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Affiliation(s)
- Karen Lane
- School of Humanities and Social Science, Faculty of Arts and Education, Deakin University, Burwood, Victoria, Australia
| | - Jayne Garrod
- School of Humanities and Social Science, Faculty of Arts and Education, Deakin University, Burwood, Victoria, Australia
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Doula Support During Childbearing—Aiming for the Best Birthing Experience: A Phenomenological Study. INTERNATIONAL JOURNAL OF CHILDBIRTH 2017. [DOI: 10.1891/2156-5287.7.3.139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A growing body of evidence indicates that doula support improves childbirth outcomes. The purpose of this study was to examine women’s lived experience of such support. Hermeneutic phenomenology was used to carry out and analyze in-depth interviews with 14 women who had doulas for support during pregnancy, childbirth, and the immediate postpartum period. Six main themes were revealed. The women were aiming for the best birthing experience, and they believed to achieve this they needed extra support and to have a full say in their childbirth experiences. The doulas helped the women to have peace of mind prenatally, and all but one woman had an overall satisfying experience with their doulas. Whether satisfied or dissatisfied with their personal doulas, all the women believed that having a doula is valuable. However, choosing the right doula matters because a comfortable relationship between a woman and her doula is essential to achieving the best birthing experience. Health care providers and policymakers must recognize the importance women place on constant and personalized support during childbirth and endeavor to provide such care.
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Lundgren I, Healy P, Carroll M, Begley C, Matterne A, Gross MM, Grylka-Baeschlin S, Nicoletti J, Morano S, Nilsson C, Lalor J. Clinicians' views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a study from countries with low VBAC rates. BMC Pregnancy Childbirth 2016; 16:350. [PMID: 27832743 PMCID: PMC5103375 DOI: 10.1186/s12884-016-1144-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 11/01/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Caesarean section (CS) rates are increasing worldwide and the most common reason is repeat CS following previous CS. For most women a vaginal birth after a previous CS (VBAC) is a safe option. However, the rate of VBAC differs in an international perspective. Obtaining deeper knowledge of clinicians' views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Focus group interviews with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of "OptiBIRTH", an ongoing research project. The study reported here aims to explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates. METHODS Focus group interviews were held in Ireland, Italy and Germany. In total 71 clinicians participated in nine focus group interviews. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country. RESULTS The findings are presented in four main categories with several sub-categories: 1) "prameters for VBAC", including the importance of the obstetric history, present obstetric factors, a positive attitude among those who are centrally involved, early follow-up after CS and antenatal classes; 2) "organisational support and resources for women undergoing a VBAC", meaning a successful VBAC requires clinical expertise and resources during labour; 3) "fear as a key inhibitor of successful VBAC", including understanding women's fear of childbirth, clinicians' fear of VBAC and the ways that clinicians' fear can be transferred to women; and 4) "shared decision making - rapport, knowledge and confidence", meaning ensuring consistent, realistic and unbiased information and developing trust within the clinician-woman relationship. CONCLUSIONS The findings indicate that increasing the VBAC rate depends on organisational factors, the care offered during pregnancy and childbirth, the decision-making process and the strategies employed to reduce fear in all involved.
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Affiliation(s)
- Ingela Lundgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30 Gothenburg, Sweden
| | - Patricia Healy
- School of Nursing and Midwifery, National University of Ireland, Upper Newcastle Road, Galway, Ireland
| | - Margaret Carroll
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Andrea Matterne
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Mechthild M. Gross
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Susanne Grylka-Baeschlin
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jane Nicoletti
- Universita Degli Studi di Genova, Via Balbi 5, 16126 Genova, Italy
| | - Sandra Morano
- IRCCS Azienda Ospedaliera Universitaria S. Martino IST, Largo R. Benzi, 10 16132 Genova, Italy
| | - Christina Nilsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30 Gothenburg, Sweden
| | - Joan Lalor
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, Ireland
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Sudhinaraset M, Treleaven E, Melo J, Singh K, Diamond-Smith N. Women's status and experiences of mistreatment during childbirth in Uttar Pradesh: a mixed methods study using cultural health capital theory. BMC Pregnancy Childbirth 2016; 16:332. [PMID: 27793115 PMCID: PMC5084395 DOI: 10.1186/s12884-016-1124-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 10/22/2016] [Indexed: 11/20/2022] Open
Abstract
Background Mistreatment of women in healthcare settings during childbirth has been gaining attention globally. Mistreatment during childbirth directly and indirectly affects health outcomes, patient satisfaction, and the likelihood of delivering in a facility currently or in the future. It is important that we study patients’ reports of mistreatment and abuse to develop a deeper understanding of how it is perpetrated, its consequences, and to identify potential points of intervention. Patients’ perception of the quality of care is dependent, not only on the content of care, but importantly, on women’s expectations of care. Methods This study uses rich, mixed-methods data to explore women’s characteristics and experiences of mistreatment during childbirth among slum-resident women in Uttar Pradesh, India. To understand the ways in which women’s social and cultural factors influence their expectations of care and consequently their perceptions of respectful care, we adopt a Cultural Health Capital (CHC) framework. The quantitative sample includes 392 women, and the qualitative sample includes 26 women. Results Quantitative results suggest high levels of mistreatment (over 57 % of women reported any form of mistreatment). Qualitative findings suggest that lack of cultural health capital disadvantages patients in their patient-provider relationships, and that women use resources to improve care they receive. Participants articulated how providers set expectations and norms regarding behaviors in facilities; patients with lower social standing may not always understand standard practices and are likely to suffer poor health outcomes as a result. Of importance, however, patients also blame themselves for their own lack of knowledge. Conclusions Lack of cultural health capital disadvantages women during delivery care in India. Providers set expectations and norms around behaviors during delivery, while women are often misinformed and may have low expectations of care.
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Affiliation(s)
- May Sudhinaraset
- Department of Epidemiology and Biostatistics and Global Health Sciences, University of California, San Francisco. 550 16th Street, Box 1224, San Francisco, CA, 94158, USA.
| | - Emily Treleaven
- Department of Social and Behavioral Sciences, University of California, San Francisco. 3333 California St., San Francisco, CA, 94143, USA
| | - Jason Melo
- Division of Global Public Health, Department of Medicine, University of California, San Diego. 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Kanksha Singh
- Foundation for Research in Health Systems, 214, Sydicate House, Inderlok, Delhi, India
| | - Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics and Global Health Sciences, University of California, San Francisco. 550 16th Street, Box 1224, San Francisco, CA, 94158, USA
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A systematic review of the relationship factor between women and health professionals within the multivariant analysis of maternal satisfaction. Midwifery 2016; 41:68-78. [PMID: 27551856 DOI: 10.1016/j.midw.2016.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 07/17/2016] [Accepted: 08/05/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION personalised support provided to women by health professionals is one of the prime factors attaining women's satisfaction during pregnancy and childbirth. However the multifactorial nature of 'satisfaction' makes difficult to assess it. Statistical multivariate analysis may be an effective technique to obtain in depth quantitative evidence of the importance of this factor and its interaction with the other factors involved. This technique allows us to estimate the importance of overall satisfaction in its context and suggest actions for healthcare services. METHODS systematic review of studies that quantitatively measure the personal relationship between women and healthcare professionals (gynecologists, obstetricians, nurse, midwifes, etc.) regarding maternity care satisfaction. The literature search focused on studies carried out between 1970 and 2014 that used multivariate analyses and included the woman-caregiver relationship as a factor of their analysis. RESULTS twenty-four studies which applied various multivariate analysis tools to different periods of maternity care (antenatal, perinatal, post partum) were selected. The studies included discrete scale scores and questionnaires from women with low-risk pregnancies. The "personal relationship" factor appeared under various names: care received, personalised treatment, professional support, amongst others. The most common multivariate techniques used to assess the percentage of variance explained and the odds ratio of each factor were principal component analysis and logistic regression. DISCUSSION the data, variables and factor analysis suggest that continuous, personalised care provided by the usual midwife and delivered within a family or a specialised setting, generates the highest level of satisfaction. In addition, these factors foster the woman's psychological and physiological recovery, often surpassing clinical action (e.g. medicalization and hospital organization) and/or physiological determinants (e.g. pain, pathologies, etc.).
