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Soman DA, Joseph A, Moore A. Influence of the Physical Environment on Maternal Care for Culturally Diverse Women: A Narrative Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:306-328. [PMID: 38379226 DOI: 10.1177/19375867241227601] [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] [Indexed: 02/22/2024]
Abstract
OBJECTIVES This narrative literature review aims to develop a framework that can be used to understand, study, and design maternal care environments that support the needs of women from diverse racial and ethnic groups. BACKGROUND Childbirth and the beginning of life hold particular significance across many cultures. People's cultural orientation and experiences influence their preferences within healthcare settings. Research suggests that culturally sensitive care can help improve the experiences and outcomes and reduce maternal health disparities for women from diverse cultures. At the same time, the physical environment of the birth setting influences the birthing experience and maternal outcomes such as the progression of labor, the use of interventions, and the type of birth. METHODS The review synthesizes articles from three categories: (a) physical environment of birthing facilities, (b) physical environment and culturally sensitive care, and (c) physical environment and culturally sensitive birthing facilities. RESULTS Fifty-five articles were identified as relevant to this review. The critical environmental design features identified in these articles were categorized into different spatial scales: community, facility, and room levels. CONCLUSIONS Most studies focus on maternal or culturally sensitive care settings outside the United States. Since the maternal care environment is an important aspect of their culturally sensitive care experience, further studies exploring the needs and perspectives of racially and ethnically diverse women within maternal care settings in the United States are necessary. Such research can help future healthcare designers contribute toward addressing the ongoing maternal health crisis within the country.
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Affiliation(s)
- Devi A Soman
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, SC, USA
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, Clemson University, SC, USA
- School of Architecture and Industrial Engineering, Clemson University, SC, USA
| | - Arelis Moore
- Community Health and Spanish, Department of Languages, Clemson University, SC, USA
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Myhre EL, Garnweidner-Holme L, Dahl B, Reigstad MM, Lukasse M. Development of and Experiences With an Informational Website on Early Labor: Qualitative User Involvement Study. JMIR Form Res 2021; 5:e28698. [PMID: 34569940 PMCID: PMC8506263 DOI: 10.2196/28698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/21/2021] [Accepted: 08/01/2021] [Indexed: 01/30/2023] Open
Abstract
Background The period of regular contractions before 4 cm of cervical dilatation is often referred to as the latent phase or early labor. Women find it challenging to prepare for and cope with this phase of labor, and easily accessed web-based information from reliable sources may be useful in this preparation. Objective The aim of this study is to describe the development of a Norwegian website, Latens.no, for people seeking information on early labor and to explore users’ experiences with the website to increase its user-friendliness. Methods We developed a website using an iterative process involving a multidisciplinary research team, health personnel, users, a graphic designer, and an expert in software development. We explored the website’s user-friendliness using semistructured individual interviews and the think-aloud method. All interviews were audio recorded and transcribed. We then analyzed the participants’ feedback on the website. Results Participants included women who had recently given birth to their first baby (n=2), women who were pregnant with their first baby (n=4), and their partners (n=2). Results from participants’ experiences completing tasks included positive feedback related to the content of Latens.no, positive feedback related to the website’s design, and suggestions for improvement. Participants wanted to find information on early labor on the internet. Moreover, they found the information on the website relevant, trustworthy, and easy to read, and the design was attractive and easy to use. Overall, the participants performed the tasks easily, with few clicks and minimal effort. Conclusions The think-aloud method, while performing tasks, allowed for detailed feedback. The participants confirmed the user-friendliness of the website but at the same time provided information enabling improvement. We expect that changes made based on this user-centered design study will further increase the usability and acceptability of Latens.no.
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Affiliation(s)
- Enid Leren Myhre
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Lisa Garnweidner-Holme
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Bente Dahl
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Marte Myhre Reigstad
- Norwegian Research Centre for Women's Health, Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Mirjam Lukasse
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
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Buyuk GN, Kansu-Celik H, Kaplan ZAO, Kisa B, Ozel S, Engin-Ustun Y. Risk Factors for Intrapartum Cesarean Section Delivery in Low-risk Multiparous Women Following at Least a Prior Vaginal Birth (Robson Classification 3 and 4). REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:436-441. [PMID: 34318468 PMCID: PMC10411140 DOI: 10.1055/s-0041-1731378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/19/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate the risk factors for cesarean section (C-section) in low-risk multiparous women with a history of vaginal birth. METHODS The present retrospective study included low-risk multiparous women with a history of vaginal birth who gave birth at between 37 and 42 gestational weeks. The subjects were divided into 2 groups according to the mode of delivery, as C-section Group and vaginal delivery Group. Risk factors for C-section such as demographic characteristics, ultrasonographic measurements, smoking, weight gain during pregnancy (WGDP), interval time between prior birth, history of macrosomic birth, and cervical dilatation at the admission to the hospital were obtained from the charts of the patients. Obstetric and neonatal outcomes were compared between groups. RESULTS The most common C-section indications were fetal distress and macrosomia (33.9% [n = 77 and 20.7% [n = 47] respectively). A bivariate correlation analysis demonstrated that mothers aged > 30 years old (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.30-3.34; p = 0.002), parity >1 (OR: 1.81; 95%CI: 1.18-2.71; p = 0.006), fetal abdominal circumference (FAC) measurement > 360 mm (OR: 34.20; 95%CI: 8.04-145.56; p < 0.001)) and < 345 mm (OR: 3.06; 95%CI: 1.88-5; p < 0.001), presence of large for gestational age (LGA) fetus (OR: 5.09; 95%CI: 1.35-19.21; p = 0.016), premature rupture of membranes (PROM) (OR: 1.52; 95%CI: 1-2.33; p = 0.041), and cervical dilatation < 5cm at admission (OR: 2.12; 95%CI: 1.34-3.34; p = 0.001) were associated with the group requiring a C-section. CONCLUSION This is the first study evaluating the risk factors for C-section in low-risk multiparous women with a history of vaginal birth according to the Robson classification 3 and 4. Fetal distress and suspected fetal macrosomia constituted most of the C-section indications.
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Affiliation(s)
- Gul Nihal Buyuk
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Hatice Kansu-Celik
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Zeynep Asli Oskovi Kaplan
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Burcu Kisa
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Sule Ozel
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
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Schaefer KM, Modest AM, Hacker MR, Chie L, Connor Y, Golen T, Molina RL. Language Preference and Risk of Primary Cesarean Delivery: A Retrospective Cohort Study. Matern Child Health J 2021; 25:1110-1117. [PMID: 33904024 DOI: 10.1007/s10995-021-03129-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES While some medical indications for cesarean delivery are clear, subjective provider and patient factors contribute to the rising cesarean delivery rates and marked disparities between racial/ethnic groups. We aimed to determine the association between language preference and risk of primary cesarean delivery. METHODS We conducted a retrospective cohort study of nulliparous, term, singleton, vertex (NTSV) deliveries of patients over 18 years old from 2011-2016 at an academic medical center, supplemented with data from the Massachusetts Department of Public Health. We used modified Poisson regression with robust error variance to calculate risk ratios for cesarean delivery between patients with English language preference and other language preference, with secondary outcomes of Apgar score, maternal readmission, blood transfusion, and NICU admission. RESULTS Of the 11,298 patients included, 10.3% reported a preferred language other than English, including Mandarin and Cantonese (61.7%), Portuguese (9.7%), and Spanish (7.5%). The adjusted risk ratio for cesarean delivery among patients with a language preference other than English was 0.85 (95% CI 0.72-0.997; p = 0.046) compared to patients with English language preference. No significant differences in risk of secondary outcomes between English and other language preference were found. DISCUSSION After adjusting for confounders, this analysis demonstrates a decreased risk of cesarean delivery among women who do not have an English language preference at one institution. This disparity in cesarean delivery rates in an NTSV population warrants future research, raising the question of what clinical and social factors may be contributing to these lower cesarean delivery rates.
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Affiliation(s)
| | - Anna M Modest
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA
| | - Michele R Hacker
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA
| | - Lucy Chie
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA
| | - Yamicia Connor
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA
| | - Toni Golen
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA
| | - Rose L Molina
- Harvard Medical School, Boston, MA, USA.
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA.
