101
|
Kataoka Y, Eto H, Iida M. Outcomes of independent midwifery attended births in birth centres and home births: a retrospective cohort study in Japan. Midwifery 2013; 29:965-72. [PMID: 23415360 DOI: 10.1016/j.midw.2012.12.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 06/13/2012] [Accepted: 12/17/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE the objective of this study was to describe and compare perinatal and neonatal outcomes of women who received care from independent midwives practicing home births and at birth centres in Tokyo. DESIGN a retrospective cohort study. SETTINGS birth centres and homes serviced by independent midwives in Tokyo. PARTICIPANTS of the 43 eligible independent midwives 19 (44%) (10 assisted birth at birth centres, nine assisted home birth) participated in the study. A total of 5477 women received care during their pregnancy and gave birth assisted by these midwives between 2001 and 2006. METHODS researchers conducted a retrospective chart review of women's individual data. Collected data included demographic characteristics, process of pregnancy and perinatal and neonatal outcomes. We also collected data about independent midwives and their practice. FINDINGS of the 5477 women, 83.9% gave birth at birth centres and 16.1% gave birth at home. The average age was 31.7 years old and the majority (70.6%) were multiparas. All women had vaginal spontaneous deliveries, with no vacuum, forceps or caesarean section interventions. No maternal fatalities were reported, nor were breech or multiple births. The average duration of the first and second stages of labour was 14.9 hours for primiparas and 6.2 hours for multiparas. Most women (97.1%) gave birth within 24 hours of membrane rupture. Maternal position during labour varied and family attended birth was common. The average blood loss was 371.3mL, while blood loss over 500mL was 22.6% and over 1000mL was 3.6%. Nearly 60% of women had intact perinea. There were few preterm births (0.6%) and post mature births (1.3%). Infant's average birth weight was 3126g and 0.5% were low-birthweight-infants, while 3.3% had macrosomia. Among primiparas, the birth centre group had more women experiencing an excess of 500mL blood loss compared to the home birth group (27.2% versus 17.6% respectively; RR 1.54; 95%CI 1.10 to 2.16). Multiparas delivering at birth centres were more likely to have a blood loss over 500mL (RR1.28; 95%CI 1.07 to 1.53) and over 1000mL (RR1.75; 95%CI 1.04 to 2.82) compared to women birthing at home. CONCLUSION our results for birth outcomes with independent midwives at birth centres and home births in Japan indicated a high degree of safety and evidence-based practice. This study had some limitations because of its incomplete data and low response rate. However, this is one of the few studies that reported outcomes of Japanese independent midwives and the safety of their practice. A birth registry system would provide us with more accurate and complete information of all childbirths with which to evaluate the safety of independent Japanese midwives.
Collapse
Affiliation(s)
- Yaeko Kataoka
- St. Luke's College of Nursing, 10-1 Akashi-cho Chuo-ku, Tokyo, Japan.
| | | | | |
Collapse
|
102
|
Kozhimannil KB, Hardeman RR, Attanasio LB, Blauer-Peterson C, O'Brien M. Doula care, birth outcomes, and costs among Medicaid beneficiaries. Am J Public Health 2013; 103:e113-21. [PMID: 23409910 DOI: 10.2105/ajph.2012.301201] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared childbirth-related outcomes for Medicaid recipients who received prenatal education and childbirth support from trained doulas with outcomes from a national sample of similar women and estimated potential cost savings. METHODS We calculated descriptive statistics for Medicaid-funded births nationally (from the 2009 Nationwide Inpatient Sample; n = 279,008) and births supported by doula care (n = 1079) in Minneapolis, Minnesota, in 2010 to 2012; used multivariate regression to estimate impacts of doula care; and modeled potential cost savings associated with reductions in cesarean delivery for doula-supported births. RESULTS The cesarean rate was 22.3% among doula-supported births and 31.5% among Medicaid beneficiaries nationally. The corresponding preterm birth rates were 6.1% and 7.3%, respectively. After control for clinical and sociodemographic factors, odds of cesarean delivery were 40.9% lower for doula-supported births (adjusted odds ratio = 0.59; P < .001). Potential cost savings to Medicaid programs associated with such cesarean rate reductions are substantial but depend on states' reimbursement rates, birth volume, and current cesarean rates. CONCLUSIONS State Medicaid programs should consider offering coverage for birth doulas to realize potential cost savings associated with reduced cesarean rates.
Collapse
Affiliation(s)
- Katy Backes Kozhimannil
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, USA.
| | | | | | | | | |
Collapse
|
103
|
Merry L, Small R, Blondel B, Gagnon AJ. International migration and caesarean birth: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2013; 13:27. [PMID: 23360183 PMCID: PMC3621213 DOI: 10.1186/1471-2393-13-27] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 01/23/2013] [Indexed: 12/18/2022] Open
Abstract
Background Perinatal health disparities including disparities in caesarean births have been observed between migrant and non-migrant women and some literature suggests that non-medical factors may be implicated. A systematic review was conducted to determine if migrants in Western industrialized countries consistently have different rates of caesarean than receiving-country-born women and to identify the reasons that explain these differences. Methods Reports were identified by searching 12 literature databases (from inception to January 2012; no language limits) and the web, by bibliographic citation hand-searches and through key informants. Studies that compared caesarean rates between international migrants and non-migrants living in industrialized countries and that did not have a ‘fatal flaw’ according to the US Preventative Services Task Force criteria were included. Studies were summarized, analyzed descriptively and where possible, meta-analyzed. Results Seventy-six studies met inclusion criteria. Caesarean rates between migrants and non-migrants differed in 69% of studies. Meta-analyses revealed consistently higher overall caesarean rates for Sub-Saharan African, Somali and South Asian women; higher emergency rates for North African/West Asian and Latin American women; and lower overall rates for Eastern European and Vietnamese women. Evidence to explain the consistently different rates was limited. Frequently postulated risk factors for caesarean included: language/communication barriers, low SES, poor maternal health, GDM/high BMI, feto-pelvic disproportion, and inadequate prenatal care. Suggested protective factors included: a healthy immigrant effect, preference for a vaginal birth, a healthier lifestyle, younger mothers and the use of fewer interventions during childbirth. Conclusion Certain groups of international migrants consistently have different caesarean rates than receiving-country-born women. There is insufficient evidence to explain the observed differences.
Collapse
Affiliation(s)
- Lisa Merry
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.
| | | | | | | |
Collapse
|
104
|
Sawyer A, Rabe H, Abbott J, Gyte G, Duley L, Ayers S. Parents' experiences and satisfaction with care during the birth of their very preterm baby: a qualitative study. BJOG 2013; 120:637-43. [PMID: 23289929 PMCID: PMC3613739 DOI: 10.1111/1471-0528.12104] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2012] [Indexed: 11/29/2022]
Abstract
Objective To assess parents' experiences and satisfaction with care during very preterm birth and to identify domains associated with positive and negative experiences of care. Design Qualitative study using semi-structured interviews. Setting Three neonatal units in tertiary care hospitals in South-East England. Population Thirty-two mothers and seven fathers who had a baby born before 32 weeks of gestation and spoke English well. Methods Semi-structured interviews were conducted. Results were analysed using thematic analysis. Main outcome measures Participants' experiences and satisfaction with care during the birth of their preterm baby. Results Overall, 80% of participants were extremely satisfied with the care during the birth of their preterm baby, seven were generally satisfied but felt some things could be improved and one was dissatisfied. Four key determinants of experiences of care were identified: staff professionalism, which included information and explanation, being calm in a crisis, appearing confident and in control, and conversely not listening to the woman; staff empathy, which included caring and emotional support, and encouragement and reassurance; involvement of the father; and birth environment. Conclusions Although the determinants of experiences of care are generally consistent with previous research on term births, unique factors to preterm birth were identified. These were the importance of the staff appearing calm during the birth, and the staff portraying confidence and taking control during the birth. Women valued being listened to, and both they and their partners valued staff helping fathers to feel involved during the birth.