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Ferrarello D, Carmichael T. Sudden Unexpected Postnatal Collapse of the Newborn. Nurs Womens Health 2016; 20:268-275. [PMID: 27287353 DOI: 10.1016/j.nwh.2016.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/03/2015] [Indexed: 06/06/2023]
Abstract
Sudden unexpected postnatal collapse is a rare but devastating neonatal event. A well-appearing, full-term newborn with Agpar scores of eight or more suddenly crashes, often with full respiratory and cardiac arrest. Up to half of newborns with sudden unexpected postnatal collapse die, with many survivors suffering serious neurological damage. The first 2 hours of life are the hours of greatest risk, coinciding with the time frame when nurses encourage breastfeeding and uninterrupted skin-to-skin contact between women and newborns. Nursing assessments and measures to promote neonates' optimal transition to extrauterine life through skin-to-skin contact and early breastfeeding while decreasing the risk of this catastrophic event are described. Nursing surveillance to promote optimal transition in a safe environment is essential, and birth facilities should allocate staffing resources accordingly.
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Ayala A, Christensson K, Velandia M, Erlandsson K. Fathers' care of the newborn infant after caesarean section in Chile: A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 8:75-81. [DOI: 10.1016/j.srhc.2016.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 02/02/2016] [Accepted: 02/20/2016] [Indexed: 10/22/2022]
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Gisladottir A, Luque-Fernandez MA, Harlow BL, Gudmundsdottir B, Jonsdottir E, Bjarnadottir RI, Hauksdottir A, Aspelund T, Cnattingius S, Valdimarsdottir UA. Obstetric Outcomes of Mothers Previously Exposed to Sexual Violence. PLoS One 2016; 11:e0150726. [PMID: 27007230 PMCID: PMC4805168 DOI: 10.1371/journal.pone.0150726] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 02/17/2016] [Indexed: 02/05/2023] Open
Abstract
Background There is a scarcity of data on the association of sexual violence and women's subsequent obstetric outcomes. Our aim was to investigate whether women exposed to sexual violence as teenagers (12–19 years of age) or adults present with different obstetric outcomes than women with no record of such violence. Methods We linked detailed prospectively collected information on women attending a Rape Trauma Service (RTS) to the Icelandic Medical Birth Registry (IBR). Women who attended the RTS in 1993–2010 and delivered (on average 5.8 years later) at least one singleton infant in Iceland through 2012 formed our exposed cohort (n = 1068). For each exposed woman's delivery, nine deliveries by women with no RTS attendance were randomly selected from the IBR (n = 9126) matched on age, parity, and year and season of delivery. Information on smoking and Body mass index (BMI) was available for a sub-sample (n = 792 exposed and n = 1416 non-exposed women). Poisson regression models were used to estimate Relative Risks (RR) with 95% confidence intervals (CI). Results Compared with non-exposed women, exposed women presented with increased risks of maternal distress during labor and delivery (RR 1.68, 95% CI 1.01–2.79), prolonged first stage of labor (RR 1.40, 95% CI 1.03–1.88), antepartum bleeding (RR 1.95, 95% CI 1.22–3.07) and emergency instrumental delivery (RR 1.16, 95% CI 1.00–1.34). Slightly higher risks were seen for women assaulted as teenagers. Overall, we did not observe differences between the groups regarding the risk of elective cesarean section (RR 0.86, 95% CI 0.61–1.21), except for a reduced risk among those assaulted as teenagers (RR 0.56, 95% CI 0.34–0.93). Adjusting for maternal smoking and BMI in a sub-sample did not substantially affect point estimates. Conclusion Our prospective data suggest that women with a history of sexual assault, particularly as teenagers, are at increased risks of some adverse obstetric outcomes.
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Affiliation(s)
- Agnes Gisladottir
- Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
- * E-mail:
| | - Miguel Angel Luque-Fernandez
- London School of Hygiene and Tropical Medicine, Department of Non-Communicable Diseases Epidemiology, London, United Kingdom
- Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Bernard L. Harlow
- Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Berglind Gudmundsdottir
- Rape Trauma Service and the Trauma Center, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
- Psychology Department, University of Iceland, Reykjavik, Iceland
| | - Eyrun Jonsdottir
- Rape Trauma Service and the Trauma Center, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ragnheidur I. Bjarnadottir
- Department of Obstetrics and Gynecology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Arna Hauksdottir
- Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Thor Aspelund
- Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
- The Icelandic Heart Association, Kopavogur, Iceland
| | - Sven Cnattingius
- Unit of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Unnur A. Valdimarsdottir
- Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
- Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden
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Affiliation(s)
- Scott Hartman
- Department of Family Medicine, University of Rochester , Rochester, New York
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Diniz CSG, Niy DY, Andrezzo HFDA, Carvalho PCA, Salgado HDO. A vagina-escola: seminário interdisciplinar sobre violência contra a mulher no ensino das profissões de saúde. INTERFACE-COMUNICACAO SAUDE EDUCACAO 2016. [DOI: 10.1590/1807-57622015.0736] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
O ensino de obstetrícia no Brasil tradicionalmente requer que o aluno realize um certo número de procedimentos para que seja avaliado, o que levou a uma cultura de ensino do uso não informado, não consentido, das vaginas das parturientes mais pobres, usuárias do SUS, pelos alunos de medicina e outras profissões, para o treinamento de habilidades cirúrgicas. Tais abusos permanecem normalizados por uma cultura institucional que não os reconhece como violações de direitos, promovendo um ensino de habilidades descolado do ensino de valores e dos direitos das usuárias. Para promover um diálogo entre os setores envolvidos, realizamos em março de 2015 o evento “A Vagina-escola: seminário sobre violência contra a mulher no ensino das profissões de saúde”. O seminário foi especialmente oportuno por acompanhar a recente declaração da Oorganização Mundial de Saúde (OMS) “Prevenção e eliminação de abusos, desrespeito e maus-tratos durante o parto em instituições de saúde”, reforçando a urgência do tema na Saúde Coletiva.