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McClelland WS. Birth by a thousand cuts. Birth 2020; 47:301-303. [PMID: 33263213 DOI: 10.1111/birt.12517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 10/22/2022]
Affiliation(s)
- W Spencer McClelland
- Department of Obstetrics and Gynecology, Lenox Hill Hospital-Northwell Health, New York, NY, USA
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Miller YD, Armanasco AA, McCosker L, Thompson R. Variations in outcomes for women admitted to hospital in early versus active labour: an observational study. BMC Pregnancy Childbirth 2020; 20:469. [PMID: 32807137 PMCID: PMC7430117 DOI: 10.1186/s12884-020-03149-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/31/2020] [Indexed: 11/20/2022] Open
Abstract
Background There is no available evidence for the prevalence of early labour admission to hospital or its association with rates of intervention and clinical outcomes in Australia. The objectives of this study were to: estimate the prevalence of early labour admission in one hospital in Australia; compare rates of clinical intervention, length of hospital stay and clinical outcomes for women admitted in early (< 4 cm cervical dilatation) or active (≥4 cm) labour; and determine the impact of recent recommendations to define early labour as < 5 cm on the findings. Methods We conducted a retrospective cohort study using medical record data from a random sample of 1223 women from live singleton births recorded between July 2013 and December 2015. Analyses included women who had spontaneous onset of labour at ≥37 weeks gestation whilst not a hospital inpatient, who had not scheduled a caesarean section before labour onset or delivered prior to hospital admission. Associations between timing of hospital admission in labour and clinical intervention, outcomes and hospital stay were assessed using logistic regression. Results Between 32.4% (< 4 cm) and 52.9% (< 5 cm) of eligible women (N = 697) were admitted to hospital in early labour. After adjustment for potential confounders, women admitted in early labour (< 4 cm) were more likely to have their labour augmented by oxytocin (AOR = 3.57, 95% CI 2.39–5.34), an epidural (AOR = 2.27, 95% CI 1.51–3.41), a caesarean birth (AOR = 3.50, 95% CI 2.10–5.83), more vaginal examinations (AOR = 1.73, 95% CI = 1.53–1.95), and their baby admitted to special care nursery (AOR = 1.54, 95% CI = 1.01–2.35). Defining early labour as < 5 cm cervical dilatation produced additional significant associations with artificial rupture of membranes (AOR = 1.41, 95% CI = 1.02–1.95), assisted vaginal birth (AOR = 1.96, 95% CI = 1.12–3.41) neonatal resuscitation (AOR = 1.73, 95% CI = 1.01–2.99) and longer maternal hospital stay (AOR = 1.21, 95% CI = 1.04–1.40). Conclusions Findings provide preliminary evidence that a notable proportion of labouring women are admitted in early labour and are more likely to experience several medical procedures, neonatal resuscitation and admission to special care nursery, and longer hospital stay.
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Affiliation(s)
- Yvette D Miller
- Queensland University of Technology, Institute of Health & Biomedical Innovation, School of Public Health & Social Work, Kelvin Grove, Brisbane, QLD, 4059, Australia.
| | - Ashleigh A Armanasco
- Queensland University of Technology, Institute of Health & Biomedical Innovation, School of Public Health & Social Work, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Laura McCosker
- Queensland University of Technology, Institute of Health & Biomedical Innovation, School of Public Health & Social Work, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Rachel Thompson
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
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Tilden EL, Phillippi JC, Ahlberg M, King TL, Dissanayake M, Lee CS, Snowden JM, Caughey AB. Describing latent phase duration and associated characteristics among 1281 low-risk women in spontaneous labor. Birth 2019; 46:592-601. [PMID: 30924182 PMCID: PMC6765461 DOI: 10.1111/birt.12428] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/24/2019] [Accepted: 03/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent research suggests that latent phase of labor may terminate at 6 rather than 4 centimeters of cervical dilation. The objectives of this study were to: (a) characterize duration of the latent phase of labor among term, low-risk, United States women in spontaneous labor using the women's self-identified onset; and (b) quantify associations between demographic and maternal/newborn health characteristics and the duration of the latent phase. METHODS This prospective study (n = 1281) described the duration of the latent phase of labor in hours, stratified by parity at the mean, median, and 80th, 90th, and 95th percentiles. The duration of the latent phase was compared for each characteristic using t tests or Wilcoxon rank-sum tests and regression models that controlled for confounders. RESULTS In this sample of predominantly white, healthy women, duration of the latent phase of labor was longer than described in previous studies: The median duration was 9.0 hours and mean duration was 11.8 hours in nulliparous women. The median duration was 6.8 hours and mean duration was 9.3 hours in multiparous women. Among nulliparous women, longer duration was seen in women whose fetus was in a malposition. Among multiparous women, longer durations were noted in women with chorioamnionitis and those who gave birth between 41 and 41 + 6 weeks' gestation (vs between 40 and 40 + 6 weeks' gestation). CONCLUSIONS The latent phase of labor may be longer than previously estimated. Contemporary estimates of latent phase of labor duration will help women and providers accurately anticipate, prepare, and cope during spontaneous labor.
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Affiliation(s)
- Ellen L Tilden
- Department of Nurse-Midwifery, Oregon Health & Science University School of Nursing, Portland, Oregon
- Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | | | | | - Tekoa L King
- Department of Obstetrics and Gynecology, University of California, San Francisco, California
| | - Mekhala Dissanayake
- Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | | | - Jonathan M Snowden
- Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon
| | - Aaron B Caughey
- Department of Nurse-Midwifery, Oregon Health & Science University School of Nursing, Portland, Oregon
- Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
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Roberts J. The ontology of early labour (and the difficulties of talking about it): Using interview methods to investigate uncertain and gendered concepts. METHODOLOGICAL INNOVATIONS 2019. [DOI: 10.1177/2059799119825594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This article presents reflections on the process of collecting interview data about fathers’ experiences of ‘early labour’. Early labour is the first phase of labour, defined in textbooks by regular contractions and cervical dilation of up to 4 cm. Women are typically encouraged to stay at home during early labour and only travel to hospital when they are in ‘active labour’. Maternity services (and other providers of antenatal education) devote a great deal of attention to educating parents-to-be about the phases of labour and about how to recognise the ‘right time’ to travel to hospital but ‘early’ admission remains a problem. Prompted by suggestions in the existing literature that male partners may influence when women seek admission, my research set out to explore fathers’ understanding and experiences of early labour. However, interviewing fathers about early labour was challenging and, in this article, I will argue that this was due to a particular configuration of practical, epistemological and ontological issues. I argue that early labour is a slippery and uncertain concept beyond the clinical context and that Mol’s ‘multiple ontologies’ provides productive tools for reflecting on the difficulty of asking about early labour, keeping early labour in focus during the interviews, and finding early labour in the data. However, the gendered nature of reproductive social research requires additional analysis to understand the gender dynamics at work when asking about reproductive research objects of multiple or uncertain ontologies.
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Affiliation(s)
- Julie Roberts
- School of Health Sciences, The University of Nottingham, Nottingham, UK
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Breckenkamp J, Läcke EM, Henrich W, Borde T, Brenne S, David M, Razum O. Advanced cervical dilatation as a predictor for low emergency cesarean delivery: a comparison between migrant and non-migrant Primiparae - secondary analysis in Berlin, Germany. BMC Pregnancy Childbirth 2019; 19:1. [PMID: 30606156 PMCID: PMC6318868 DOI: 10.1186/s12884-018-2145-y] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/12/2018] [Indexed: 02/07/2023] Open
Abstract
Background Cesarean rates are higher in women admitted to labor ward during early stages rather than at later stages of labor. In a study in Germany, crude cesarean rates among Turkish and Lebanese immigrant women were low compared to non-immigrant women. We evaluated whether these immigrant women were admitted during later stages of labor, and if so, whether this explains their lower cesarean rates. Methods We enrolled 1413 nulliparous women with vertex pregnancies, singleton birth, and 37+ week of gestation, excluding elective cesarean deliveries, in three Berlin obstetric hospitals. We applied binary logistic regression to adjust for social and obstetric factors; and standardized coefficients to rank predictors derived from the regression model. Results At the time of admission to labor ward, a smaller proportion of Turkish migrant women was in the active phase of labor (cervical dilation: 4+ cm), compared to women of Lebanese origin and non-immigrant women. Rates of cesarean deliveries were lower in women of Turkish and Lebanese origin (15.8 and 13.9%) than in non-immigrant women (23.9%). In the logistic regression analysis, more advanced cervical dilatation was inversely associated with the outcome cesarean delivery (OR: 0.76, 95%CI: 0.70–0.82). In addition, higher maternal age (OR: 1.06, 95%CI: 1.04–1.09), application of oxytocic agents (OR: 0.55, 95%CI: 0.42–0.72), and obesity (OR: 2.25, 95%CI: 1.51–3.34) were associated with the outcome. Ranking of predictors indicate that cervical dilatation is the most relevant predictor derived from the regression model. Conclusions Advanced cervical dilatation at the time of admission to labor ward does not explain lower emergency cesarean delivery rates in Turkish and Lebanese migrant women, despite the fact that this is the strongest among the predictors for emergency cesarean delivery identified in this study.