Collapse
Affiliation(s)
- A Sawyer
- School of Psychology, University of Sussex, Brighton, UK
| | | | | | | | | | | | | |
Collapse
|
105
|
McComish JF, Groh CJ, Moldenhauer JA. Development of a Doula Intervention for Postpartum Depressive Symptoms: Participants' Recommendations. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2013; 26:3-15. [DOI: 10.1111/jcap.12019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
106
|
Hidaka R, Callister LC. Giving birth with epidural analgesia: the experience of first-time mothers. J Perinat Educ 2013; 21:24-35. [PMID: 23277728 DOI: 10.1891/1058-1243.21.1.24] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of our qualitative descriptive study was to describe the birth experiences of women using epidural analgesia for pain management. We interviewed nine primiparas who experienced vaginal births. Five themes emerged: (a) coping with pain, (b) finding epidural administration uneventful, (c) feeling relief having an epidural, (d) experiencing joy, and (e) having unsettled feelings of ambivalence. Although epidural analgesia was found to be effective for pain relief and may contribute to some women's satisfaction with the birth experience, it does not guarantee a quality birth experience. In order to support and promote childbearing women's decision making, we recommend improved education on the variety of available pain management options, including their risks and benefits. Fostering a sense of caring, connection, and control in women is a key factor to ensure positive birth experiences, regardless of pain management method.
Collapse
|
107
|
Baas C, Wiegers T, de Cock P, Koelewijn J, Hutton E. Continuous Support During Childbirth by Maternity Care Assistants: An Exploration of Opinions in the Netherlands. INTERNATIONAL JOURNAL OF CHILDBIRTH 2013. [DOI: 10.1891/2156-5287.3.2.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND:The Netherlands maintain a high rate of home births relative to other well-resourced countries. Maternity care assistants (MCAs) play an important role, as part of the maternity care team, assisting the midwife during birth and providing postpartum care to women and babies in their homes. A Cochrane review recently described the advantages of continuous support during childbirth. We were interested in the opinions of MCAs about them having an expanded role to include continuous emotional support during childbirth as well as medical tasks such as checking the condition of the fetus and maternal labor progress through internal examination.METHODS:To explore the opinions of MCAs, four semistructured group discussions took place and 190 questionnaires were sent out to MCAs nationally.RESULTS:In both the group discussions and questionnaires, MCAs displayed positive attitudes toward providing continuous support during childbirth. In general, MCAs were not keen on adding medical tasks. The importance of a clear distribution of responsibilities between midwives and MCAs was reported. Most (60.0%) thought midwives would appreciate MCAs providing continuous support. Furthermore, 40.5% disagreed with dividing the profession into childbirth care and postpartum care teams. Two-thirds mentioned the need for extra training in childbirth assistance.CONCLUSION:In general, MCAs were positive about providing continuous support during childbirth. Most MCAs think that it is unwise to give MCAs additional medical responsibilities. The opinions differ concerning issues of practical organization. MCAs generally thought extra schooling was important to be and feel competent to assist childbirth.
Collapse
|
108
|
Al-Mandeel HM, Almufleh AS, Al-Damri AJT, Al-Bassam DA, Hajr EA, Bedaiwi NA, Alshehri SM. Saudi womens acceptance and attitudes towards companion support during labor: should we implement an antenatal awareness program? Ann Saudi Med 2013; 33:28-33. [PMID: 23458937 PMCID: PMC6078577 DOI: 10.5144/0256-4947.2013.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the known benefits of support during chilbirth, most hospitals in Saudi Arabia do not allow a companion during labor. This can be due to cultural beliefs among pregnant Saudi women. The aims of this study are to describe Saudi women's preferences towards supportive companions during labor and to explore their attitudes and knowledge about the importance of support during childbirth. DESIGN AND SETTING Prospective cohort study conducted in three governmental tertiary hospitals within Riyadh. SUBJECTS AND METHODS Women who consented were interviewed during their postpartum hospital stay using a validated standardized Arabic questionnaire. Participants were asked about their preferences and attitudes towards companions during childbirth, as well as about their knowledge on the importance of such support. RESULTS Of 402 women who participated in the study, 182 women (45.3%) preferred the presence of a companion during childbirth and only 57 of all interviewed women (14.2%) had ever had a supportive companion during any of their previous childbirths. The mother (58%) or husband (51%) was the most preferred person as a childbirth companion. Age, level of educational, or antenatal, intrapartum or postpartum status had no impact on their decision. However, women who had some sort of antenatal educational classes and/or read educational material about childbirth were more likely to prefer support during labor. More than one-third of participants (35.9%) thought that having a companion as support during labor would not help, but the most common reason for not preferring to have a companion was their fear of being exposed most of the time to their companion (64.1%). CONCLUSIONS A significant percentage of surveyed Saudi women preferred not to have a supportive companion during childbirth. The reason might be a lack of understanding of the positive role of a companion during childbirth or because of cultural beliefs. Education of women during their antenatal care about the importance and the implementation of such a practice are warranted.
Collapse
Affiliation(s)
- Hazem Mahmoud Al-Mandeel
- Obstetrics and Gynecology Department, King Khalid University Hospital, College of Medicine King Saud University, Riyadh, Saudi Arabia.
| | | | | | | | | | | | | |
Collapse
|
109
|
Supporting Healthy and Normal Physiologic Childbirth: A Consensus Statement by ACNM, MANA, and NACPM. J Perinat Educ 2013; 22:14-8. [PMID: 24381472 PMCID: PMC3647729 DOI: 10.1891/1058-1243.22.1.14] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
110
|
Thorstensson S, Ekström A, Lundgren I, Hertfelt Wahn E. Exploring Professional Support Offered by Midwives during Labour: An Observation and Interview Study. Nurs Res Pract 2012; 2012:648405. [PMID: 23304482 PMCID: PMC3529493 DOI: 10.1155/2012/648405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 11/02/2012] [Indexed: 11/17/2022] Open
Abstract
Support in labour has an impact on the childbirth experience as well as on childbirth outcomes. Both social and professional support is needed. The aim of this study was to explore professional support offered by midwives during labour in relation to the supportive needs of the childbearing woman and her partner. The study used a qualitative, inductive design using triangulation, with observation followed by interviews. Seven midwives were observed when caring for seven women/couples in labour. After the observations, individual interviews with midwives, women, and their partners were conducted. Data were analysed using hermeneutical text interpretation. The results are presented with three themes. (1) Support as a professional task seems unclear and less well defined than medical controls. (2) Midwives and parents express somewhat different supportive ideas about how to create a sense of security. (3) Partner and midwife interact in support of the childbearing woman. The main interpretation shows that midwives' supportive role during labour could be understood as them mainly adopting the "with institution" ideology in contrast to the "with woman" ideology. This may increase the risk of childbearing women and their partners perceiving lack of support during labour. There is a need to increase efficiency by providing support for professionals to adopt the "with woman" ideology.