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Pregnant women's expectations about pain intensity during childbirth and their attitudes towards pain management: Findings from an Icelandic national study. SEXUAL & REPRODUCTIVE HEALTHCARE 2015; 6:211-8. [DOI: 10.1016/j.srhc.2015.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 05/13/2015] [Accepted: 05/19/2015] [Indexed: 11/17/2022]
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Getting the first birth right: A retrospective study of outcomes for low-risk primiparous women receiving standard care versus midwifery model of care in the same tertiary hospital. Women Birth 2015; 28:279-84. [DOI: 10.1016/j.wombi.2015.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/28/2015] [Accepted: 06/29/2015] [Indexed: 11/19/2022]
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Chor J, Lyman P, Tusken M, Patel A, Gilliam M. Women's experiences with doula support during first-trimester surgical abortion: a qualitative study. Contraception 2015; 93:244-8. [PMID: 26480890 DOI: 10.1016/j.contraception.2015.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore how doula support influences women's experiences with first-trimester surgical abortion. STUDY DESIGN We conducted semistructured interviews with women given the option to receive doula support during first-trimester surgical abortion in a clinic that uses local anesthesia and does not routinely allow support people to be present during procedures. Dimensions explored included (a) reasons women did or did not choose doula support; (b) key aspects of the doula interaction; and (c) future directions for doula support in abortion care. Interviews were transcribed, and computer-assisted content analysis was performed; salient themes are presented. RESULTS Thirty women were interviewed: 19 received and 11 did not receive doula support. Reasons to accept doula support included (a) wanting companionship during the procedure and (b) being concerned about the procedure. Reasons to decline doula support included (a) a sense of stoicism and desiring privacy or (b) not wanting to add emotion to this event. Women who received doula support universally reported positive experiences with the verbal and physical techniques used by doulas during the procedure, and most women who declined doula support subsequently regretted not having a doula. Many women endorsed additional roles for doulas in abortion care, including addressing informational and emotional needs before and after the procedure. CONCLUSION Women receiving first-trimester surgical abortion in this setting value doula support at the time of the procedure. This intervention has the potential to be further developed to help women address pre- and postabortion informational and emotional needs. IMPLICATIONS In a setting that does not allow family or friends to be present during the abortion procedure, women highly valued the presence of trained abortion doulas. This study speaks to the importance of providing support to women during abortion care. Developing a volunteer doula service is one approach to addressing this need, especially in clinics that otherwise do not permit support people in the procedure room or for women who do not have a support person and desire one.
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Affiliation(s)
- Julie Chor
- Department of Obstetrics and Gynecology, The University of Chicago, USA.
| | - Phoebe Lyman
- Department of Obstetrics and Gynecology, The University of Chicago, USA
| | - Megan Tusken
- The Pritzker School of Medicine, The University of Chicago, USA
| | - Ashlesha Patel
- Department of Obstetrics and Gynecology, The John H. Stroger, Jr. Hospital of Cook County, USA
| | - Melissa Gilliam
- Department of Obstetrics and Gynecology, The University of Chicago, USA
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Revisit of risk factors for major obstetric hemorrhage: insights from a large medical center. Arch Gynecol Obstet 2015; 292:819-28. [DOI: 10.1007/s00404-015-3725-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/13/2015] [Indexed: 11/25/2022]
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Hoogenboom G, Thwin MM, Velink K, Baaijens M, Charrunwatthana P, Nosten F, McGready R. Quality of intrapartum care by skilled birth attendants in a refugee clinic on the Thai-Myanmar border: a survey using WHO Safe Motherhood Needs Assessment. BMC Pregnancy Childbirth 2015; 15:17. [PMID: 25652646 PMCID: PMC4332741 DOI: 10.1186/s12884-015-0444-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 01/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing the number of women birthing with skilled birth attendants (SBAs) as one of the strategies to reduce maternal mortality and morbidity must be partnered with a minimum standard of care. This manuscript describes the quality of intrapartum care provided by SBAs in Mae La camp, a low resource, protracted refugee context on the Thai-Myanmar border. METHODS In the obstetric department of Shoklo Malaria Research Unit (SMRU) the standardized WHO Safe Motherhood Needs Assessment tool was adapted to the setting and used: to assess the facility; interview SBAs; collect data from maternal records during a one year period (August 2007 - 2008); and observe practice during labour and childbirth. RESULTS The facility assessment recorded no 'out of stock' or 'out of date' drugs and supplies, equipment was in operating order and necessary infrastructure e.g. a stand-by emergency car, was present. Syphilis testing was not available. SBA interviews established that danger signs and symptoms were recognized except for sepsis and endometritis. All SBAs acknowledged receiving theoretical and 'hands-on' training and regularly attended deliveries. Scores for the essential elements of antenatal care from maternal records were high (>90%) e.g. providing supplements, recording risk factors as well as regular and correct partogram use. Observed good clinical practice included: presence of a support person; active management of third stage; post-partum monitoring; and immediate and correct neonatal care. Observed incorrect practice included: improper controlled cord traction; inadequate hand washing; an episiotomy rate in nulliparous women 49% (34/70) and low rates 30% (6/20) of newborn monitoring in the first hours following birth. Overall observed complications during labour and birth were low with post-partum haemorrhage being the most common in which case the SBAs followed the protocol but were slow to recognize severity and take action. CONCLUSIONS In the clinic of SMRU in Mae La refugee camp, SBAs were able to comply with evidence-based guidelines but support to improve quality of care in specific areas is required. The structure of the WHO Safe Motherhood Needs Assessment allowed significant insights into the quality of intrapartum care particularly through direct observation, identifying a clear pathway for quality improvement.
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Affiliation(s)
- Gabie Hoogenboom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - May Myo Thwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - Kris Velink
- AVAG Midwifery Academy Amsterdam Groningen, Amsterdam, The Netherlands.
| | - Marijke Baaijens
- AVAG Midwifery Academy Amsterdam Groningen, Amsterdam, The Netherlands.
| | - Prakaykaew Charrunwatthana
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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Renfrew MJ, McFadden A, Bastos MH, Campbell J, Channon AA, Cheung NF, Silva DRAD, Downe S, Kennedy HP, Malata A, McCormick F, Wick L, Declercq E. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. Lancet 2014; 384:1129-45. [PMID: 24965816 DOI: 10.1016/s0140-6736(14)60789-3] [Citation(s) in RCA: 723] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this first paper in a series of four papers on midwifery, we aimed to examine, comprehensively and systematically, the contribution midwifery can make to the quality of care of women and infants globally, and the role of midwives and others in providing midwifery care. Drawing on international definitions and current practice, we mapped the scope of midwifery. We then developed a framework for quality maternal and newborn care using a mixed-methods approach including synthesis of findings from systematic reviews of women's views and experiences, effective practices, and maternal and newborn care providers. The framework differentiates between what care is provided and how and by whom it is provided, and describes the care and services that childbearing women and newborn infants need in all settings. We identified more than 50 short-term, medium-term, and long-term outcomes that could be improved by care within the scope of midwifery; reduced maternal and neonatal mortality and morbidity, reduced stillbirth and preterm birth, decreased number of unnecessary interventions, and improved psychosocial and public health outcomes. Midwifery was associated with more efficient use of resources and improved outcomes when provided by midwives who were educated, trained, licensed, and regulated. Our findings support a system-level shift from maternal and newborn care focused on identification and treatment of pathology for the minority to skilled care for all. This change includes preventive and supportive care that works to strengthen women's capabilities in the context of respectful relationships, is tailored to their needs, focuses on promotion of normal reproductive processes, and in which first-line management of complications and accessible emergency treatment are provided when needed. Midwifery is pivotal to this approach, which requires effective interdisciplinary teamwork and integration across facility and community settings. Future planning for maternal and newborn care systems can benefit from using the quality framework in planning workforce development and resource allocation.
