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Borján E. Perineal protection techniques during labor. Eur J Midwifery 2024; 8:EJM-8-39. [PMID: 38974927 PMCID: PMC11225174 DOI: 10.18332/ejm/190068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/08/2023] [Accepted: 06/13/2024] [Indexed: 07/09/2024] Open
Affiliation(s)
- Eszter Borján
- Department of Clinical Studies in Obstetrics and Gynaecology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
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DaCosta MC, Mogaka J, Gebhardt L, Goff SL, Qasba N, Attanasio L. Readiness to Implement a Doula-Hospital Partnership Program. J Obstet Gynecol Neonatal Nurs 2024; 53:197-206. [PMID: 38145632 DOI: 10.1016/j.jogn.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/27/2023] Open
Abstract
OBJECTIVE To assess obstetric clinicians' and leaders' baseline knowledge, attitudes, and experience with doulas and their readiness to implement a novel doula-hospital partnership program. DESIGN Survey of obstetric clinicians and leaders before implementation of the doula program. SETTING/LOCAL PROBLEM Academic medical center in Western Massachusetts that was preparing to pilot a doula-hospital partnership program with Black doulas for Black women to address racial disparities in maternal morbidity and mortality. PARTICIPANTS Obstetric clinicians and leaders (N = 48). INTERVENTION/MEASUREMENTS We used established questions from the Organizational Readiness for Implementing Change (ORIC) scale and original questions to assess participants' knowledge, attitudes, and experiences with doulas and their readiness to implement the planned doula program. We distributed the questionnaire to 103 potential respondents. We conducted descriptive and bivariate analyses and analyzed open-ended responses using content analysis. RESULTS Forty-eight participants responded to the survey. Of those who provided intrapartum care (n = 45), all were familiar with doula roles. Respondents who reported having experience working with a doula, 47.3% (n = 18/38) had at least one prior negative experience with a doula and 76.3% (n = 29/38) reported positive experiences with doulas. However, there was a mean score of 12.62 on the attitude toward doulas (scale range: 3-15). The mean score on the ORIC change commitment subscale was 20.65 (range: 15-25) and on the ORIC change efficacy subscale, mean score was 29.31 (range: 19-35). Results did not differ by participants characteristics. CONCLUSION Our findings suggested strong support for and readiness to implement the doula-hospital partnership program.
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Shahbazi Sighaldeh S, Azadpour A, Vakilian K, Rahimi Foroushani A, Vasegh Rahimparvar SF, Hantoushzadeh S. Comparison of maternal outcomes in caring by Doula, trained lay companion and routine midwifery care. BMC Pregnancy Childbirth 2023; 23:765. [PMID: 37907873 PMCID: PMC10619238 DOI: 10.1186/s12884-023-05987-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/10/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION The aim of this study was to compare maternal and neonatal outcomes in the care provided by Doula, trained lay companion, and routine midwifery care in the labor and obstetric units. In this study, only results related to maternal outcomes were presented. METHOD This is a quasi-experimental study, which was conducted on 150 women with low-risk pregnancies who had been selected for vaginal birth at private clinics and public hospitals of Arak, Iran. Participants were divided into three groups, two intervention groups, doula and trained lay companion, and one control group, midwife's routine care. The intervention groups, in addition to receiving routine care from the labor and maternity units, also received support and training by doula or a trained lay companion, but 50 the control group received only routine midwifery care. In the control group and the trained companion, the samples were taken from 10 clinics of different parts of the city by random sampling method using the SIB center system. Then, among selected numbers, we randomly selected samples for each group. But in Doula group, because of limited number of samples, convenience sampling was used and all women enrolled in doula care were included in the study until the number reached 50. In each group, outcomes such as the duration of active phase and second stage of labor, as well as the severity of pain, anxiety and maternal satisfaction with birth were measured and compared with other groups. Data were collected by a researcher-made checklist, the Spielberger's State-Trait Anxiety Inventory (STAI), the Pain Visual Assessment Scale (VAS), and the Hollins Martin's Birth Satisfaction Scale-Revised (BSS-R). Data were analyzed by SPSS-22 statistical software using Kruskal Wallis, Chi-Square, ANOVA and Fisher's exact tests. FINDINGS Based on the results, the mean duration of active phase between three groups was 234.68 ± 118.74, 256.66 ± 108.75 and 279 ± 94.37 min, respectively (p = 0.022). Also, the mean duration of second stage in three groups was 10 ± 5.61, 10.35 ± 5.1 and 22.30 ± 75.57 min, respectively (p < 0.001). The difference between mean pain scores in the first, second, third, fourth and fifth hours was not statistically significant. The average difference in anxiety score in the two stages of labor was higher in the lay companion group, and this difference was statistically significant (p < 0.001); however, the level of satisfaction in doula group was higher compared to the lay companion and control groups (p < 0.00 1). CONCLUSION According to present study, doula care has a greater effect on reducing the duration of labor than other care models. Based on the study, there was no statistically significant difference between the three groups in terms of variables such as the severity of labor pain. However, the level of anxiety of pregnant mothers in the group supported by lay companion was lower than the other two groups, which indicates the positive effect of mothers' training on increasing maternal comfort and satisfaction. It is suggested that further research investigate the severity of labor pain in groups supported by different care models and also we recommend the use of lay companion' support during childbearing of mothers who could not afford doula. TRAIL REGISTRATION This article has been registered in Iran's Clinical Trial Center with the code: IRCT20230620058548N1. 2023/08/29.
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Affiliation(s)
- Shirin Shahbazi Sighaldeh
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Breastfeeding Research Center-Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Azadpour
- MSc in Maternal and Child Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Katayoun Vakilian
- Department of Midwifery, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sedigheh Hantoushzadeh
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Erkaya R, Karabulutlu Ö, Çalik KY. Uterine massage to reduce blood loss after vaginal delivery. Health Care Women Int 2023; 44:1346-1362. [PMID: 34369853 DOI: 10.1080/07399332.2021.1940184] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 06/03/2021] [Indexed: 10/20/2022]
Abstract
Postpartum hemorrhage (PPH) is a major cause of maternal mortality and disability. A need for simple, inexpensive techniques to prevent PPH and provide treatment exists, particularly in cases where uterotonics cannot be accessed. Uterine massage is recommended as part of the routine active management of the third stage of labor. This study was conducted to determine the effectiveness of uterine massage after delivery of the placenta in reducing postpartum blood loss. Thus, a randomized controlled trial was conducted in Turkey between March 2018 and September 2018. A total of 176 pregnant women (88 in the control and 88 in the uterine massage groups) were randomly allocated to the two groups: one group receiving sustained uterine massage, while the other comprising the control group. The uterine massage group was administered transabdominal uterine massage, starting immediately after delivery of the placenta and continuing every 15 min for a duration of 2 h until the uterus hardened. The blood loss within 2 h of delivery was recorded. Level of significance was taken as p < 0.05, and the chi-square, t, and Mann-Whitney U tests as well as Spearman's correlation and linear regression were employed in the analysis of the data. The average amount blood loss within 2 h of the delivery was significantly higher in the control group than in the massage group (X = 170.49 ± 61.46 and X = 186.20 ± 47.59, p < 0.05). A statistically significant difference was present between the uterine massage and control groups in terms of hemoglobin, hematocrit, WBC, and RCB pre-delivery and pre-discharge (first 24 h) values and in the use of additional uterotonics and the amount of blood loss (p < 0.05). The results of the analysis show that postpartum uterine massage has a reducing effect on the amount of PPH.
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Affiliation(s)
- Reyhan Erkaya
- Faculty of Health Science, Obstetrics and Gynaecology Nursing Department, Karadeniz Technical University, Trabzon, Turkey
| | - Özlem Karabulutlu
- Faculty of Health Sciences, Department of Midwifery, Kafkas University, Kars, Turkey
| | - Kıymet Yeşilçiçek Çalik
- Faculty of HealthScience, Obstetrics and Gynaecology Nursing Department, Karadeniz Technical University, Trabzon, Turkey
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Olsen O, Clausen JA. Planned hospital birth compared with planned home birth for pregnant women at low risk of complications. Cochrane Database Syst Rev 2023; 3:CD000352. [PMID: 36884026 PMCID: PMC9994459 DOI: 10.1002/14651858.cd000352.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Observational studies of increasingly better quality and in different settings suggest that planned hospital birth in many places does not reduce mortality and morbidity but increases the frequency of interventions and complications. Euro-Peristat (part of the European Union's Health Monitoring Programme) has raised concerns about iatrogenic effects of obstetric interventions, and the World Health Organization (WHO) has raised concern that the increasing medicalisation of childbirth tends to undermine women's own capability to give birth and negatively impacts their childbirth experience. This is an update of a Cochrane Review first published in 1998, and previously updated in 2012. OBJECTIVES To compare the effects of planned hospital birth with planned home birth attended by a midwife or others with midwifery skills and backed up by a modern hospital system in case a transfer to hospital should turn out to be necessary. The primary focus is on women with an uncomplicated pregnancy and low risk of medical intervention during birth. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register (which includes trials from CENTRAL, MEDLINE, Embase, CINAHL, WHO ICTRP, and conference proceedings), ClinicalTrials.gov (16 July 2021), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing planned hospital birth with planned home birth in low-risk women as described in the objectives. Cluster-randomised trials, quasi-randomised trials, and trials published only as an abstract were also eligible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked the data for accuracy. We contacted study authors for additional information. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included one trial involving 11 participants. This was a small feasibility study to show that well-informed women - contrary to common beliefs - were prepared to be randomised. This update did not identify any additional studies for inclusion, but excluded one study that had been awaiting assessment. The included study was at high risk of bias for three out of seven risk of bias domains. The trial did not report on five of the seven primary outcomes, and reported zero events for one primary outcome (caesarean section), and non-zero events for the remaining primary outcome (baby not breastfed). Maternal mortality, perinatal mortality (non-malformed), Apgar < 7 at 5 minutes, transfer to neonatal intensive care unit, and maternal satisfaction were not reported. The overall certainty of the evidence for the two reported primary outcomes was very low according to our GRADE assessment (downgraded two levels for high overall risk of bias (due to high risk of bias arising from lack of blinding, high risk of selective reporting and lack of ability to check for publication bias) and two levels for very serious imprecision (single study with few events)). AUTHORS' CONCLUSIONS: This review shows that for selected, low-risk pregnant women, the evidence from randomised trials to support that planned hospital birth reduces maternal or perinatal mortality, morbidity, or any other critical outcome is uncertain. As the quality of evidence in favour of home birth from observational studies seems to be steadily increasing, it might be just 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 RCTs. As women and healthcare practitioners may be aware of evidence from observational studies, and as the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives collaboratively conclude that there is strong evidence that out-of-hospital birth supported by a registered midwife is safe, equipoise may no longer exist, and randomised trials may now thus be considered unethical or hardly feasible.