Collapse
Affiliation(s)
- Stina Thorstensson
- School of Life Sciences, University of Skövde, P.O. Box 408, 54128 Skövde, Sweden
- School of Health and Medical Sciences, Örebro University, 70182 Örebro, Sweden
| | - Anette Ekström
- School of Life Sciences, University of Skövde, P.O. Box 408, 54128 Skövde, Sweden
| | - Ingela Lundgren
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530 Gothenburg, Sweden
| | | |
Collapse
|
111
|
Jiang H, Li M, Yang D, Wen LM, Hunter C, He G, Qian X. Awareness, intention, and needs regarding breastfeeding: findings from first-time mothers in Shanghai, China. Breastfeed Med 2012; 7:526-34. [PMID: 22424469 PMCID: PMC3523237 DOI: 10.1089/bfm.2011.0124] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite efforts, a decline in breastfeeding rates has been documented in China recently. This study explored the awareness of the World Health Organization (WHO) guidelines for breastfeeding and intention to breastfeed among first-time mothers and identified the gap between mothers' needs and perinatal care provision regarding breastfeeding promotion. SUBJECTS AND METHODS In total, 653 women at 5-22 gestational weeks were recruited from four community health centers in Shanghai, China. They completed a self-administered questionnaire at recruitment. Two focus group discussions were held among third-trimester pregnant women who had received prenatal education. Twenty-four in-depth interviews were conducted among postpartum mothers. RESULTS During early pregnancy, a substantial proportion of mothers were not aware of the nutritional value of breastmilk (40%) or the value of exclusive breastfeeding for 6 months (80%) or any breastfeeding for 24 months (98%). The awareness of the WHO guidelines for breastfeeding was associated with intention to breastfeed (adjusted odds ratio [OR] 2.67, 95% confidence interval [CI] 1.88, 3.78) or intention to breastfeed exclusively (adjusted OR 3.31, 95% CI 1.81, 6.06). In late pregnancy and postpartum, most mothers were still not fully aware of the breastfeeding recommendations and nutritional value of breastmilk. Limited communications with healthcare providers and lack of support for dealing with breastfeeding difficulties were reported. CONCLUSIONS Low awareness of the WHO breastfeeding guidelines was found among first-time mothers in Shanghai. Awareness of breastfeeding guidelines was independently associated with mothers' intention to breastfeed and intention to breastfeed exclusively. The health benefits of breastfeeding and the recommended duration of breastfeeding should be emphasized in prenatal education programs.
Collapse
Affiliation(s)
- Hong Jiang
- School of Public Health, Fudan University, Shanghai, China
| | | | | | | | | | | | | |
Collapse
|
112
|
Abstract
Health care organizations often struggle with issues related to communication with patients who have limited English proficiency. Providing quality interpreter services is necessary to comply with regulatory mandates and to provide safe, effective health care. Maternity care presents a unique situation due to the intimate and unpredictable nature of birth. A unique interpreter/doula program in which trained medical interpreters received additional education in labor and postpartum doula skills was tested at a large urban hospital maternity center with a large population of Spanish-speaking patients. Results showed that interpreter/doulas can offer timely, competent care in a variety of maternity situations. They also were cost-effective and associated with increased patient and staff satisfaction.
Collapse
Affiliation(s)
- Sandra Maher
- IU Health/Methodist Hospital in Indianapolis, IN, USA
| | | | | |
Collapse
|
113
|
Madden K, Middleton P, Cyna AM, Matthewson M, Jones L. Hypnosis for pain management during labour and childbirth. Cochrane Database Syst Rev 2012; 11:CD009356. [PMID: 23152275 DOI: 10.1002/14651858.cd009356.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This review is one in a series of Cochrane Reviews investigating pain management for childbirth. These reviews all contribute to an overview of systematic reviews of pain management for women in labour, and share a generic protocol. We examined the current evidence regarding the use of hypnosis for pain management during labour and childbirth. This review updates the findings regarding hypnosis from an earlier review of complementary and alternative therapies for pain management in labour into a stand-alone review. OBJECTIVES To examine the effectiveness and safety of hypnosis for pain management during labour and childbirth. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (11 January 2012) and the reference lists of primary studies and review articles. SELECTION CRITERIA Randomised controlled trials and quasi-randomised controlled trials comparing preparation for labour using hypnosis and/or use of hypnosis during labour, with or without concurrent use of pharmacological or non-pharmacological pain relief methods versus placebo, no treatment or any analgesic drug or technique. DATA COLLECTION AND ANALYSIS Two assessors independently extracted data and assessed trial quality. Where possible we contacted study authors seeking additional information about data and methodology. MAIN RESULTS We included seven trials randomising a total of 1213 women. All but one of the trials were at moderate to high risk of bias. Although six of the seven trials assessed antenatal hypnotherapy, there were considerable differences between these trials in timing and technique. One trial provided hypnotherapy during labour. No significant differences between women in the hypnosis group and those in the control group were found for the primary outcomes: use of pharmacological pain relief (average risk ratio (RR) 0.63, 95% confidence interval (CI) 0.39 to 1.01, six studies, 1032 women), spontaneous vaginal birth (average RR 1.35, 95% CI 0.93 to 1.96, four studies, 472 women) or satisfaction with pain relief (RR 1.06, 95% CI 0.94 to 1.20, one study, 264 women). There was significant statistical heterogeneity in the data for use of pharmacological pain relief and spontaneous vaginal birth. The primary outcome of sense of coping with labour was reported in two studies as showing no beneficial effect (no usable data available for this review). For secondary outcomes, no significant differences were identified between women in the hypnosis group and women in the control group for most outcomes where data were available. For example, there was no significant difference for satisfaction with the childbirth experience (average RR 1.36, 95% CI 0.52 to 3.59, two studies, 370 women), admissions to the neonatal intensive care unit (average RR 0.58, 95% CI 0.12 to 2.89, two studies, 347 women) or breastfeeding at discharge from hospital (RR 1.00, 95% CI 0.97 to 1.03, one study, 304 women). There was some evidence of benefits for women in the hypnosis group compared with the control group for pain intensity, length of labour and maternal hospital stay, although these findings were based on single studies with small numbers of women. Pain intensity was found to be lower for women in the hypnosis group than those in the control group in one trial of 60 women (mean difference (MD) -0.70, 95% CI -1.03 to -0.37). The same study found that the average length of labour from 5 cm dilation to birth (minutes) was significantly shorter for women in the hypnosis group (mean difference -165.20, 95% CI -223.53 to -106.87, one study, 60 women). Another study found that a smaller proportion of women in the hypnosis group stayed in hospital for more than two days after the birth compared with women in the control group (RR 0.11, 95% CI 0.02 to 0.83, one study, 42 women). AUTHORS' CONCLUSIONS There are still only a small number of studies assessing the use of hypnosis for labour and childbirth. Although the intervention shows some promise, further research is needed before recommendations can be made regarding its clinical usefulness for pain management in maternity care.
Collapse
Affiliation(s)
- Kelly Madden
- School of Psychology, University of Tasmania, Hobart, Australia.
