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Alruwaili TA, Crawford K, Fooladi E. Shared decision-making in maternity care in Saudi Arabia: A cross-sectional study. Midwifery 2024; 138:104147. [PMID: 39180884 DOI: 10.1016/j.midw.2024.104147] [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: 04/04/2024] [Revised: 07/31/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Shared decision-making (SDM) in maternity care involves women actively in decisions, thereby reducing decisional conflicts and enhancing satisfaction with care. AIM To investigate SDM and the factors associated with it, and its correlation with respect in maternity care in Saudi Arabia. METHODS A comprehensive, nationwide online questionnaire-based study was conducted between January to May 2023, involving women aged 18 years and above who were either pregnant or had experienced pregnancy/childbirth in the past 12 months. The Mothers' Autonomy in Decision-Making (MADM) scale and the Mothers of Respect Index (MORi) were used. Low to very low SDM was defined as a score of ≤ 24 on the MADM and low to very low respected was defined as a score of ≤ 49 on the MORi. RESULTS A total of 505 women completed the survey. Low to very low SDM was reported by 137 (34.1 %, 95 confidence interval (CI), 29.6 % - 38.9 %) women. Factors significantly associated with low to very low SDM included seeing different obstetricians of different gender at each visit (adjusted odds ratio (AOR) 2.0, 95 % CI, 1.0 - 3.9), not meeting the same obstetrician throughout the pregnancy (AOR 2.6, 95 % CI, 1.2 - 5.6) and having an instrumental vaginal birth (AOR 6.67, 95 % CI, 1.6 - 28.1). There was a positive association between low to very SDM and feeling of low to very low respect ((χ2 = 83.8173, p < 0.001). CONCLUSION More than one-third of women experienced low to very low SDM in maternity care. This should alert healthcare providers to the importance of continuity of care in Saudi Arabia.
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Affiliation(s)
- Tahani Ali Alruwaili
- Monash Nursing and Midwifery School, Monash University, Melbourne, VIC, Australia; College of Nursing, Aljouf University, Sakaka, Saudi Arabia.
| | - Kimberley Crawford
- Monash Nursing and Midwifery School, Monash University, Melbourne, VIC, Australia. https://twitter.com/Kim_E_Crawford
| | - Ensieh Fooladi
- Monash Nursing and Midwifery School, Monash University, Melbourne, VIC, Australia. https://twitter.com/NC_Fooladi
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Weerasingha TK, Ratnayake C, Abeyrathne R, Tennakoon SU. Evidence-based intrapartum care during vaginal births: Direct observations in a tertiary care hospital in Central Sri Lanka. Heliyon 2024; 10:e28517. [PMID: 38571647 PMCID: PMC10988013 DOI: 10.1016/j.heliyon.2024.e28517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
Background Evidence-based practice (EBP) is an effective approach to improve maternal and newborn outcomes at birth. Objective This study aimed to assess the current intrapartum practices of a tertiary care hospital in Central Province, Sri Lanka, during vaginal births. The benchmark for this assessment was the World Health Organisation's (WHO) recommendations on intrapartum care for a positive childbirth experience. Methods An observational study was conducted at the delivery room of Teaching Hospital, Peradeniya with the participation of 196 labouring women who were selected using systematic random sampling. A non-participant observation checklist covering labour room admission procedures, management of the first, second, and third stages of labour, and immediate care of the newborn and postpartum mother was used for the data collection. The care interventions implemented throughout labour and childbirth were observed and recorded. The data analysis was done using SPSS version 22. Results WHO-recommended practices such as providing privacy (33.2%), offering oral fluids (39.3%), and opioids for pain relief (48.5%) were found to be infrequent. Encouraging correct pushing techniques (77.6%), early breastfeeding (83.2%), regular assessment of vaginal bleeding (91.3%), skin-to-skin contact (93.4%), and using prophylactic uterotonics (100.0%) were found to be frequent. However, labour companionship, use of upright positions during labour, women's choice of birth position, and use of manual or relaxation techniques for pain relief were not observed in hospital intrapartum care. Conclusion The findings of the study indicate that additional attention and monitoring are required to align the current intrapartum care practices with the WHO recommendations. Moreover, the adoption of evidence-based intrapartum care should be encouraged by conveying the standard evidence-based intrapartum care guidelines to the grassroots level healthcare workers to avoid intrapartum interventions.