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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
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Kurt B, Demirel G, Caglayan IS, Doganer A. The Effect on the Birth Process of Endogenous Oxytocin Release Via Coitus at Home in Pregnant Women in the Latent Phase. Z Geburtshilfe Neonatol 2023; 227:134-140. [PMID: 36808611 DOI: 10.1055/a-2019-5031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVES This study was conducted to determine the effect of endogenous oxytocin release via coitus at home on the delivery process in pregnant women who were not hospitalized in the latent phase. BACKGROUND For healthy pregnant women who can deliver spontaneously, it is recommended to be admitted to the delivery room during the active phase of labor. When the pregnant woman is admitted to the delivery room in the latent phase before the active stage, pregnant women spend more time in the delivery room, which makes medical intervention inevitable. METHODS 112 pregnant women for whom hospitalization in the latent phase was recommended were included in the randomized controlled study. They were divided into two groups in which sexual activity in the latent phase was recommended (n=56) and the control group (n=56). RESULTS In our study, the duration of the 1st stage of labor was found to be significantly shorter in the group in which sexual activity in the latent phase was recommended, compared to the control group (p=0.001). Again, the need for amniotomy, labor induction with oxytocin, analgesics and episiotomy decreased. CONCLUSION Sexual activity can be considered as a natural way to speed up labor, reduce medical interventions, and prevent postterm pregnancy.
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Affiliation(s)
- Begum Kurt
- Department of Obstetrics and Gynecology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | | | - Ilkin Seda Caglayan
- Department of Obstetrics and Gynecology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Adem Doganer
- Department of Biostatistics and Medical Informatics, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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KARAMAN ÖE, YILDIZ H. The Effect on Birth Pain and Process of the Freedom of Movement in the First Stage of Labor: A Randomized Controlled Study. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.1016033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To determine the effect of freedom of movement implemented in the dilatation stage, which is the first stage of labor, on the labor process in pregnant women who will give their first birth.
Methods: This study was designed as a randomized controlled trial. The study consisted of 70 primiparous women, including 35 in the study group (SG) and 35 in the control group (CG). Freedom of movement was provided to the study group in the first stage of labor. Data were collected using a Personal Information Questionnaire, a Labor Assessment Form, and the Visual Analog Scale (VAS) for perceived pain.
Results: The SG was observed to be walking when dilatations were 4-7 cm and mostly squatting when 8-10 cm (94.2%). The level of effacement, frequency of contraction, and descent of the fetal head were faster (p
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Raoust GM, Bergström J, Bolin M, Hansson SR. Decision-making during obstetric emergencies: A narrative approach. PLoS One 2022; 17:e0260277. [PMID: 35081113 PMCID: PMC8791468 DOI: 10.1371/journal.pone.0260277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/07/2021] [Indexed: 11/17/2022] Open
Abstract
This study aims to explore how physicians make sense of and give meaning to their decision-making during obstetric emergencies. Childbirth is considered safe in the wealthiest parts of the world. However, variations in both intervention rates and delivery outcomes have been found between countries and between maternity units of the same country. Interventions can prevent neonatal and maternal morbidity but may cause avoidable harm if performed without medical indication. To gain insight into the possible causes of this variation, we turned to first-person perspectives, and particularly physicians’ as they hold a central role in the obstetric team. This study was conducted at four maternity units in the southern region of Sweden. Using a narrative approach, individual in-depth interviews ignited by retelling an event and supported by art images, were performed between Oct. 2018 and Feb. 2020. In total 17 obstetricians and gynecologists participated. An inductive thematic narrative analysis was used for interpreting the data. Eight themes were constructed: (a) feeling lonely, (b) awareness of time, (c) sense of responsibility, (d) keeping calm, (e) work experience, (f) attending midwife, (g) mind-set and setting, and (h) hedging. Three decision-making perspectives were constructed: (I) individual-centered strategy, (II) dialogue-distributed process, and (III) chaotic flow-orientation. This study shows how various psychological and organizational conditions synergize with physicians during decision-making. It also indicates how physicians gave decision-making meaning through individual motivations and rationales, expressed as a perspective. Finally, the study also suggests that decision-making evolves with experience, and over time. The findings have significance for teamwork, team training, patient safety and for education of trainees.
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Affiliation(s)
- Gabriel M. Raoust
- Department of Clinical Sciences Lund, Division of Obstetrics and Gynecology, Faculty of Medicine, Lund University, Lund, Sweden
- Women’s Health Clinic, Ystad Hospital, Ystad, Sweden
- * E-mail:
| | - Johan Bergström
- Division for Risk Management and Societal Safety, Faculty of Engineering, Lund University, Lund, Sweden
| | - Maria Bolin
- Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden
| | - Stefan R. Hansson
- Department of Clinical Sciences Lund, Division of Obstetrics and Gynecology, Faculty of Medicine, Lund University, Lund, Sweden
- Women’s Health Clinic, Skåne University Hospital, Lund, Sweden
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Di Mascio D, Buca D, Berghella V, Khalil A, Rizzo G, Odibo A, Saccone G, Galindo A, Liberati M, D'Antonio F. Counseling in maternal-fetal medicine: SARS-CoV-2 infection in pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:687-697. [PMID: 33724545 PMCID: PMC8251147 DOI: 10.1002/uog.23628] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 02/05/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a zoonotic coronavirus that crossed species to infect humans, causing coronavirus disease 2019 (COVID-19). Despite a potentially higher risk of pregnant women acquiring SARS-CoV-2 infection compared with the non-pregnant population (particularly in some ethnic minorities), no additional specific recommendations to avoid exposure are needed in pregnancy. The most common clinical symptoms and laboratory signs of SARS-CoV-2 infection in pregnancy are fever, cough, lymphopenia and elevated C-reactive protein levels. Pregnancy is associated with a higher risk of severe SARS-CoV-2 infection compared with the non-pregnant population, including pneumonia, admission to the intensive care unit and death, even after adjusting for potential risk factors for severe outcomes. The risk of miscarriage does not appear to be increased in women with SARS-CoV-2 infection. Evidence with regards to preterm birth and perinatal mortality is conflicting, but these risks are generally higher only in symptomatic, hospitalized women. The risk of vertical transmission, defined as the transmission of SARS-CoV-2 from the mother to the fetus or the newborn, is generally low. Fetal invasive procedures are considered to be generally safe in pregnant women with SARS-CoV-2 infection, although the evidence is still limited. In pregnant women with COVID-19, use of steroids should not be avoided if clinically indicated; the preferred regimen is a 2-day course of dexamethasone followed by an 8-day course of methylprednisolone. Non-steroidal anti-inflammatory drugs may be used if there are no contraindications. Hospitalized pregnant women with severe COVID-19 should undergo thromboprophylaxis throughout the duration of hospitalization and at least until discharge, preferably with low molecular weight heparin. Hospitalized women who have recovered from a period of serious or critical illness with COVID-19 should be offered a fetal growth scan about 14 days after recovery from their illness. In asymptomatic or mildly symptomatic women who have tested positive for SARS-CoV-2 infection at full term (i.e. ≥ 39 weeks of gestation), induction of labor might be reasonable. To date, there is no clear consensus on the optimal timing of delivery for critically ill women. In women with no or few symptoms, management of labor should follow routine evidence-based guidelines. Regardless of COVID-19 status, mothers and their infants should remain together and breastfeeding, skin-to-skin contact, kangaroo mother care and rooming-in throughout the day and night should be practiced, while applying necessary infection prevention and control measures. Many pregnant women have already undergone vaccination, mostly in the USA where the first reports show no significant difference in pregnancy outcomes in pregnant women receiving SARS-CoV-2 vaccination during pregnancy compared with the background risk. Vaccine-generated antibodies were present in the umbilical cord blood and breast milk samples of pregnant and lactating women who received the mRNA COVID-19 vaccine. Based on the available limited data on the safety of the COVID-19 vaccine in pregnancy, it seems reasonable to offer the option of vaccination to pregnant women after accurate counseling on the potential risk of a severe course of the disease and the unknown risk of fetal exposure to the vaccine. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D. Di Mascio
- Department of Maternal and Child Health and Urological Sciences“Sapienza” University of RomeRomeItaly
| | - D. Buca
- Center for High‐Risk Pregnancy and Fetal Care, Department of Obstetrics and GynecologyUniversity of ChietiChietiItaly
| | - V. Berghella
- Department of Obstetrics and Gynecology, Division of Maternal‐Fetal Medicine, Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPAUSA
| | - A. Khalil
- Fetal Medicine UnitSt George's University Hospitals NHS Foundation Trust, University of LondonLondonUK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research InstituteSt George's University of LondonLondonUK
| | - G. Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo ReUniversity of Rome Tor VergataRomeItaly
- Department of Obstetrics and GynecologyThe First I.M. Sechenov Moscow State Medical UniversityMoscowRussia
| | - A. Odibo
- Division of Maternal Fetal MedicineUniversity of South FloridaTampaFLUSA
| | - G. Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of MedicineUniversity of Naples Federico IINaplesItaly
| | - A. Galindo
- Fetal Medicine Unit – Maternal and Child Health and Development Network, Department of Obstetrics and GynecologyUniversity Hospital 12 de Octubre, 12 de Octubre Research Institute, Complutense University of MadridMadridSpain