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Affiliation(s)
- Mary J Renfrew
- Mother and Infant Research Unit, School of Nursing and Midwifery, College of Medicine, Dentistry and Nursing, University of Dundee, Dundee, UK.
| | - Alison McFadden
- Mother and Infant Research Unit, School of Nursing and Midwifery, College of Medicine, Dentistry and Nursing, University of Dundee, Dundee, UK
| | | | - James Campbell
- Instituto de Cooperación Social Integrare, Barcelona, Spain
| | - Andrew Amos Channon
- Division of Social Statistics and Demography, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Ngai Fen Cheung
- Midwifery Expert Committee of the Maternal and Child Health Association of China, Beijing, China
| | | | - Soo Downe
- School of Health, University of Central Lancashire, Preston, Lancashire, UK
| | | | - Address Malata
- Kamuzu College of Nursing University of Malawi, Lilongwe, Malawi
| | - Felicia McCormick
- Department of Health Sciences, University of York, Heslington West, York, UK
| | - Laura Wick
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Eugene Declercq
- Community Health Sciences, Boston University School of Public Health, Boston, MD, USA
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O’Reilly A, Choby D, Séjourné N, Callahan S. Feelings of control, unconditional self-acceptance and maternal self-esteem in women who had delivered by caesarean. J Reprod Infant Psychol 2014. [DOI: 10.1080/02646838.2014.930111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Shlafer RJ, Hellerstedt WL, Secor-Turner M, Gerrity E, Baker R. Doulas' Perspectives about Providing Support to Incarcerated Women: A Feasibility Study. Public Health Nurs 2014; 32:316-26. [PMID: 24980835 DOI: 10.1111/phn.12137] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To document the logistical feasibility of a doula program for pregnant incarcerated women and to assess doulas' perceptions of their achievements. DESIGN AND SAMPLE Six doulas provided written case notes ("birth stories") about their experiences with 18 pregnant women in one Midwestern state prison. MEASURES The birth stories were analyzed by two coders to identify major themes related to doulas' perceptions about providing support to incarcerated women. Analyses involved coder consensus about major themes and doula affirmation of findings. RESULTS All doulas reported that they met key objectives for a successful relationship with each of their clients. Key themes were their ability to empower clients, establish a trusting relationship, normalize the delivery, and support women as they were separated from their newborns. CONCLUSIONS The intervention was logistically feasible, suggesting that doulas can adapt their practice for incarcerated women. Doulas may need specific training to prepare themselves for institutional restrictions that may conflict with the traditional roles of doula care. It may be important for doulas to understand the level of personal and professional resources they may have to expend to support incarcerated women if they are separated from their infants soon after delivery.
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Affiliation(s)
- Rebecca J Shlafer
- Division of General Pediatrics & Adolescent Health, University of Minnesota, Minneapolis, Minnesota
| | - Wendy L Hellerstedt
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota
| | | | - Erica Gerrity
- Isis Rising - Everyday Miracles, Minneapolis, Minnesota
| | - Rae Baker
- Isis Rising - Everyday Miracles, Minneapolis, Minnesota
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Donovan Sharpe MJ. Resistance and Possibility: The Struggle to Preserve Normal Birth. WOMEN’S HEALTH BULLETIN 2014. [DOI: 10.17795/whb-21001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Reshaping maternal services in Nigeria: any need for spiritual care? BMC Pregnancy Childbirth 2014; 14:196. [PMID: 24902710 PMCID: PMC4057573 DOI: 10.1186/1471-2393-14-196] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 06/05/2014] [Indexed: 11/26/2022] Open
Abstract
Background High maternal and perinatal mortalities occur from deliveries conducted in prayer houses in Nigeria. Although some regulatory efforts have been deployed to tackle this problem, less attention has been placed on the possible motivation for seeking prayer house intervention which could be hinged on the spiritual belief of patients about pregnancy and childbirth. This study therefore seeks to determine the perception of booked antenatal patients on spiritual care during pregnancy and their desire for such within hospital setting. Method A total of 397 antenatal attendees from two tertiary health institutions in southwest Nigeria were sampled. A pretested questionnaire was used to obtain information on socio-demographic features of respondents, perception of spiritual care during pregnancy and childbirth; and how they desire that their spiritual needs are addressed. Responses were subsequently collated and analyzed. Results Most of the women, 301 (75.8%), believe there is a need for spiritual help during pregnancy and childbirth. About half (48.5%) were currently seeking for help in prayer/mission houses while another 8.6% still intended to. Overwhelmingly, 281 (70.8%) felt it was needful for health professionals to consider their spiritual needs. Most respondents, 257 (64.7%), desired that their clergy is allowed to pray with them while in labour and sees such collaboration as incentive that will improve hospital patronage. There was association between high family income and desire for collaboration of healthcare providers with one’s clergy (OR 1.82; CI 1.03-3.21; p = 0.04). Conclusion Our women desire spiritual care during pregnancy and childbirth. Its incorporation into maternal health services will improve hospital delivery rates.
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Brüggemann OM, Ebsen ES, Oliveira MED, Gorayeb MK, Ebele RR. Reasons which lead the health services not to allow the presence of the birth companion: nurses' discourses. TEXTO & CONTEXTO ENFERMAGEM 2014. [DOI: 10.1590/0104-07072014002860013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This qualitative research aimed to investigate the reasons the health services of Santa Catarina, Brazil, do not allow the presence of the birth partner of choice of women in the birthing process. The data were collected from September 2011 to January 2012 through semi-structured interviews with 12 nurses responsible for obstetric centers which did not permit, or permitted sometimes, the presence of the birth companion. The interviews were analyzed using the Discourse of the Collective Subject, in which three themes emerged: professionals' resistance to the presence of the companion; lack of physical infrastructure and human and material resources; and the institution's resistance to implementing the Companion's Law. The discourses show that impeding the presence of the companion is mainly related to the decision of the professionals and the inadequacy of the organizational structure. This requires changes in the attitude of the staff, institutional support, and management strategies to increase the support for the presence of the woman's companion of choice.