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Affiliation(s)
| | - Chathura Ratnayake
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - R.M. Abeyrathne
- Department of Sociology, Faculty of Arts, University of Peradeniya, Sri Lanka
| | - Sampath U.B. Tennakoon
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
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Al-Otaibi AG, Aboshaiqah AE, Aburshaid FA. Structural Empowerment, Resilience, and Intent to Stay Among Nurses and Midwives in Obstetrics and Gynecology Departments: A Phenomenological Inquiry Study in Saudi Arabia. SAGE Open Nurs 2024; 10:23779608241247434. [PMID: 38638413 PMCID: PMC11025421 DOI: 10.1177/23779608241247434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/17/2024] [Accepted: 03/23/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Staff turnover is a major obstacle to the success of Saudi Arabia's health transformation agenda and the realization of Saudi Vision 2030. Nurses' and midwives' intentions to remain with the organization are heavily influenced by their sense of structural empowerment and resilience. Objectives To gain insight into the perspectives of nurses and midwives working in the Obstetrics and Gynecology departments of a selection of Saudi Arabian governmental hospitals about structural empowerment, resilience, and intentions to stay in their current positions. Methods Qualitative Descriptive Phenomenology. Purposive sampling was used to choose eighteen nurses and midwives working in the OB/GYN department in three government hospitals in the Eastern Province of Saudi Arabia. Semi-structured interviews were conducted to gather the participants' perceptions. Colaizzi's steps were used as a data analysis method. Results The narratives of the selected participants generated five major themes: (a) "nurturing physical and physiological," (b) "developing psychological," (c) "managing financial," (e) "restructuring organizational," and (f) "enriching professional and occupational." Conclusions The emerging major themes highlighted the perceptive elements of nurses and midwives that keep them empowered, resilient, and determined to stay in their organization. A failure to fulfill any one of these elements will affect the others. To improve organizational outcomes, empowerment and resilience must be obtained.
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Affiliation(s)
- Areej Ghalib Al-Otaibi
- Fundamental of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmad E. Aboshaiqah
- Nursing Administration and Education Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
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Alghamdi RS, Perra O, Boyle B, Stockdale J. Perceived treatment of respectful maternity care among pregnant women at healthcare facilities in the Kingdom of Saudi Arabia: A cross-sectional study. Midwifery 2023; 123:103714. [PMID: 37229839 DOI: 10.1016/j.midw.2023.103714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Mistreatment of women during childbirth is a global issue and a violation of fundamental human rights. Respectful maternity care has been affirmed as a universal right of childbearing women. However, little is known about the level of respect experienced by women in the Kingdom of Saudi Arabia (KSA); which is undergoing key reforms in the scope of its healthcare provision. We explored the occurrence of respect perceived by women giving birth in the KSA and compared results between national healthcare sectors, as well as with previous international studies. METHOD We conducted a cross-sectional study using an online survey. The online questionnaire included demographic questions, a translation of the internationally validated Mother on Respect index (MORi) scale, which we adapted to investigate KSA women's experiences, and questions to further investigate women's experiences (e.g. respect of privacy). Women who gave birth within five years at a Saudi healthcare facility were recruited through social media using a snowballing approach. RESULTS Overall, 586 participants were recruited, 54% of whom had been cared for in government hospitals, 65% were aged between 25 and 34, and almost 79% had a BSc or higher qualification. Overall, women's perception about respectful maternity care was positive, however, opinions varied between governmental and private sectors. Women cared for in the government sector reported significantly lower levels of respect compared to those cared for in the private sector (β = -.132, p = .001). The results also highlighted an issue of concern: one in five women (21.8%) reported having been physically abused. Our participants perceived their childbirth experiences to be less respectful compared to those in other high-income countries. CONCLUSION Women birthing in the private sector reported a more respectful experience, which may be explained by the private sector being more consumer-focused. Women who gave birth in the KSA perceived their care to be less respectful than women giving birth in Canada and the USA. Beginning to understand what has provoked the occurrences of mistreatment in childbirth worldwide will inevitably contribute to the development of a solution. Respectful maternity care should be focused on providing women-centred care and quality of care which meets the WHO vision for women's and their families' needs being fulfilled and respected.