| | - M. Liberati
- Center for High‐Risk Pregnancy and Fetal Care, Department of Obstetrics and GynecologyUniversity of ChietiChietiItaly
| | - F. D'Antonio
- Center for High‐Risk Pregnancy and Fetal Care, Department of Obstetrics and GynecologyUniversity of ChietiChietiItaly
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da Matta Machado Fernandes L, Lansky S, Reis Passos H, T. Bozlak C, A. Shaw B. Brazilian women's use of evidence-based practices in childbirth after participating in the Senses of Birth intervention: A mixed-methods study. PLoS One 2021; 16:e0248740. [PMID: 33861756 PMCID: PMC8051805 DOI: 10.1371/journal.pone.0248740] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 03/04/2021] [Indexed: 01/02/2023] Open
Abstract
Brazil has a cesarean rate of 56% and low use of Intrapartum Evidence-based Practices (IEBP) of 3.4%, reflecting a medically centered and highly interventionist maternal health care model. The Senses of Birth (SoB) is a health education intervention created to promote normal birth, use of EBP, and reduce unnecessary c-sections. This study aimed to understand the use of intrapartum EBP by Brazilian women who participated in the SoB intervention. 555 women answered the questionnaire between 2015 and 2016. Bivariate analysis and ANOVA test were used to identify if social-demographic factors, childbirth information, and perceived knowledge were associated with the use of EBP. A qualitative analysis was performed to explore women’s experiences. Research participants used the following EBP: birth plan (55.2%), companionship during childbirth (81.6%), midwife care (54.2%), freedom of mobility during labor (57.7%), choice of position during delivery (57.2%), and non-pharmacological pain relief methods (74.2%). Doula support was low (26.9%). Being a black woman was associated with not using a birth plan or having doula support. Women who gave birth in private hospitals were more likely not to use the EBP. Barriers to the use of EBP identified by women were an absence of individualized care, non-respect for their choices or provision of EBP by health care providers, inadequate structure and ambiance in hospitals to use EBP, and rigid protocols not centered on women’s needs. The SoB intervention was identified as a potential facilitator. Women who used EBP described a sense of control over their bodies and perceived self-efficacy to advocate for their chosen practices. Women saw the strategies to overcome barriers as a path to become their childbirth protagonist. Health education is essential to increase the use of EBP; however, it should be implemented combined with changes in the maternal care system, promoting woman-centered and evidence-based models.
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Affiliation(s)
| | - Sônia Lansky
- Department of Health, Belo Horizonte, Minas Gerais, Brazil
| | | | - Christine T. Bozlak
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, NY, United States of America
| | - Benjamin A. Shaw
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, NY, United States of America
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Akyıldız D, Çoban A, Gör Uslu F, Taşpınar A. Effects of Obstetric Interventions During Labor on Birth Process and Newborn Health. FLORENCE NIGHTINGALE JOURNAL OF NURSING 2021; 29:9-21. [PMID: 34263219 PMCID: PMC8137733 DOI: 10.5152/fnjn.2021.19093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 03/26/2020] [Indexed: 11/25/2022]
Abstract
AIM This study aimed to investigate the effects of the interventions in the delivery room on the delivery process and the newborn health. METHOD The analytical-cross-sectional study was carried out with 354 puerperal women who gave birth in hospital between December 2016 and June 2017 in a public hospital. The data were collected by the data collection form developed by the researchers. Data analysis was done by using descriptive statistics and chi-square test in SPSS 21.00 program. RESULTS The interventions were determined in continuous electro fetal monitoring (80.5%), oxytocin induction (79.9%), restriction of free movement (56.8%), amniotomy (49.7%), enema (44.1%), and movement restriction (56.8%). The intervention period of the second phase of delivery was longer and the rate of cesarean section was higher, and the need for NICU, suction difficulty, 5th APGAR score less than 7, trauma development, difficulty in suction, and higher trauma rates were found in infants. It was determined that the rate of oxygen need in puerperals admitted to the delivery room with cervical dilatation below five cm, vacuum and episiotomy applications in those who underwent amniotomy, and vacuum application rates in those undergoing oxytocin inductions were found to be high. In addition, the rate of fundal compression and episiotomy was significantly higher in patients who used continuous electro fetal monitoring, fundal compression and vacuum rate in patients who were administered analgesic drugs, and episiotomy rates in patients using analgesic drugs. CONCLUSION It has been concluded that interventions in the first phase of labor negatively affect the delivery process and neonatal health and increase the need for intervention in the second phase.
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Affiliation(s)
- Deniz Akyıldız
- Department of Midwifery, Kahramanmaras Sütçü İmam University, Faculty of Health Sciences, Kahramanmaraş, Turkey
| | - Ayden Çoban
- Department of Midwifery, Faculty of Health Sciences, Aydın Adnan Menderes University, Aydın, Turkey
| | | | - Ayten Taşpınar
- Department of Midwifery, Faculty of Health Sciences, Aydın Adnan Menderes University, Aydın, Turkey
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Real-time data analysis using a machine learning model significantly improves prediction of successful vaginal deliveries. Am J Obstet Gynecol 2020; 223:437.e1-437.e15. [PMID: 32434000 DOI: 10.1016/j.ajog.2020.05.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/28/2020] [Accepted: 05/12/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The process of childbirth is one of the most crucial events in the future health and development of the offspring. The vulnerability of parturients and fetuses during the delivery process led to the development of intrapartum monitoring methods and to the emergence of alternative methods of delivery. However, current monitoring methods fail to accurately discriminate between cases in which intervention is unnecessary, partly contributing to the high rates of cesarean deliveries worldwide. Machine learning methods are applied in various medical fields to create personalized prediction models. These methods are used to analyze abundant, complex data with intricate associations to aid in decision making. Initial attempts to predict vaginal delivery vs cesarean deliveries using machine learning tools did not utilize the vast amount of data recorded during labor. The data recorded during labor represent the dynamic process of labor and therefore may be invaluable for dynamic prediction of vaginal delivery. OBJECTIVE We aimed to create a personalized machine learning-based prediction model to predict successful vaginal deliveries using real-time data acquired during the first stage of labor. STUDY DESIGN Electronic medical records of labor occurring during a 12-year period in a tertiary referral center were explored and labeled. Four different models were created using input from multiple maternal and fetal parameters. Initial risk assessments for vaginal delivery were calculated using data available at the time of admission to the delivery unit, followed by models incorporating cervical examination data and fetal heart rate data, and finally, a model that integrates additional data available during the first stage of labor was created. RESULTS A total of 94,480 cases in which a trial of labor was attempted were identified. Based on approximately 180 million data points from the first stage of labor, machine learning models were developed to predict successful vaginal deliveries. A model using data available at the time of admission to the delivery unit yielded an area under the curve of 0.817 (95% confidence interval, 0.811-0.823). Models that used real-time data increased prediction accuracy. A model that includes real-time cervical examination data had an initial area under the curve of 0.819 (95% confidence interval, 0.813-0.825) at first examination, which increased to an area under the curve of 0.917 (95% confidence interval, 0.913-0.921) by the end of the first stage. Adding the real-time fetal heart monitor data provided an area under the curve of 0.824 (95% confidence interval, 0.818-0.830) at first examination, which increased to an area under the curve of 0.928 (95% confidence interval, 0.924-0.932) by the end of the first stage. Finally, adding additional real-time data increased the area under the curve initially to 0.833 (95% confidence interval, 0.827-0.838) at the first cervical examination and up to 0.932 (95% confidence interval, 0.928-0.935) by the end of the first stage. CONCLUSION Real-time data acquired throughout the process of labor significantly increased the prediction accuracy for vaginal delivery using machine learning models. These models enable translation and quantification of the data gathered in the delivery unit into a clinical tool that yields a reliable personalized risk score and helps avoid unnecessary interventions.
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Abstract
The World Health Organization recommended that the oral intake of low-risk pregnant women during labor should not be restricted. Hospitals in different countries take different measures to manage the intake during labor, but it is not clear about the current situation of oral intake management measures in the hospital during labor in China. Thus, the objective of this study was to investigate the current situation of oral intake management measures during labor in China, so as not only provide references for developing appropriate midwifery technology training and formulating relevant policies, but also provide a basis for exploring and implementing better oral intake management measures in the future.A cross-sectional survey was conducted. From December 2017 to November 2018, the oral intake management measures of 1213 hospitals in 22 provinces, cities, and autonomous regions in China were investigated by a self-designed questionnaire. χ test was used for statistical analysis.Different hospitals in China have adopted different oral intake management measures. Among the 1213 hospitals, 939(77.4%) hospitals took measures to allow pregnant women to bring the easily digestible food, 813(67.0%) hospitals took measures to allow pregnant women to eat what she wanted to eat. Few hospitals provide pregnant women with oral nutrition solution or provide a suitable diet for pregnant women. Thirty-four (2.8%) hospitals still restrict pregnant women's fluid intake.Oral intake management measures that are more suitable for Chinese pregnant women should be explored to better ensure the women energy needs and they safely go through childbirth.