| | | | | | | | | |
Collapse
|
114
|
Hofmeyr GJ, Novikova N. Perineal dilators for facilitating the second stage of labour. Hippokratia 2012. [DOI: 10.1002/14651858.cd010197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- G Justus Hofmeyr
- University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health; Department of Obstetrics and Gynaecology, East London Hospital Complex; Frere and Cecilia Makiwane Hospitals Private Bag X 9047 East London Eastern Cape South Africa 5200
| | - Natalia Novikova
- Walter Sisulu University; Department of Obstetrics and Gynaecology, East London Hospital Complex; Private Bag X9047 East London South Africa 5200
| |
Collapse
|
115
|
Deline J, Varnes-Epstein L, Dresang LT, Gideonsen M, Lynch L, Frey JJ. Low primary cesarean rate and high VBAC rate with good outcomes in an Amish birthing center. Ann Fam Med 2012; 10:530-7. [PMID: 23149530 PMCID: PMC3495927 DOI: 10.1370/afm.1403] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Recent national guidelines encourage a trial of labor after cesarean (TOLAC) as a means of increasing vaginal births after cesarean (VBACs) and decreasing the high US cesarean birth rate and its consequences (2010 National Institute of Health Consensus Statement and American College of Obstetricians and Gynecologists revised guideline). A birthing center serving Amish women in Southwestern Wisconsin offered an opportunity to look at the effects of local culture and practices that support vaginal birth and TOLAC. This study describes childbirth and perinatal outcomes during a 17-year period in LaFarge, Wisconsin. METHODS We undertook a retrospective analysis of the records of all women admitted to the birth center in labor. Main outcome measures include rates of cesarean deliveries, TOLAC and VBAC deliveries, and perinatal outcomes for 927 deliveries between 1993 and 2010. RESULTS The cesarean rate was 4% (35 of 927), the TOLAC rate was 100%, and the VBAC rate was 95% (88 of 92). There were no cases of uterine rupture and no maternal deaths. The neonatal death rate of 5.4 of 1,000 was comparable to that of Wisconsin (4.6 of 1,000) and the United States (4.5 of 1,000). CONCLUSIONS Both the culture of the population served and a number of factors relating to the management of labor at the birthing center have affected the rates of cesarean delivery and TOLAC. The results of the LaFarge Amish study support a low-technology approach to delivery where good outcomes are achieved with low cesarean and high VBAC rates.
Collapse
|
116
|
Thies-Lagergren L, Kvist LJ, Sandin-Bojö AK, Christensson K, Hildingsson I. Labour augmentation and fetal outcomes in relation to birth positions: a secondary analysis of an RCT evaluating birth seat births. Midwifery 2012; 29:344-50. [PMID: 23084490 DOI: 10.1016/j.midw.2011.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 12/11/2011] [Accepted: 12/17/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE the aim of this study was to compare the use of synthetic oxytocin for augmentation, duration of labour and birth and infant outcomes in nulliparous women randomised to birth on a birth seat or any other position. STUDY DESIGN a randomised controlled trial in Sweden where 1002 women were randomised to birth on a birth seat (experimental group) or birth in any other position (control group). Data were collected between November 2006 and July 2009. The outcome measurements included synthetic oxytocin augmentation, duration of the second stage of labour and fetal outcome. Analysis was by intention to treat. SETTING southern Sweden. FINDINGS the main findings of this study were that women randomised to the experimental group had a statistically significant shorter second stage of labour than women randomised to the control group. There were no differences between the groups for use of synthetic oxytocin augmentation or for neonatal outcomes. CONCLUSIONS women allocated to the birth seat had a significantly shorter second stage of labour despite similar numbers of women subjected to synthetic oxytocin augmentation in the study groups. The adverse neonatal outcomes did not differ between groups. The birth seat can be suggested as non-medical intervention used to reduce duration of second stage labour and birth. The birth seat can be suggested as a non-medical intervention that may facilitate reduced duration of the second stage of labour. Furthermore it is recommended that caregivers, both midwives and midwifery students, should learn skills to assist women in using a variety of birth positions. TRIAL REGISTRATION unique Protocol ID: Dnr 2009/739 (register.clinicaltrials.gov).
Collapse
Affiliation(s)
- Li Thies-Lagergren
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | | | |
Collapse
|
117
|
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 (30 June 2012). 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.
Collapse
Affiliation(s)
- Ellen D Hodnett
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | | | | | | |
Collapse
|
118
|
Abstract
Some intrapartum care practices promote vaginal birth, whereas others may increase the risk for cesarean section. Electronic fetal monitoring and use of the Friedman graph to plot and monitor labor progress are associated with increasing the cesarean section rate. Continuous one-to-one support and midwifery management are associated with lower cesarean section rates. This article reviews the evidence that links specific intrapartum care practices to cesarean section. Strategies that can be implemented in the current social and cultural setting of obstetrics today are recommended.
Collapse
Affiliation(s)
- Tekoa L King
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
| |
Collapse
|
119
|
Wei S, Wo BL, Qi HP, Xu H, Luo ZC, Roy C, Fraser WD. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database Syst Rev 2012; 9:CD006794. [PMID: 22972098 PMCID: PMC4160792 DOI: 10.1002/14651858.cd006794.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Caesarean section rates are over 20% in many developed countries. The main diagnosis contributing to the high rate in nulliparae is dystocia or prolonged labour. The present review assesses the effects of a policy of early amniotomy with early oxytocin administration for the prevention of, or the therapy for, delay in labour progress. OBJECTIVES To estimate the effects of early augmentation with amniotomy and oxytocin for prevention of, or therapy for, delay in labour progress on the caesarean birth rate and on indicators of maternal and neonatal morbidity. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 February 2012), MEDLINE (1966 to 15 February 2012), EMBASE (1980 to 15 February 2012), CINAHL (1982 to 15 February 2012), MIDIRS (1985 to February 2012) and contacted authors for data from unpublished trials. SELECTION CRITERIA Randomized and quasi-randomized controlled trials that compared oxytocin and amniotomy with expectant management. DATA COLLECTION AND ANALYSIS Three review authors extracted data independently. We stratified the analyses into 'Prevention Trials' and 'Therapy Trials' according to the status of the woman at the time of randomization. Participants in the 'Prevention Trials' were unselected women, without slow progress in labour, who were randomized to a policy of early augmentation or to routine care. In 'Treatment Trials' women were eligible if they had an established delay in labour progress. MAIN RESULTS For this update, we have included a further two new clinical trials. This updated review includes 14 trials, randomizing a total of 8033 women. The unstratified analysis found early intervention with amniotomy and oxytocin to be associated with a modest reduction in the risk of caesarean section; however, the confidence interval (CI) included the null effect (risk ratio (RR) 0.89; 95% CI 0.79 to 1.01; 14 trials; 8033 women). In prevention trials, early augmentation was associated with a modest reduction in the number of caesarean births (RR 0.87; 95% CI 0.77 to 0.99; 11 trials; 7753). A policy of early amniotomy and early oxytocin was associated with a shortened duration of labour (average mean difference (MD) - 1.28 hours; 95% CI -1.97 to -0.59; eight trials; 4816 women). Sensitivity analyses excluding four trials with a full package of active management did not substantially affect the point estimate for risk of caesarean section (RR 0.87; 95% CI 0.73 to 1.05; 10 trials; 5165 women). We found no other significant effects for the other indicators of maternal or neonatal morbidity. AUTHORS' CONCLUSIONS In prevention trials, early intervention with amniotomy and oxytocin appears to be associated with a modest reduction in the rate of caesarean section over standard care.
Collapse
Affiliation(s)
- Shuqin Wei
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montréal, Canada
| | - Bi Lan Wo
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montréal, Canada
| | - Hui-Ping Qi
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Hairong Xu
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montréal, Canada
| | - Zhong-Cheng Luo
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montréal, Canada
| | - Chantal Roy
- Unité de recherche clinique appliquée, CHU Ste-Justine, Montreal, Canada
| | - William D Fraser
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montréal, Canada
| |
Collapse
|
120
|
Abstract
BACKGROUND Observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications. This is an update of a Cochrane review first published in 1998. OBJECTIVES To assess the effects of planned hospital birth compared with planned home birth in selected low-risk women, assisted by an experienced midwife with collaborative medical back up in case transfer should be necessary. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 March 2012) and contacted editors and authors involved with possible trials. SELECTION CRITERIA Randomised controlled trials comparing planned hospital birth with planned home birth in low-risk women as described in the objectives. DATA COLLECTION AND ANALYSIS The two review authors as independently as possible assessed trial quality and extracted data. We contacted study authors for additional information. MAIN RESULTS Two trials met the inclusion criteria but only one trial involving 11 women provided some outcome data and was included. The evidence from this trial was of moderate quality and too small to allow conclusions to be drawn. AUTHORS' CONCLUSIONS There is no strong evidence from randomised trials to favour either planned hospital birth or planned home birth for low-risk pregnant women. However, the trials show that women living in areas where they are not well informed about home birth may welcome ethically well-designed trials that would ensure an informed choice. As the quality of evidence in favour of home birth from observational studies seems to be steadily increasing, it might be as important to prepare a regularly updated systematic review including observational studies as described in the Cochrane Handbook for Systematic Reviews of Interventions as to attempt to set up new randomised controlled trials.
