Open research questions in Maternal and Perinatal Health Interventions

What the literature leaves open

• Finally, other factors that may influence pregnant women's knowledge and practices, such as cultural beliefs, family support, health literacy, quality of antenatal care services, and healthcare provider-related factors, were not investigated and therefore could not be evaluated in the present study. First, the cross-sectional design assessed participants at a single point in time; therefore, causal relationships between the studied variables could not be established.

  ASSESSMENT OF PREGNANT WOMEN'S KNOWLEDGE AND PRACTICES REGARDING ANTENATAL CARE AT AL-QUDIS PRIMARY HEALTH CARE CENTER, MOSUL CITY · 2026 · DOI

• Future mult(center prospect(ve stud(es are warranted to further evaluate (ntervent(ons, (nclud(ng opt(m(zed labor management and appropr(ate (mplementat(on of vag(nal b(rth after cesarean (VBAC), to (mprove maternal and neonatal outcomes.

  Analysis of cesarean section rates using the Robson Ten-Group Classification System in a secondary-level hospital in Türkiye · 2026 · DOI

• For Clinical Practice: (1) Integrate evidence-based non-pharmacological anxiety-reduction interventions into routine perioperative cesarean care; (2) Incorporate standardized maternal anxiety assessment during preoperative nursing evaluation; (3) Utilize feasible interventions such as music therapy, aromatherapy, relaxation techniques, therapeutic communication, and structured patient education. For Nursing Education: (1) Strengthen educational preparation related to maternal anxiety assessment and perioperative psychological care; (2) Provide continuing professional development opportunities focused on evidencebased supportive interventions. For Future Researches: (1) Conduct large-scale, multicenter randomized controlled trials to strengthen the evidence base; (2) Improve methodological standardization regarding intervention protocols and anxiety measurement tools; (3) Investigate long-term maternal psychological outcomes following non-pharmacological interventions; (4) Compare the relative effectiveness of different intervention categories to guide clinical implementation; and lastly, (5) Continue evaluating emerging technologies, including virtual reality and digital psychological support interventions, within obstetric perioperative care.

  Non-Pharmacological Strategies for Managing Peri-operative Anxiety Among Women Undergoing Cesarean Delivery: A Systematic Review · 2026 · DOI

• Therefore, our instruments should be validated in different regions to ensure their representativeness and external validity, as well as potential further refinements following piloting. A notable limitation of our study is that due to budgetary constraints, we were not able to properly pilot the developed instruments.

  Developing comprehensive perinatal quality of care instruments in Mexico: An inclusive, multidisciplinary, and culturally sensitive approach · 2026 · DOI

• The prevalence of adequate RMC in the tertiary health facility in Calabar was 54.9%, with notable deficits in the domains of independence in decision-making and informed permission. Education, ANC attendance, continuity of type were significant caregiver, and ward positive determinants of RMC, while grand multiparity and nocturnal delivery were negatively associated with quality of care. These for a findings underscore multidimensional approach to improving RMC in Nigerian tertiary hospitals.

  Determinants of Respectful Maternity Care at a Tertiary Hospital in Nigeria: A Cross-Sectional Study · 2026 · DOI

• This study is not without limitations. First, Current Procedural Terminology codes were not available for this study, which could have impacted our documentation measure. Second, while most documentation was done using ICD-10 code, these codes were likely not entered directly by the clinician providing care to the pregnant individual. Physicians, especially those in large practices, often document patient information in structured notes in the patient’s record,29,30 and these notes are later turned into diagnosis codes by trained coders.31 Some documentation of pregnancy could have been “lost in translation,” if it was not deemed to be a billable ICD-10 code diagnosis or it was recorded in the patient’s chart outside the free-text fields included in this study. Therefore, absence of pregnancy documentation in the patient’s record does not necessarily indicate that the pregnancy was not verbally discussed. Third, some patients may have chosen not to disclose their pregnancy status to their clinician due to privacy concerns.

  Association of Pregnancy Documentation with Radiological Imaging in the Emergency Department · 2026 · DOI

• Improvement of the conditions in the healing structures: in the follow-up of pregnancy; in hospitals, in the delivery process; 2. Improving patient-healthcare professional communication; 3. Removal is Administration of pre-hospital assistance activities; 4. Conducting informed campaigns on the benefits of natural childbirth; 5. Institutional policy and increased control by the state to reduce the percentage of operational births, for the performance of which it is necessary to comply with the medical criteria (absolute and relative criteria). 6. Restoring the image of the obstetric profession and providing legal rights for conducting patronage care, independent midwifery competences. 7. Development of good practices for conducting quality obstetric care (standards in the different directions of obstetric 8. competences and care). Introduction of psychoprophylaxis and psychological help in preparing the pregnant woman for the upcoming changes and processes. Formation of multidisciplinary teams to provide quality and supportive midwifery care at a global level.