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Affiliation(s)
- Chuan-Ya Huang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education
- Department of Nursing, West China Second University Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Bi-Ru Luo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education
- Department of Nursing, West China Second University Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Juan Hu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education
- Department of Nursing, West China Second University Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
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Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. Int Urogynecol J 2020; 31:1735-1745. [DOI: 10.1007/s00192-020-04302-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
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Fernandes LMM, Lansky S, Oliveira BJ, Friche AAL, Bozlak CT, Shaw BA. Changes in perceived knowledge about childbirth among pregnant women participating in the Senses of Birth intervention in Brazil: a cross-sectional study. BMC Pregnancy Childbirth 2020; 20:265. [PMID: 32370737 PMCID: PMC7201865 DOI: 10.1186/s12884-020-02874-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 03/12/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Senses of Birth (SoB) is a health education intervention in Brazil that aims to reduce unnecessary cesareans in the country by providing information on reproductive rights, benefits and risks of childbirth, and use of intrapartum evidence-based practices (EBP) which are recommended by the World Health Organization (WHO) to improve childbirth outcomes and satisfaction. This study evaluates the impact of the SoB on pregnant women's perceived knowledge about normal birth (NB), cesarean, and use of EBP. METHODS 1287 pregnant women answered a structured survey immediately after their visit to the intervention, between March 2015 and March 2016. To estimate the potential impact of the intervention on women's perceived knowledge, and possible associations between sociodemographic characteristics and perceived knowledge, statistical analyses were performed, including paired T-tests, ANOVA, and logistic and linear regressions. RESULTS The mean score (MS) of perceived knowledge after the intervention was higher than the MS before experiencing the intervention for all three knowledge domains: Normal Birth (MS Before = 3.71 x MS After = 4.49), Cesarean (MS Before = 3.54 x MS After = 4.26) and EBPs (MS Before = 3.14 x MS After = 4.14). The results suggest that perceived knowledge increased more for low-income women (B = 0.206; p < 0.001 for EBP), women without private health insurance (OR 2.47, 95% CI: 1.49-4.09 for NB), with private prenatal care (OR 2.42, 95% CI: 1.59-3.66 for NB), experiencing their first pregnancy (OR 1.92, 95% CI: 1.31-2.82 for EBP; OR 1.37, 95% CI: 1.03-1.84 for NB; OR 1.37, 95% CI: 1.03-1.84 for cesarean), and in their first or second trimester (OR 1.64, 95% CI: 1.13-2.39 for EBP; OR 1.48, 95% CI: 1.11-1.97 for NB; OR 1.85, 95% CI: 1.40-2.41 for cesarean). CONCLUSION The study showed that participation in the SoB was associated with an increase in perceived knowledge among Brazilian pregnant women. The intervention gains relevance considering the lack of evidence of the impact of non-clinical interventions to reduce unnecessary cesareans in middle and low-income countries.
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Affiliation(s)
- Luísa M M Fernandes
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, 12144, USA.
| | - Sônia Lansky
- Department of Health, City Hall, Belo Horizonte, Minas Gerais, Brazil
| | - Bernardo J Oliveira
- School of Education, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Amélia A L Friche
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Christine T Bozlak
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, 12144, USA
| | - Benjamin A Shaw
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, 12144, USA
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Berghella V, Di Mascio D. Evidence-based labor management: before labor (Part 1). Am J Obstet Gynecol MFM 2019; 2:100080. [PMID: 33345992 DOI: 10.1016/j.ajogmf.2019.100080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 11/16/2022]
Abstract
In preparation for labor and delivery, there is high-quality evidence for providers to recommend perineal massage with oil for 5-10 minutes daily starting at 34 weeks until labor; ≥1 daily sets of repeated voluntary contractions of the pelvic floor muscles, performed at least several days of the week starting at approximately 30-32 weeks gestation; no x-ray pelvimetry; sweeping of membranes weekly starting at 37-38 weeks gestation; for women with a risk factor for abnormal outcome plans should be made to deliver in a hospital setting; for low-risk women, alongside birth center birth is associated with maternal benefits and higher satisfaction, compared with hospital birth; midwife-led care for low-risk women; continuous support by a professional such as doula, midwife, or nurse during labor; and training of birth attendants in low- and middle-income countries.
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Affiliation(s)
- Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
| | - Daniele Di Mascio
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA; Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
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Neel K, Goldman R, Marte D, Bello G, Nothnagle MB. Hospital-based maternity care practitioners' perceptions of doulas. Birth 2019; 46:355-361. [PMID: 30734958 DOI: 10.1111/birt.12420] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A birth doula provides continuous informational, physical, and emotional support during pregnancy, labor, and immediately postpartum. Existing data on the benefits of doulas, especially for low-resource, high-need patients, do not address how and why individual practitioners decide to recommend this model of care. This project aims to describe best practices of integrating doulas into hospital-based maternity care teams to facilitate access to this evidence-based service for improving maternal health outcomes. METHODS Semi-structured interviews using open-ended questions were conducted in person with 47 maternity care practitioners-OB/GYNs, family medicine physicians, RNs, and nurse-midwives-across three hospitals. Interview analysis was conducted using the Template Organizing Style qualitative analysis approach. RESULTS Results demonstrated varied support for doula care given practitioners' experiences. Positive experiences centered on doulas' supportive role and strong relationships with patients. Some conflicts between practitioners and doulas may stem from a cross-cultural divide between mainstream obstetric/physician culture and a natural birth "counter culture." Suggestions to facilitate good working relationships centered on three overlapping themes: mutual respect between doulas and hospital staff, education about doulas' training, and clarification of roles on maternity care teams especially among staff with overlapping roles. CONCLUSIONS Among maternity care practitioners, some frustration, anger, and resentment persist with respect to work with doulas. Adequate staff training in the doula model of care, explicit role definition, and increasing practitioner exposure to doulas may promote effective integration of doulas into hospital maternity care teams.
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Affiliation(s)
- Kira Neel
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Roberta Goldman
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Denise Marte
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Gisel Bello
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Clesse C, Lighezzolo-Alnot J, De Lavergne S, Hamlin S, Scheffler M. Factors related to episiotomy practice: an evidence-based medicine systematic review. J OBSTET GYNAECOL 2019; 39:737-747. [DOI: 10.1080/01443615.2019.1581741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Christophe Clesse
- Interpsy Laboratory (EA4432), Université de Lorraine, Nancy, France
- Hospital Centre of Jury-les-Metz – Route d’Ars Laquenexy, Jury-Lesmetz, France
- Polyclinic Majorelle, Nancy, France
| | | | | | | | - Michèle Scheffler
- Polyclinic Majorelle, Nancy, France
- Cabinet de Gynécologie Médicale et Obstétrique, Nancy, France
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Goueslard K, Cottenet J, Roussot A, Clesse C, Sagot P, Quantin C. How did episiotomy rates change from 2007 to 2014? Population-based study in France. BMC Pregnancy Childbirth 2018; 18:208. [PMID: 29866103 PMCID: PMC5987447 DOI: 10.1186/s12884-018-1747-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 04/19/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Since the 2000s, selective episiotomy has been systematically recommended worldwide. In France, the recommended episiotomy rate in vaginal deliveries is less than 30%. The aims of this study were to describe the evolution of episiotomy rates between 2007 and 2014, especially for vaginal deliveries without instrumental assistance and to assess individual characteristics and birth environment factors associated with episiotomy. METHODS This population-based study included all hospital discharge abstracts for all deliveries in France from 2007 to 2014. The use of episiotomy in vaginal deliveries was identified by one code in the French Common Classification of Medical Procedures. The episiotomy rate per department and its evolution is described from 2007 to 2014. A mixed model was used to assess associations with episiotomy for non-operative vaginal deliveries and the risk factors related to the women's characteristics and the birth environment. RESULTS There were approximately 540,000 non-operative vaginal deliveries per year, in the study period. The national episiotomy rate for vaginal deliveries overall significantly decreased from 26.7% in 2007 to 19.9% in 2014. For non-operative deliveries, this rate fell from 21.1% to 14.1%. For the latter, the use of episiotomy was significantly associated with breech vaginal delivery (aOR = 1.27 [1.23-1.30]), epidural analgesia (aOR = 1.45 [1.43-1.47]), non-reassuring fetal heart rate (aOR = 1.47 [1.47-1.49]), and giving birth for the first time (aOR = 3.85 [3.84-4.00]). CONCLUSIONS The episiotomy rate decreased throughout France, for vaginal deliveries overall and for non-operative vaginal deliveries. This decrease is probably due to proactive changes in practices to restrict the number of episiotomies, which should be performed only if beneficial to the mother and the infant.