Collapse
Affiliation(s)
- Ole Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen,Copenhagen K, Denmark. @gmail.com
| | | |
Collapse
|
121
|
Gaudineau A, Sauleau EA, Nisand I, Langer B. [Obstetric and neonatal outcomes in a home-like birth centre: a case-control study]. ACTA ACUST UNITED AC 2012; 40:524-8. [PMID: 22902711 DOI: 10.1016/j.gyobfe.2012.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 05/07/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare intervention rates associated with labor in low-risk women who began their labor in the "home-like birth centre" and the traditional delivery room. PATIENTS AND METHODS This retrospective study used data that were collected from January 2005 through June 2008, from women admitted to the "home-like birth centre" (n=316) and compared to a group of randomly selected low-risk women admitted to the traditional labor ward (n=890) using the Baysian Information Criterion to select the best predictive model. RESULTS Women in the "home-like birth centre" had spontaneous vaginal deliveries more often (88.6% versus 82.8%, P value 0.034) and perineal lesions less often (60.1% versus 62.5%, P value 0.013). The frequency of adverse neonatal outcomes did not differ statistically between the two groups, although mean clamped at birth umbilical arterial pH level was higher in the "home-like birth centre" group. The transfer rate from "home-like birth centre" to traditional labor ward was 31.3%. DISCUSSION AND CONCLUSIONS It appears that women could benefit from "home-like birth centre" care in settings such as the one studied. Larger observational studies are warranted to validate these results.
Collapse
Affiliation(s)
- A Gaudineau
- Département de gynécologie-obstétrique, centre hospitalo-universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | | | | | | |
Collapse
|
122
|
What is meant by one-to-one support in labour: Analysing the concept. Midwifery 2012; 28:391-7. [DOI: 10.1016/j.midw.2011.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 06/22/2011] [Accepted: 07/09/2011] [Indexed: 11/24/2022]
|
123
|
Abstract
The purpose of this metasynthesis is to describe and interpret qualitative research relating to midwife-led care to see if it sheds light on why low-risk women experience fewer birth interventions within this model of care. Eleven articles were included in the review. Three themes emerged: (a) relationally mediated benefits for women that resulted in increased agency and empathic care; (b) the problematic interface of midwife-led units with host maternity units, stemming from a clash of models and culture; and (c) greater agency for midwives within midwife-led models of care though bounded by the relationship with the host maternity unit. This metasynthesis suggests that lower rates of interventions could be linked to the greater agency experienced by women and midwives within midwife-led models, and that these effects are mediated, in part, by the smallness of scale in these settings.
Collapse
|
124
|
Aquino EML, Menezes G, Barreto-de-Araújo TV, Alves MT, Alves SV, Almeida MDCCD, Schiavo E, Lima LP, Menezes CASD, Marinho LFB, Coimbra LC, Campbell O. Qualidade da atenção ao aborto no Sistema Único de Saúde do Nordeste brasileiro: o que dizem as mulheres? CIENCIA & SAUDE COLETIVA 2012; 17:1765-76. [DOI: 10.1590/s1413-81232012000700015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 04/10/2012] [Indexed: 11/21/2022] Open
Abstract
O aborto é grave problema de saúde no Brasil e suas complicações podem ser evitadas por atenção adequada e oportuna. O artigo avalia a qualidade da atenção às mulheres admitidas por aborto em hospitais do Sistema Único de Saúde, em Salvador, Recife e São Luís, tendo como referência as normas do Ministério da Saúde e o grau de satisfação das usuárias. Trata-se de inquérito com 2.804 usuárias, internadas por complicações do aborto em 19 hospitais, de agosto a dezembro de 2010. Considerou-se 4 dimensões - acolhimento e orientação, insumos/ambiente físico, qualidade técnica e continuidade do cuidado - desdobradas em critérios e indicadores. A adequação às normas foi maior quanto aos critérios de acolhimento e orientação. O apoio social e o direito à informação alcançaram valores baixos nas três cidades. A qualidade técnica do cuidado foi mal avaliada. Em insumos e ambiente físico, a limpeza foi o critério menos adequado. A situação é mais crítica na continuidade do cuidado nas 3 cidades, pela falta de consulta agendada de revisão, de informações sobre cuidados após alta hospitalar, risco de gravidez e planejamento familiar. A atenção ao aborto nessas cidades encontra-se distante do que propõem as normas brasileiras e os organismos internacionais.
Collapse
|
125
|
Sapkota S, Kobayashi T, Kakehashi M, Baral G, Yoshida I. In the Nepalese context, can a husband's attendance during childbirth help his wife feel more in control of labour? BMC Pregnancy Childbirth 2012; 12:49. [PMID: 22698006 PMCID: PMC3464724 DOI: 10.1186/1471-2393-12-49] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 05/28/2012] [Indexed: 11/30/2022] Open
Abstract
Background A husband’s support during childbirth is vital to a parturient woman’s emotional well-being. Evidence suggests that this type of support enables a woman to feel more in control during labour by reducing maternal anxiety during childbirth. However, in Nepal, where childbearing is considered an essential element of a marital relationship, the husband’s role in this process has not been explored. Therefore, we examined whether a woman in Nepal feels more in control during labour when her husband is present, compared to when another woman accompanies her or when she has no support person. Methods The study participants were low risk primigravida women in the following categories: women who gave birth with their husband present (n = 97), with a female friend present (n = 96), with mixed support (n = 11), and finally, a control group (n = 105). The study was conducted in the public maternity hospital in Kathmandu in 2011. The Labour Agentry Scale (LAS) was used to measure the extent to which women felt in control during labour. The study outcome was compared using an F-test from a one-way analysis of variance, and multiple regression analyses. Results The women who gave birth with their husband’s support reported higher mean LAS scores (47.92 ± 6.95) than the women who gave birth with a female friend’s support (39.91 ± 8.27) and the women in the control group (36.68 ± 8.31). The extent to which the women felt in control during labour was found to be positively associated with having their husband’s company during childbirth (β = 0.54; p < 0.001) even after adjusting for background variables. In addition, having a female friend’s company during childbirth was related to the women’s feeling of being in control during labour (β = 0.19; p < 0.001) but the effect size was smaller than for a husband’s company. Conclusion The results show that when a woman’s husband is present at the birth, she feels more in control during labour. This finding has strong implications for maternity practices in Nepal, where maternity wards rarely encourage a woman to bring her husband to a pregnancy appointment and to be present during childbirth.