  Leading Factors Relevant to the Choice of Mode of Childbirth Among Pregnant Women · 2026 · DOI

• This study utilized a large, nationally representative sample of 388,015 women from 10 Sub-Saharan African countries, enhancing generalizability. A range of modern machine learning algorithms was tested and compared, offering a robust evaluation of predictive performance. SHAP values and feature importance techniques were used to ensure interpretability and transparency of model predictions. Statistical rigor was enhanced through repeated cross-validation, reporting of confidence intervals, and formal comparison against a logistic regression baseline. Balanced datasets using SMOTE enhanced the models’ sensitivity in detecting minority class events (i.e., CS deliveries). As a cross-sectional study, causal inferences cannot be drawn. Potential recall bias may exist since the DHS data is self-reported and retrospective. Sensitivity analyses using alternative balancing strategies and country-stratified validation were not conducted; therefore, robustness across analytic assumptions and settings remains uncertain. Despite balancing techniques, the original class imbalance could influence model behavior. Some potentially relevant clinical variables, such as maternal BMI, gestational age, and labor progress data, were not included, as they were unavailable in the DHS datasets. The absence of clinical variables such as BMI and gestational age may limit the model's ability to capture all medically relevant predictors, a challenge noted in similar ML-based obstetric studies. Future research could explore the integration of LightGBM-based tools into antenatal care systems to provide real-time classification of utilization patterns, supporting clinicians in making timely, data-driven decisions.

  Use of explainable machine learning in risk classification of Cesarean section delivery: A cross-sectional analysis of Demographic and Health Surveys from ten Sub-Saharan African countries (2016–2024) · 2026 · DOI

• Despite these limitations, the study offers rich, in-depth insights into an under-researched phase of childbirth and highlights the interplay between individual experiences, social circumstances, and structural conditions. In addition, no standardized socio-demographic vari- ables (e.

  Navigating the latent phase of labour: women’s experiences within structural constraints – a qualitative study from Germany · 2026 · DOI

• IntroductionThe ARRIVE trial first demonstrated that elective induction of labour (IOL) at 39 weeks in low-risk pregnancies reduced the likelihood of caesarean section (CS) without compromising perinatal safety; however, the generalizability of these findings remains debated, leading to uncertainty in clinical practice.

  Labour Induction in low-risk women at 39 weeks of gestation: a Randomised trial in China (LIRIC) - Protocol of an open label, randomised controlled trial · 2026 · DOI

• However, the real-world impact of NBAP in private hospitals—where maternal preference, fear of childbirth, institutional dynamics, and medico-legal concerns strongly influence mode of birth—remains unclear.

  Early effects of the normal birth action plan on mode of birth, maternal preference, and cesarean indications in a private hospital setting in Türkiye · 2026 · DOI

• awareness—delivered within RMCH's OPD and extended to community health outreach platforms— are warranted to advance safe motherhood outcomes in the Rajshahi region.

  Knowledge on Antenatal Care among Pregnant Women at the Outpatient Department of Rajshahi Medical College Hospital · 2026 · DOI

• This pilot intervention study on RMC using Forum Play represents a novel and innovative approach within the hierar- chical clinical context of Nepal. Alongside doctors and nurses, baseline and follow-up data were initially sought from PLOS One | https://doi.org/10.1371/journal.pone.0349437 June 3, 2026 11 / 15 Table 6. Difference between the groups regarding perception towards respectful maternity care before and after the intervention.

  Effectiveness of Forum Play to promote respectful maternity care: A pilot intervention investigating self-reported perception and behaviour among care providers in urban Nepal · 2026 · DOI