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Affiliation(s)
- Karine Goueslard
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
| | - Christophe Clesse
- Laboratoire interpsy (EA4432), université de Lorraine, Nancy 2, 3, place Godeffroy-de-Bouillon, 54000 Nancy, France
- Centre hospitalier de Jury-les-Metz, route d’Ars-Laquenexy, 57073 Jury-Les-Metz cedex 03, BP 75088 Nancy, France
| | - Paul Sagot
- Gynecology Obstetrics Center, François-Mitterrand Hospital, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
- Inserm, CIC 1432, Dijon, France; Dijon University Hospital, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon, France
- Inserm, CIC 1432, Dijon, France ; Dijon University Hospital, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon, France
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Everson CL, Cheyney M, Bovbjerg ML. Outcomes of Care for 1,892 Doula-Supported Adolescent Births in the United States: The DONA International Data Project, 2000 to 2013. J Perinat Educ 2018; 27:135-147. [PMID: 30364259 PMCID: PMC6193361 DOI: 10.1891/1058-1243.27.3.135] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This is the largest study to-date to report on outcomes of care for a national sample of doula-supported adolescent births (n = 1,892, birth years 2000 to 2013). Descriptive statistics were calculated for maternal demographics, risk profiles, labor/birth interventions and occurrences, and birth outcomes. In this national sample, childbearing adolescents and their neonates experienced improved health outcomes and lower rates of intervention relative to national statistics for adolescent deliveries in the United States. Key findings are consistent with previous studies on the effects of doula care for marginalized and medically underserved communities. Results strengthen the case for doulas as a perinatal care strategy for improving maternal and infant health outcomes and decreasing inequities among childbearing adolescents.
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Prado DS, Mendes RB, Gurgel RQ, Barreto IDDC, Bezerra FD, Cipolotti R, Gurgel RQ. Practices and obstetric interventions in women from a state in the Northeast of Brazil. ACTA ACUST UNITED AC 2018; 63:1039-1048. [PMID: 29489987 DOI: 10.1590/1806-9282.63.12.1039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/20/2017] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To describe practices and interventions used during labor and childbirth and factors associated with such practices in puerperae in the state of Sergipe. METHOD A cross-sectional study with 768 postpartum women from 11 maternity hospitals interviewed 6 hours after delivery, and hospital records review. The associations between best practices and interventions used during labor and delivery with exposure variables were described using simple frequencies, percentages, crude and adjusted odds ratio (ORa) with the confidence interval. RESULTS Of the women in the study, 10.6% received food and 27.8% moved during labor; non-pharmacological methods for pain relief were performed in 26.1%; a partogram was filled in 39.4% of the charts; and an accompanying person was present in 40.6% of deliveries. Oxytocin, amniotomy and labor analgesia were used in 59.1%, 49.3% and 4.2% of women, respectively. Lithotomy position during childbirth was used in 95.2% of the cases, episiotomy in 43.9% and Kristeller maneuver in 31.7%. The variables most associated with cesarean section were private financing (ORa=4.27, 95CI 2.44-7.47), higher levels of education (ORa=4.54, 95CI 2.56-8.3) and high obstetric risk (ORa=1.9, 95CI 1.31-2.74). Women whose delivery was funded privately were more likely to have an accompanying person present (ORa=2.12, 95CI 1.18-3.79) and to undergo labor analgesia (ORa=4.96, 95CI 1.7-14.5). CONCLUSION Best practices are poorly performed and unnecessary interventions are frequent. The factors most associated with c-section were private funding, greater length of education and high obstetric risk.
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Affiliation(s)
| | | | | | | | | | - Rosana Cipolotti
- Department of Medicine, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil
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Malvasi A, Zaami S, Tinelli A, Trojano G, Montanari Vergallo G, Marinelli E. Kristeller maneuvers or fundal pressure and maternal/neonatal morbidity: obstetric and judicial literature review. J Matern Fetal Neonatal Med 2018; 32:2598-2607. [PMID: 29466899 DOI: 10.1080/14767058.2018.1441278] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM A significant amount of data concerning maternal-fetal damage arising from the exertion of Kristeller maneuvers (KMs) or fundal pressure (FP) go unreleased due to medicolegal implications. MATERIALS AND METHODS For this reason, the paper gathers information as to the real magnitude of litigation related to FP-induced damages and injuries. The authors have undertaken a research in order to include general search engines (PubMed-Medline, Cochrane, Embase, Google, GyneWeb) and legal databases (De Jure, Italian database of jurisprudence daily update; Westlaw, Thomson Reuters, American ruling database and Bailii, UK Court Ruling Database). RESULTS Results confirm said phenomenon to be more wide ranging than it appears through official channels. Several courts of law, both in the United States of America (USA) and in European Union (EU) Member States as well, have ruled against the use of the maneuver itself, assuming a stance conducive to a presumption of guilt against those doctors and healthcare providers who resorted to KMs or FP during deliveries. Given how rife FP is in mainstream obstetric practice, it is as if there were a wide gap between obstetric real-life and what official jurisprudence and healthcare institutions-sanctioned official practices are. CONCLUSION The authors think that it would be desirable to draft specifically targeted guidelines or recommendations on maneuvers during vaginal delivery, in which to point out exactly what kinds of maneuvering techniques are to be absolutely banned and what maneuvers are to be allowed, and under what conditions their application can be considered appropriate.
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Affiliation(s)
- Antonio Malvasi
- a Department of Obstetrics and Gynaecology , GVM Care & Research Santa Maria Hospital , Bari , Italy.,b International Translational Medicine and Biomodelling Research Group, Department of Applied Mathematics , Moscow Institute of Physics and Technology, State University , Moscow , Russia
| | - Simona Zaami
- c Department of Anatomical, Histological, Forensic and Orthopaedic Sciences , "Sapienza" University of Rome , Rome , Italy
| | - Andrea Tinelli
- b International Translational Medicine and Biomodelling Research Group, Department of Applied Mathematics , Moscow Institute of Physics and Technology, State University , Moscow , Russia.,d Department of Obstetrics and Gynecology , Vito Fazzi Hospital , Lecce , Italy
| | - Giuseppe Trojano
- e Department of Obstetrics and Gynaecology 2 , AOU Policlinico , Bari , Italy
| | - Gianluca Montanari Vergallo
- c Department of Anatomical, Histological, Forensic and Orthopaedic Sciences , "Sapienza" University of Rome , Rome , Italy
| | - Enrico Marinelli
- c Department of Anatomical, Histological, Forensic and Orthopaedic Sciences , "Sapienza" University of Rome , Rome , Italy
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Senanayake H, Wijesinghe RD, Nayar KR. Is the policy of allowing a female labor companion feasible in developing countries? Results from a cross sectional study among Sri Lankan practitioners. BMC Pregnancy Childbirth 2017; 17:392. [PMID: 29166880 PMCID: PMC5700526 DOI: 10.1186/s12884-017-1578-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 11/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Companionship during labor is known to have both physical and psychosocial benefits to mother and baby. Sri Lanka made a policy decision to allow a labour companion in 2011. However, implementation has been unsatisfactory. Given the leading role Obstetricians play in the implementation of policy, a study was undertaken to assess the knowledge, attitudes and practices among them. Method A descriptive cross sectional study was conducted among consultant obstetricians working in the state hospitals using the platform ‘Survey Monkey’. Results Out of the 140 consultant obstetricians invited, 68(48.5%) participated. Among the study participants, 40 (58.8%) did not allow labour companions in their wards. Lack of space (n = 32; 80%) and the volume of work in the labor wards (n = 22; 55%) were the commonest reasons for not allowing a companion. Only 16.7% (n = 5) of the obstetricians handling more than 300 deliveries per month allowed a companion (p = 0.001). Less than 50% of the obstetricians were aware of the advantages associated with the practice such as shorter labor, lesser analgesic requirement, higher chances of a normal birth, improved neonatal outcome and reduced requirements for labor augmentation for slow progress of labor. Knowledge on advantages on breast feeding and reduced need of instrumental delivery also remained low. Conclusion In an individual unit, the consultant often decides policy. The study points out the need to improve awareness among the practitioners.
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Affiliation(s)
- Hemantha Senanayake
- Department of Obstetrice & Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Sudhinaraset M, Afulani P, Diamond-Smith N, Bhattacharyya S, Donnay F, Montagu D. Advancing a conceptual model to improve maternal health quality: The Person-Centered Care Framework for Reproductive Health Equity. Gates Open Res 2017; 1:1. [PMID: 29355215 PMCID: PMC5764229 DOI: 10.12688/gatesopenres.12756.1] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Globally, substantial health inequities exist with regard to maternal, newborn and reproductive health. Lack of access to good quality care-across its many dimensions-is a key factor driving these inequities. Significant global efforts have been made towards improving the quality of care within facilities for maternal and reproductive health. However, one critically overlooked aspect of quality improvement activities is person-centered care. Main body: The objective of this paper is to review existing literature and theories related to person-centered reproductive health care to develop a framework for improving the quality of reproductive health, particularly in low and middle-income countries. This paper proposes the Person-Centered Care Framework for Reproductive Health Equity, which describes three levels of interdependent contexts for women's reproductive health: societal and community determinants of health equity, women's health-seeking behaviors, and the quality of care within the walls of the facility. It lays out eight domains of person-centered care for maternal and reproductive health. Conclusions: Person-centered care has been shown to improve outcomes; yet, there is no consensus on definitions and measures in the area of women's reproductive health care. The proposed Framework reviews essential aspects of person-centered reproductive health care.
