外围分娩单位的护理提供者，特别是初级人员有效使用partograph。

BACKGROUND & AIMS: OBJECTIVE:to explore the relationship between maternity hospital practices and breast feeding self-efficacy. DESIGN:the data were collected using a cross-sectional survey. The study is a part of a larger longitudinal research and development project called 'Urban parenthood'. SETTING:three urban maternity hospitals in Southern Finland. PARTICIPANTS:altogether 1400 questionnaires were given out and 573 primiparous and multiparous women completed the questionnaire within a week after childbirth. The response rate was 41%. FINDINGS:early and successful initiation of breast feeding, rooming-in and exclusive breast feeding during the hospital stay were associated with higher maternal breast feeding self-efficacy in both primiparous and multiparous women. The reason (medical or non-medical), frequency or method (bottle or cup) for supplementation was not associated with breast feeding self-efficacy. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE:breast feeding experiences during the immediate postpartum period have an association with breast feeding self-efficacy. Mothers who are not able to initiate breast feeding within an hour after birth or whose infants are supplemented during the hospital stay may benefit from additional support and breast feeding counselling.

背景与目标：

BACKGROUND & AIMS: :Background This study aimed to identify the perinatal mortality coefficient, the epidemiological profile, causes and avoidable factors at a reference public maternity hospital in southern Brazil. Methods In this cross-sectional study, 334 medical records of postpartum women and newborns were evaluated between January 1st, 2011 and December 31st, 2015. The Expanded Wigglesworth Classification was used to assess the causes of perinatal mortality and the International Statistical Classification of Diseases and Related Health Problems (ICD-10/SEADE Foundation) was used for the preventable perinatal mortality analysis. Absolute numbers and percentages were used for data analysis. The perinatal mortality formula was used to calculate the perinatal mortality rate. Results The perinatal mortality rate was 13.2/1000 total births, with a predominance of white race/color; mothers were 21-30 years of age, had experienced their first pregnancy and had completed their high school education. Conclusion The main factors associated with perinatal death were antepartum fetal death in 182 (54.49%) cases, and avoidable death through appropriate prenatal care in 234 (70.05%) cases.

背景与目标： : 背景本研究旨在确定巴西南部一家参考公立妇产医院的围产期死亡率系数，流行病学概况，原因和可避免的因素。方法在这项横断面研究中，在2011年1月1日和2015年12月31日之间评估了334例产后妇女和新生儿的病历。扩大的Wigglesworth分类用于评估围产期死亡率的原因，国际疾病和相关健康问题统计分类 (ICD-10/SEADE基金会) 用于可预防的围产期死亡率分析。数据分析采用绝对数字和百分比。围产期死亡率公式用于计算围产期死亡率。结果围产期死亡率为13.2/1000例，以白人/肤色为主; 母亲年龄在21-30岁之间，经历了第一次怀孕并完成了高中教育。结论围产期死亡的主要因素是182 (54.49%) 例产前胎儿死亡，234 (70.05%) 例可通过适当的产前护理避免死亡。

BACKGROUND & AIMS: AIM:This paper is a report of a study to describe the maternity care experiences narrated by a sample of lesbian couples. BACKGROUND:Pregnant and labouring women are dependent on the professional skill and caring ability of the healthcare provider. Studies show that lesbian women who reveal their sexual identity are exposed to homophobic prejudice and discrimination in midwifery care. METHOD:A phenomenological hermeneutical study inspired by the French philosopher Paul Ricoeur was conducted. Six lesbian couples were recruited in Norway by a snowball method, reporting a total of eight children conceived by donor insemination. Joint interviews were performed in January 2006, and the participants were encouraged to share narratives about important events in their maternity care experiences. FINDINGS:The fundamental life conditions of vulnerability, responsibility and caring permeated the narratives, and were related with the couples' decisions to be open about their sexual identity. Being exposed, they experienced under- and over-focusing on sexuality. They felt responsible for having the right attitude in interactions, which meant being open, but not over-assertive. They described genuinely caring situations as well as being content with less genuine care, and demonstrated that in addition to receiving care, they provided care in the encounters. CONCLUSION:Lesbian women are a vulnerable group when encountering maternity care. They took responsibility in caring situations because of healthcare providers' uncertainty and anxiety. Existential needs, such as being seen, being cared for and communicated with, should be considered equally important for lesbian women and heterosexual women in labour.