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Affiliation(s)
- Jürgen Breckenkamp
- School of Public Health, Department of Epidemiology & International Public Health, Bielefeld University, Bielefeld, Germany.
| | - Eileen Marie Läcke
- School of Public Health, Department of Epidemiology & International Public Health, Bielefeld University, Bielefeld, Germany
| | - Wolfgang Henrich
- Obstetrics Clinics, Charité University Medicine Berlin, Campus Virchow-Klinikum and Mitte, Berlin, Germany
| | - Theda Borde
- Alice Salomon Hochschule Berlin, University of Applied Sciences, Berlin, Germany
| | - Silke Brenne
- Clinic for Gynaecology, Charité University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany.,Institute of General Medicine, Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Matthias David
- Clinic for Gynaecology, Charité University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Oliver Razum
- School of Public Health, Department of Epidemiology & International Public Health, Bielefeld University, Bielefeld, Germany
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Stubert J, Peschel A, Bolz M, Glass Ä, Gerber B. Accuracy of immediate antepartum ultrasound estimated fetal weight and its impact on mode of delivery and outcome - a cohort analysis. BMC Pregnancy Childbirth 2018; 18:118. [PMID: 29716537 PMCID: PMC5930666 DOI: 10.1186/s12884-018-1772-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/24/2018] [Indexed: 11/29/2022] Open
Abstract
Background The aim of the study was to investigate the accuracy of ultrasound-derived estimated fetal weight (EFW) and to determine its impact on management and outcome of delivery. Methods In this single-center cohort analysis, women with a singleton term pregnancy in the beginning stages of labor were included. Women with immediately antepartum EFW (N = 492) were compared to women without ultrasound (N = 515). Results EFW was correct (deviation from birth weight ≤ 10%) in 72.2% (355/492) of patients with fetal biometry; 19.7% (97/492) were underestimated, and 8.1% (40/492) were overestimated. Newborns with a lower birth weight were more frequently overestimated, and newborns with higher birth weight were more frequently underestimated. The mean difference between EFW and real birth weight was − 114.5 g (standard deviation ±313 g, 95% confidence interval 87.1–142.0). The rate of non-reassuring fetal heart tracing (9.8% vs. 1.9%, P < 0.001) and of caesarean delivery (9.1% vs. 5.0%, P = 0.013) was higher in women with EFW. Overestimation was associated with an increased risk for delivery by caesarean section (odds ratio 2.80; 95% confidence interval 1.2–6.5, P = 0.017). After adjustment, EFW remained associated with increased non-reassuring fetal heart tracing (odds ratio 4.73; 95% confidence interval 2.3–9.6) and caesarean delivery (odds ratio 1.86; 95% confidence interval 1.1–3.1). The incidence of perineal tears of grade 3/4, shoulder dystocia, postnatal depression and neonatal acidosis did not differ between groups. Conclusions Antepartum ultrasound-derived EFW does not improve maternal and fetal outcome and is therefore not recommended.
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Affiliation(s)
- Johannes Stubert
- Department of Obstetrics and Gynecology, University of Rostock, Suedring 81, 18059, Rostock, Germany.
| | - Adam Peschel
- Department of Radiology, Hospital Asklepios Klinik Barmbek, Hamburg, Germany
| | - Michael Bolz
- Department of Obstetrics and Gynecology, University of Rostock, Suedring 81, 18059, Rostock, Germany
| | - Änne Glass
- Institute for Biostatistics and Informatics in Medicine, University of Rostock, Rostock, Germany
| | - Bernd Gerber
- Department of Obstetrics and Gynecology, University of Rostock, Suedring 81, 18059, Rostock, Germany
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Abalos E, Oladapo OT, Chamillard M, Díaz V, Pasquale J, Bonet M, Souza JP, Gülmezoglu AM. Duration of spontaneous labour in 'low-risk' women with 'normal' perinatal outcomes: A systematic review. Eur J Obstet Gynecol Reprod Biol 2018. [PMID: 29518643 PMCID: PMC5884320 DOI: 10.1016/j.ejogrb.2018.02.026] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite decades of research, the concept of normality in labour in terms of its progression and duration is not universal or standardized. However, in clinical practice, it is important to define the boundaries that distinguish what is normal from what is abnormal to enable women and care providers have a shared understanding of what to expect and when labour interventions are justified. OBJECTIVES To synthesise available evidence on the duration of latent and active first stage and the second stage of spontaneous labour in women at low risk of complications with 'normal' perinatal outcomes. SEARCH STRATEGY PubMed, EMBASE, CINAHL, POPLINE, Global Health Library, and reference lists of eligible studies. SELECTION CRITERIA Observational studies and other study designs. DATA COLLECTION AND ANALYSIS Four authors extracted data on: maternal characteristics; labour interventions; duration of latent first stage, active first stage, and second stage of labour; and the definitions of onset of latent and active first stage, and second stage where reported. Heterogeneity in the included studies precluded meta-analysis and data were presented descriptively. MAIN RESULTS Thirty-seven studies reporting the duration of first and/or second stages of labour for 208,000 women met our inclusion criteria. Among nulliparous women, the median duration of active first stage (when the starting reference point was 4 cm) ranged from 3.7-5.9 h (95th percentiles: 14.5-16.7 h). With active phase starting from 5 cm, the median duration was from 3.8-4.3 h (95th percentiles: 11.3-12.7 h). The median duration of second stage ranged from 14 to 66 min (95th percentiles: 65-138 min) and from 6 to 12 min (95th percentiles: 58-76 min) in nulliparous and parous women, respectively. Sensitivity analyses excluding first and second stage interventions did not significantly impact on these findings CONCLUSIONS: The duration of spontaneous labour in women with good perinatal outcomes varies from one woman to another. Some women may experience labour for longer than previously thought, and still achieve a vaginal birth without adverse perinatal outcomes. Our findings question the rigid limits currently applied in clinical practice for the assessment of prolonged first or second stage that warrant obstetric intervention.
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Affiliation(s)
- Edgardo Abalos
- Centro Rosarino de Estudios Perinatales, Moreno 878, P6. (2000), Rosario, Argentina.
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), World Health Organization, Avenue Appia 20, Geneva 27 CH-1211, Switzerland
| | - Mónica Chamillard
- Centro Rosarino de Estudios Perinatales, Moreno 878, P6. (2000), Rosario, Argentina
| | - Virginia Díaz
- Centro Rosarino de Estudios Perinatales, Moreno 878, P6. (2000), Rosario, Argentina
| | - Julia Pasquale
- Centro Rosarino de Estudios Perinatales, Moreno 878, P6. (2000), Rosario, Argentina
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), World Health Organization, Avenue Appia 20, Geneva 27 CH-1211, Switzerland
| | - Joao Paulo Souza
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), World Health Organization, Avenue Appia 20, Geneva 27 CH-1211, Switzerland
| | - A Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), World Health Organization, Avenue Appia 20, Geneva 27 CH-1211, Switzerland
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12
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Abstract
OBJECTIVES To explore women's experiences of early labour care focusing on sociodemographic differences, and to examine the effect of antenatal education, using mixed methods. SETTING England, 2014. PARTICIPANTS Women who completed postal questionnaires about their experience of maternity care, including questions about antenatal education, early labour and sociodemographic factors, included space for free-text comments. OUTCOME MEASURES Worries about labour, contact with midwives in early labour and subsequent care. METHODS This study was based on secondary analysis of a national maternity survey carried out in England in 2014. Quantitative data were analysed using descriptive statistics and binary logistic regression; qualitative data were analysed using a thematic content analytic approach. RESULTS Completed questionnaires were received from 4578 women (47% response rate). There were significant differences by sociodemographic factors, particularly ethnicity, in women's worries about early labour. Compared with white women, women from black or minority ethnic groups had an adjusted OR of 1.93 (95% CI 1.56 to 2.39) of feeling worried about not knowing when labour would start. Among women who contacted a midwife at the start of labour, 84% perceived their advice as appropriate, more in older and multiparous women. Overall, 64% of women were asked to come to the hospital at this time, more in multiparous women (adjusted OR 1.63, 95% CI 1.35 to 1.96). Those who did not have access to antenatal education experienced greater worry about early labour. Five themes emerged from the qualitative analysis: 'Differentiating between early and active labour', 'Staff attitudes', 'Not being allowed…', 'Previous labours' and 'Perceived consequences for women'. CONCLUSION These findings reinforce the importance of providing reassurance to women in early labour, taking care that women do not feel neglected or dismissed. In particular, primiparous and ethnic minority women reported greater worry about early labour and require additional reassurance.
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Affiliation(s)
- Jane Henderson
- Nuffield Department of Population Health, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Maggie Redshaw
- Nuffield Department of Population Health, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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Neal JL, Lowe NK, Phillippi JC, Ryan SL, Knupp AM, Dietrich MS, Thung SF. Likelihood of cesarean delivery after applying leading active labor diagnostic guidelines. Birth 2017; 44:128-136. [PMID: 28198038 PMCID: PMC7608623 DOI: 10.1111/birt.12274] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 12/09/2016] [Accepted: 12/11/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Friedman, the United Kingdom's National Institute for Health and Care Excellence (NICE), and the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) support different active labor diagnostic guidelines. Our aims were to compare likelihoods for cesarean delivery among women admitted before vs in active labor by diagnostic guideline (within-guideline comparisons) and between women admitted in active labor per one or more of the guidelines (between-guideline comparisons). DESIGN Active labor diagnostic guidelines were retrospectively applied to cervical examination data from nulliparous women with spontaneous labor onset (n = 2573). Generalized linear models were used to determine outcome likelihoods within- and between-guideline groups. RESULTS At admission, 15.7%, 48.3%, and 10.1% of nulliparous women were in active labor per Friedman, NICE, and ACOG/SMFM diagnostic guidelines, respectively. Cesarean delivery was more likely among women admitted before vs in active labor per the Friedman (AOR 1.75 [95% CI 1.08-2.82] or NICE guideline (AOR 2.55 [95% CI 1.84-3.53]). Between guidelines, cesarean delivery was less likely among women admitted in active labor per the NICE guideline, as compared with the ACOG/SMFM guideline (AOR 0.55 [95% CI 0.35-0.88]). CONCLUSION Many nulliparous women are admitted to the hospital before active labor onset. These women are significantly more likely to have a cesarean delivery. Diagnosing active labor before admission or before intervention to speed labor may be one component of a multi-faceted approach to decreasing the primary cesarean rate in the United States. The NICE diagnostic guideline is more inclusive than Friedman or ACOG/SMFM guidelines and its use may be the most clinically useful for safely lowering cesarean rates.