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Nair M, Yoshida S, Lambrechts T, Boschi-Pinto C, Bose K, Mason EM, Mathai M. Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview. BMJ Open 2014; 4:e004749. [PMID: 24852300 PMCID: PMC4039842 DOI: 10.1136/bmjopen-2013-004749] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 04/10/2014] [Accepted: 05/02/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Conduct a global situational analysis to identify the current facilitators and barriers to improving quality of care (QoC) for pregnant women, newborns and children. STUDY DESIGN Metareview of published and unpublished systematic reviews and meta-analyses conducted between January 2000 and March 2013 in any language. Assessment of Multiple Systematic Reviews (AMSTAR) is used to assess the methodological quality of systematic reviews. SETTINGS Health systems of all countries. Study outcome: QoC measured using surrogate indicators--effective, efficient, accessible, acceptable/patient centred, equitable and safe. ANALYSIS Conducted in two phases (1) qualitative synthesis of extracted data to identify and group the facilitators and barriers to improving QoC, for each of the three population groups, into the six domains of WHO's framework and explore new domains and (2) an analysis grid to map the common facilitators and barriers. RESULTS We included 98 systematic reviews with 110 interventions to improve QoC from countries globally. The facilitators and barriers identified fitted the six domains of WHO's framework--information, patient-population engagement, leadership, regulations and standards, organisational capacity and models of care. Two new domains, 'communication' and 'satisfaction', were generated. Facilitators included active and regular interpersonal communication between users and providers; respect, confidentiality, comfort and support during care provision; engaging users in decision-making; continuity of care and effective audit and feedback mechanisms. Key barriers identified were language barriers in information and communication; power difference between users and providers; health systems not accounting for user satisfaction; variable standards of implementation of standard guidelines; shortage of resources in health facilities and lack of studies assessing the role of leadership in improving QoC. These were common across the three population groups. CONCLUSIONS The barriers to good-quality healthcare are common for pregnant women, newborns and children; thus, interventions targeted to address them will have uniform beneficial effects. Adopting the identified facilitators would help countries strengthen their health systems and ensure high-quality care for all.
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Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Sachiyo Yoshida
- Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Thierry Lambrechts
- Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Cynthia Boschi-Pinto
- Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Krishna Bose
- Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Elizabeth Mary Mason
- Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Matthews Mathai
- Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
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Devasenapathy N, George MS, Ghosh Jerath S, Singh A, Negandhi H, Alagh G, Shankar AH, Zodpey S. Why women choose to give birth at home: a situational analysis from urban slums of Delhi. BMJ Open 2014; 4:e004401. [PMID: 24852297 PMCID: PMC4039791 DOI: 10.1136/bmjopen-2013-004401] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 05/01/2014] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Increasing institutional births is an important strategy for attaining Millennium Development Goal -5. However, rapid growth of low income and migrant populations in urban settings in low-income and middle-income countries, including India, presents unique challenges for programmes to improve utilisation of institutional care. Better understanding of the factors influencing home or institutional birth among the urban poor is urgently needed to enhance programme impact. To measure the prevalence of home and institutional births in an urban slum population and identify factors influencing these events. DESIGN Cross-sectional survey using quantitative and qualitative methods. SETTING Urban poor settlements in Delhi, India. PARTICIPANTS A house-to-house survey was conducted of all households in three slum clusters in north-east Delhi (n=32 034 individuals). Data on birthing place and sociodemographic characteristics were collected using structured questionnaires (n=6092 households). Detailed information on pregnancy and postnatal care was obtained from women who gave birth in the past 3 months (n=160). Focus group discussions and in-depth interviews were conducted with stakeholders from the community and healthcare facilities. RESULTS Of the 824 women who gave birth in the previous year, 53% (95% CI 49.7 to 56.6) had given birth at home. In adjusted analyses, multiparity, low literacy and migrant status were independently predictive of home births. Fear of hospitals (36%), comfort of home (20.7%) and lack of social support for child care (12.2%) emerged as the primary reasons for home births. CONCLUSIONS Home births are frequent among the urban poor. This study highlights the urgent need for improvements in the quality and hospitality of client services and need for family support as the key modifiable factors affecting over two-thirds of this population. These findings should inform the design of strategies to promote institutional births.
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Affiliation(s)
- Niveditha Devasenapathy
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Mathew Sunil George
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Suparna Ghosh Jerath
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Archna Singh
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Himanshu Negandhi
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Gursimran Alagh
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Anuraj H Shankar
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Sanjay Zodpey
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, Haryana, India
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Offerhaus PM, de Jonge A, van der Pal–de Bruin KM, Hukkelhoven CW, Scheepers PL, Lagro-Janssen AL. Change in primary midwife-led care in the Netherlands in 2000–2008: A descriptive study of caesarean sections and other interventions among 789,795 low risk births. Midwifery 2014; 30:560-6. [DOI: 10.1016/j.midw.2013.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/05/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
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Abstract
BACKGROUND: Caregivers need to better understand women’s experiences of support during childbirth because research suggests that social support positively influences childbirth.AIM: This study describes women’s experiences of support given by caregivers during pregnancy and childbirth.METHOD: The study design was inspired by grounded theory. Seven interviews of women were analyzed with an open coding, and different time-related categories related to the childbirth process emerged. The categories were marked by fear and a negative birth experience, being guided on own terms, feel supported, and transformation into courage to give birth. The analysis continued with a selective coding, reflecting the process of mistrust to trust in caregivers.FINDINGS: The mistrust in caregivers began with feelings of fear of birth and a negative birth experience. Through being guided on own terms and feeling supported by the caregivers, a trusting relationship could be established. If the trusting relationship continued during labor, then a woman could transform the fear of birth into the courage to give birth.CONCLUSIONS: Women’s experience of support can be seen as a product of earlier experiences from interactions with caregivers. Therefore, caregivers must be sensitive to the potential power and far-reaching consequences their actions can have.
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Edwards RC, Thullen MJ, Korfmacher J, Lantos JD, Henson LG, Hans SL. Breastfeeding and complementary food: randomized trial of community doula home visiting. Pediatrics 2013; 132 Suppl 2:S160-6. [PMID: 24187119 DOI: 10.1542/peds.2013-1021p] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Despite recent efforts to increase breastfeeding, young African American mothers continue to breastfeed at low rates, and commonly introduce complementary foods earlier than recommended. This study examines the effects of a community doula home visiting intervention on infant feeding practices among young mothers. METHODS Low-income, African American mothers (n = 248) under age 22 years participated in a randomized trial of a community doula intervention. Intervention-group mothers received services from paraprofessional doulas: specialized home visitors trained as childbirth educators and lactation counselors. Doulas provided home visits from pregnancy through 3 months postpartum, and support during childbirth. Control-group mothers received usual prenatal care. Data were obtained from medical records and maternal interviews at birth and 4 months postpartum. RESULTS Intent-to-treat analyses showed that doula-group mothers attempted breastfeeding at a higher rate than control-group mothers (64% vs 50%; P = .02) and were more likely to breastfeed longer than 6 weeks (29% vs 17%; P = .04), although few mothers still breastfed at 4 months. The intervention also impacted mothers' cereal/solid food introduction (P = .008): fewer doula-group mothers introduced complementary foods before 6 weeks of age (6% vs 18%), while more waited until at least 4 months (21% vs 13%) compared with control-group mothers. CONCLUSIONS Community doulas may be effective in helping young mothers meet breastfeeding and healthy feeding guidelines. The intervention's success may lie in the relationship that develops between doula and mother based on shared cultural background and months of prenatal home visiting, and the doula's presence at the birth, where she supports early breastfeeding experiences.
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Affiliation(s)
- Renee C Edwards
- The University of Chicago, School of Social Service Administration, 969 E 60th St, Chicago, IL 60637.