• Taysa Cristina Cardoso Freitas1, Marlete Scremin2, Jean Carl Silva2, Roberta Barroso3, Isabela Barbosa Cruz4, Naftali Janaina Carvalho Soares Costa1, Kamilla Oliveira Santos1, Gizelle Coelho Azevedo5, Elisabete Cordeiro Muniz Silva4, Simone Teixeira Mendes6, Yanca Curty Ribeiro Christoff Ornelas1, Priscilla Loreddany Santos Queiroz e Silva1, Karine Alencar Froes1, Joyce Micaelle Alves Caldeira1, Joice Fernanda Costa Quadros Pimenta1 1Montes Claros State University. 2University of the Joinville Region. 3Federal University of Uberlândia. 4University Center of Northern Minas Gerais. 5Santa Cruz State University 6FIPMOC University Center. Abstract: This study aimed to evaluate the factors associated with anxiety and depression among medical students. An integrative literature review was conducted, and articles retrieved from the secondary databases Virtual Health Library, Latin American and Caribbean Literature in Health Sciences, Scientifi c Electronic Library Online, and Online System for Medical Literature Search and Analysis were analyzed using the descriptors violence; childbirth and obstetric violence. The analysis revealed that the normalization of outdated and harmful procedures — such as the Kristeller maneuver and routine episiotomy — refl ects a gap in the training of healthcare professionals and a resistance to adopting practices based on scientifi c evidence; obstetric violence, therefore, manifests as a failure to guarantee reproductive rights and a deviation from the concept of humanized childbirth. Addressing this issue requires more than legislative reforms; it requires a paradigm shift in hospital management and ongoing education for healthcare teams. The implementation of strategies such as the Birth Plan, strengthening the Stork Network, and empowering women through information are essential ways to mitigate these harms. ISSN: 2675-7451 / Vol. 07 - n 02 - ano 2026 - Edição Suplementar 23 Keywords: violence; childbirth; obstetric violence. INTRODUCTION Nearly two decades ago, the World Health Organization (WHO) compiled information on normal childbirth care, outlining recommended obstetric practices that should be maintained, as well as those that need to be performed with caution due to a lack of evidence of their benefi ts; harmful or detrimental practices that should be abolished; and inappropriate practices (WHO, 1996). Based on this document, in 2000, the Ministry of Health (MS) launched the Humanization of Prenatal and Birth Program to guarantee the recommendations and rights of women during the pregnancy-puerperium cycle (BRAZIL, 2000). Within this context, the concept of obstetric violence emerges, which is mainly expressed through negligence in care, social discrimination, verbal, physical and psychological violence.

  FACTORS ASSOCIATED WITH OBSTETRIC VIOLENCE: GENDER PERSPECTIVES · 2026 · DOI

• Data from January 1, 2016 to December 31, 2023 from the CDC WONDER database was used for this study. However, CDC WONDER did not begin to categorize Dominicans as a unique Hispanic Origin until 2019. As such, the sample size of the Dominican group (n = 60) is decreased in relation to other groups in this study, limiting this study’s ability to detect differences in neuraxial labor analgesia rates in this population. Additionally, this study did not analyze qualita- tive data that may contribute to the decision to use neuraxial labor analgesia by each group. The mother’s primary spoken language and associated language barriers and cultural influences contribute to dis- parities in neuraxial labor analgesia rates [13]. The mother’s primary spoken language was not available in the CDC WONDER dataset and therefore limited this study’s abil- ity to examine differences between English and non-English speakers. Additionally, this study utilized aggregate-level data from the CDC WONDER database. Because group-level statistics rather than individual-level statistics were utilized, multivariable regression modeling adjustment for potential confounders was unable to be performed. Therefore, the observed differences in neuraxial analgesia usage should be interpreted cautiously as confounding variables may con- tribute to results. Furthermore, it was not possible to per- form statistical tests comparing descriptive variables such as maternal age and BMI. Despite these limitations, the CDC WONDER database provides a large sample set, allowing for the identification of disparities in neuraxial analgesia use on the national level. These identified disparities may then warrant further research.

  The Impact of Birthplace on Neuraxial Labor Analgesia Rates among Hispanic Women in the United States · 2026 · DOI

• Cultural beliefs play a strong role in the decision to use neuraxial labor analgesia, and many patients in this popu- lation express hesitancy towards neuraxial labor analgesia use. Ultimately, the choice to receive neuraxial labor anal- gesia is a personal decision, underscoring the importance of patient-centered care. To support informed decision mak- ing, healthcare providers should prioritize patient education on the safety and benefits of neuraxial labor analgesia to ensure that they have accurate information. Togioka et al. found that Hispanic women in a language-concordant edu- cational program regarding labor epidurals were 33% more likely to choose epidural analgesia compared to their coun- terparts who were not in the program [20]. Patient education has the power to change outcomes in the decision to pursue neuraxial labor analgesia. Future studies should expand upon these findings by incorporating a more diverse array of Latin American coun- tries, as this analysis was limited by the availability of data on the CDC WONDER platform. Additionally, investigating neuraxial labor analgesia usage in Latin American countries themselves would provide valuable insights into regional trends and cultural influences on analgesia preferences. Due to dataset limitations, this study was unable to con- trol for confounders when examining the differences in neuraxial analgesia use among Hispanic subgroups. Future research should expand upon these findings by analyzing individual-level rather than group level data to adjust for Journal of Racial and Ethnic Health Disparities1 3 potential confounders, including maternal age, socioeco- nomic status, and access to healthcare.