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Affiliation(s)
- Reem Saeed Alghamdi
- Maternal and Child Health Care Department, College of Nursing, Building 12, King Saud University, 12372, Riyadh, Kingdom of Saudi Arabia.
| | - Oliver Perra
- The Faculty of Medicine, Health, and Life Sciences, School of Nursing & Midwifery, Queen's University, MBC Building, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, United Kingdom
| | - Breidge Boyle
- The Faculty of Medicine, Health, and Life Sciences, School of Nursing & Midwifery, Queen's University, MBC Building, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, United Kingdom
| | - Janine Stockdale
- The Faculty of Medicine, Health, and Life Sciences, School of Nursing & Midwifery, Queen's University, MBC Building, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, United Kingdom
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Al Aryani Z, Orabi A, Fouly H. Examining the impact of upright and recumbent positions on labor outcomes in Saudi Arabia: A quasi-experiment. BELITUNG NURSING JOURNAL 2022; 8:316-324. [PMID: 37546496 PMCID: PMC10401374 DOI: 10.33546/bnj.2114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/06/2022] [Accepted: 07/18/2022] [Indexed: 08/08/2023] Open
Abstract
Background Helping the woman to adopt a comfortable position during childbirth significantly affects labor changes and pain management. However, there is a lack of consensus on the impacts of different childbirth positions on labor outcomes. In addition, a scarce of studies have assessed the effects of the upright and recumbent positions on delivery outcomes, especially in the Kingdom of Saudi Arabia. Objective This study aimed to examine and compare the influence of upright and recumbent childbirth positions on birth outcomes. Methods The setting was the childbirth unit at East Jeddah Hospital from November 2020 to March 2021. The research design was quasi-experimental, including 300 women in labor under 18-45 years. The sample includes two equal groups of 150 women: upright (experiment) and recumbent (comparison) position groups. Three tools were used to collect data: a structured interviewing questionnaire, the modified WHO partograph, and the Wong-Baker FACES® pain rating scale. Descriptive statistics, chi-square, independent t-test, and paired t-test were used for data analysis. Results Women in the recumbent position spent a longer duration in the first, second, and third stages of childbirth and had higher pain scores and less satisfaction with the assumed position than women in the upright position, with a highly significant difference (p <0.001). Conclusion Laboring women in upright positions experienced faster progress of labor, shorter duration of childbirth, less pain, and higher satisfaction than those assumed recumbent positions. This study serves as an input for midwives and nurses to enable them to offer appropriate advice to improve intrapartum care. In addition, educational programs targeting pregnant women about the positive impacts of upright position on women's birth experience are encouraged.