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Affiliation(s)
- May Sudhinaraset
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, 94105, USA.,Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Patience Afulani
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, 94105, USA
| | - Nadia Diamond-Smith
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, 94105, USA
| | | | - France Donnay
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | - Dominic Montagu
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, 94105, USA
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Discontinuing Oxytocin Infusion in the Active Phase of Labor: A Systematic Review and Meta-analysis. Obstet Gynecol 2017; 130:1090-1096. [PMID: 29016497 DOI: 10.1097/aog.0000000000002325] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the benefits and harms of discontinuation of oxytocin after the active phase of labor is reached. DATA SOURCES Electronic databases (ie, MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, ScienceDirect, the Cochrane Library at the CENTRAL Register of Controlled Trials, Scielo) were searched from their inception until April 2017. METHODS OF STUDY SELECTION We included all randomized controlled trials comparing discontinuation (ie, intervention group) and continuation (ie, control group) of oxytocin infusion after the active phase of labor is reached, either after induction or augmentation of labor. Discontinuation of oxytocin infusion was defined as discontinuing oxytocin infusion when the active phase of labor was achieved. Continuation of oxytocin infusion was defined as continuing oxytocin infusion until delivery. Only trials in singleton gestations with vertex presentation at term were included. The primary outcome was the incidence of cesarean delivery. TABULATION, INTEGRATION, AND RESULTS Nine randomized controlled trials, including 1,538 singleton gestations, were identified as relevant and included in the meta-analysis. All nine trials included only women undergoing induction of labor. In the discontinuation group, if arrest of labor occurred, usually defined as no cervical dilation in 2 hours or inadequate uterine contractions for 2 hours or more, oxytocin infusion was restarted. Women in the control group had oxytocin continued until delivery usually at the same dose used at the time the active phase was reached. Women who were randomized to have discontinuation of oxytocin infusion after the active phase of labor was reached had a significantly lower risk of cesarean delivery (9.3% compared with 14.7%; relative risk 0.64, 95% CI 0.48-0.87) and of uterine tachysystole (6.2% compared with 13.1%; relative risk 0.53, 95% CI 0.33-0.84) compared with those who were randomized to have continuation of oxytocin infusion until delivery. Discontinuation of oxytocin infusion was associated with an increase in the duration of the active phase of labor (mean difference 27.65 minutes, 95% CI 3.94-51.36). CONCLUSION In singleton gestations with cephalic presentation at term undergoing induction, discontinuation of oxytocin infusion after the active phase of labor at approximately 5 cm is reached reduces the risk of cesarean delivery and of uterine tachysystole compared with continuous oxytocin infusion. Given this evidence, discontinuation of oxytocin infusion once the active stage of labor is established in women being induced should be considered as an alternative management plan.
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Abstract
Controlling labor pain is one of the basic goals for caregivers during the birthing process. There are many pharmacological and nonpharmacological methods that are used for controlling pain and helping the mother to cope with pain and have a favorable labor. The study was planned as a randomized, controlled experimental study to detect the effect of acupressure applied to Point LI4 on perceived labor pains. The study sample comprised 88 pregnant women (44 acupressure group, 44 control group), who complied with the study guidelines, agreed with the conditions of the study, and signed the informed consent. Acupressure was applied to the study group when cervical dilatation reached 4 to 5 cm and again when cervical dilation was 7 to 8 cm. Acupressure was applied to Point LI4 on both the hands at the same time from the beginning to the end of the contraction (16 times). Evaluation with the visual analog scale was made 6 times: when the pregnant woman was first admitted to the hospital, before and after acupressure, and within 2 hours after delivery. The control group received routine care. There were statistically significant differences between the groups in subjective labor pain scores (P < .0001). There was a significant difference between the groups in terms of total duration of labor. As shown from our study, applying acupressure to Point LI4 was found to be effective in decreasing the perception of labor pains and shortening the labor (P < .05). Mothers were pleased with this treatment, but they found it insufficient to control their pain.
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Javernick JA, Dempsey A. Reducing the Primary Cesarean Birth Rate: A Quality Improvement Project. J Midwifery Womens Health 2017; 62:477-483. [DOI: 10.1111/jmwh.12606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/07/2016] [Accepted: 12/11/2016] [Indexed: 11/28/2022]
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Dias BAS, Santos ETD, Andrade MAC. Classification systems for avoidability of infant deaths: different methods, different repercussions? CAD SAUDE PUBLICA 2017; 33:e00125916. [PMID: 28614450 DOI: 10.1590/0102-311x00125916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 02/06/2017] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to compare the avoidability of infant deaths according to different classification methods. This was a descriptive comparative study from 2006 to 2013 in Espírito Santo State, Brazil, focusing on the classification of 5,316 infant deaths according to five different methods. The methods of the International Collaborative Effort on Infant Mortality (ICE) and the SEADE Foundation correctly classified the highest proportions of deaths as avoidable versus unavoidable (94.6% and 94.4% correct classification, respectively). Most deaths resulted from quality problems in prenatal, childbirth, and postpartum care, regardless of which classification method was used. There were also considerable numbers of deaths from "ill-defined" causes according to all the methods, suggesting difficulty in access or precious care in health services. Avoidability methods provide an important instrument for diagnosis of quality problems in health services performance and orientation of measures to reduce avoidable infant deaths. Thus, strengthening maternal and child care and investment in training and capacity-building for health professionals and services are priorities for public policies to reduce infant mortality.
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Barasinski C, Vendittelli F. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 3: Interventions associated with oxytocin administration during spontaneous labor. J Gynecol Obstet Hum Reprod 2017; 46:489-497. [DOI: 10.1016/j.jogoh.2017.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Rousseau A, Burguet A. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 5: Maternal risk and adverse effects of using oxytocin augmentation during spontaneous labor. J Gynecol Obstet Hum Reprod 2017; 46:509-521. [PMID: 28473291 DOI: 10.1016/j.jogoh.2017.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- A Rousseau
- Département de Maïeutique, UFR des Sciences de la Santé Simone-Veil, Université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France; EA 7285 RISCQ, UFR des Sciences de la Santé Simone-Veil, Université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France.
| | - A Burguet
- Pédiatrie 2, CHU de Dijon, 21030 Dijon cedex, France; Réseau Périnatal Franche-Comté, CHU de Besançon, 25030 Besançon cedex, France
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Karaçam Z, Arslan Kurnaz D, Güneş G. Evaluating the content and quality of intrapartum care in vaginal births: An example of a state hospital. Turk J Obstet Gynecol 2017; 14:10-17. [PMID: 28913129 PMCID: PMC5558312 DOI: 10.4274/tjod.88123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 02/28/2017] [Indexed: 12/01/2022] Open
Abstract
Objective: The purpose of the research was to assess the content and quality of the intrapartum care offered in vaginal births in Turkey, based on the example of a state hospital. Materials and Methods: This cross-sectional study was conducted between January 1st, 2013 and December 31st, 2014 at Aydın Maternity and Children’s Hospital. The study sample consisted of 303 women giving vaginal birth, who were recruited into the study using the method of convenience sampling. Research data were collected with a questionnaire created by the researchers and assessed using the Bologna score. Numbers and percentages were assessed in the data analysis. Results: The mean age of the women was 25.14±5.37 years and 40.5% had given one live birth. Of the women, 45.2% were admitted to hospital in the latent phase, 76.6% were administered an enema, 3.3% had epidural anesthesia, 2.6% delivered using vacuum extraction, and 54.1% underwent an episiotomy. Some 23.8% of the women experienced spontaneous laceration that needed sutures. The babies of two women exhibited an Apgar score below 7 in the fifth minute. When the quality of the intrapartum care given to the women was assessed with the Bologna score, it was found that 92.7% went into labor spontaneously, 100% of the births were supervised by midwives and doctors, 97.7% of the women had no supporting companion, and the nonsupine position was only used in 0.3% of the women. A partogram was used to follow up on the birth process in 72.6% of the women, and 82.5% achieved contact with their babies within the first hour after birth. Induction was applied in 76.6% of the women and fundal pressure in 27.4%. Conclusion: The study revealed that the quality of intrapartum care in vaginal births was inadequate. Reformulating the guidelines regarding intrapartum care in accordance with World Health Organization recommendations and evidence-based practices may contribute to improving mother and infant health.
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Affiliation(s)
- Zekiye Karaçam
- Adnan Menderes University Faculty of Health Sciences, Division of Midwifery, Aydın, Turkey
| | | | - Gizem Güneş
- Adnan Menderes University Faculty of Health Sciences, Division of Midwifery, Aydın, Turkey
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Namli Kalem M, Köşüş A, Kamalak Z, Köşüş N, Kalem Z. Factors affecting the rates of caesarean sections in cases with premature rupture of membranes (PROM) at term. J OBSTET GYNAECOL 2017; 37:585-590. [PMID: 28285555 DOI: 10.1080/01443615.2016.1274291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this retrospective study was to investigate the factors affecting the rates of caesarean section in cases with premature rupture of membranes (PROM) in term pregnancies. Eighty-two term PROM patients who presented to Turgut Ozal University and Erzurum Nene Hatun Hospitals between 2012 and 2014 were included. The effects of demographics, nulliparity, active-latent phase durations, presence of meconium and chorioamnionitis, requirement of oxytocin and cervical dilation at the initial examination on C/S rates were assessed. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%. C/S rates did not change with other variables. We conclude that the factors increasing the risk for C/S in PROM at term group are not different from the non-term PROM. Impact statement The aim of this retrospective study was to investigate the factors affecting the rates of caesarean section (C/S) in cases with premature rupture of membranes (PROM) in term pregnancies. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%. We conclude that the factors increasing the risk for C/S in PROM at term group, are not different from the non-term PROM groups. Currently, the PROM is considered the start of a pathological process in both term and preterm pregnancies and also considered to increase the rates of caesarean sections. Studies on the management of PROM at term have concentrated rather on whether to intervene for accelerating the labour or spontaneous monitorisation. As found by the studies like this one in the literature, the factors having an impact on C/S rates in the cases of PROM at term are similar to those of non-PROM patients at term, may prevent clinicians from taking an invasive or aggressive approach towards the cases of PROM at term.
