Client-tailored maternity care to increase maternal empowerment: cluster randomized controlled trial protocol; the healthy pregnancy 4 All-2 program

Abstract

BackgroundThe postpartum period is an important period for preventive strategies as common maternal and child health risks may become manifest. Women with a lower socioeconomic status tend to have lower maternal empowerment. Increasing their risks of adverse maternal and child health outcomes. This study aims to assess the effectiveness of a primary care level intervention. Delivered to maternity care assistants, aiming to increase maternal empowerment postpartum.MethodsThis study is part of the Dutch nationwide “Healthy Pregnancy 4 All-2” (HP4All-2) program, which aims to identify vulnerable mothers and young children at risk of adverse health outcomes, and subsequently improve their care. This program targets women from deprived neighborhoods.A pragmatic cluster randomized controlled trial will be undertaken in 12 maternity care organizations. Maternity care organizations in urban municipalities (i.e. the clusters) will be randomized to either a systematic risk assessment during pregnancy with emphasis on identification of non-medical risk factors for adverse maternal and neonatal health outcomes, and subsequent adaptation of care towards a client-tailored approach during pregnancy and the postpartum period, or solely the systematic risk assessment. The primary outcome is the prevalence of a low maternal empowerment score postpartum. Secondary maternal outcomes cover health-related quality of life, postnatal depression, smoking, alcohol consumption, illicit drug use. Finally, maternal and neonatal health care utilization postpartum are recorded. All outcomes will be analyzed according to the intention-to-treat principle, using multi-level mixed effects models.DiscussionThe study will contribute to evidence regarding the effectiveness of client-tailored, risk-based maternity care to increase maternal empowerment postpartum.Trial registrationNetherlands Trial Registry (NTR) 6311, registered 03-27-2017.

Association of Maternal Microbiota and Diet in Cord Blood Cytokine and Immunoglobulin Profiles

“…On the other hand, an increase in adiponectin in both MP and UCP in Enterotype II group was observed. Daryasari et al observed differences on maternal plasma adiponectin levels depending on the mode of delivery [ 43 ]. They found that umbilical cord blood from vaginal delivery had higher levels of adiponectin.…”

A Mobile Phone-based Multimedia Application Could Improve Maternal Health in Rural Southwestern Uganda: Mixed Methods Study

“…Lack of friendly maternal health services have previously been cited as a major barrier to adoption of maternal healthcare seeking behavior in low resource settings [31]. Providing tailored information could potentially increase women's knowledge, understanding, and engagement while at the same time creating a sense of empowerment to cope with pregnancy, which can prevent adverse maternal and child health outcomes [32]. Since they can be watched, paused, and repeated anytime, the videos and audios provide an opportunity for self-paced learning which facilitates learning and recall, that may otherwise not be possible with face-to-face approaches.…”

Risk-guided maternity care to enhance maternal empowerment postpartum: A cluster randomized controlled trial

“…We conducted a cluster-randomised controlled trial (C-RCT) in six municipalities in the Netherlands to assess the effectiveness of a complex intervention to advance maternal empowerment in the postpartum period [ 24 , 25 ]. The intervention consisted of a systematic risk assessment including both medical and social factors, and a patient-centred, risk-guided approach to address risks identified during pregnancy and the postpartum period.…”

“…The study design and rationale are briefly outlined below; a detailed study protocol was previously published ( S1 File ) [ 25 ]. This two-arm, parallel, pragmatic C-RCT was conducted with 12 independent maternity care organisations, which were geographically spread over the Netherlands with 16 offices ( Fig 2 ).…”

“…Besides the unwillingness to sign a written informed consent form, there were no exclusion criteria for participants. Eligible participants were informed about the study and written informed consent was obtained prior to inclusion [ 25 ]. Participants were enrolled between July 2015 and December 2016.…”