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Hindley C, Hinsliff SW, Thomson AM. English Midwives' Views and Experiences of Intrapartum Fetal Heart Rate Monitoring in Women at Low Obstetric Risk: Conflicts and Compromises. J Midwifery Womens Health 2010; 51:354-360. [PMID: 16945783 DOI: 10.1016/j.jmwh.2006.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the last 20 years in the United Kingdom, midwives have implemented the routine use of intrapartum fetal monitoring regardless of the risk status of laboring women. This practice is at odds with the published research. The discrepancy between practice and best evidence merits further investigation. A qualitative study was conducted to evaluate midwives' attitudes and experiences about the use of fetal monitoring for women at low obstetric risk. Fifty-eight midwives working in two hospitals in the north of England were interviewed by using a semistructured approach. The taped interviews were transcribed and analyzed by using a general thematic approach. Issues included midwives' perceptions of low-risk status, the socialization of midwives, and the loss of woman-centered care. Midwives subscribed to the notion of woman-centered care, but because of a complexity of factors experienced in their daily working lives, they felt vulnerable when attempting to implement evidence-based fetal monitoring practices. Midwives regretted the loss of a woman-centered approach to care when technologic methods of intrapartum fetal heart rate monitoring were used indiscriminately. An appreciation of the complex factors affecting the ability of midwives to implement evidence-based practice is important when attempting to facilitate the development of appropriate fetal monitoring practices for women at low obstetric risk.
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Affiliation(s)
- Carol Hindley
- Carol Hindley, RM, MSc, ADM, Certified Editor, is a full-time lecturer in midwifery in the School of Nursing, Midwifery, and Social Work, University of Manchester. She devised the project, gained external funding, gathered and analyzed the data, and managed the project.Sophie Wren Hinsliff, RM, MPhil, is currently employed as a part-time clinical midwife. At the time of the project, she was the full-time research assistant who helped with data gathering and analysis.Ann M. Thomson, RM, MSc, ADM, MTD, is a professor in Midwifery in the School of Nursing, Midwifery, and Social Work, University of Manchester. Professor Thomson supervised the project and helped analyze the data
| | - Sophie Wren Hinsliff
- Carol Hindley, RM, MSc, ADM, Certified Editor, is a full-time lecturer in midwifery in the School of Nursing, Midwifery, and Social Work, University of Manchester. She devised the project, gained external funding, gathered and analyzed the data, and managed the project.Sophie Wren Hinsliff, RM, MPhil, is currently employed as a part-time clinical midwife. At the time of the project, she was the full-time research assistant who helped with data gathering and analysis.Ann M. Thomson, RM, MSc, ADM, MTD, is a professor in Midwifery in the School of Nursing, Midwifery, and Social Work, University of Manchester. Professor Thomson supervised the project and helped analyze the data
| | - Ann M Thomson
- Carol Hindley, RM, MSc, ADM, Certified Editor, is a full-time lecturer in midwifery in the School of Nursing, Midwifery, and Social Work, University of Manchester. She devised the project, gained external funding, gathered and analyzed the data, and managed the project.Sophie Wren Hinsliff, RM, MPhil, is currently employed as a part-time clinical midwife. At the time of the project, she was the full-time research assistant who helped with data gathering and analysis.Ann M. Thomson, RM, MSc, ADM, MTD, is a professor in Midwifery in the School of Nursing, Midwifery, and Social Work, University of Manchester. Professor Thomson supervised the project and helped analyze the data
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Tracy SK, Sullivan E, Wang YA, Black D, Tracy M. Birth outcomes associated with interventions in labour amongst low risk women: A population-based study. Women Birth 2007; 20:41-8. [PMID: 17467355 DOI: 10.1016/j.wombi.2007.03.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Revised: 03/21/2007] [Accepted: 03/22/2007] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite concern over high rates of operative birth in many countries, particularly amongst low risk healthy women, the obstetric antecedents of operative birth are poorly described. We aimed to determine the association between interventions introduced during labour with interventions in the birth process amongst women of low medical risk. METHODS We undertook a population-based descriptive study of all low risk women amongst the 753,895 women who gave birth in Australia during 2000-2002. Adjusted odds ratios (AOR) were calculated using multinomial logistic regression to describe the association between mode of birth and each of four labour intervention subgroups separately for primiparous and multiparous women. RESULTS We observed increased rates of operative birth in association with each of the interventions offered during the labour process. For first time mothers the association was particularly strong. CONCLUSIONS This study underlines the need for better clinical evidence of the effects of epidurals and pharmacological agents introduced in labour. At a population level it demonstrates the magnitude of the fall in rates of unassisted vaginal birth in association with a cascade of interventions in labour and interventions at birth particularly amongst women with no identified risk markers and having their first baby. This information may be useful for women wanting to explore other methods of influencing the course of labour and the management of pain in labour, especially in their endeavour to achieve a normal vaginal birth.