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Henderson J, Gao H, Redshaw M. Experiencing maternity care: the care received and perceptions of women from different ethnic groups. BMC Pregnancy Childbirth 2013; 13:196. [PMID: 24148317 PMCID: PMC3854085 DOI: 10.1186/1471-2393-13-196] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/07/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND According to the Office for National Statistics, approximately a quarter of women giving birth in England and Wales are from minority ethnic groups. Previous work has indicated that these women have poorer pregnancy outcomes than White women and poorer experience of maternity care, sometimes encountering stereotyping and racism. The aims of this study were to examine service use and perceptions of care in ethnic minority women from different groups compared to White women. METHODS Secondary analysis of data from a survey of women in 2010 was undertaken. The questionnaire asked about women's experience of care during pregnancy, labour and birth, and the postnatal period, as well as demographic factors. Ethnicity was grouped into eight categories: White, Mixed, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African, and Other ethnicity. RESULTS A total of 24,319 women completed the survey. Compared to White women, women from minority ethnic groups were more likely to be younger, multiparous and without a partner. They tended to access antenatal care later in pregnancy, have fewer antenatal checks, fewer ultrasound scans and less screening. They were less likely to receive pain relief in labour and, Black African women in particular, were more likely to deliver by emergency caesarean section. Postnatally, women from minority ethnic groups had longer lengths of hospital stay and were more likely to breastfeed but they had fewer home visits from midwives. Throughout their maternity care, women from minority ethnic groups were less likely to feel spoken to so they could understand, to be treated with kindness, to be sufficiently involved in decisions and to have confidence and trust in the staff. CONCLUSION Women in all minority ethnic groups had a poorer experience of maternity services than White women. That this was still the case following publication of a number of national policy documents and local initiatives is a cause for concern.
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Affiliation(s)
- Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road, Oxford OX3 7LF, UK
| | - Haiyan Gao
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road, Oxford OX3 7LF, UK
| | - Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road, Oxford OX3 7LF, UK
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Abstract
BACKGROUND It is more common for women in both high- and low-income countries giving birth in health facilities, to labour in bed. There is no evidence that this is associated with any advantage for women or babies, although it may be more convenient for staff. Observational studies have suggested that if women lie on their backs during labour this may have adverse effects on uterine contractions and impede progress in labour, and in some women reduce placental blood flow. OBJECTIVES To assess the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labour on duration of labour, type of birth and other important outcomes for mothers and babies. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2013). SELECTION CRITERIA Randomised and quasi-randomised trials comparing women randomised to upright versus recumbent positions in the first stage of labour. DATA COLLECTION AND ANALYSIS We used methods described in the Cochrane Handbook for Systematic Reviews of Interventions for carrying out data collection, assessing study quality and analysing results. Two review authors independently evaluated methodological quality and extracted data for each study. We sought additional information from trial authors as required. We used random-effects analysis for comparisons in which high heterogeneity was present. We reported results using the average risk ratio (RR) for categorical data and mean difference (MD) for continuous data. MAIN RESULTS Results should be interpreted with caution as the methodological quality of the 25 included trials (5218 women) was variable.For Comparison 1: Upright and ambulant positions versus recumbent positions and bed care, the first stage of labour was approximately one hour and 22 minutes shorter for women randomised to upright as opposed to recumbent positions (average MD -1.36, 95% confidence interval (CI) -2.22 to -0.51; 15 studies, 2503 women; random-effects, T(2) = 2.39, Chi(2) = 203.55, df = 14, (P < 0.00001), I(2) = 93%). Women who were upright were also less likely to have caesarean section (RR 0.71, 95% CI 0.54 to 0.94; 14 studies, 2682 women) and less likely to have an epidural (RR 0.81, 95% CI 0.66 to 0.99, nine studies, 2107 women; random-effects, T(2) = 0.02, I(2) = 61%). Babies of mothers who were upright were less likely to be admitted to the neonatal intensive care unit, however this was based on one trial (RR 0.20, 95% CI 0.04 to 0.89, one study, 200 women). There were no significant differences between groups for other outcomes including duration of the second stage of labour, or other outcomes related to the well being of mothers and babies.For Comparison 2: Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), there were no significant differences between groups for outcomes including duration of the second stage of labour, or other outcomes related to the well being of mothers and babies. AUTHORS' CONCLUSIONS There is clear and important evidence that walking and upright positions in the first stage of labour reduces the duration of labour, the risk of caesarean birth, the need for epidural, and does not seem to be associated with increased intervention or negative effects on mothers' and babies' well being. Given the great heterogeneity and high performance bias of study situations, better quality trials are still required to confirm with any confidence the true risks and benefits of upright and mobile positions compared with recumbent positions for all women. Based on the current findings, we recommend that women in low-risk labour should be informed of the benefits of upright positions, and encouraged and assisted to assume whatever positions they choose.
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Affiliation(s)
- Annemarie Lawrence
- Health & Well Being Service Group and Tropical Health Research Unit for Nursing and Midwifery Practice, The Townsville Hospital and Health Service, Douglas, Queensland, Australia, 4810
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Walsh D, Evans K. Critical realism: an important theoretical perspective for midwifery research. Midwifery 2013; 30:e1-6. [PMID: 24139687 DOI: 10.1016/j.midw.2013.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 08/19/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND there is a dearth of papers in midwifery journals exploring the philosophical underpinnings of various research methods. However, explaining and justifying particular ontological and epistemological positions gives coherence and credibility to chosen research methods. OBJECTIVES to explore and explain the philosophical underpinning of critical realism and argue for it to be more widely adopted by midwifery researchers, using the exemplar of dystocia research. DISCUSSION critical realism as originally espoused by Bhaskar sees reality as layered (realist ontology) and seeks to explore causative mechanisms for what is experienced and observed. In this way it illuminates the complexity of health care, though recognising that knowledge of this complexity is filtered through an interpretive lens (constructionist epistemology). Critical realism encourages a holistic exploration of phenomena, premised on multiple research questions that utilise multiple research methods. IMPLICATIONS FOR RESEARCH critical realism as a philosophical underpinning is therefore particularly apposite for researching midwifery issues and concerns.
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Affiliation(s)
- Denis Walsh
- Academic Division of Midwifery, University of Nottingham, A Floor, Medical School, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK.
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Brown HC, Paranjothy S, Dowswell T, Thomas J. Package of care for active management in labour for reducing caesarean section rates in low-risk women. Cochrane Database Syst Rev 2013:CD004907. [PMID: 24043476 DOI: 10.1002/14651858.cd004907.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Approximately 15% of women have caesarean sections (CS) and while the rate varies, the number is increasing in many countries. This is of concern because higher CS rates do not confer additional health gain but may adversely affect maternal health and have implications for future pregnancies. Active management of labour has been proposed as a means of reducing CS rates. This refers to a package of care including strict diagnosis of labour, routine amniotomy, oxytocin for slow progress and one-to-one support in labour. OBJECTIVES To determine whether active management of labour reduces CS rates in low-risk women and improves satisfaction. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (16 April 2013). SELECTION CRITERIA Randomised controlled trials comparing low-risk women receiving a predefined package of care (active management) with women receiving routine (variable) care. Trials where slow progress had been diagnosed before entry into the trial were excluded. DATA COLLECTION AND ANALYSIS At least two review authors extracted data. We assessed included studies for risk of bias. MAIN RESULTS We included seven trials, with a total of 5390 women. The quality of studies was mixed. The CS rate was slightly lower in the active management group compared with the group that received routine care, but this difference did not reach statistical significance (RR 0.88, 95% CI 0.77 to 1.01). However, in one study there was a large number of post-randomisation exclusions. On excluding this study, CS rates in the active management group were statistically significantly lower than in the routine care group (RR 0.77 95% CI 0.63 to 0.94). More women in the active management group had labours lasting less than 12 hours, but there was wide variation in length of labour within and between trials. There were no differences between groups in use of analgesia, rates of assisted vaginal deliveries or maternal or neonatal complications. Only one trial examined maternal satisfaction; the majority of women (over 75%) in both groups were very satisfied with care. AUTHORS' CONCLUSIONS Active management is associated with small reductions in the CS rate, but it is highly prescriptive and interventional. It is possible that some components of the active management package are more effective than others. Further work is required to determine the acceptability of active management to women in labour.