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Affiliation(s)
- Zahra Al Aryani
- NICU Department, King Fahad Hospital Al-Baha, Kingdom of Saudi Arabia
| | - Abeer Orabi
- College of Nursing - Jeddah, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
- Maternal and Newborn Health Nursing Department, Faculty of Nursing, Cairo University, Egypt
| | - Howieda Fouly
- College of Nursing - Jeddah, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
- Obstetrics and Gynecology Nursing Department, Assiut University, Egypt
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Modoor S, Fouly H, Rawas H. The effect of warm compresses on perineal tear and pain intensity during the second stage of labor: A randomized controlled trial. BELITUNG NURSING JOURNAL 2021; 7:210-218. [PMID: 37469347 PMCID: PMC10353617 DOI: 10.33546/bnj.1452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/25/2021] [Accepted: 05/26/2021] [Indexed: 07/21/2023] Open
Abstract
Background Warm compress is believed to reduce perineal tear occurrence and decrease pain intensity during the second stage of childbirth. Objective This study aimed to determine the effect of warm compresses on perineal tear and pain intensity during the second stage of labor. Methods A randomized controlled trial was conducted between 28 September 2018 to 30 October 2018 in King Khaled Hospital (KKH), affiliated with the Ministry of National Guard Hospital Affairs, King Abdul-Aziz Medical City Western Region, Saudi Arabia. According to eligibility criteria, the sample randomly recruited through lottery included 100 primigravida pregnant women, with 50 in each intervention and control group. Data were presented in the form of frequency and percentages, standard deviation, and mean. Chi-square test was used for data analysis, with p-value significance at ˂ 0.05. Results Sociodemographic data revealed no statistically significant difference in the age, education, occupation, and residence of both the control and experimental group. The perineum area's pain intensity after birth showed a statistically significant difference between the intervention and the control groups (p = 0.001). The perineal tear was also significantly different between both groups (p = 0.001). Conclusion The applied warm compresses on the perineum area positively reduce second and third-degree perineal tear and pain intensity during the second stage of labor and after childbirth. Therefore, midwives and nurses are expected to actively provide effective planned in-service training programs regarding warm compresses' advantages in the second stage of labor and apply this procedure actively.
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Affiliation(s)
- Soumaya Modoor
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Sciences, Kingdom of Saudi Arabia
- Maternity and Children Hospital, Makkah, Kingdom of Saudi Arabia
| | - Howieda Fouly
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Sciences, Kingdom of Saudi Arabia
- Faculty of Nursing, Assiut University, Egypt
| | - Hawazen Rawas
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Sciences, Kingdom of Saudi Arabia
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Conceptual Framework for Implementing the Saudi Childbirth Initiative. INTERNATIONAL JOURNAL OF CHILDBIRTH 2021. [DOI: 10.1891/ijcbirth-d-20-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are many efforts internationally to achieve safe and respectful Mother-Baby–Family maternity care. This article is the first to provide a conceptual framework for implementing the Saudi Childbirth Initiative (SCI) in all health institutions in Saudi Arabia. It introduces the 10 Steps of the SCI to strategically achieve a safe and respectful Mother-Baby–Family maternity care in order to improve maternal and infant outcome and implement evidence-based maternity care in Saudi Arabia. The SCI is developed upon previous initiatives and integrates and supports much of the current work being carried out by many organizations. The aim of the SCI's 10 Steps is to improve care throughout the childbearing continuum, to save lives, prevent illness and harm from the overuse of obstetric technologies, and promote health for mothers and babies and to provide clear guidelines for providing optimal maternity care. Safe and respectful Mother-Baby–Family Maternity Care is measurable and for each of the 10 Steps, there is an associated assessment tool to ensure these guidelines are being established by health institutions. SCI envisions that successful implementation of the 10 Steps can be measured and monitored using the a combination of statistical information and key performance indicators (KPIs) to measure maternal mortality and morbidity outcomes (currently in development) using local assessors.