Collapse
Affiliation(s)
- Sabitri Sapkota
- Department of Health Promotion and Development, Graduate School of Health Sciences, Hiroshima University, Hiroshima, Japan.
| | | | | | | | | |
Collapse
|
126
|
Tingstig C, Gottvall K, Grunewald C, Waldenström U. Satisfaction with a modified form of in-hospital birth center care compared with standard maternity care. Birth 2012; 39:106-14. [PMID: 23281858 DOI: 10.1111/j.1523-536x.2012.00533.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND For safety reasons an in-hospital birth center was replaced by a modified form of birth center care with the same medical guidelines and equipment as in standard care. The aim of this study was to investigate women's and men's satisfaction with modified care compared with standard care. METHODS Women in both groups gave birth from July 2007 to July 2008. The same medical low-risk criteria during pregnancy applied to both groups. Of those invited to the study, 547 (82.7%) women in modified birth center care and 445 (66.7%) men returned a questionnaire posted 2 months after the birth, and 786 (71.6%) women and 639 (58.2%) men in standard care. Odds ratios (ORs) for being satisfied were calculated with 95 percent confidence intervals (CIs) and adjusted for possible confounders. We also explored the effects of different components of care on overall satisfaction. RESULTS Adjusted ORs for being satisfied overall were approximately doubled in the modified birth center group compared with the standard care group: antenatal care-OR: 2.1 (95% CI: 1.6-2.7) in women and OR: 2.2 (95% CI: 1.5-2.8) in men; intrapartum care-OR: 2.2 (95% CI: 1.7-2.9) in women and OR: 1.7 (95% CI: 1.3-2.4) in men; and postpartum care-OR: 1.7 in women (95% CI: 1.4-2.2) and OR: 2.1 (95% CI: 1.6-2.8) in men. Important explanations of these differences included perception of the midwife as being more supportive, the presence of a calmer environment and atmosphere (intrapartum), and the option for fathers to stay overnight (postpartum). CONCLUSION In-hospital birth center with medical equipment on site increased overall satisfaction with all episodes of care compared with standard care. (BIRTH 39:2 June 2012).
Collapse
|
127
|
Williams ADC, Morris J, Stevens K, Gessler S, Cella M, Baxter J. What influences midwives in estimating labour pain? Eur J Pain 2012; 17:86-93. [DOI: 10.1002/j.1532-2149.2012.00154.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2012] [Indexed: 12/30/2022]
Affiliation(s)
- A.C. de C. Williams
- Research Department of Clinical, Education and Health Psychology; University College London; UK
| | - J. Morris
- Research Department of Clinical, Education and Health Psychology; University College London; UK
| | | | - S. Gessler
- UCL Elizabeth Garrett Anderson Institute for Women's Health; University College London Hospitals NHS Trust; UK
| | - M. Cella
- Research Department of Clinical, Education and Health Psychology; University College London; UK
| | - J. Baxter
- Women and Children's Division; Buckinghamshire Healthcare NHS Trust; Stoke Mandeville Hospital; Aylesbury; UK
| |
Collapse
|
128
|
Vixner L, Mårtensson LB, Stener-Victorin E, Schytt E. Manual and electroacupuncture for labour pain: study design of a longitudinal randomized controlled trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2012; 2012:943198. [PMID: 22577468 PMCID: PMC3345610 DOI: 10.1155/2012/943198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 02/10/2012] [Accepted: 02/12/2012] [Indexed: 11/18/2022]
Abstract
Introduction. Results from previous studies on acupuncture for labour pain are contradictory and lack important information on methodology. However, studies indicate that acupuncture has a positive effect on women's experiences of labour pain. The aim of the present study was to evaluate the efficacy of two different acupuncture stimulations, manual or electrical stimulation, compared with standard care in the relief of labour pain as the primary outcome. This paper will present in-depth information on the design of the study, following the CONSORT and STRICTA recommendations. Methods. The study was designed as a randomized controlled trial based on western medical theories. Nulliparous women with normal pregnancies admitted to the delivery ward after a spontaneous onset of labour were randomly allocated into one of three groups: manual acupuncture, electroacupuncture, or standard care. Sample size calculation gave 101 women in each group, including a total of 303 women. A Visual Analogue Scale was used for assessing pain every 30 minutes for five hours and thereafter every hour until birth. Questionnaires were distributed before treatment, directly after the birth, and at one day and two months postpartum. Blood samples were collected before and after the first treatment. This trial is registered at ClinicalTrials.gov: NCT01197950.
Collapse
Affiliation(s)
- Linda Vixner
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Retzius väg 13A, 171 77 Stockholm, Sweden
- School of Health and Social Studies, Dalarna University, Högskolan Dalarna, 791 88 Falun, Sweden
| | - Lena B. Mårtensson
- School of Life Sciences, University of Skövde, P.O. Box 408, 541 28 Skövde, Sweden
- College of Nursing, University of Rhode Island, White Hall, 2 Heathman Road, Kingston, RI 02881-2021, USA
| | - Elisabet Stener-Victorin
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Erica Schytt
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Retzius väg 13A, 171 77 Stockholm, Sweden
- Centre for Clinical Research Dalarna, Nissers väg 3, 791 82 Falun, Sweden
| |
Collapse
|
129
|
"Da lag sie eben da, wie Jesus am Kreuz ..." - Die Erfahrungen von Vätern bei der Geburt. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2012; 58:26-41. [DOI: 10.13109/zptm.2012.58.1.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
130
|
Overgaard C, Fenger-Grøn M, Sandall J. The impact of birthplace on women's birth experiences and perceptions of care. Soc Sci Med 2012; 74:973-81. [PMID: 22326105 DOI: 10.1016/j.socscimed.2011.12.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 12/01/2011] [Accepted: 12/05/2011] [Indexed: 01/19/2023]
Abstract
Overall birth experience is an important outcome of birth, and studies of psycho-social birth outcomes and women's perspectives on care are increasingly used to evaluate and develop maternity care services. We examined the influence of birthplace on women's birth experiences and perceptions of care in two freestanding midwifery units (FMU) and two obstetric units (OU) in north Denmark, all pursuing an ideal of high-quality, humanistic and patient-centred care. As part of a matched cohort study, a postal questionnaire survey was undertaken. Two hundred and eighteen low-risk women in FMU care, admitted between January-October 2006, and an obstetrically/socio-demographically matched control group of 218 low-risk women admitted to an OU were invited to participate. Three hundred and seventy-five women (86%) responded. Birth experience and satisfaction with care were rated significantly more positively by FMU than by OU women. Significantly better results for FMU care were also found for specific patient-centred care elements (support, participation in decision-making, attentiveness to psychological needs and to wishes for birth, information, and for women's feeling of being listened to). Adjustment for medical birth factors slightly increased the positive effect of FMU care. Subgroup analysis showed that a significant, negative effect of low education and employment level on birth experience was found only for the OU group. Our results provide strong support of FMU care and underline the big challenges in providing individual and supportive care for all women, especially in OUs. Policy-makers and professionals need to consider how the advantages provided by FMU care can support the effort to improve women's birth experience and possibly also the combat of the negative effect of social disadvantage on health.
Collapse
Affiliation(s)
- Charlotte Overgaard
- Department of Sociology and Social work, Aalborg University, Krogstræde 5, room 10, 9220 Aalborg Øst, Denmark.
| | | | | |
Collapse
|
131
|
Larsen R, Plog M. The Effectiveness of Childbirth Classes for Increasing Self-Efficacy in Women and Support Persons. INTERNATIONAL JOURNAL OF CHILDBIRTH 2012. [DOI: 10.1891/2156-5287.2.2.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE: Determine the effectiveness of childbirth classes for increasing self-efficacy on expectant women and support persons.MATERIALS & METHODS: This quasi-experimental study used an 18-question self-efficacy instrument to survey 115 expectant women and 103 support persons prior to and immediately following childbirth classes.RESULTS: Childbirth classes significantly increased self-efficacy scores of both the women (t[82] = 211.059, p < 0.000) and the support person (t[77] = 11.673, p < 0.000). Support persons had significantly higher self-efficacy scores after the childbirth class than the women (t[175] = 22.55, p = 0.012). Type of class attended did not significantly affect self-efficacy. Dealing with labor without pain medication continued to be an area of low self-efficacy for women following childbirth classes. Evaluation of childbirth classes will help educators refine content and methods for delivery of childbirth education. Ultimately, improved patient education will result in greater patient satisfaction and optimal birth outcomes.