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Affiliation(s)
- Heather C Brown
- Department of Obstetrics and Gynaecology, Royal Sussex County Hospital, Eastern Road, Brighton, UK, BN2 5BE
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81
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Abstract
A supportive medical team should be well informed on the various pharmacologic and nonpharmacologic modalities of coping with or mitigating labor pain to appropriately support and respectfully care for parturients. Using the methodical rigor of previously published Cochrane systematic reviews, this summary evaluates and discusses the efficacy of nonpharmacologic labor analgesic interventions.
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Affiliation(s)
- Katherine W Arendt
- Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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Abstract
BACKGROUND It is more common for women in both high- and low-income countries giving birth in health facilities, to labour in bed. There is no evidence that this is associated with any advantage for women or babies, although it may be more convenient for staff. Observational studies have suggested that if women lie on their backs during labour this may have adverse effects on uterine contractions and impede progress in labour, and in some women reduce placental blood flow. OBJECTIVES To assess the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labour on duration of labour, type of birth and other important outcomes for mothers and babies. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2013). SELECTION CRITERIA Randomised and quasi-randomised trials comparing women randomised to upright versus recumbent positions in the first stage of labour. DATA COLLECTION AND ANALYSIS We used methods described in the Cochrane Handbook for Systematic Reviews of Interventions for carrying out data collection, assessing study quality and analysing results. Two review authors independently evaluated methodological quality and extracted data for each study. We sought additional information from trial authors as required. We used random-effects analysis for comparisons in which high heterogeneity was present. We reported results using the average risk ratio (RR) for categorical data and mean difference (MD) for continuous data. MAIN RESULTS Results should be interpreted with caution as the methodological quality of the 25 included trials (5218 women) was variable.For Comparison 1: Upright and recumbent positions versus recumbent positions and bed care, the first stage of labour was approximately one hour and 22 minutes shorter for women randomised to upright as opposed to recumbent positions (average MD -1.36, 95% confidence interval (CI) -2.22 to -0.51; 15 studies, 2503 women; random-effects, T(2) = 2.39, Chi(2) = 203.55, df = 14, (P < 0.00001), I(2) = 93%). Women who were upright were also less likely to have caesarean section (RR 0.71, 95% CI 0.54 to 0.94; 14 studies, 2682 women) and less likely to have an epidural (RR 0.81, 95% CI 0.66 to 0.99, nine studies, 2107 women; random-effects, T(2) = 0.02, I(2) = 61%). Babies of mothers who were upright were less likely to be admitted to the neonatal intensive care unit, however this was based on one trial (RR 0.20, 95% CI 0.04 to 0.89, one study, 200 women). There were no significant differences between groups for other outcomes including duration of the second stage of labour, or other outcomes related to the well being of mothers and babies.For Comparison 2: Upright and recumbent positions versus recumbent positions and bed care (with epidural: all women), there were no significant differences between groups for outcomes including duration of the second stage of labour, or other outcomes related to the well being of mothers and babies. AUTHORS' CONCLUSIONS There is clear and important evidence that walking and upright positions in the first stage of labour reduces the duration of labour, the risk of caesarean birth, the need for epidural, and does not seem to be associated with increased intervention or negative effects on mothers' and babies' well being. Given the great heterogeneity and high performance bias of study situations, better quality trials are still required to confirm with any confidence the true risks and benefits of upright and mobile positions compared with recumbent positions for all women. Based on the current findings, we recommend that women in low-risk labour should be informed of the benefits of upright positions, and encouraged and assisted to assume whatever positions they choose.
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Affiliation(s)
- Annemarie Lawrence
- Health & Well Being Service Group and Tropical Health Research Unit for Nursing and Midwifery Practice, The Townsville Hospital and Health Service, Douglas, Queensland, Australia, 4810
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83
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Ross-Davie MC, Cheyne H, Niven C. Measuring the quality and quantity of professional intrapartum support: testing a computerised systematic observation tool in the clinical setting. BMC Pregnancy Childbirth 2013; 13:163. [PMID: 23945049 PMCID: PMC3751507 DOI: 10.1186/1471-2393-13-163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 08/13/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Continuous support in labour has a significant impact on a range of clinical outcomes, though whether the quality and quantity of support behaviours affects the strength of this impact has not yet been established. To identify the quality and quantity of support, a reliable means of measurement is needed. To this end, a new computerised systematic observation tool, the 'SMILI' (Supportive Midwifery in Labour Instrument) was developed.The aim of the study was to test the validity and usability of the 'Supportive Midwifery in Labour Instrument' (SMILI) and to test the feasibility and acceptability of the systematic observation approach in the clinical intrapartum setting. METHODS Systematic observation was combined with a postnatal questionnaire and the collection of data about clinical processes and outcomes for each observed labour.The setting for the study was four National Health Service maternity units in Scotland, UK. Participants in this study were forty five midwives and forty four women.The SMILI was used by trained midwife observers to record labour care provided by midwives. Observations were undertaken for an average of two hours and seventeen minutes during the active first stage of labour and, in 18 cases, the observation included the second stage of labour. Content validity of the instrument was tested by the observers, noting the extent to which the SMILI facilitated the recording of all key aspects of labour care and interactions. Construct validity was tested through exploration of correlations between the data recorded and women's feelings about the support they received. Feasibility and usability data were recorded following each observation by the observer. Internal reliability and construct validity were tested through statistical analysis of the data. RESULTS One hundred and four hours of labour care were observed and recorded using the SMILI during forty nine labour episodes. CONCLUSION The SMILI was found to be a valid and reliable instrument in the intrapartum setting in which it was tested. The study identified that the SMILI could be used to test correlations between the quantity and quality of support and outcomes. The systematic observational approach was found to be an acceptable and feasible method of enquiry.