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Baljon KJ, Romli MH, Ismail AH, Khuan L, Chew BH. Effectiveness of breathing exercises, foot reflexology and back massage (BRM) on labour pain, anxiety, duration, satisfaction, stress hormones and newborn outcomes among primigravidae during the first stage of labour in Saudi Arabia: a study protocol for a randomised controlled trial. BMJ Open 2020; 10:e033844. [PMID: 32540887 PMCID: PMC7299053 DOI: 10.1136/bmjopen-2019-033844] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Labour pain is among the severest pains primigravidae may experience during pregnancy. Failure to address labour pain and anxiety may lead to abnormal labour. Despite the many complementary non-pharmacological approaches to coping with labour pain, the quality of evidence is low and best approaches are not established. This study protocol describes a proposed investigation of the effects of a combination of breathing exercises, foot reflexology and back massage (BRM) on the labour experiences of primigravidae. METHODS AND ANALYSIS This randomised controlled trial will involve an intervention group receiving BRM and standard labour care, and a control group receiving only standard labour care. Primigravidae of 26-34 weeks of gestation without chronic diseases or pregnancy-related complications will be recruited from antenatal clinics. Eligible and consenting patients will be randomly allocated to the intervention or the control group stratified by intramuscular pethidine use. The BRM intervention will be delivered by a trained massage therapist. The primary outcomes of labour pain and anxiety will be measured during and after uterine contractions at baseline (cervical dilatation 6 cm) and post BRM hourly for 2 hours. The secondary outcomes include maternal stress hormone (adrenocorticotropic hormone, cortisol and oxytocin) levels, maternal vital signs (V/S), fetal heart rate, labour duration, Apgar scores and maternal satisfaction. The sample size is estimated based on the between-group difference of 0.6 in anxiety scores, 95% power and 5% α error, which yields a required sample size of 154 (77 in each group) accounting for a 20% attrition rate. The between-group and within-group outcome measures will be examined with mixed-effect regression models, time series analyses and paired t-test or equivalent non-parametric tests, respectively. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethical Committee for Research Involving Human Subjects of the Ministry of Health in the Saudi Arabia (H-02-K-076-0319-109) on 14 April 2019, and from the Ethics Committee for Research Involving Human Subjects (JKEUPM) Universiti Putra Malaysia on 23 October 2019, reference number: JKEUPM-2019-169. Written informed consent will be obtained from all participants. Results from this trial will be presented at regional, national and international conferences and published in indexed journals. TRIAL REGISTRATION NUMBER ISRCTN87414969, registered 3 May 2019.
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Affiliation(s)
- Kamilya Jamel Baljon
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Nursing, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Muhammad Hibatullah Romli
- Department of Nursing & Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Adibah Hanim Ismail
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Lee Khuan
- Department of Nursing & Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Boon How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Abdulghani N, Edvardsson K, Amir LH. Health care providers’ perception of facilitators and barriers for the practice of skin-to-skin contact in Saudi Arabia: A qualitative study. Midwifery 2020; 81:102577. [DOI: 10.1016/j.midw.2019.102577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 10/23/2019] [Accepted: 11/16/2019] [Indexed: 12/13/2022]
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Altaweli R, McCourt C, Scamell M, Curtis Tyler K. Ethnographic study of the use of interventions during the second stage of labor in Jeddah, Saudi Arabia. Birth 2019; 46:500-508. [PMID: 30198111 PMCID: PMC6767456 DOI: 10.1111/birt.12395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 12/04/2022]
Abstract
BACKGROUND Routine use of medical interventions during labor has been identified as a clinical area for concern, since such routinized practice is not consistent with an evidence-based approach to care and continues to increase despite efforts to encourage normal childbirth. Therefore, the aim of our study was to explore maternity health professionals' use of interventions during the second stage of labor in two hospitals in Jeddah, Saudi Arabia, to understand what influences their decision-making and practices. METHODS This was an exploratory study using an ethnographic approach. Data collection methods included participant observations of 19 labors and births (n = 8 at City Hospital and n = 11 at King's Hospital) and semi-structured interviews with 29 health care professionals. In addition, the hospital labor and delivery ward policies and guidelines from those hospitals were collected. Data were analyzed thematically. RESULTS Medical interventions were used during the second stage of labor routinely, regardless of clinical indication. Three core influences that shaped the clinical decision-making were identified as follows: (a) organizational culture, (b) a medical concept of birth, and (c) a hierarchical system of control. We suggest that the clinical decision-making and routine practice in this setting arises out of the interface between these three core influences whereby hierarchical control and clinicians' exercise of power and feelings of powerlessness are fundamental drivers for an organizational culture of medicalized childbirth, despite the differing models of childbirth which professionals described. CONCLUSIONS Clinical decisions relating to the use of interventions during childbirth are both complex and socially negotiated. The findings reflect the complexity of the use of interventions during the second stage of labor and the multiple influences on professionals' practices. We have shown how three key influences interact to shape clinical decision-making during the second stage of labor in this cultural setting and how the use of medical interventions can be analyzed as an illustration of the power dynamic in the maternity health care system. We suggest that written policies are insufficient to bring about evidence-based practice and approaches to change need to take into account these different levels of influence.