Collapse
|
132
|
Roberts CL, Algert CS, Ford JB, Todd AL, Morris JM. Pathways to a rising caesarean section rate: a population-based cohort study. BMJ Open 2012; 2:bmjopen-2012-001725. [PMID: 22952166 PMCID: PMC3437430 DOI: 10.1136/bmjopen-2012-001725] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To determine whether the obstetric pathways leading to caesarean section changed from one decade to another. We also aimed to explore how much of the increase in caesarean rate could be attributed to maternal and pregnancy factors including a shift towards delivery in private hospitals. DESIGN Population-based record linkage cohort study. SETTING New South Wales, Australia. PARTICIPANTS For annual rates, all women giving birth in NSW during 1994 to 2009 were included. To examine changes in obstetric pathways two cohorts were compared: all women with a first-birth during either 1994-1997 (82 988 women) or 2001-2004 (85 859 women) and who had a second (sequential) birth within 5 years of their first-birth. PRIMARY OUTCOME MEASURES Caesarean section rates, by parity and onset of labour. RESULTS For first-births, prelabour and intrapartum caesarean rates increased from 1994 to 2009, with intrapartum rates rising from 6.5% to 11.7%. This fed into repeat caesarean rates; from 2003, over 18% of all multiparous births were prelabour repeat caesareans. In the 1994-1997 cohort, 17.7% of women had a caesarean delivery for their first-birth. For their second birth, the vaginal birth after caesarean (VBAC) rate was 28%. In the 2001-2004 cohort, 26.1% of women had a caesarean delivery for their first-birth and the VBAC rate was 16%. Among women with a first-birth, maternal and pregnancy factors and increasing deliveries in private hospitals, only explained 24% of the rise in caesarean rates from 1994 to 2009. CONCLUSIONS Rising first-birth caesarean rates drove the overall increase. Maternal factors and changes in public/private care could explain only a quarter of the increase. Changes in the perceived risks of vaginal birth versus caesarean delivery may be influencing the pregnancy management decisions of clinicians and/or mothers.
Collapse
Affiliation(s)
- Christine L Roberts
- Department of Obstetrics, Gynaecology and Neonatology, University of Sydney at Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | | | | | | | | |
Collapse
|
133
|
From Home to Hospital: Mistreatment of Childbearing Women and Barriers to Facility-Based Birth in Nicaragua. INTERNATIONAL JOURNAL OF CHILDBIRTH 2012. [DOI: 10.1891/2156-5287.2.1.40] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Worldwide, women continue to die during childbirth despite efforts to reduce maternal mortality. Nicaragua, particularly the North Atlantic Autonomous Region (RAAN), possesses extremely high rates of maternal mortality. It has been suggested that promoting facility-based birth is an effective method to reduce maternal mortality through providing essential obstetric and emergency obstetric care to the most women. A significant barrier to increasing rates of facility-based birth globally is mistreatment of women patients in health care settings. This case report illustrates the mistreatment of childbearing women during facility-based birth in the RAAN, including verbal abuse, physical abuse, neglect, and use of unnecessary medical interventions.
Collapse
|
134
|
Wang Z, Sun W, Zhou H. Midwife-led care model for reducing caesarean rate: A novel concept for worldwide birth units where standard obstetric care still dominates. JOURNAL OF MEDICAL HYPOTHESES AND IDEAS 2012. [DOI: 10.1016/j.jmhi.2012.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
135
|
Abstract
BACKGROUND Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labour. However, there are concerns regarding unintended adverse effects on the mother and infant. OBJECTIVES To assess the effects of all modalities of epidural analgesia (including combined-spinal-epidural) on the mother and the baby, when compared with non-epidural or no pain relief during labour. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2011). SELECTION CRITERIA Randomised controlled trials comparing all modalities of epidural with any form of pain relief not involving regional blockade, or no pain relief in labour. DATA COLLECTION AND ANALYSIS Two of the review authors independently assessed trials for eligibility, methodological quality and extracted all data. We entered data into RevMan and double checked it for accuracy. Primary analysis was by intention to treat; we conducted subgroup and sensitivity analyses where substantial heterogeneity was evident. MAIN RESULTS We included 38 studies involving 9658 women; all but five studies compared epidural analgesia with opiates. Epidural analgesia was found to offer better pain relief (mean difference (MD) -3.36, 95% confidence interval (CI) -5.41 to -1.31, three trials, 1166 women); a reduction in the need for additional pain relief (risk ratio (RR) 0.05, 95% CI 0.02 to 0.17, 15 trials, 6019 women); a reduced risk of acidosis (RR 0.80, 95% CI 0.68 to 0.94, seven trials, 3643 women); and a reduced risk of naloxone administration (RR 0.15, 95% CI 0.10 to 0.23, 10 trials, 2645 women). However, epidural analgesia was associated with an increased risk of assisted vaginal birth (RR 1.42, 95% CI 1.28 to 1.57, 23 trials, 7935 women), maternal hypotension (RR 18.23, 95% CI 5.09 to 65.35, eight trials, 2789 women), motor-blockade (RR 31.67, 95% CI 4.33 to 231.51, three trials, 322 women), maternal fever (RR 3.34, 95% CI 2.63 to 4.23, six trials, 2741 women), urinary retention (RR 17.05, 95% CI 4.82 to 60.39, three trials, 283 women), longer second stage of labour (MD 13.66 minutes, 95% CI 6.67 to 20.66, 13 trials, 4233 women), oxytocin administration (RR 1.19, 95% CI 1.03 to 1.39, 13 trials, 5815 women) and an increased risk of caesarean section for fetal distress (RR 1.43, 95% CI 1.03 to 1.97, 11 trials, 4816 women). There was no evidence of a significant difference in the risk of caesarean section overall (RR 1.10, 95% CI 0.97 to 1.25, 27 trials, 8417 women), long-term backache (RR 0.96, 95% CI 0.86 to 1.07, three trials, 1806 women), Apgar score less than seven at five minutes (RR 0.80, 95% CI 0.54 to 1.20, 18 trials, 6898 women), and maternal satisfaction with pain relief (RR 1.31, 95% CI 0.84 to 2.05, seven trials, 2929 women). We found substantial heterogeneity for the following outcomes: pain relief; maternal satisfaction; need for additional means of pain relief; length of second stage of labour; and oxytocin augmentation. This could not be explained by subgroup or sensitivity analyses, where data allowed analysis. No studies reported on rare but potentially serious adverse effects of epidural analgesia. AUTHORS' CONCLUSIONS Epidural analgesia appears to be effective in reducing pain during labour. However, women who use this form of pain relief are at increased risk of having an instrumental delivery. Epidural analgesia had no statistically significant impact on the risk of caesarean section, maternal satisfaction with pain relief and long-term backache and did not appear to have an immediate effect on neonatal status as determined by Apgar scores. Further research may be helpful to evaluate rare but potentially severe adverse effects of epidural analgesia on women in labour and long-term neonatal outcomes.