背景与目标：

BACKGROUND & AIMS: :Adequate environmental conditions, comprising sufficient environmental hygiene items (e.g. gloves, soap, and disinfectant), adequate infrastructure (e.g. sanitation facilities, water supply), a clean environment, and hygienic behaviors in healthcare facilities (HCFs) are necessary for safe care in maternity wards. Few data are available describing environmental conditions in maternity wards in rural areas of low- and middle-income countries (LMICs). We collected data on these conditions from 1547 HCFs with maternity wards in 14 countries (Ethiopia, Ghana, Honduras, India, Kenya, Malawi, Mali, Mozambique, Niger, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe). We described patterns and availability of essential environmental conditions, and a regression model was developed to explore predictive factors. 73% of HCFs offering maternal and neonatal health (MNH) services did not meet the guidelines for the World Health Organization 'six cleans' (clean perineum, clean bed surface, clean hands, clean blade, clean cord tie, and clean towels to wrap the baby and mother). The items with the lowest availability were clean towels (40%). In a multivariable logistic regression model, HCFs that provided maternity services were more likely to have all 'six cleans' available if they: had at least an improved water source; had an infection prevention and control (IPC) protocol; had a budget considered sufficient that included funding for water, sanitation, hygiene, and IPC; and emphasized the importance of IPC within the nearby community. Our results demonstrate substantial differences between countries in the availability of environmental hygiene items, facility cleanliness, and quality of environmental health infrastructure in HCF maternity wards. There are several low-cost, high-impact, context-relevant opportunities to enhance essential environmental conditions that would improve the quality of neonatal and maternal care in maternity wards in HCFs in LMICs.

背景与目标： 适当的环境条件，包括足够的环境卫生物品 (例如手套，肥皂和消毒剂)，足够的基础设施 (例如卫生设施，供水)，清洁的环境以及医疗保健设施 (HCFs) 的卫生行为是必要的在产科病房中进行安全护理。描述中低收入国家农村地区产科病房环境状况的数据很少。我们从14个国家 (埃塞俄比亚，加纳，洪都拉斯，印度，肯尼亚，马拉维，马里，莫桑比克，尼日尔，卢旺达，坦桑尼亚，乌干达，赞比亚和津巴布韦) 的1547个HCFs中收集了有关这些情况的数据。我们描述了基本环境条件的模式和可用性，并开发了一个回归模型来探索预测因素。提供孕产妇和新生儿健康 (MNH) 服务的HCFs 73% 不符合世界卫生组织 “六种清洁” (清洁会阴，清洁床面，清洁手，清洁刀片，清洁绳带和清洁毛巾包裹婴儿和母亲) 的指南。可用性最低的项目是干净的毛巾 (40%)。在多变量逻辑回归模型中，提供产妇服务的HCFs更有可能获得所有 “六种清洁”，如果它们: 至少有改善的水源; 有感染预防和控制 (IPC) 协议; 有足够的预算，包括水，卫生，和IPC; 并强调了IPC在附近社区中的重要性。我们的结果表明，各国在HCF产科病房的环境卫生用品，设施清洁度和环境卫生基础设施质量方面存在重大差异。在lmic中，有一些低成本，高影响力，与背景相关的机会可以改善基本环境条件，从而提高HCFs产科病房的新生儿和产妇护理质量。

BACKGROUND & AIMS: :In this article, the authors use the context of childbirth to consider the power that is endemic in certain forms of evidence within maternity care research. First, there is consideration of how the current evidence hierarchy and experimental-based studies are the gold standard to determine and direct women's maternity experiences, although this can be at the detriment of care and irrespective of women's needs. This is followed by a critique of how the predominant means to assess women's experiences via satisfaction surveys is of limited utility, offering impartial and restricted insights to assess the quality of care provision. A counter position of hermeneutic phenomenology as research method is then described. This approach offers an alternative perspective by penetrating the taken-for-granted ordinariness of an event (such as childbirth) to elicit rich emic meanings. Whilst all approaches to understanding maternity care have a place, depending on the question(s) being asked, the contribution of phenomenology is how it can uncover a depth of contextual understanding into what matters to women and to inform and transform care delivery.

背景与目标： : 在本文中，作者使用分娩的背景来考虑产妇护理研究中某些形式的证据中特有的力量。首先，考虑当前的证据等级和基于实验的研究如何成为确定和指导妇女产妇经历的金标准，尽管这可能不利于护理，也不考虑妇女的需求。随后是对通过满意度调查评估妇女经历的主要手段如何效用有限的批评，它提供了公正和有限的见解来评估护理质量。然后描述了诠释学现象学作为研究方法的相反位置。这种方法通过渗透事件 (例如分娩) 的准予性来激发丰富的意义，从而提供了另一种观点。尽管所有了解产妇护理的方法都有一席之地，但取决于所提出的问题，现象学的贡献在于它如何揭示对妇女重要的背景理解的深度，并告知和改变护理的交付。