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Affiliation(s)
- Jeremy L. Neal
- Vanderbilt University School of Nursing, Nashville, TN, USA
| | - Nancy K. Lowe
- College of Nursing, University of Colorado, Aurora, CO, USA
| | | | - Sharon L. Ryan
- Clinical Nursing, The Ohio State University College of Nursing, Columbus, OH, USA
| | - Amy M. Knupp
- Nursing Quality Improvement & Patient Safety at The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mary S. Dietrich
- Schools of Nursing and Medicine at Vanderbilt University, Nashville, TN, USA
| | - Stephen F. Thung
- Department of Obstetrics &Gynecology, The Ohio State University, Columbus, OH, USA
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14
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Freyermuth MG, Muños JA, Ochoa MDP. From therapeutic to elective cesarean deliveries: factors associated with the increase in cesarean deliveries in Chiapas. Int J Equity Health 2017; 16:88. [PMID: 28545459 PMCID: PMC5445324 DOI: 10.1186/s12939-017-0582-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 05/12/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cesarean deliveries have increased over the past decade in Mexico, including those states with high percentages of indigenous language speakers, e.g., Chiapas. However, the factors contributing to this trend and whether they affect indigenous languages populations remain unknown. Thus, this work aims to identify some of the factors controlling the prevalence of cesarean sections (C-sections) in Chiapas between the 2011-2014 period. METHODS We analyzed certified birth data, compiled by the Subsystem of Information on Births of the Secretary of Health and the National Institute of Statistics and Geography, and information regarding the Human Development Index (HDI), assembled by the United Nations Development Program. A descriptive analysis of the variables and a multilevel logistics regression model were employed to assess the role of the different factors in the observed trends. RESULTS The results show that the factors contributing to the increased risk of C-sections are (i) women residing in municipalities with indigenous population and municipalities with high HDIs, (ii) advanced schooling, (iii) frequent prenatal checkups, and (iv) deliveries occurring in private health clinics. Furthermore, C-sections might also be associated with prolonged hospital stays. CONCLUSIONS The increasing frequency of C-sections among indigenous populations in Chiapas seems to be related to public policies aimed at reducing maternal mortality in Mexico. Therefore, public health policy needs to be revisited to ensure that reproductive rights are being respected.
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Affiliation(s)
- María Graciela Freyermuth
- The Centro de Investigaciones y Estudios Superiores en Antropología Social (CIESAS), Unidad Sureste and Technical Secretary of the Observatory of Maternal Mortality in Mexico (OMM), San Cristobal de las Casas, Chiapas México
| | - José Alberto Muños
- The CONACYT- Center of Research and Higher Studies in Social Anthropology (CIESAS), South Pacific Unit, Oaxaca, México
| | - María del Pilar Ochoa
- Masters in Population and Development, Advisor in the Ministry of Health, Ciudad de México, México
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15
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Kobayashi S, Hanada N, Matsuzaki M, Takehara K, Ota E, Sasaki H, Nagata C, Mori R. Assessment and support during early labour for improving birth outcomes. Cochrane Database Syst Rev 2017; 4:CD011516. [PMID: 28426160 PMCID: PMC6478316 DOI: 10.1002/14651858.cd011516.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The progress of labour in the early or latent phase is usually slow and may include painful uterine contractions. Women may feel distressed and lose their confidence during this phase. Support and assessment interventions have been assessed in two previous Cochrane Reviews. This review updates and replaces these two reviews, which have become out of date. OBJECTIVES To investigate the effectiveness of assessment and support interventions for women during early labour.In order to measure the effectiveness of the interventions, we compared the duration of labour, the rate of obstetrical interventions, and the rate of other maternal or neonatal outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (31 October 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials of any assessment or support intervention in the latent phase of labour. We planned to include cluster-randomised trials if they were eligible. We did not include quasi-randomised trials. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We resolved any disagreement by discussion or by involving a third assessor. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS We included five trials with a total of 10,421 pregnant women in this review update. The trials were conducted in the UK, Canada and America. The trials compared interventions in early labour versus usual care. We examined three comparisons: early labour assessment versus immediate admission to hospital; home visits by midwives versus usual care (telephone triage); and one-to-one structured midwifery care versus usual care. These trials were at moderate- risk of bias mainly because blinding women and staff to these interventions is not generally feasible. For important outcomes we assessed evidence using GRADE; we downgraded evidence for study design limitations, imprecision, and where we carried out meta-analysis, for inconsistency.One trial with 209 women compared early labour assessment with direct admission to hospital. Duration of labour from the point of hospital admission was reduced for women in the assessment group (mean difference (MD) -5.20 hours, 95% confidence interval (CI) -7.06 to -3.34; 209 women, low-quality evidence). There were no clear differences between groups for the number of women undergoing caesarean section or instrumental vaginal birth (risk ratio (RR) 0.72, 95% CI 0.30 to 1.72, very low quality evidence; and, RR 0.86, 95% CI 0.58 to 1.26, very low quality evidence, respectively). Serious maternal morbidity was not reported. Women in the early assessment group were slightly less likely to have epidural anaesthesia (RR 0.87, 95% CI 0.78 to 0.98, low-quality evidence), and considerably less likely to have oxytocin for labour augmentation (RR 0.57, 95% CI 0.37 to 0.86) and this group also had increased satisfaction with their care compared with women in the immediate admission group (MD 16.00, 95% CI 7.53 to 24.47). No babies were born before admission to hospital and only one infant had a low Apgar score at five minutes after the birth (very low quality evidence). Admission to neonatal special care was not reported.Three studies examined home assessment and midwifery support versus telephone triage. One trial reported the duration of labour; home visits did not appear to have any clear impact compared with usual care (MD 0.29 hours, 95% CI -0.14 to 0.72; 1 trial, 3474 women, low-quality evidence). There was no clear difference for the rate of caesarean section (RR 1.05, 95% CI 0.95 to 1.17; 3 trials, 5170 women; I² = 0%; moderate-quality evidence) or the rate of instrumental vaginal birth (average RR 0.95, 95% CI 0.79 to 1.15; 2 trials, 4933 women; I² = 69%; low-quality evidence). One trial reported birth before arrival at hospital or unplanned home birth; there was no clear difference between the groups (RR 1.33, 95% CI 0.30 to 5.95; 1 trial, 3474 women). No clear differences were identified for serious maternal morbidity (RR 0.93, 95% CI 0.61 to 1.42; 1 trial, 3474 women; low-quality evidence), or use of epidural (average RR 0.95, 95% CI 0.87 to 1.05; 3 trials, 5168 women; I² = 60%; low-quality evidence). There were no clear differences for neonatal admission to special care (average RR 0.84, 95% CI 0.50 to 1.42; 3 trials, 5170 infants; I² = 71%; very low quality evidence), or for Apgar score less than seven at five minutes after birth (RR 1.19, 95% CI 0.71 to 1.99; 3 trials, 5170 infants; I² = 0%; low-quality evidence).One study, with 5002 women, examined one-to-one structured care in early labour versus usual care. Length of labour was not reported. There were no clear differences between groups for the rate of caesarean section (RR 0.93, 95% CI 0.84 to 1.02; 4996 women, high-quality evidence), or for instrumental vaginal birth (RR 0.94, 95% CI 0.82 to 1.08; 4996 women, high-quality evidence). No clear differences between groups were reported for serious maternal morbidity (RR 1.13, 95% CI 0.84 to 1.52; 4996 women, moderate-quality evidence). Use of epidural was similar in the two groups (RR 1.00, 95% CI 0.99 to 1.01; 4996 women, high-quality evidence). For infant outcomes, there were no clear differences between groups (admission to neonatal intensive care unit: RR 0.98, 95% CI 0.80 to 1.21; 4989 infants, high-quality evidence; Apgar score less than seven at five minutes: RR 1.07, 95% CI 0.64 to 1.79; 4989 infants, moderate-quality evidence). AUTHORS' CONCLUSIONS Assessment and support in early labour does not have a clear impact on rate of caesarean section or instrumental vaginal birth, or whether the baby was born before arrival at hospital or in an unplanned home birth. However, evidence suggested that interventions may have an impact on reducing the use of epidural anaesthesia, labour augmentation and on increasing maternal satisfaction with giving birth. Evidence about the effectiveness of early labour assessment versus immediate admission was very limited and more research is needed in this area.