  The Impact of Birthplace on Neuraxial Labor Analgesia Rates among Hispanic Women in the United States · 2026 · DOI

• This study conducted a multidimensional analysis of Chinese women’s childbirth experiences on social media by integrating LDA topic modeling with BERT-based sentiment analysis. Using a corpus of over 17,000 childbirth-related posts from Weibo and REDnote, we identified six major themes that together portray a rich landscape of childbirth narratives, ranging from high-risk pregnancy and labour processes to postoperative recovery, family meaning and daily mother–baby diaries. Sentiment analysis revealed a pronounced “bittersweet” pattern, with negative emotions more prevalent overall, particularly in vaginal birth narratives, yet interwoven with positive feelings of love, gratitude and life meaning. Vaginal birth and caesarean section narratives exhibited distinct emotional profiles and psychosocial tensions, highlighting the need for differentiated clinical communication and support. Methodologically, the study demonstrates the feasibility and value of combining LDA and deep learning–based sentiment analysis for mining large-scale, user-generated health narratives in Chinese. The integrated framework not only captures the thematic structure of childbirth stories, but also quantifies emotional patterns across topics, thereby offering a scalable tool for obstetric humanities research and health communication studies. However, several limitations must be acknowledged, which point toward directions for future work. First, the data were drawn exclusively from Weibo and REDnote, which exhibit selection bias.

  Multidimensional analysis of childbirth experiences on Chinese social media: an integrated approach using LDA, sentiment analysis and deep learning · 2026 · DOI

• Although the sample size is limited in the total number of participants, each participant is an expert and respected professional in obstetrics and gynaecology with a very close alliance with the midwife specialists in clinical practice. The authors planned to conduct a study in all nine provinces of South Africa. However, seven provinces approved the study. The scarcity of the obstetricians because of time constraints resulted in nine participants from six provinces. The small sample size and the number of provinces represented in the study suggest that the findings cannot be generalised to the South African context. On the other hand, the recruitment of participants from six provinces and hospitals demonstrates geographical diversity. Therefore, the study was not isolated to a single geographical area. Although the sample size was small, the participants were obstetricians with vast knowledge and expertise in obstetrics, which enabled them to provide rich, comprehensive insights into the research topic. Therefore, the adequacy of the data was achieved with fewer participants. The participants’ expertise in obstetrics ensured the emergence of key themes and patterns interviews, which confirmed data consistently across saturation despite the small sample size. A major limitation is that the study was conducted in the academic hospitals, an obstetrician-led environment based on the complexity of obstetric conditions being managed at that level of care. The autonomous role and responsibilities of the midwife specialists are more apparent in the lower levels of care such as primary health care clinics, midwife-led obstetric units and district hospitals. These are facilities where obstetricians do not render direct health care services collaboratively with the midwife specialists. Therefore, the obstetricians’ perspectives are limited to midwife specialists’ role in academic hospitals, and findings cannot be generalised to lower-level facilities. The study forms part of a doctoral study in which midwife specialists’ practice was explored and described. The obstetricians described midwife specialists’ practice from their own experiences and perceptions, which provides a varying perspective.

  Obstetricians’ perceptions of midwife specialists’ roles in South Africa · 2026 · DOI

• In order to address this gap in the literature, we propose the Pregnancy Decision-Making Model (PDMM), a comprehensive model of the factors that are likely to affect pregnancy decisions in the context of unintended pregnancy, with special attention to relational and intersectional components of pregnancy decisions.

  A Pregnancy Decision-Making Model: Psychological, Relational, and Cultural Factors Affecting Unintended Pregnancy · 2020 · DOI

• Many women with a previous cesarean birth are affected by these bans, but there are limited data on the effect of these bans and whether women would consider changing delivery hospitals in the setting of a real or hypothetical TOLAC ban.

  Hospital bans on trial of labor after cesarean and antepartum transfer of care · 2019 · DOI

• 9, 10 The Statement notes, however, that the association between CS rates and other relevant outcomes such as stillbirths, maternal and perinatal morbidity, paediatric outcomes and psychological or social well-being could not be determined due to the lack of data on these other outcomes at the population level.

  <scp>WHO</scp> Statement on Caesarean Section Rates · 2015 · DOI

• BACKGROUND: Little is known of the experience and perceptions of care for survivors of emergency peripartum hysterectomy (EPH), an obstetric event that is increasing in incidence.