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Affiliation(s)
- Sally K Tracy
- Australian Institute of Health and Welfare, National Perinatal Statistics Unit, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2031, Australia.
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Altman MR, Lydon-Rochelle MT. Prolonged second stage of labor and risk of adverse maternal and perinatal outcomes: a systematic review. Birth 2006; 33:315-22. [PMID: 17150071 DOI: 10.1111/j.1523-536x.2006.00129.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Safe and effective management of the second stage of labor presents a clinical challenge for laboring women and practitioners of obstetric care. This systematic review was conducted to evaluate evidence for the influence of prolonged second stage of labor on the risk of selected adverse maternal and neonatal outcomes. METHODS Articles were searched using PubMed, Cochrane Library, and CINAHL from 1980 until 2005. Studies were included according to 3 criteria: if they reported duration of the second stage of labor, if they reported maternal and/or neonatal outcomes in relation to prolonged second stage, and if they reported original research. RESULTS Our systematic review found evidence of a strong association between prolonged second stage and operative delivery. Although significant associations with maternal outcomes such as postpartum hemorrhage, infection, and severe obstetric lacerations were reported, inherent limitations in methodology were evident in the studies. Recurrent limitations included oversimplified categorization of second stage, inconsistency in study population characteristics, and lack of control of confounding factors. No associations between prolonged second stage and adverse neonatal outcomes were reported. CONCLUSIONS The primary findings of our review indicated that most of the studies are flawed and do not answer the important questions for maternity caregivers to safely manage prolonged second stage. Meanwhile, approaches for promoting a normal second stage of labor are available to caregivers, such as maternal positioning and pain relief measures and also promoting effective pushing technique.
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Affiliation(s)
- Molly R Altman
- Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA
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Chou YJ, Huang N, Lin IF, Deng CY, Tsai YW, Chen LS, Lee CH. Do physicians and their relatives have a decreased rate of cesarean section? A 4-year population-based study in Taiwan. Birth 2006; 33:195-202. [PMID: 16948719 DOI: 10.1111/j.1523-536x.2006.00104.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The increased rate of cesarean deliveries may be partly due to a lack of consumer knowledge. Assuming that physicians and their relatives are well informed of the risks and benefits associated with the different methods of delivery, our goal was to compare cesarean rates between female physicians, female relatives of physicians, and women with high socioeconomic status in Taiwan. METHODS Two subgroups of 588 female physicians and 5,021 relatives of physicians aged 20 to 50 years were compared with 93,737 pregnant women with a monthly wage 40,000 dollars New Taiwan (NT) dollars or more as identified in nationwide National Health Insurance databases of Taiwan from 2000 to 2003. RESULTS Female physicians (adjusted odds ratio 0.66; 95% CI 0.47, 0.93) and female relatives of physicians (adjusted odds ratio 0.84; 95% CI 0.74, 0.95) were significantly less likely to undergo a cesarean section than other high socioeconomic status women, adjusted for clinical and nonclinical factors. CONCLUSIONS In this study, the cesarean delivery rate was lower among women who may have greater access to medical knowledge. However, the lower rates observed among female physicians and physician relatives in Taiwan are still considerably higher than the national averages of many countries. This finding suggests that other than information, practice patterns, and social and cultural milieu may play a role.
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Affiliation(s)
- Yiing-Jenq Chou
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
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