Purpose: Delayed onset of lactogenesis is a significant barrier to achieving the WHO-recommended 50% exclusive breastfeeding rate in the first six months. This study maps the main factors influencing this condition, addressing gaps in the current research landscape. Methods: Following Arksey and O’Malley’s scoping review framework, databases such as PubMed, Web of Science (WOS), Embase, Cochrane Library, CINAHL plus with full text, China National Knowledge Infrastructure (CNIK), Weipu Chinese Journal Service Platform (VIP), Wanfang Data Knowledge Service Platform, and China Biomedical Literature Database (CBM) were searched on February 1, 2023. Studies in Chinese and English involving pregnant and postpartum women, focusing on delayed onset of lactogenesis, were included without restrictions on publication date or geography. Results: Forty-six studies published between 2002 and 2022 met the inclusion criteria, revealing variable incidences of delayed lactogenesis among different groups. Thirty-four influencing factors were identified and organized into five themes: maternal-infant characteristics, perinatal mental state, physical activity participation during pregnancy, breastfeeding behaviors, and medical staff interventions. Within eighteen major factors highlighted, factors such as age, pre-pregnancy BMI, gestational weight gain, average LATCH score within 24 hours postpartum, labor analgesia, sleep, frequency of postpartum breastfeeding, and timing of initial breast suckling/pumping showed inconsistent or conflicting conclusions. Conclusion: High and variable incidences of delayed lactogenesis underline its multifactorial nature. Effective interventions require strong advocacy from healthcare professionals and adherence by pregnant women. Further research using standardized methods is essential to clarify inconsistent or conflicting findings on the influencing factors.

Non-pharmaceutical midwifery techniques, including perineal warm compresses, to improve maternal outcomes remain controversial. The aims of this study are to assess the effects of perineal warm compresses on reducing perineal trauma and postpartum perineal pain relief. This systematic review included randomized controlled trials (RCTs). We searched seven bibliographic databases, three RCT register websites, and two dissertation databases for publications from inception to 15 March 2023. Chinese and English publications were included. Two independent reviewers conducted the risk of bias assessment, data extraction, and the evaluation of the certainty of the evidence utilizing the Cochrane risk of bias 2.0 assessment criteria, the Review Manager 5.4, and the online GRADEpro tool, respectively. Seven RCTs involving 1362 primiparous women were included. The combined results demonstrated a statistically significant reduction in the second-, third- and/or fourth- degree perineal lacerations, the incidence of episiotomy, and the relief of the short-term perineal pain postpartum (within two days). There was a potential favorable effect on improving the integrity of the perineum. However, the results did not show a statistically significant supportive effect on reducing first-degree perineal lacerations and the rate of perineal lacerations requiring sutures. In summary, perineal warm compresses effectively reduced the second-, third-/or fourth-degree perineal trauma and decreased the short-term perineal pain after birth.

To identify the essential competencies for different grades of midwives in China. A nationwide modified Delphi process was implemented to amend and screen the indicators. Thirty expert panellists including practitioners (nurse-midwives), clinical managers, academic educators and obstetricians completed a two-round Delphi study through an electronic survey that was supplemented by an expert panel meeting for discussion of comments and suggestions. All panellists completed two rounds of Delphi study and at least 75% of them achieved a consensus on 224 items (W1 = 0.150, W2 = 0.173). Seven domains were established, namely, 'Professional quality', 'Antenatal care', 'Intrapartum care', 'Postnatal care', 'Neonatal care', 'Gynaecological care', 'Public health care & Integrative competency'. Generalised maternal and neonatal knowledge and perinatal care skills were set for 'junior' midwives, pathological care for 'senior' ones and supervisory abilities and promotion of discipline for 'expert' ones. This research developed three grades of essential competencies for midwives in China. The next step will be assessment in clinical settings for further response. The set was in line with the concepts of International Confederation of Midwives under the domestic context. This set could be adopted as a reference in developing normalised midwifery practice, education and certification.

Existing research concerning the effects of the sitting birth position during the second stage of labour on maternal and neonatal outcomes remains controversial, and there is a lack of studies to explore its effect on the childbirth experience. The objective of this study is to explore whether the sitting birth position would influence maternal and neonatal outcomes, as well as the childbirth experience. The prospective cohort design was conducted in the study from February to June 2023, a total of 222 women (including primiparous women and multiparous women) were enrolled in our study, and they were divided into the sitting position cohort (n = 106) or the lithotomy position cohort (n = 116). The pre-designed questionnaire and Childbirth Experience Questionnaire (CEQ) were used for data collection during hospitalisation. Chi-square, Fisher’s exact test, t-tests, or the Mann–Whitney U test were utilised to assess differences between groups. Multivariate linear regression and logistic regression were employed to control possible confounders. The study found that primiparous women in the sitting position cohort had a shorter duration of the second stage of labour, higher spontaneous vaginal birth rates, lower episiotomy rates, and a better childbirth experience (p < 0.01). After adjusting for confounding factors through multiple linear and logistic regression analyses, the results remained consistent with those reported above. No neonate in each cohort had Apgar scores at 1 min and 5 min postpartum less than 7 or a Cord artery pH less than 7.00, regardless of parity. Based on the findings, we recommend that women could take the sitting birth position into account when giving birth for a positive childbirth experience, especially for primiparous women. The study could also serve as a reference for healthcare providers in the management of childbirth positions and the development of high-quality maternal care.

Objective To review the definition and scope of the practice of midwives in Sweden, Finland, the United Kingdom, the United States, and Australia to find models and make suggestions for reforms in the midwifery policies of China. Methods This article reviewed the midwifery policies published by authorities, organizations, and governments of these countries and relevant literature in the databases of PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), and Wanfang database. Results The definition and scope of practice of midwives in five representative countries and China were reviewed. The similarities and differences in midwifery policies among them show that most countries set standards based on the definition and scope of practice of midwives recommended by International Confederation of Midwives. Conclusions The definition of midwives should include registration, midwifery education, and acceptance standards. The scope of practice of midwives should specify an autonomous environment, the objective of care, the period of care involved, prescribing rights, emergency treatment, and health counseling.

Existing research concerning the effects of the sitting birth position during the second stage of labour on maternal and neonatal outcomes remains controversial, and there is a lack of studies to explore its effect on the childbirth experience. The objective of this study is to explore whether the sitting birth position would influence maternal and neonatal outcomes, as well as the childbirth experience reported by Chinese women using the Childbirth Experience Questionnaire (CEQ). A total of 296 women (including primiparous women and multiparous women) were enrolled in our study, and they were divided into the sitting position cohort (n=106) or the lithotomy position cohort(n=116). The study found that primiparous women in the sitting position cohort had a shorter duration of the second stage of labour, higher spontaneous vaginal birth rates, lower episiotomy rates and better childbirth experience (p0.05) between the two cohorts of primiparous women. After adjusting for confounding factors through multiple linear and logistic regression analyses, the results remained consistent with those reported above. No neonate in each cohort had Apgar scores at 1min and 5 min postpartum less than 7 or the Cord artery pH less than 7.00, regardless of parity. In addition, among multiparous women, there was no significant difference in any maternal and neonatal outcomes and women’s CEQ scores (p>0.05) between two cohorts. Based on the findings, we recommend that women could take the sitting birth position into account when giving birth for a positive childbirth experience, especially for primiparous women. The study could also serve as a reference for healthcare providers in the management of childbirth positions and the development of high-quality maternal care.