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Affiliation(s)
- Shinobu Kobayashi
- National Center for Child Health and DevelopmentDepartment of Health Policy10‐1, Okura 2 chomeTokyoTokyoJapan157‐8535
| | - Nobutsugu Hanada
- National Center for Child Health and DevelopmentDepartment of Health Policy10‐1, Okura 2 chomeTokyoTokyoJapan157‐8535
| | - Masayo Matsuzaki
- Osaka University Graduate School of MedicineDepartment of Children and Women's Health1‐7 YamadaokaSuitaOsakaJapan565‐0871
| | - Kenji Takehara
- National Center for Child Health and DevelopmentDepartment of Health Policy10‐1, Okura 2 chomeTokyoTokyoJapan157‐8535
| | - Erika Ota
- St. Luke's International University, Graduate School of Nursing SciencesGlobal Health Nursing10‐1 Akashi‐choChuo‐KuTokyoJapan104‐0044
| | - Hatoko Sasaki
- National Center for Child Health and DevelopmentDepartment of Health Policy10‐1, Okura 2 chomeTokyoTokyoJapan157‐8535
| | - Chie Nagata
- National Center for Child Health and DevelopmentDepartment of Education for Clinical Research2‐10‐1 OkuraSetagaya‐kuTokyoJapan157‐8535
| | - Rintaro Mori
- National Center for Child Health and DevelopmentDepartment of Health Policy10‐1, Okura 2 chomeTokyoTokyoJapan157‐8535
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Dias MAB, Domingues RMSM, Schilithz AOC, Nakamura-Pereira M, do Carmo Leal M. Factors associated with cesarean delivery during labor in primiparous women assisted in the Brazilian Public Health System: data from a National Survey. Reprod Health 2016; 13:114. [PMID: 27766983 PMCID: PMC5073796 DOI: 10.1186/s12978-016-0231-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The rate of cesarean delivery (CD) in Brazil has increased over the past 40 years. The CD rate in public services is three times above the World Health Organization recommended values. Among strategies to reduce CD, the most important is reduction of primary cesarean. This study aimed to describe factors associated with CD during labor in primiparous women with a single cephalic pregnancy assisted in the Brazilian Public Health System (SUS). METHODS This study is part of the Birth in Brazil survey, a national hospital-based study of 23,894 postpartum women and their newborns. The rate of CD in primiparous women was estimated. Univariate and multivariable logistic regression was performed to analyze factors associated with CD during labor in primiparous women with a single cephalic pregnancy, including estimation of crude and adjusted odds ratios and their respective 95 % confidence intervals. RESULTS The analyzed data are related to the 2814 eligible primiparous women who had vaginal birth or CD during labor in SUS hospitals. In adjusted analyses, residing in the Southeast region was associated with lower CD during labor. Occurrence of clinical and obstetric conditions potentially related to obstetric emergencies before delivery, early admission with < 4 cm of dilatation, a decision late in pregnancy for CD, and the use of analgesia were associated with a greater risk for CD. Favorable advice for vaginal birth during antenatal care, induction of labor, and the use of any good practices during labor were protective factors for CD. The type of professional who attended birth was not significant in the final analyses, but bivariate analysis showed a higher use of good practices and a smaller proportion of epidural analgesia in women cared for by at least one nurse midwife. CONCLUSIONS The CD rate in primiparous women in SUS in Brazil is extremely high and can compromise the health of these women and their newborns. Information and support for vaginal birth during antenatal care, avoiding early admission, and promoting the use of good practices during labor assistance can reduce unnecessary CD. Considering the experience of other countries, incorporation of nurse midwives in childbirth care may increase the use of good practices during labor.
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Affiliation(s)
| | | | | | - Marcos Nakamura-Pereira
- Instituto Fernandes Figueira/FIOCRUZ, Av. Rui Barbosa 716, Rio de Janeiro, CEP: 22250-020 Brasil
| | - Maria do Carmo Leal
- Escola Nacional Saúde Publica Sérgio Arouca/FIOCRUZ, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, CEP: 21040-360 Brasil
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17
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Mikolajczyk RT, Zhang J, Grewal J, Chan LC, Petersen A, Gross MM. Early versus Late Admission to Labor Affects Labor Progression and Risk of Cesarean Section in Nulliparous Women. Front Med (Lausanne) 2016; 3:26. [PMID: 27446924 PMCID: PMC4921453 DOI: 10.3389/fmed.2016.00026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/21/2016] [Indexed: 11/29/2022] Open
Abstract
Background Rates of cesarean section increase worldwide, and the components of this increase are partially unknown. A strong role is prescribed to dystocia, and at the same time, the diagnosis of dystocia is highly subjective. Previous studies indicated that risk of cesarean is higher when women are admitted to the hospital early in the labor. Methods We examined data on 1,202 nulliparous women with singleton, vertex pregnancies and spontaneous labor onset. We selected three groups based on cervical dilatation at admission: early (0.5–1.5 cm, N = 178), intermediate (2.5–3.5 cm, N = 320), and late (4.5–5.5 cm, N = 175). The Kaplan–Meier estimator was used to analyze the risk of delivery by cesarean section at a given dilatation, and thin-plate spline regression with a binary outcome (R library gam) to assess the form of the associations between the cesarean section in either the first or second stage versus vaginal delivery and dilatation at admission. Results Women who were admitted to labor early had a higher risk of delivery by cesarean section (18 versus 4% in the late admission group), while the risk of instrumental delivery did not differ (24 versus 24%). Before 4 cm dilatation, the earlier a woman was admitted to labor, the higher was her risk of delivery by cesarean section. After 4 cm dilatation, however, the relationship disappeared. These patterns were true for both first and second stage cesarean deliveries. Oxytocin use was associated with a higher risk of cesarean section only in the middle group (2.5–3.5 cm dilatation at admission). Conclusion Early admission to labor was associated with a significantly higher risk of delivery by cesarean section during the first and second stages. Differential effects of oxytocin augmentation depending on dilation at admission may suggest that admission at the early stage of labor is an indicator rather than a risk factor itself, but admission at the intermediate stage (2.5–3.5 cm) becomes a risk factor itself. Further research is needed to study this hypothesis.
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Affiliation(s)
- Rafael T Mikolajczyk
- Department for Epidemiology of Infectious Diseases, Hannover Medical School, Hannover, Germany; Department of Epidemiology, Helmholtz-Centre for Infection Research, Braunschweig, Germany
| | - Jun Zhang
- Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Jagteshwar Grewal
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda, MD , USA
| | - Linda C Chan
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Naval Hospital Camp Lejeune , Camp Lejeune, NC , USA
| | - Antje Petersen
- Midwifery Research and Education Unit, Department of Gynecology and Obstetrics, Hannover Medical School , Hannover , Germany
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Department of Gynecology and Obstetrics, Hannover Medical School , Hannover , Germany
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18
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Faivre M, Mottet N, Bourtembourg A, Ramanah R, Maillet R, Riethmuller D. Pronostic obstétrical de la présentation du siège en cas d’admission en travail avancé. ACTA ACUST UNITED AC 2016; 45:585-91. [DOI: 10.1016/j.jgyn.2015.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 05/18/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
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Tilden EL, Emeis CL, Caughey AB, Weinstein SR, Futernick SB, Lee CS. The Influence of Group Versus Individual Prenatal Care on Phase of Labor at Hospital Admission. J Midwifery Womens Health 2016; 61:427-34. [DOI: 10.1111/jmwh.12437] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Hanley GE, Munro S, Greyson D, Gross MM, Hundley V, Spiby H, Janssen PA. Diagnosing onset of labor: a systematic review of definitions in the research literature. BMC Pregnancy Childbirth 2016; 16:71. [PMID: 27039302 PMCID: PMC4818892 DOI: 10.1186/s12884-016-0857-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnosis of labor onset has been described as one of the most important judgments in maternity care. There is compelling evidence that the duration of both latent and active phase labor are clinically important and require consistent approaches to measurement. In order to measure the duration of labor phases systematically, we need standard definitions of their onset. We reviewed the literature to examine definitions of labor onset and the evidentiary basis provided for these definitions. METHODS Five electronic databases were searched using predefined search terms. We included English, French and German language studies published between January 1978 and March 2014 defining the onset of latent labor and/or active labor in a population of healthy women with term births. Studies focusing exclusively on induced labor were excluded. RESULTS We included 62 studies. Four 'types' of labor onset were defined: latent phase, active phase, first stage and unspecified. Labor onset was most commonly defined through the presence of regular painful contractions (71% of studies) and/or some measure of cervical dilatation (68% of studies). However, there was considerable discrepancy about what constituted onset of labor even within 'type' of labor onset. The majority of studies did not provide evidentiary support for their choice of definition of labor onset. CONCLUSIONS There is little consensus regarding definitions of labor onset in the research literature. In order to avoid misdiagnosis of the onset of labor and identify departures from normal labor trajectories, a consistent and measurable definition of labor onset for each phase and stage is essential. In choosing standard definitions, the consequences of their use on rates of maternal and fetal morbidity must also be examined.
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Affiliation(s)
- Gillian E. Hanley
- />Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC Canada
- />Child and Family Research Institute, University of British Columbia, Vancouver, BC Canada
| | - Sarah Munro
- />Interdisciplinary Studies Department, University of British Columbia, Vancouver, BC Canada
- />School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
- />Child and Family Research Institute, University of British Columbia, Vancouver, BC Canada
| | - Devon Greyson
- />Interdisciplinary Studies Department, University of British Columbia, Vancouver, BC Canada
| | - Mechthild M. Gross
- />Midwifery Research and Education Unit, Hannover Medical School, Hanover, Germany
| | - Vanora Hundley
- />Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | - Helen Spiby
- />School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Patricia A. Janssen
- />School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
- />Child and Family Research Institute, University of British Columbia, Vancouver, BC Canada
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Neal JL, Lowe NK, Schorn MN, Holley SL, Ryan SL, Buxton M, Wilson‐Liverman AM. Labor Dystocia: A Common Approach to Diagnosis. J Midwifery Womens Health 2015; 60:499-509. [DOI: 10.1111/jmwh.12360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Woo JH, Kim JH, Lee GY, Baik HJ, Kim YJ, Chung RK, Yun DG, Lim CH. The degree of labor pain at the time of epidural analgesia in nulliparous women influences the obstetric outcome. Korean J Anesthesiol 2015; 68:249-53. [PMID: 26045927 PMCID: PMC4452668 DOI: 10.4097/kjae.2015.68.3.249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 02/25/2015] [Accepted: 03/15/2015] [Indexed: 11/11/2022] Open
Abstract
Background The increased pain at the latent phase can be associated with dysfunctional labor as well as increases in cesarean delivery frequency. We aimed to research the effect of the degree of pain at the time of epidural analgesia on the entire labor process including the mode of delivery. Methods We performed epidural analgesia to 102 nulliparous women on patients' request. We divided the group into three based on NRS (numeric rating scale) at the moment of epidural analgesia; mild pain, NRS 1-4; moderate pain, NRS 5-7; severe pain, NRS 8-10. The primary outcome was the mode of delivery (normal labor or cesarean delivery). Results There were significant differences in the mode of delivery among groups. Patients with severe labor pain had a significantly higher cesarean delivery compared to patients with moderate labor pain (P = 0.006). The duration of the first and second stage of labor, fetal heart rate, use of oxytocin and premature rupture of membranes had no differences in the three groups. Conclusions Our research showed that the degree of pain at the time of epidural analgesia request might influence the rate of cesarean delivery. Further research would be necessary for clarifying the mechanism that the augmentation of pain affects the mode of delivery.