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Affiliation(s)
| | - Christine McCourt
- Department of Maternal and Child Health, School of Health SciencesCity, University of LondonLondonUK
| | - Mandie Scamell
- School of Health SciencesCity, University of LondonLondonUK
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Kaddoura R, DeJong J, Zurayk H, Kabakian T, Abbyad C, Mirza FG. Episiotomy practice in the Middle East: A Lebanese teaching tertiary care centre experience. Women Birth 2018; 32:e223-e228. [PMID: 30057367 DOI: 10.1016/j.wombi.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 04/16/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
PROBLEM There is lack of data on the rate of episiotomy in Lebanon and the study's hospital. BACKGROUND Only a few studies have addressed episiotomy practice in Lebanon and the Middle East and they show varying rates. AIM To identify the rate, and change in rate, of episiotomy practice over the years at a teaching hospital in Lebanon and to assess whether maternal age, parity, fetal weight, woman's hospital admission class, and physician's gender were associated with episiotomy. We also tested the association between episiotomy and postpartum hemorrhage and/or high degree perineal tears. METHODS A retrospective observational study was conducted on 1756 records for women having a normal vaginal birth at a single centre from January 2009 to January 2014. FINDINGS The rate of episiotomy at the hospital was very high, with 97.4% of women receiving an episiotomy in 2009. A major decrease in the rate was identified with a decline from 97.4% in 2009 to 73.3% in January 2014. Episiotomy was found to be associated with parity, maternal age, and with high degree perineal tears. DISCUSSION The episiotomy rate at this centre remains higher than the 10% rate recommended by the World Health Organization, although there has been a significant reduction after a call for restrictive rather than liberal use. CONCLUSION Raising awareness among providers appeared to play a significant role in reducing this rate, although more efforts remain warranted. Other strategies - such as raising awareness of women about potential risks of episiotomy - are also worth exploring.
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Affiliation(s)
- Rima Kaddoura
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Jocelyn DeJong
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Huda Zurayk
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Tamar Kabakian
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | | | - Fadi G Mirza
- Department of Obstetrics and Gynecology, American University of Beirut Medical centre, Beirut, Lebanon; Department of Obstetrics and Gynecology, Columbia University Medical centre, New York, USA.
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DeJong J, Zurayk H, Myntti C, Tekçe B, Giacaman R, Bashour H, Ghérissi A, Gaballah N. Health research in a turbulent region: the Reproductive Health Working Group. REPRODUCTIVE HEALTH MATTERS 2018; 25:4-15. [PMID: 29120294 DOI: 10.1080/09688080.2017.1379864] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The Reproductive Health Working Group (RHWG) was established in 1988 in Cairo to advance research in the Arab countries and Turkey on the health of women, broadly defined. The paper considers the ways in which the group contributed to global health conversations through three examples of interdisciplinary research that, in privileging local contexts, modified or even challenged prevailing approaches to health and often raised entirely new issues for consideration. The three examples cited in the paper are: (i) the network's early research on reproductive morbidity; (ii) a broad set of ongoing studies on childbirth/maternal health; and (iii) emerging research on health and conflict. The paper discusses how the RHWG has strengthened research capability in the region, and explores the reasons for the longevity of this research network.