  Women's Experiences, Emotional Responses, and Perceptions of Care After Emergency Peripartum Hysterectomy: A Qualitative Survey of Women from 6 Months to 3 Years Postpartum · 2013 · DOI

• A combined package of using currently available evidence, formulating best practices, instituting regular review and feedback to hospitals and practitioners about intervention rates, and a public health approach to educate women has the potential to achieve an acceptable balance between when intervention in the labor and delivery process is warranted and when it is unnecessary.

  Obstetric Variation, Intervention, and Outcomes: Doing More but Accomplishing Less · 2012 · DOI

• Cesarean birth rates have risen dramatically during the past decade, reaching more than 50% in some regions of the world, despite a lack of evidence of any increase in obstetric emergencies.

  Is planned cesarean childbirth a safe alternative? · 2007 · DOI

• BACKGROUND: Although there are two methods of caring for women with epidural anesthesia during second-stage labor (coached closed-glottis pushing immediately at 10-cm cervical dilation or delayed pushing until the woman feels the urge to push, passive fetal descent, and encouragement of open-glottis pushing when the woman has the urge to push), there are limited data concerning which method is most optimal for fetal well-being.

  Effects of Immediate Versus Delayed Pushing During Second-Stage Labor on Fetal Well-Being · 2005 · DOI

Most-cited papers in Maternal and Perinatal Health Interventions

• <scp>WHO</scp> Statement on Caesarean Section Rates · BJOG An International Journal of Obstetrics & Gynaecology · 2015 · 828 citations
• Satisfaction With Care in Labor and Birth: A Survey of 790 Australian Women · Birth · 1994 · 200 citations
• Wide differences in mode of delivery within Europe: risk‐stratified analyses of aggregated routine data from the Euro‐Peristat study · BJOG An International Journal of Obstetrics & Gynaecology · 2015 · 199 citations
• Women's Views of Pregnancy Ultrasound: A Systematic Review · Birth · 2002 · 191 citations
• WHO model of intrapartum care for a positive childbirth experience: transforming care of women and babies for improved health and wellbeing · BJOG An International Journal of Obstetrics & Gynaecology · 2018 · 188 citations
• Fear of Childbirth and Risk of Cesarean Delivery: A Cohort Study in Six European Countries · Birth · 2015 · 176 citations
• How Implicit Bias Contributes to Racial Disparities in Maternal Morbidity and Mortality in the United States · Journal of Women s Health · 2020 · 176 citations
• What matters to women: a systematic scoping review to identify the processes and outcomes of antenatal care provision that are important to healthy pregnant women · BJOG An International Journal of Obstetrics & Gynaecology · 2015 · 175 citations
• The Childbirth Experience: A Study of 295 New Mothers · Birth · 1996 · 163 citations
• A study of progress of labour using intrapartum translabial ultrasound, assessing head station, direction, and angle of descent · BJOG An International Journal of Obstetrics & Gynaecology · 2010 · 163 citations

Most recent work

• A Scoping Review of Certified Nurse‐Midwife and Certified Midwife Care in the United States: Assessing Outcomes Across Six Patient Care Domains · Milbank Quarterly · 2026
• Using positive affirmation cards to increase confidence and alleviate fears in the perinatal period · British Journal of Midwifery · 2026
• Prevalence of Labor Induction, its Indication, and Feto-Maternal Outcomes in Ethiopia: A Systematic Review and Meta-Analysis · INQUIRY The Journal of Health Care Organization Provision and Financing · 2026
• Early effects of the normal birth action plan on mode of birth, maternal preference, and cesarean indications in a private hospital setting in Türkiye · Frontiers in Medicine · 2026
• Obstetricians’ perceptions of midwife specialists’ roles in South Africa · African Journal of Primary Health Care & Family Medicine · 2026
• Multidimensional analysis of childbirth experiences on Chinese social media: an integrated approach using LDA, sentiment analysis and deep learning · Frontiers in Public Health · 2026
• FACTORS INFLUENCING THE PATIENT’S DECISION BETWEEN VAGINAL DELIVERY AND CESAREAN SECTION · Asclepius International Journal of Scientific Health Science · 2026
• O papel da enfermagem obstetra na humanização do parto em unidades de saúde pública: uma revisão integrativa · Revista JRG de Estudos Acadêmicos · 2026
• A retrospective analysis of the risk factors for vacuum-assisted vaginal deliveries and outcomes following mid/low cavity and perineal applications · The Journal of Maternal-Fetal & Neonatal Medicine · 2026
• Labor analgesia: knowledge, attitudes, and practices among pregnant women and husbands in Wuhan: a cross-sectional study · Annals of Medicine · 2026

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