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Affiliation(s)
- Mary C Ross-Davie
- Educational Projects Manager, Midwifery and Reproductive Health, NHS Education for Scotland, Westport 102Westport, Edinburgh EH3 9DN, UK
| | - Helen Cheyne
- Royal College of Midwives Professor of Midwifery & Professor of Maternal and Child Health Research, NMAHP Research Unit, University of Stirling, Stirling FK9 4LA, UK
| | - Catherine Niven
- Emeritus Professor, University of Stirling, Stirling FK9 4LA, UK
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De Vries R, Nieuwenhuijze M, Buitendijk SE. What does it take to have a strong and independent profession of midwifery? Lessons from the Netherlands. Midwifery 2013; 29:1122-8. [PMID: 23916404 DOI: 10.1016/j.midw.2013.07.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 06/28/2013] [Accepted: 07/04/2013] [Indexed: 11/15/2022]
Abstract
In the 1970s, advocates of demedicalising pregnancy and birth 'discovered' Dutch maternity care. The Netherlands presented an attractive model because its maternity care system was characterised by a strong and independent profession of midwifery, close co-operation between obstetricians and midwives, a very high rate of births at home, little use of caesarean section, and morbidity and mortality statistics that were among the best in the developed world. Over the course of the following 40 years much has changed in the Netherlands. Although the home birth rate remains quite high when compared to other modern countries, it is half of what it was in the 1970s. Midwifery is still an independent medical profession, but a move toward 'integrated care' threatens to bring midwives into hospitals under the direction of medical specialists, more women are interested in medical pain relief, and there is a growing concern that current, albeit slight, increases in rates of intervention in physiological births foreshadow the end of the unique approach to birth in the Netherlands. The story of Dutch maternity care thus offers an ideal opportunity to examine the social, organisational, and cultural factors that work to support, and to diminish, the independent practice of midwifery in high-resource countries. We may wish to believe that providing ample and convincing evidence of the value of midwifery care will be enough to promote more and better use of midwifery, but the lessons from the Netherlands make clear that an array of social forces play a critical role determining the place of midwives in the health care system and how the care they provide is deployed.
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Affiliation(s)
- Raymond De Vries
- Faculty of Midwifery Education & Studies, Zuyd University, Maastricht, Netherlands; CAPHRI, School for Public Health and Primary Care, Maastricht University, Netherlands; Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
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85
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Abstract
BACKGROUND Historically, women have been attended and supported by other women during labour. However, in hospitals worldwide, continuous support during labour has become the exception rather than the routine. OBJECTIVES Primary: to assess the effects of continuous, one-to-one intrapartum support compared with usual care. Secondary: to determine whether the effects of continuous support are influenced by: (1) routine practices and policies; (2) the provider's relationship to the hospital and to the woman; and (3) timing of onset. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2013). SELECTION CRITERIA All published and unpublished randomised controlled trials comparing continuous support during labour with usual care. DATA COLLECTION AND ANALYSIS We used standard methods of The Cochrane Collaboration Pregnancy and Childbirth Group. Two review authors independently evaluated methodological quality and extracted the data. We sought additional information from the trial authors. We used random-effects analyses for comparisons in which high heterogeneity was present, and we reported results using the average risk ratio (RR) for categorical data and mean difference (MD) for continuous data. MAIN RESULTS Twenty-two trials involving 15,288 women met inclusion criteria and provided usable outcome data. Results are of random-effects analyses, unless otherwise noted. Women allocated to continuous support were more likely to have a spontaneous vaginal birth (RR 1.08, 95% confidence interval (CI) 1.04 to 1.12) and less likely to have intrapartum analgesia (RR 0.90, 95% CI 0.84 to 0.96) or to report dissatisfaction (RR 0.69, 95% CI 0.59 to 0.79). In addition, their labours were shorter (MD -0.58 hours, 95% CI -0.85 to -0.31), they were less likely to have a caesarean (RR 0.78, 95% CI 0.67 to 0.91) or instrumental vaginal birth (fixed-effect, RR 0.90, 95% CI 0.85 to 0.96), regional analgesia (RR 0.93, 95% CI 0.88 to 0.99), or a baby with a low five-minute Apgar score (fixed-effect, RR 0.69, 95% CI 0.50 to 0.95). There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, or breastfeeding. Subgroup analyses suggested that continuous support was most effective when the provider was neither part of the hospital staff nor the woman's social network, and in settings in which epidural analgesia was not routinely available. No conclusions could be drawn about the timing of onset of continuous support. AUTHORS' CONCLUSIONS Continuous support during labour has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labour and birth.
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Affiliation(s)
- Ellen D Hodnett
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, Canada, M5T 1P8
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86
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Bogaerts A, Witters I, Van den Bergh BRH, Jans G, Devlieger R. Obesity in pregnancy: altered onset and progression of labour. Midwifery 2013; 29:1303-13. [PMID: 23427851 DOI: 10.1016/j.midw.2012.12.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/27/2012] [Accepted: 12/20/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND the incidence of obesity increases in all developed countries to frightful percentages, also in women of reproductive age. Maternal obesity is associated with important obstetrical complications; and this group also exhibits a higher incidence of prolonged pregnancies and labours. OBJECTIVE to review the literature on the pathophysiology of onset and progression of labour in obese woman and translate this knowledge into practical recommendations for clinical management. METHODS a literature review, in particular a critical summary of research, in order to determine associations, gaps or inconsistencies in this specific but limited body of research. FINDINGS the combination of a higher incidence of post-term childbirths and increased inadequate contraction pattern during the first stage of labour suggests an influence of obesity on myometrial activity. A pathophysiologic pathway for altered onset and progression of labour in obese pregnant women is proposed. CONCLUSIONS analysis of the literature shows that obesity is associated with an increased duration of pregnancy and prolonged duration of first stage of labour. IMPLICATIONS FOR PRACTICE an adapted clinical approach is suggested in these patients.
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Affiliation(s)
- Annick Bogaerts
- Limburg Catholic University College, PHL University College, Department of PHL-Healthcare Research, Oude Luikerbaan, 79, 3500 Hasselt, Belgium
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Griffiths C, McAra-Couper J, Nayar S. Staying Involved “Because the Need Seems So Huge”: Midwives Working With Women Living in Areas of High Deprivation. INTERNATIONAL JOURNAL OF CHILDBIRTH 2013. [DOI: 10.1891/2156-5287.3.4.218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this research was to answer the research question “what is the midwifery care provided by midwives to women living in areas of high deprivation?” It has been identified that rates of stillbirth and neonatal death are significantly higher in women living in the most socioeconomically deprived areas of New Zealand. A potential contributory factor to these rates is the issue of access to, and engagement with, maternity services. Yet, little is known about the care midwives provide to women living in areas of socioeconomic deprivation.Using grounded theory methodology, a conceptual framework was developed from data analysis of 8 interviews undertaken with midwives between August 2000 and March 2001. Findings revealed a core category of “staying involved `because the need seems so huge.”’ Four further categories were identified: “Forming relationships with the wary,” “Giving `an awful lot of support,”’ “Remaining close by,” and “Ensuring personal coping.” Throughout, the midwives’ continued involvement with the woman ensured an optimal pregnancy outcome for both the woman and her new baby.The findings from this study inform the care provided by midwives who work with women living in areas of high deprivation and begin to address factors regarding access to, and engagement with, maternity services.
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Roggeveen Y, Birks L, Kats JV, Manyama M, Hatfield J, Bunders J, Scheele F, Roosmalen JV. Low utilization of skilled birth attendants in Ngorongoro Conservation Area, Tanzania: A complex reality requiring action. Health (London) 2013. [DOI: 10.4236/health.2013.57a4011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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