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Affiliation(s)
- Jocelyn DeJong
- a Professor and Associate Dean, Faculty of Health Sciences , American University of Beirut , Beirut , Lebanon
| | - Huda Zurayk
- b Emeritus Professor, Faculty of Health Sciences , American University of Beirut , Beirut , Lebanon
| | | | - Belgin Tekçe
- d Professor, Sociology Department , Bogazici University , Istanbul , Turkey
| | - Rita Giacaman
- e Professor, Institute for Community and Public Health , Birzeit University , Birzeit , Palestine
| | - Hyam Bashour
- f Professor, Department of Family and Community Medicine, Faculty of Medicine , Damascus University
| | - Atf Ghérissi
- g Assistant Professor, Tunis El Manar University , Tunis , Tunisia
| | - Noha Gaballah
- h Program manager, Reproductive Health Working Group , Cairo , Egypt
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Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comandé D, Diaz V, Geller S, Hanson C, Langer A, Manuelli V, Millar K, Morhason-Bello I, Castro CP, Pileggi VN, Robinson N, Skaer M, Souza JP, Vogel JP, Althabe F. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Lancet 2016; 388:2176-2192. [PMID: 27642019 DOI: 10.1016/s0140-6736(16)31472-6] [Citation(s) in RCA: 638] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/23/2016] [Accepted: 07/11/2016] [Indexed: 12/29/2022]
Abstract
On the continuum of maternal health care, two extreme situations exist: too little, too late (TLTL) and too much, too soon (TMTS). TLTL describes care with inadequate resources, below evidence-based standards, or care withheld or unavailable until too late to help. TLTL is an underlying problem associated with high maternal mortality and morbidity. TMTS describes the routine over-medicalisation of normal pregnancy and birth. TMTS includes unnecessary use of non-evidence-based interventions, as well as use of interventions that can be life saving when used appropriately, but harmful when applied routinely or overused. As facility births increase, so does the recognition that TMTS causes harm and increases health costs, and often concentrates disrespect and abuse. Although TMTS is typically ascribed to high-income countries and TLTL to low-income and middle-income ones, social and health inequities mean these extremes coexist in many countries. A global approach to quality and equitable maternal health, supporting the implementation of respectful, evidence-based care for all, is urgently needed. We present a systematic review of evidence-based clinical practice guidelines for routine antenatal, intrapartum, and postnatal care, categorising them as recommended, recommended only for clinical indications, and not recommended. We also present prevalence data from middle-income countries for specific clinical practices, which demonstrate TLTL and increasing TMTS. Health-care providers and health systems need to ensure that all women receive high-quality, evidence-based, equitable and respectful care. The right amount of care needs to be offered at the right time, and delivered in a manner that respects, protects, and promotes human rights.
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Affiliation(s)
- Suellen Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | | | - Agustin Ciapponi
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Daniela Colaci
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Daniel Comandé
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Virginia Diaz
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Stacie Geller
- Center for Research on Women and Gender, University of Illinois, Chicago, IL, USA
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Langer
- Maternal Health Task Force, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Victoria Manuelli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Kathryn Millar
- Maternal Health Task Force, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Imran Morhason-Bello
- University of Ibadan, Ibadan, Nigeria; London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia Pileggi Castro
- GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil; Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Vicky Nogueira Pileggi
- GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil; Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | - João Paulo Souza
- GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil; Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Joshua P Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Fernando Althabe
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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Scamell M, Altaweli R, McCourt C. Sarah's birth. How the medicalisation of childbirth may be shaped in different settings: Vignette from a study of routine intervention in Jeddah, Saudi Arabia. Women Birth 2016; 30:e39-e45. [PMID: 27692959 DOI: 10.1016/j.wombi.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The expansion of the medicalisation of childbirth has been described in the literature as being a global phenomenon. The vignette described in this paper, selected from an ethnographic study of routine intervention in Saudi Arabian hospitals illustrates how the worldwide spread of the bio-medical model does not take place within a cultural vacuum. AIM To illuminate the ways in which the medicalisation of birth may be understood and practised in different cultural settings, through a vignette of a specific birth, drawn as a typical case from an ethnographic study that investigated clinical decision-making in the second stage of labour in Saudi Arabia. METHODS Ethnographic data collection methods, including participant observation and interviews. The data presented in this paper are drawn from ethnographic field notes collected during field work in Saudi Arabia, and informed by analysis of a wider set of field notes and interviews with professionals working in this context. FINDINGS While the medicalisation of care is a universal phenomenon, the ways in which the care of women is managed using routine medical intervention are framed by the local cultural context in which these practices take place. DISCUSSION The ethnographic data presented in this paper shows the medicalisation of birth thesis to be incomplete. The evidence presented in this paper illustrates how local belief systems are not so much subsumed by the expansion of the bio-medical model of childbirth, rather they may actively facilitate a process of localised reinterpretation of such universalised and standardised practices. In this case, aspects of the social and cultural context of Jeddah operates to intensify the biomedical model at the expense of respectful maternity care. CONCLUSION In this article, field note data on the birth of one Saudi Arabian woman is used as an illustration of how the medicalisation of childbirth has been appropriated and reinterpreted in Jeddah, Saudi Arabia.