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Affiliation(s)
- Jae Hee Woo
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jong Hak Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Guie Yong Lee
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hee Jung Baik
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Youn Jin Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Rack Kyung Chung
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Du Gyun Yun
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chae Hwang Lim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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McLelland G, Morgans A, McKenna L. Victorian paramedics' encounters and management of women in labour: an epidemiological study. BMC Pregnancy Childbirth 2015; 15:13. [PMID: 25652103 PMCID: PMC4332426 DOI: 10.1186/s12884-015-0430-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/05/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Although it is generally accepted that paramedics attend unexpected births, there is a paucity of literature about their management of women in labour. This study aimed to investigate the caseload of women in labour attended by a statewide ambulance service in Australia during one year and the management provided by paramedics. METHODS Retrospective clinical data collected on-scene by paramedics via in-field electronic patient care records were provided by Ambulance Victoria. Patient case reports were electronically extracted from the Ambulance Victoria's Clinical Data Warehouse via comprehensive filtering followed by manual sorting. Descriptive statistics were analysed using Statistical Package for Social Sciences (SPSS v.19). RESULTS Over a 12-month period, paramedics were called to 1517 labouring women. Two thirds of women were at full-term gestation, and 40% of pre-term pregnancies were less than 32 weeks gestation. Paramedics documented 630 case reports of women in early labour and a further 767 in established labour. There were 204 women thought to be second stage labour, including 134 who progressed to childbirth under paramedic care. When paramedics assisted with births, the on-scene time was significantly greater than those patients transported in labour. Pain relief was provided significantly more often to women in established labour than in early labour. Oxygen was given to significantly more women in preterm labour. While paramedics performed a range of procedures including intravenous cannulation, administration of analgesia and oxygen, most women required minimal intervention. Paramedics needed to manage numerous obstetric and medical complications during their management. CONCLUSIONS Paramedics provide emergency care and transportation for women in labour. Most of the women were documented to be at term gestation with minimal complications. To enable appropriate decision making about management and transportation, paramedics require a range of clinical assessment skills comprising essential knowledge about antenatal and intrapartum care.
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Affiliation(s)
- Gayle McLelland
- School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, VIC, 3199, Australia.
| | - Amee Morgans
- Research Development Manager, Ambulance Victoria, 375 Manningham Road, Doncaster, 3108, Australia.
- Adjunct Senior Research Fellow, Department of Primary Health Care, Monash University, Frankston, VIC, 3199, Australia.
| | - Lisa McKenna
- School of Nursing and Midwifery, Monash University, Building 13C, Clayton Campus, Clayton, 3199, Australia.
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Neal JL, Lamp JM, Lowe NK, Gillespie SL, Sinnott LT, McCarthy DO. Differences in inflammatory markers between nulliparous women admitted to hospitals in preactive vs active labor. Am J Obstet Gynecol 2015; 212:68.e1-8. [PMID: 25086275 DOI: 10.1016/j.ajog.2014.07.050] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 07/16/2014] [Accepted: 07/25/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether labor-associated inflammatory markers differ between low-risk, nulliparous women in preactive vs active labor at hospital admission and over time. STUDY DESIGN Prospective comparative study of low-risk, nulliparous women with spontaneous labor onset at term (n = 118) sampled from 2 large Midwestern hospitals. Circulating concentrations of inflammatory markers were measured at admission and again 2 and 4 hours later: namely, neutrophil, and monocyte counts; and serum inflammatory cytokines (interleukin -1β, interleukin-6, tumor necrosis factor-α, interleukin-10) and chemokines (interleukin-8). Biomarker concentrations and their patterns of change over time were compared between preactive (n = 63) and active (n = 55) labor admission groups using Mann-Whitney U tests. RESULTS Concentrations of interleukin-6 and interleukin-10 in the active labor admission group were significantly higher than concentrations in the preactive labor admission group at all 3 time points. Neutrophil levels were significantly higher in the active group at 2 and 4 hours after admission. The rate of increase in neutrophils and interleukin-10 between admission and 2 hours later was faster in the active group (P < .001 and P = .003, respectively). CONCLUSION Circulating concentrations of several inflammatory biomarkers are higher and their rate of change over time since admission is faster among low-risk, nulliparous women admitted to hospitals in active labor, as compared with those admitted in preactive labor. More research is needed to determine if progressive changes in inflammatory biomarkers might be a useful adjunct to improving the assessment of labor progression and determining the optimal timing of labor admission.
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Affiliation(s)
- Jeremy L Neal
- School of Nursing, Vanderbilt University, Nashville, TN.
| | - Jane M Lamp
- Department of Women's Health Services, Riverside Methodist Hospital, Columbus, OH
| | - Nancy K Lowe
- College of Nursing, University of Colorado Denver, Aurora, CO
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Marowitz A. Caring for Women in Early Labor: Can We Delay Admission and Meet Women's Needs? J Midwifery Womens Health 2014; 59:645-650. [DOI: 10.1111/jmwh.12252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Janssen PA, Weissinger S. Women's perception of pre-hospital labour duration and obstetrical outcomes; a prospective cohort study. BMC Pregnancy Childbirth 2014; 14:182. [PMID: 24884415 PMCID: PMC4060864 DOI: 10.1186/1471-2393-14-182] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 05/23/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Progress during early labour may impact subsequent labour trajectories. Women admitted to hospital in latent phase (<3 cm cervical dilation) labour have been shown to be at higher risk of obstetrical interventions. METHODS We conducted a secondary analysis of data from a randomized controlled trial of 1247 healthy nulliparous women in spontaneous labour at term with a singleton fetus in cephalic presentation at seven hospitals in Southwestern British Columbia. We computed relative risks and their 95% confidence intervals to examine our primary outcome of cesarean section and secondary outcomes including obstetrical interventions and maternal and newborn outcomes according to women's perception of length of pre-hospital labour. Women were asked on admission to hospital how long they had been experiencing contractions prior to coming to hospital. RESULTS Women indicating that they had been in labour for 24 hours or longer at the time of hospital admission were at elevated risk for cesarean birth, relative risk (RR) 1.40, (95% Confidence Intervals 1.15-1.72), admission with a cervical dilation of 3 cm or less, RR 1.21 (1.07-1.36), more obstetrical interventions including continuous electronic fetal monitoring RR 1.11 (1.03-1.20), augmentation of labour RR 1.33 (1.23-1.44), use of narcotic RR 1.21 (1.06-1.37) and epidural analgesia RR 1.18 (1.09-1.28). Adverse neonatal outcomes did not differ apart from a significant increase in meconium-stained amniotic fluid RR 1.60 (1.09-2.35). CONCLUSIONS A single question asked of women on presentation to hospital was an important predictor of cesarean birth and may have utility in identifying women who would benefit from close observation and more active management of labour.
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Affiliation(s)
- Patricia A Janssen
- University of British Columbia, School of Population and Public Health, Child and Family Research Institute, 2206 East Mall, Vancouver, BC V6T-1Z3, Canada
| | - Sandra Weissinger
- University of British Columbia, Faculty of Medicine, Midwifery Program, Vancouver, Canada
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Neal JL, Lamp JM, Buck JS, Lowe NK, Gillespie SL, Ryan SL. Outcomes of nulliparous women with spontaneous labor onset admitted to hospitals in preactive versus active labor. J Midwifery Womens Health 2014; 59:28-34. [PMID: 24512265 DOI: 10.1111/jmwh.12160] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The timing of when a woman is admitted to the hospital for labor care following spontaneous contraction onset may be among the most important decisions that labor attendants make because it can influence care patterns and birth outcomes. The aims of this study were to estimate the percentage of low-risk, nulliparous women at term who are admitted to labor units prior to active labor and to evaluate the effects of the timing of admission (ie, preactive vs active labor) on labor interventions and mode of birth. METHODS Data from low-risk, nulliparous women with spontaneous labor onset at term gestation were merged from 2 prospective studies conducted at 3 large Midwestern hospitals. Baseline characteristics, labor interventions, and outcomes were compared between groups using Fisher's exact and Mann-Whitney U tests, as appropriate. Likelihoods for oxytocin augmentation, amniotomy, and cesarean birth were assessed by logistic regression. RESULTS Of the sample of 216 low-risk nulliparous women, 114 (52.8%) were admitted in preactive labor and 102 (47.2%) were admitted in active labor. Women who were admitted in preactive labor were more likely to undergo oxytocin augmentation (84.2% and 45.1%, respectively; odds ratio [OR], 6.5; 95% confidence interval [CI], 3.43-12.27) but not amniotomy (55.3% and 61.8%, respectively; OR, 0.8; 95% CI, 0.44-1.32) when compared to women admitted in active labor. The likelihood of cesarean birth was higher for women admitted before active labor onset (15.8% and 6.9%, respectively; OR, 2.6; 95% CI, 1.02-6.37). DISCUSSION Many low-risk nulliparous women with regular, spontaneous uterine contractions are admitted to labor units before active labor onset, which increases their likelihood of receiving oxytocin and giving birth via cesarean. An evidence-based, standardized approach for labor admission decision making is recommended to decrease inadvertent admissions of women in preactive labor. When active labor cannot be diagnosed with relative certainty, observation before admission to the birthing unit is warranted.