Collapse
Affiliation(s)
- Millicent Anim-Somuah
- Tameside Hospital NHS Foundation Trust, Fountain Street, Ashton-under-Lyne, UK, OL6 9RW
| | | | | |
Collapse
|
136
|
To improve maternity care in the United States, think midwives. Contraception 2011; 85:128-9; author reply 129. [PMID: 22036472 DOI: 10.1016/j.contraception.2011.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 05/09/2011] [Indexed: 11/27/2022]
|
137
|
Affiliation(s)
- Jane Fry
- Jane Fry Senior Lecturer in Midwifery, School of Health and Social Care, Bournemouth University, Supervisor of Midwives, Portsmouth Hospital Trust
| | - Stella Rawnson
- Stella Rawnson Senior Lecturer in Midwifery, School of Health and Social Care, Bournemouth University
| | - Professor Paul Lewis
- Professor Paul Associate Dean, School of Health and Social Care, Bournemouth University
| |
Collapse
|
138
|
Slater P, Sellors J, Cyna AM. Communications during epidural catheter placement for labour analgesia. Anaesthesia 2011; 66:1006-11. [DOI: 10.1111/j.1365-2044.2011.06852.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
139
|
Khunpradit S, Tavender E, Lumbiganon P, Laopaiboon M, Wasiak J, Gruen RL. Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev 2011:CD005528. [PMID: 21678348 DOI: 10.1002/14651858.cd005528.pub2] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Caesarean section rates are steadily increasing globally. The factors contributing to these observed increases are complex. Non-clinical interventions, those applied independent of patient care in a clinical encounter, may have a role in reducing unnecessary caesarean sections. OBJECTIVES To evaluate the effectiveness and safety of non-clinical interventions for reducing unnecessary caesarean sections. SEARCH STRATEGY We searched the following electronic databases: the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (29 March 2010), the Cochrane Pregnancy and Childbirth Group Specialised Register (29 March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 2); MEDLINE (1950 to March 2010); EMBASE (1947 to March 2010) and CINAHL (1982 to March 2010). SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-experimental studies, controlled clinical trials (CCTs), controlled before and after studies (CBAs) with at least two intervention and control sites, and interrupted time series analyses (ITS) where the intervention time was clearly defined and there were at least three data points before and three after the intervention. Studies evaluated non-clinical interventions to reduce unnecessary caesarean section rates. Participants included pregnant women and their families, healthcare providers who work with expectant mothers, communities and advocacy groups. DATA COLLECTION AND ANALYSIS Three review authors independently assessed the quality and abstracted data of all eligible studies using a standardised data extraction form, modified from the Cochrane EPOC checklists. We contacted study authors for additional information. MAIN RESULTS We included 16 studies in this review.Six studies specifically targeted pregnant women. Two RCTs were shown to be effective in reducing caesarean section rates: a nurse-led relaxation training programme for women with a fear or anxiety of childbirth and birth preparation sessions. However, both RCTs were small in size and targeted younger mothers with their first pregnancies. There is insufficient evidence that prenatal education and support programmes, computer patient decision-aids, decision-aid booklets and intensive group therapy are effective.Ten studies targeted health professionals. Three of these studies were effective in reducing caesarean section rates. A cluster-RCT of guideline implementation with mandatory second opinion resulted in a small, statistically significant reduction in total caesarean section rates (adjusted risk difference (RD) -1.9; 95% confidence interval (CI) -3.8 to -0.1); this reduction was predominately in intrapartum sections. An ITS study of mandatory second opinion and peer review feedback at department meetings found statistically significant results at 48 months for reducing repeat caesarean section rates (change in level was -6.4%; 95% CI -9.7% to -3.1% and change in slope -1.14%; 95% CI -1.9% to -0.3%) but not for total caesarean section rates. A cluster-RCT of guideline implementation with support from local opinion leaders increased the proportion of women with a previous caesarean section being offered a trial of labour (absolute difference 16.8%) and the number who had a vaginal birth (VBAC rates) (absolute difference 13.5%). The P values are, however, not reported due to unit of analysis errors. There was insufficient evidence that audit and feedback, training of public health nurses, insurance reform, external peer review and legislative changes are effective. AUTHORS' CONCLUSIONS Implementation of guidelines with mandatory second opinion can lead to a small reduction in caesarean section rates, predominately in intrapartum sections. Peer review, including pre-caesarean consultation, mandatory secondary opinion and postcaesarean surveillance can lead to a reduction in repeat caesarean section rates. Guidelines disseminated with endorsement and support from local opinion leaders may increase the proportion of women with previous caesarean sections being offered a trial of labour in certain settings. Nurse-led relaxation classes and birth preparation classes may reduce caesarean section rates in low-risk pregnancies.
Collapse
Affiliation(s)
- Suthit Khunpradit
- Department of Obstetrics and Gynaecology, Lamphun Hospital, 177 Jamthevee Road, Lamphun, Lamphun, Thailand, 51000
| | | | | | | | | | | |
Collapse
|
140
|
Simkin P. Pain, suffering, and trauma in labor and prevention of subsequent posttraumatic stress disorder. J Perinat Educ 2011; 20:166-76. [PMID: 22654466 PMCID: PMC3209770 DOI: 10.1891/1058-1243.20.3.166] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In this column, Kimmelin Hull, community manager of Science & Sensibility, Lamaze International's research blog, reprints and discusses a recent blog post series by acclaimed writer, lecturer, doula, and normal birth advocate Penny Simkin. Examined here is the fruitful dialog that ensued-including testimonies from blog readers about their own experiences with traumatic birth and subsequent posttraumatic stress disorder. Hull further highlights the impact traumatic birth has not only on the birthing woman but also on the labor team-including doulas and childbirth educators-and the implied need for debriefing processes for birth workers. Succinct tools for assessing a laboring woman's experience of pain versus suffering are offered by Simkin, along with Hull's added suggestions for application during the labor and birth process.
Collapse
|
141
|
Raynes-Greenow CH, Nassar N, Torvaldsen S, Trevena L, Roberts CL. Assisting informed decision making for labour analgesia: a randomised controlled trial of a decision aid for labour analgesia versus a pamphlet. BMC Pregnancy Childbirth 2010; 10:15. [PMID: 20377844 PMCID: PMC2868791 DOI: 10.1186/1471-2393-10-15] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 04/08/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Most women use some method of pain relief during labour. There is extensive research evidence available of pharmacological pain relief during labour; however this evidence is not readily available to pregnant women. Decision aids are tools that present evidence based information and allow preference elicitation. METHODS We developed a labour analgesia decision aid. Using a RCT design women either received a decision aid or a pamphlet. Eligible women were primiparous, > or = 37 weeks, planning a vaginal birth of a single infant and had sufficient English to complete the trial materials. We used a combination of affective (anxiety, satisfaction and participation in decision-making) and behavioural outcomes (intention and analgesia use) to assess the impact of the decision aid, which were assessed before labour. RESULTS 596 women were randomised (395 decision aid group, 201 pamphlet group). There were significant differences in knowledge scores between the decision aid group and the pamphlet group (mean difference 8.6, 95% CI 3.70, 13.40). There were no differences between decisional conflict scores (mean difference -0.99 (95% CI -3.07, 1.07), or anxiety (mean difference 0.3, 95% CI -2.15, 1.50). The decision aid group were significantly more likely to consider their care providers opinion (RR 1.28 95%CI 0.64, 0.95). There were no differences in analgesia use and poor follow through between antenatal analgesia intentions and use. CONCLUSIONS This decision aid improves women's labour analgesia knowledge without increasing anxiety. Significantly, the decision aid group were more informed of labour analgesia options, and considered the opinion of their care providers more often when making their analgesia decisions, thus improving informed decision making. TRIAL REGISTRATION Trial registration no: ISRCTN52287533.
Collapse
Affiliation(s)
- Camille H Raynes-Greenow
- Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Sydney School of Public health, University of Sydney, Sydney, NSW, Australia
| | - Natasha Nassar
- Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Siranda Torvaldsen
- Sydney School of Public health, University of Sydney, Sydney, NSW, Australia
| | - Lyndal Trevena
- Sydney School of Public health, University of Sydney, Sydney, NSW, Australia
| | - Christine L Roberts
- Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|