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Affiliation(s)
- Mandie Scamell
- Centre for Maternal and Child Health, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, England, United Kingdom.
| | - Roa Altaweli
- Centre for Maternal and Child Health, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, England, United Kingdom
| | - Christine McCourt
- Centre for Maternal and Child Health, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, England, United Kingdom
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Abstract
BackgroundPubic or perineal shaving is a procedure performed before birth in order to lessen the risk of infection if there is a spontaneous perinealtear or if an episiotomy is performed.ObjectivesTo assess the effects of routine perineal shaving before birth onmaternal and neonatal outcomes, according to the best available evidence.Search methodsWe searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (12 June 2014).Selection criteriaAll controlled trials (including quasi-randomised) that compare perineal shaving versus no perineal shaving.Data collection and analysisTwo review authors independently assessed all potential studies for inclusion, assessed risk of bias and extracted the data using apredesigned form. Data were checked for accuracy.Main resultsThree randomised controlled trials (1039 women) published between 1922 and 2005 fulfilled the prespecified criteria. In the earliesttrial, 389 women were alternately allocated to receive either skin preparation and perineal shaving or clipping of vulval hair only. In thesecond trial, which included 150 participants, perineal shaving was compared with the cutting of long hairs for procedures only. In thethird and most recent trial, 500 women were randomly allocated to shaving of perineal area or cutting of perineal hair. The primaryoutcome for all three trials was maternal febrile morbidity; no differences were found (risk ratio (RR) 1.14, 95% confidence interval(CI) 0.73 to 1.76). No differences were found in terms of perineal wound infection (RR 1.47, 95% CI 0.80 to 2.70) and perinealwound dehiscence (RR 0.33, 95% CI 0.01 to 8.00) in the most recent trial involving 500 women, which was the only trial to assessthese outcomes. In the smallest trial, fewer women who had not been shaved had Gram-negative bacterial colonisation compared withwomen who had been shaved (RR 0.83, 95% CI 0.70 to 0.98). There were no instances of neonatal infection in either group in theone trial that reported this outcome. There were no differences in maternal satisfaction between groups in the larger trial reporting this outcome (mean difference (MD) 0.00, 95% CI -0.13 to 0.13). No trial reported on perineal trauma. One trial reported on side-effectsand these included irritation, redness, burning and itching.The overall quality of evidence ranged from very low (for the outcomes postpartum maternal febrile morbidity and neonatal infection)to low (for the outcome maternal satisfaction and wound infection).Authors’ conclusionsThere is insufficient evidence to recommend perineal shaving for women on admission in labour.
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Affiliation(s)
- Vittorio Basevi
- SaPeRiDoc, Primary health care, general medicine, planning and development of health services, Emilia-Romagna Regional health authority, Bologna, Italy.
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Sandall J. Culture, context and the implementation challenge to achieve a better birth experience. Midwifery 2014; 30:803. [DOI: 10.1016/j.midw.2014.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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