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Davey MA, McLachlan HL, Forster D, Flood M. Influence of timing of admission in labour and management of labour on method of birth: Results from a randomised controlled trial of caseload midwifery (COSMOS trial). Midwifery 2013; 29:1297-302. [DOI: 10.1016/j.midw.2013.05.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/14/2013] [Accepted: 05/29/2013] [Indexed: 11/26/2022]
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Nyman V, Bondas T, Downe S, Berg M. Glancing beyond or being confined to routines: labour ward midwives' responses to change as a result of action research. Midwifery 2013; 29:573-8. [PMID: 23566557 DOI: 10.1016/j.midw.2013.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 09/23/2012] [Accepted: 02/21/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE to examine midwives' responses to a changed approach in the initial encounters with women and their partners in the labour ward. DESIGN as part of a local project to improve hospital based childbirth care, Action Research (AR) was undertaken with midwives. To establish their beliefs, practices, and responses to change during the first cycle, 37 out of 57 midwives were interviewed. Data analysis was guided by interpretative description. SETTING a labour ward in western Sweden. FINDINGS two themes emerged: 'Glancing beyond routines' describes how the changed care approach enabled 'valuing the idea' and 'acquiring extended space to create a lingering presence'. The theme 'being confined to inherent routines' expresses 'resistance to the need for change' and a 'feeling of pressure to change'. KEY CONCLUSIONS the AR study design enabled the midwives to reflect on their routines and to transform tacit use-in-action to reflection-in-action. Midwives who persisted in being confined to inherent routines felt pressured by the change process. Others felt that the AR process granted them official licence to create chronological and emotional space in which they could 'be' and not just 'do'. IMPLICATIONS FOR PRACTICE to a greater or lesser extent, midwives in this setting had integrated relatively impersonal system-wide technocratic norms of childbirth into their belief systems and behaviours. The data suggest that a whole-system shift is necessary to enable caring, behaviours based on the formation of positive relationships to become the key driver of the first encounter on the labour ward.
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Affiliation(s)
- Viola Nyman
- NÄL-Hospital, Larketorpsvagen 5, 461 85 Trollhattan, Sweden.
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Janssen PA, Desmarais SL. Women's experience with early labour management at home vs. in hospital: A randomised controlled trial. Midwifery 2013; 29:190-4. [DOI: 10.1016/j.midw.2012.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 04/11/2012] [Accepted: 05/01/2012] [Indexed: 10/28/2022]
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Murray M. Childbirth in Santiago de Chile: stratification, intervention, and child centeredness. Med Anthropol Q 2013; 26:319-37. [PMID: 23259346 DOI: 10.1111/j.1548-1387.2012.01221.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
On the basis of ethnographic work with women from different economic and educational backgrounds in Santiago, I describe the experiences of labor and birth from the point of view of women's priorities, socioeconomic constraints, and relationships with the medical system. I specifically focus on their desires expressed during the late prenatal period and their narratives of the actual birth. Class and the differences in opportunities resulting from educational and class inequalities melt down into near invisibility as vulnerability rises and women become increasingly subjected to medical decision making. The long-standing Chilean focus on child centeredness, while shown to benefit bonding, can work to obliterate women's own desires and choices by encouraging them to "sacrifice their all" for the sake of the baby. This kind of sacrifice defines the meaning of the maternal body in Chile. I suggest further analysis of these factors is essential for an understanding of the hypermedicalized Chilean context.
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Affiliation(s)
- Marjorie Murray
- Department of Sociology, Pontificia Universidad Católica de Chile
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Neal JL, Lowe NK. Physiologic partograph to improve birth safety and outcomes among low-risk, nulliparous women with spontaneous labor onset. Med Hypotheses 2012; 78:319-26. [PMID: 22138426 PMCID: PMC3254242 DOI: 10.1016/j.mehy.2011.11.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 11/10/2011] [Indexed: 11/22/2022]
Abstract
Oxytocin augmentation and cesarean rates among low-risk, term, nulliparous women with a spontaneous onset of labor in the United States approximate 50% and 26.5%, respectively. This indicates that the quality of obstetrical care is less than optimal in this nation. Exorbitant oxytocin use, the intervention most commonly associated with preventable adverse perinatal outcomes, jeopardizes birth safety while the high cesarean rate in this high-volume group compromises population health and increases health care costs. Dystocia, characterized by the slow, abnormal progression of labor, is the most commonly reported indication for primary cesareans, accounting directly for approximately 50% of all nulliparous cesareans and indirectly for most repeat cesareans. Diagnoses of dystocia are most often based on ambiguously defined delays in cervical dilation beyond which labor augmentation is deemed justified. Dystocia is known to be over-diagnosed which undoubtedly contributes to contemporary oxytocin augmentation and primary cesarean rates. Labor attendants would benefit from an evidence-based framework for homogenous labor assessment. To this end, we present a physiologically-based partograph for 'in-hospital' use in assessing the labors of low-risk, term, nulliparous women with spontaneous labor onset. This tool incorporates several evidence-based labor principles that combine to give needed clinical meaning to 'dystocia' as a diagnosis. It is hypothesized that our partograph will safely limit diagnoses of dystocia to only the slowest 10% of low-risk, nulliparous women. This should, in turn, safe-guard against unnecessary, injudicious, and potentially harmful use of oxytocin when labor is already adequately progressing while also indicating when its use may be justified. We further hypothesize that cesareans performed for dystocia in this population will decrease by ≥ 50%. No significant influence on other labor process or labor outcome variables is expected with partograph use. Widespread use of this physiologically-based partograph will be warranted if our hypotheses are supported.
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Affiliation(s)
- Jeremy L Neal
- Nurse-Midwifery & Women's Health Specialty Tracks in College of Nursing, The Ohio State University, Columbus, OH, USA.
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Eri TS, Blystad A, Gjengedal E, Blaaka G. ‘Stay home for as long as possible’: Midwives' priorities and strategies in communicating with first-time mothers in early labour. Midwifery 2011; 27:e286-92. [DOI: 10.1016/j.midw.2011.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 01/10/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
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Lucovnik M, Kuon RJ, Chambliss LR, Maner WL, Shi SQ, Shi L, Balducci J, Garfield RE. Use of uterine electromyography to diagnose term and preterm labor. Acta Obstet Gynecol Scand 2010; 90:150-7. [PMID: 21241260 DOI: 10.1111/j.1600-0412.2010.01031.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Current methodologies to assess the process of labor, such as tocodynamometry or intrauterine pressure catheters, fetal fibronectin, cervical length measurement and digital cervical examination, have several major drawbacks. They only measure the onset of labor indirectly and do not detect cellular changes characteristic of true labor. Consequently, their predictive values for term or preterm delivery are poor. Uterine contractions are a result of the electrical activity within the myometrium. Measurement of uterine electromyography (EMG) has been shown to detect contractions as accurately as the currently used methods. In addition, changes in cell excitability and coupling required for effective contractions that lead to delivery are reflected in changes of several EMG parameters. Use of uterine EMG can help to identify patients in true labor better than any other method presently employed in the clinic.
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Affiliation(s)
- Miha Lucovnik
- Department of Obstetrics and Gynecology, St Joseph's Hospital and Medical Center, Phoenix, AZ 85004, USA
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Eri TS, Blystad A, Gjengedal E, Blaaka G. Negotiating credibility: first-time mothers’ experiences of contact with the labour ward before hospitalisation. Midwifery 2010; 26:e25-30. [DOI: 10.1016/j.midw.2008.11.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 11/19/2008] [Accepted: 11/23/2008] [Indexed: 10/21/2022]
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Neal JL, Lowe NK, Patrick TE, Cabbage LA, Corwin EJ. What is the slowest-yet-normal cervical dilation rate among nulliparous women with spontaneous labor onset? J Obstet Gynecol Neonatal Nurs 2010; 39:361-9. [PMID: 20629924 DOI: 10.1111/j.1552-6909.2010.01154.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To integrate research literature that has provided insights into the cervical dilation rate that may best describe the slowest-yet-normal dilation rate among nulliparous women when beginning with criteria commonly associated with active labor onset. DATA SOURCES A literature search from 1950 through 2008 was conducted using the Medline electronic database, reference lists from identified articles, and other key references. STUDY SELECTION Research reports written in English with a focus on the cervical dilation and/or labor duration of low-risk, nulliparous women with spontaneous labor onset. DATA EXTRACTION Classic and contemporary research literature was reviewed and organized under the following subheadings: Friedman Studies, Partograph Studies, Active Management of Labor Studies, Additional Studies. DATA SYNTHESIS An integrative review of the literature approximated the slowest-yet-normal cervical dilation rate for nulliparous women when beginning with criteria commonly associated with active labor. CONCLUSIONS The slowest-yet-normal linear dilation rate approximates 0.5 cm/hour for low-risk, nulliparous women with spontaneous labor onset when starting at dilatations traditionally associated with active labor onset. However, this linear rate must be evaluated judiciously in light of the physiological acceleration of dilation that occurs during typical labor. Given this, cervical dilation for this population is likely slower than 0.5 cm/hour in earlier active labor and faster in more advanced active labor. Faster dilation expectations (e.g., 1 cm/hour) likely contribute to an overdiagnosis of dystocia ("slow, abnormal progression of labor") in contemporary practice and, subsequently, to an overuse of interventions aimed at accelerating labor progress.