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Affiliation(s)
- Muberra Namli Kalem
- a Department of Obstetrics and Gynaecology, School of Medicine , Turgut Ozal University , Ankara , Turkey
| | - Aydın Köşüş
- a Department of Obstetrics and Gynaecology, School of Medicine , Turgut Ozal University , Ankara , Turkey
| | - Zeynep Kamalak
- b Department of Obstetric and Gynecology , Erzurum Nene Hatun Hospital , Erzurum , Turkey
| | - Nermin Köşüş
- a Department of Obstetrics and Gynaecology, School of Medicine , Turgut Ozal University , Ankara , Turkey
| | - Ziya Kalem
- c Gurgan Clinic IVF and Women Health Center , Cankaya/Ankara/Ankara , Turkey
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Pinar G, Avsar F, Aslantekin F. Evaluation of the Impact of Childbirth Education Classes in Turkey on Adaptation to Pregnancy Process, Concerns About Birth, Rate of Vaginal Birth, and Adaptation to Maternity: A Case-Control Study. Clin Nurs Res 2016; 27:315-342. [PMID: 28038495 DOI: 10.1177/1054773816682331] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aims to examine the impact of childbirth education in Turkey on the adaptation to pregnancy process, concerns about birth, rate of vaginal birth, and adaptation to maternity. This quasi-experimental study with control group was conducted from December 2013 to December 2014. The sample size was 132 primiparous pregnant women ( nexperimental = 66, ncontrol = 66). The average age of the pregnant women in the experimental and control groups was 24.41 ± 3.92 and 23.68 ± 4.19, respectively. The study showed that experimental group participants had lower concerns about birth, higher levels of knowledge, and faster adaptation to pregnancy and postpartum process; they could also give positive feedback about labor pain and action and could start breastfeeding at an earlier stage when compared with those in the control group ( p < .05). Childbirth education classes increase the knowledge of pregnant women and positively contribute in pregnancy, labor, and the postpartum process.
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Affiliation(s)
- Gul Pinar
- 1 Yildirim Beyazit University, Ankara, Turkey
| | - Filiz Avsar
- 1 Yildirim Beyazit University, Ankara, Turkey
| | - Filiz Aslantekin
- 2 Ministry of Health, Public Health Institution of Turkey, Ankara, Turkey
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Roth LM, Henley MM, Seacrist MJ, Morton CH. North American Nurses' and Doulas' Views of Each Other. J Obstet Gynecol Neonatal Nurs 2016; 45:790-800. [PMID: 27622848 DOI: 10.1016/j.jogn.2016.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze factors that lead nurses and doulas to have positive views of each other. DESIGN A multivariate analysis of a cross-sectional survey, the Maternity Support Survey. SETTING Online survey with labor and delivery nurses, doulas, and childbirth educators in the United States and Canada. PARTICIPANTS A convenience sample of 704 labor and delivery nurses and 1,470 doulas. METHODS Multiple regression analysis was used to examine five sets of hypotheses about nurses' and doulas' attitudes toward each other. Scales of nurses' attitudes toward doulas and doulas' attitudes toward nurses included beliefs that nurses/doulas enhance communication, are collaborative team members, enhance a woman's birth experience, interfere with the ability to provide care, or interfere with relationships with the women for whom they care. RESULTS For nurses, exposure to doulas in their primary hospitals was associated with more positive views, whereas working more hours, feeling overworked, and a preference for clinical tasks over labor support were associated with more negative views of doulas. For doulas, working primarily in one hospital and certification were associated with more positive views of nurses. Nurses with more positive attitudes toward common obstetric practices had more negative attitudes toward doulas, whereas doulas with more positive attitudes toward common obstetric practices had more positive attitudes toward nurses. CONCLUSION Our findings show factors that influence mutual understanding and appreciation of nurses and doulas for each other. These factors can be influenced by educational efforts to improve interprofessional collaboration between these maternity care support roles.
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Xodo S, Saccone G, Cromi A, Ozcan P, Spagnolo E, Berghella V. Cephalad–caudad versus transverse blunt expansion of the low transverse uterine incision during cesarean delivery. Eur J Obstet Gynecol Reprod Biol 2016; 202:75-80. [DOI: 10.1016/j.ejogrb.2016.04.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/09/2016] [Accepted: 04/23/2016] [Indexed: 11/26/2022]
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Diamond-Smith N, Sudhinaraset M, Melo J, Murthy N. The relationship between women's experiences of mistreatment at facilities during childbirth, types of support received and person providing the support in Lucknow, India. Midwifery 2016; 40:114-23. [PMID: 27428107 DOI: 10.1016/j.midw.2016.06.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/14/2016] [Accepted: 06/19/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND a growing body of literature has highlighted the prevalence of mistreatment that women experience around the globe during childbirth, including verbal and physical abuse, neglect, lack of support, and disrespect. Much of this has been qualitative. Research around the world suggests that support during childbirth can improve health outcomes and behaviours, and improve experiences. Support can be instrumental, informational, or emotional, and can be provided by a variety of people including family (husbands, mothers) or health providers of various professional levels. This study explores women's reported experiences of mistreatment during childbirth quantitatively, and how these varied by specific types of support available and provided by specific individuals. METHODS participants were women age 16-30 who had delivered infants in a health facility in the previous five years and were living in slums of Lucknow India. Data were collected on their experiences of mistreatment, the types of support they received, and who provided that support. RESULTS women who reported lack of support were more likely to report mistreatment. Lack of support in regards to discussions with providers and provider information were most strongly associated with a higher mistreatment score. Women who received any type of support from their husband or a health worker were significantly more likely to report lower mistreatment scores. Receiving informational support from a mother/mother-in-law or emotional support from a health worker was also associated with lower mistreatment scores. However, receiving emotional support from a friend/neighbour/other family member was associated with a higher mistreatment score. CONCLUSIONS women rely on different people to provide different types of support during childbirth in this setting. Some of these individuals provide specific types of support that ultimately improve a woman's overall experience of her childbirth. Interventions aiming to reduce mistreatment to women during childbirth should consider the important role of increasing support for women, and who might be the most appropriate person to provide the most essential types of support through this process.
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Affiliation(s)
- Nadia Diamond-Smith
- University of California, San Francisco, 550 16th Street, 3rd Floor, Box 1224, San Francisco, CA 94158, United States.
| | - May Sudhinaraset
- University of California, San Francisco, 550 16th Street, 3rd Floor, Box 1224, San Francisco, CA 94158, United States.
| | - Jason Melo
- University of California, San Francisco, 550 16th Street, 3rd Floor, Box 1224, San Francisco, CA 94158, United States.
| | - Nirmala Murthy
- Foundation for Research in Health Systems, G-1, Brigade Bussiness Suites, 44, T.Mariappa Road, 100 feet Road, Jayanagar 2nd Block, Bangalore 560011, India.
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Moraloglu O, Kansu-Celik H, Tasci Y, Karakaya BK, Yilmaz Y, Cakir E, Yakut HI. The influence of different maternal pushing positions on birth outcomes at the second stage of labor in nulliparous women. J Matern Fetal Neonatal Med 2016; 30:245-249. [DOI: 10.3109/14767058.2016.1169525] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ragusa A, Gizzo S, Noventa M, Ferrazzi E, Deiana S, Svelato A. Prevention of primary caesarean delivery: comprehensive management of dystocia in nulliparous patients at term. Arch Gynecol Obstet 2016; 294:753-61. [PMID: 26924640 DOI: 10.1007/s00404-016-4046-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 02/09/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE Dystocia is the leading indication for primary caesarean sections. Our aim is to compare two approaches in the management of dystocia in labor in nulliparous women with a singleton fetus in cephalic presentation at term in spontaneous or induced labor. METHODS Prospective cohort study. Four hundred and nineteen consecutive patients were divided into two groups: the standard management group (SM), in acceleration of labor was commenced at the "action line" in the case of arrested or protracted labor, and the comprehensive management group (CM) in which arrested or protracted labor was considered as a warning sign promoting further diagnostic assessment prior to considering intervention. RESULTS Caesarean sections rate was 22.2 % in the SM group (216 patients) and 10.3 % in the CM group (203 patients) (p = 0.001). The rate of oxytocin use decreased from 33.3 % in SM group to 13.8 % in the CM group (p < 0.0005). The rate of amniotomy decreased from 41.7 % in the SM group to 7.4 % in the CM group (p < 0.0005). The percentage of newborns with 5-min Apgar score <7 and/or umbilical cord arterial pH ≤ 7.00 decreased from 2.3 % in SM cohort to 0.5 % in CM cohort (p = ns). The average length of labor did not differ between the two groups of patients (264 vs 277 min; p = ns). CONCLUSION Comprehensive management of dystocia enabled us to achieve a reduction in iatrogenic interventions in labor while maintaining good neonatal outcomes.
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Affiliation(s)
- Antonio Ragusa
- Dipartimento Materno Infantile, U.O.C. di Ginecologia e Ostetricia, Massa Carrara Hospital, Via Enrico Mattei 21, 54100, Massa Carrara, Italy.
| | - Salvatore Gizzo
- Dipartimento di Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Marco Noventa
- Dipartimento di Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Enrico Ferrazzi
- Department of Woman, Mother and Newborn, School of Medicine, Ospedale "V. Buzzi", Milan, Italy
| | - Sara Deiana
- Department of Obstetrics and Gynaecology, San Giovanni di Dio General Hospital, University of Cagliari, Cagliari, Italy
| | - Alessandro Svelato
- Department of Obstetrics and Gynaecology, Carlo Poma General Hospital, Mantua, Italy
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Badejoko OO, Ibrahim HM, Awowole IO, Bola-Oyebamiji SB, Ijarotimi AO, Loto OM. Upright or dorsal? childbirth positions among antenatal clinic attendees in Southwestern Nigeria. TROPICAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2016. [DOI: 10.4103/0189-5117.192219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Elvander C, Ahlberg M, Thies-Lagergren L, Cnattingius S, Stephansson O. Birth position and obstetric anal sphincter injury: a population-based study of 113 000 spontaneous births. BMC Pregnancy Childbirth 2015; 15:252. [PMID: 26453177 PMCID: PMC4600206 DOI: 10.1186/s12884-015-0689-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/05/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The association between birth position and obstetric anal sphincter injury (OASIS) in spontaneous vaginal deliveries is unclear. METHODS The study was based on the Stockholm-Gotland Obstetric Database (Sweden) from Jan 1(st) 2008 to Oct 22(nd) 2014 and included 113 279 singleton spontaneous vaginal births with no episiotomy. We studied risk of OASIS with respect to the following birth positions: a) sitting, b) lithotomy, c) lateral, d) standing on knees, e) birth seat, f) supine, g) squatting, h) standing and i) all fours. All analyses were stratified for parity. General linear models were used to calculate risk ratios (RR) adjusted for maternal, pregnancy and fetal characteristics. RESULTS The rates of OASIS among nulliparous women, parous women and women undergoing vaginal birth after a caesarean (VBAC) were 5.7%, 1.3% and 10.6%, respectively. The rates varied by birth position: from 3.7 to 7.1% in nulliparous women, 0.6% to 2.6% in parous women and 5.6% to 18.2% in women undergoing VBAC. Regardless of parity, the lowest rates were found among women giving birth in standing position and the highest rates among women birthing in the lithotomy position. Compared with sitting position, the lithotomy position involved an increased risk of OASIS among nulliparous (adjusted RR 1.17, 95% CI 1.06-1.29) and parous women (adjusted RR 1.66, 95% CI 1.35-2.05). Birth seat and squatting position involved an increased risk of OASIS among parous women (adjusted RR [95% CI] 1.36 [1.03-1.80] and 2.16 [1.15-4.07], respectively). Independent risk factors for OASIS were maternal age, head circumference ≥35 cm, birth weight ≥4000 g, length of gestation ≥ 40 weeks, prolonged second stage of labour, non-occiput anterior presentation and oxytocin augmentation. CONCLUSIONS Compared with sitting position, lateral position has a slightly protective effect in nulliparous women whilst an increased risk is noted among women in the lithotomy position, irrespective of parity. Squatting and birth seat position involve an increase in risk among parous women.
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Affiliation(s)
- Charlotte Elvander
- Department of Medicine, Division of Clinical Epidemiology, T2, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Mia Ahlberg
- Department of Medicine, Division of Clinical Epidemiology, T2, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Li Thies-Lagergren
- The Department of Health Sciences, Faculty of Medicine, Lund University, Box 117, 221 00, Lund, Sweden.
| | - Sven Cnattingius
- Department of Medicine, Division of Clinical Epidemiology, T2, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Olof Stephansson
- Department of Medicine, Division of Clinical Epidemiology, T2, Karolinska University Hospital, 171 76, Stockholm, Sweden.
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Demirel G, Guler H. The Effect of Uterine and Nipple Stimulation on Induction With Oxytocin and the Labor Process. Worldviews Evid Based Nurs 2015; 12:273-80. [DOI: 10.1111/wvn.12116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Gulbahtiyar Demirel
- Assistant Professor, Department of Midwifery; Faculty of Health Sciences, Cumhuriyet University; Sivas Turkey
| | - Handan Guler
- Assistant Professor, Department of Midwifery; Faculty of Health Sciences, Cumhuriyet University; Sivas Turkey
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Leslie MS, Erickson‐Owens D, Cseh M. The Evolution of Individual Maternity Care Providers to Delayed Cord Clamping: Is It the Evidence? J Midwifery Womens Health 2015; 60:561-9. [DOI: 10.1111/jmwh.12333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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He HG, Vehviläinen-Julkunen K, Qian XF, Sapountzi-Krepia D, Gong Y, Wang W. Fathers' feelings related to their partners' childbirth and views on their presence during labour and childbirth: A descriptive quantitative study. Int J Nurs Pract 2015; 21 Suppl 2:71-9. [DOI: 10.1111/ijn.12339] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Hong-Gu He
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science; Kuopio University Hospital; University of Eastern Finland; Kuopio Finland
| | - Xiao-Fang Qian
- Department of Nursing; Fujian Provincial Women's and Children's Hospital; Fuzhou Fujian China
- School of Nursing; Fujian Medical University; Fuzhou Fujian China
| | | | - Yuhua Gong
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
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Petrocnik P, Marshall JE. Hands-poised technique: The future technique for perineal management of second stage of labour? A modified systematic literature review. Midwifery 2015; 31:274-9. [DOI: 10.1016/j.midw.2014.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 09/26/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
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Dönmez S, Kavlak O. Effects of Prenatal Perineal Massage and Kegel Exercises on the Integrity of Postnatal Perine. Health (London) 2015. [DOI: 10.4236/health.2015.74059] [Citation(s) in RCA: 6] [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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Strauss N, Giessler K, McAllister E. How Doula Care Can Advance the Goals of the Affordable Care Act: A Snapshot From New York City. J Perinat Educ 2015; 24:8-15. [PMID: 26937157 PMCID: PMC4720857 DOI: 10.1891/1058-1243.24.1.8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Doula care meets each of the triple aims of the Affordable Care Act: improving health outcomes for all, improving the experience of care, and lowering costs by reducing non-beneficial and unwanted medical interventions. Cost is the greatest barrier to use of doula support. Reimbursement for doula services by private insurance, Medicaid, and Medicaid managed care organizations would significantly increase access to doulas. Widespread availability of doula care could significantly reduce cesarean rates, and increased access to community-based doula programs could reduce entrenched health disparities.
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Rezaei R, Saatsaz S, Chan YH, Nia HS. A comparison of the "hands-off" and "hands-on" methods to reduce perineal lacerations: a randomised clinical trial. J Obstet Gynaecol India 2014; 64:425-9. [PMID: 25489147 PMCID: PMC4257914 DOI: 10.1007/s13224-014-0535-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 03/08/2014] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The objective of the current study was to compare the "Hands-off" and "Hands-on" methods to reduce perineal lacerations. METHOD We conducted a randomized controlled trial to compare the effectiveness of two techniques for perineum protection during spontaneous delivery. Study participants included 600 nulliparous expectant mothers, who were divided equally between the "hands off" and "hands on" groups (n_300 per group). FINDINGS A total of 147 (49 %) women in the "Hands-on" and 143 women (47.7 %) in the "Hand -off" groups encountered perineal trauma (p = 0.74). In the "Hands-on" group, 8 women (2.7 %) experienced a third degree trauma compared with (0.3 %) that in the "Hands-off" method (p = 0.1). Episiotomy was performed on 38 women (12.7 %) from the "Hands-on" and 17 (5.7 %) women from the "Hands-off" (p = 0.003) groups. In addition, 28 women (9.3 %) from the "Hands-on" group and 47 women (15.7 %) from the "Hands-off" group experienced periurethral tears (p = 0.01) that did not need mending. CONCLUSION Application of the "Hands-off" method for vaginal delivery has a positive effect on the mother's health because of the reduction of Episiotomy and third degree tearing. Therefore, we conclude that the "Hands-off" method offers a safer alternative for perineal control during labor.
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Affiliation(s)
- Rozita Rezaei
- />Faculty of Nursing and Midwifery of Amol, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sussan Saatsaz
- />Faculty of Nursing and Midwifery of Amol, Mazandaran University of Medical Sciences, Sari, Iran
| | - Yiong Huak Chan
- />Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Hamid Sharif Nia
- />Faculty of Nursing and Midwifery of Amol, Mazandaran University of Medical Sciences, Sari, Iran
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Lansky S, Friche AADL, Silva AAMD, Campos D, Bittencourt SDDA, Carvalho MLD, Frias PGD, Cavalcante RS, Cunha AJLAD. Pesquisa Nascer no Brasil: perfil da mortalidade neonatal e avaliação da assistência à gestante e ao recém-nascido. CAD SAUDE PUBLICA 2014; 30 Suppl 1:S1-15. [DOI: 10.1590/0102-311x00133213] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 02/11/2014] [Indexed: 01/22/2023] Open
Abstract
Estudo de coorte sobre a mortalidade neonatal na pesquisa Nascer no Brasil, com entrevista e avaliação de prontuários de 23.940 puérperas entre fevereiro de 2011 e outubro de 2012. Utilizou-se modelagem hierarquizada para análise dos potenciais fatores de risco para o óbito neonatal. A taxa de mortalidade foi 11,1 por mil; maior nas regiões Norte e Nordeste e nas classes sociais mais baixas. O baixo peso ao nascer, o risco gestacional e condições do recém-nascido foram os principais fatores associados ao óbito neonatal. A inadequação do pré-natal e da atenção ao parto indicaram qualidade não satisfatória da assistência. A peregrinação de gestantes para o parto e o nascimento de crianças com peso < 1.500g em hospital sem UTI neonatal demonstraram lacunas na organização da rede de saúde. Óbitos de recém-nascidos a termo por asfixia intraparto e por prematuridade tardia expressam a evitabilidade dos óbitos. A qualificação da atenção, em especial da assistência hospitalar ao parto se configura como foco prioritário para maiores avanços nas políticas públicas de redução das taxas e das desigualdades na mortalidade infantil no Brasil.
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Affiliation(s)
- Sônia Lansky
- Secretaria Municipal de Saúde de Belo Horizonte, Brasil
| | | | | | - Deise Campos
- Fundação Hospitalar do Estado de Minas Gerais, Brasil
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The role of thumb and index finger placement in manual perineal protection. Int Urogynecol J 2014; 25:1533-40. [DOI: 10.1007/s00192-014-2425-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/29/2014] [Indexed: 01/06/2023]
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