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Affiliation(s)
- Jeremy L Neal
- Nurse Midwifery and Women's Health specialty tracks, College of Nursing, The Ohio State University, Columbus, OH, USA.
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37
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Cheyne H, Hundley V, Dowding D, Bland JM, McNamee P, Greer I, Styles M, Barnett CA, Scotland G, Niven C. Effects of algorithm for diagnosis of active labour: cluster randomised trial. BMJ 2008; 337:a2396. [PMID: 19064606 PMCID: PMC2601030 DOI: 10.1136/bmj.a2396] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the effectiveness of an algorithm for diagnosis of active labour in primiparous women with standard care in terms of maternal and neonatal outcomes. DESIGN Cluster randomised trial. SETTING Maternity units in Scotland with at least 800 annual births. PARTICIPANTS 4503 women giving birth for the first time, in 14 maternity units. Seven experimental clusters collected data from a baseline sample of 1029 women and a post-implementation sample of 896 women. The seven control clusters had a baseline sample of 1291 women and a post-implementation sample of 1287 women. INTERVENTION Use of an algorithm by midwives to assist their diagnosis of active labour, compared with standard care. Main outcomes Primary outcome: use of oxytocin for augmentation of labour. SECONDARY OUTCOMES medical interventions in labour, admission management, and birth outcome. RESULTS No significant difference was found between groups in percentage use of oxytocin for augmentation of labour (experimental minus control, difference=0.3, 95% confidence interval -9.2 to 9.8; P=0.9) or in the use of medical interventions in labour. Women in the algorithm group were more likely to be discharged from the labour suite after their first labour assessment (difference=-19.2, -29.9 to -8.6; P=0.002) and to have more pre-labour admissions (0.29, 0.04 to 0.55; P=0.03). CONCLUSIONS Use of an algorithm to assist midwives with the diagnosis of active labour in primiparous women did not result in a reduction in oxytocin use or in medical intervention in spontaneous labour. Significantly more women in the experimental group were discharged home after their first labour ward assessment. TRIAL REGISTRATION Current Controlled Trials ISRCTN00522952.
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Affiliation(s)
- Helen Cheyne
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling FK9 4LA.
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Kjaergaard H, Olsen J, Ottesen B, Nyberg P, Dykes AK. Obstetric risk indicators for labour dystocia in nulliparous women: a multi-centre cohort study. BMC Pregnancy Childbirth 2008; 8:45. [PMID: 18837972 PMCID: PMC2569907 DOI: 10.1186/1471-2393-8-45] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Accepted: 10/06/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In nulliparous women dystocia is the most common obstetric problem and its etiology is largely unknown. The frequency of augmentation and cesarean delivery related to dystocia is high although it is not clear if a slow progress justifies the interventions. Studies of risk factors for dystocia often do not provide diagnostic criteria for the diagnosis. The aim of the present study was to identify obstetric and clinical risk indicators of dystocia defined by strict and explicit criteria. METHODS A multi-centre population based cohort study with prospectively collected data from 2810 nulliparous women in term spontaneous labour with a singleton infant in cephalic presentation. Data were collected by self-administered questionnaires and clinical data-records. Logistic regression analyses were used to estimate adjusted Odds Ratios (OR) and 95% confidence intervals (CI) are given. RESULTS The following characteristics, present at admission to hospital, were associated with dystocia during labour (OR, 95% CI): dilatation of cervix < 4 cm (1.63, 1.38-1.92), tense cervix (1.31, 1.04-1.65), thick lower segment (1.32, 1.09-1.61), fetal head above the inter-spinal diameter (2.29, 1.80-2.92) and poor fetal head-to-cervix contact (1.83, 1.31-2.56). The use of epidural analgesia (5.65, 4.33-7.38) was also associated with dystocia. CONCLUSION Vaginal examinations at admission provide useful information on risk indicators for dystocia. The strongest risk indicator was use of epidural analgesia and if part of that is causal, it is of concern.
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Affiliation(s)
- Hanne Kjaergaard
- Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Denmark.
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Gennaro S, Mayberry LJ, Kafulafula U. The evidence supporting nursing management of labor. J Obstet Gynecol Neonatal Nurs 2008; 36:598-604. [PMID: 17973705 DOI: 10.1111/j.1552-6909.2007.00194.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Although nursing practice is responsive to research findings, the practice site in which a nurse works has an impact on the ability to incorporate research changes into practice in a timely fashion. This review of the evidence base for nursing management of labor care focuses on care that typically falls within the nurses' domain and highlights the evidence in five areas in which there is research on patient preferences. These include management of admission and of progression during the first stage of labor, fetal monitoring, care and comfort practices during labor, and the management of second-stage labor. Directions for achieving progress toward practice change are highlighted.
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Affiliation(s)
- Susan Gennaro
- College of Nursing, New York University, NY 10003, USA.
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Gross MM, Hecker H, Matterne A, Guenter HH, Keirse MJNC. Does the way that women experience the onset of labour influence the duration of labour? BJOG 2006; 113:289-94. [PMID: 16487200 DOI: 10.1111/j.1471-0528.2006.00817.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess whether the way in which women experience the onset of their labour influences the duration of their labour. DESIGN Longitudinal study on a convenient sample of women in spontaneous labour with a singleton pregnancy in cephalic presentation at term. SETTING University hospital in Germany. POPULATION/SAMPLE Six hundred and fifty-one women (347 primiparae and 304 parae). METHODS Women recorded how and when labour had started. Responses were subjected to structured content analysis. Two investigators independently subdivided women's reported signs and symptoms into eight predefined categories. These data were related to maternal characteristics and to the course and outcome of labour as documented in the perinatal record. MAIN OUTCOME MEASURES Women's perception of how labour had started, interval between onset of labour and rupture of the membranes and duration of first stage labour and overall duration of labour. RESULTS Only 60% of women reported contractions as a sign of the onset of their labour. These women had a longer interval between the onset of labour and rupture of the membranes but a similar duration of labour when compared with women who did not report contractions as a sign of the onset of labour. Self-reported loss of amniotic fluid was the only sign that showed a consistent relationship with the duration of labour. Other patterns of labour onset had no effect on the duration of labour. CONCLUSION Irrespective of whether they have given birth before, women experience their onset of labour in a variety of ways. A large proportion of these experiences bear no resemblance to the classical diagnosis of labour and most are unrelated to the duration of labour.
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Affiliation(s)
- Mechthild M Gross
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Germany
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Cheyne H, Dowding DW, Hundley V. Making the diagnosis of labour: midwives' diagnostic judgement and management decisions. J Adv Nurs 2006; 53:625-35. [PMID: 16553671 DOI: 10.1111/j.1365-2648.2006.03769.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIM This paper reports a study examining midwives' perceptions of the way in which they diagnose labour. BACKGROUND Diagnosis of active labour is often problematic. A midwifery workforce planning tool identified that up to 30% of women admitted to United Kingdom labour wards subsequently turned out not to have been in labour. There is evidence that if a woman is admitted to a labour ward in early labour, she is more likely to have some form of medical intervention. However, despite the impact of misdiagnosis, there is little research on the process of decision-making by midwives in relation to diagnosis of labour. METHODS This was a qualitative study, employing focus group methods. Participants were a convenience sample of midwives working in a maternity unit in the North of England during 2002. They were asked to discuss their experience of admission of women in labour. Data were analysed using latent content analysis. FINDINGS Thirteen midwives participated in one of two groups. They described using information cues, which could be separated into two categories: those arising from the woman (Physical signs, Distress and coping, Woman's expectations and Social factors) and those from the institution (Midwifery care, Organizational factors and Justifying actions). Midwives' decision-making process could be divided into two stages. The diagnostic judgement was based on the physical signs of labour: the management decision would then be made by considering the diagnostic judgement as well as cues such as how the woman was coping, her expectations and those of her family and the requirements of the institution. CONCLUSIONS Midwives may experience more difficulty with the management decision than with the initial diagnosis. It may be that the number of inappropriate admissions to labour wards could be reduced by supporting midwives to negotiate the complex management hurdles, which accompany diagnosis of labour.
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Affiliation(s)
- Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK.
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Abstract
BACKGROUND No accurate method, clinical or otherwise, currently exists to determine the onset of labor precisely. The objective of this study was to investigate what influences the duration of first stage labor in women with spontaneous labor and childbirth in a nonclinical setting. METHODS From a population-based cohort of 1,448 planned home and birth center births, we selected 932 births for absence of pathology, absence of intervention, and completeness of data. Duration of first stage labor was analyzed with regression analysis for duration data or time-to-event analysis, using a specialized Transition Data Analysis software. The effects of fixed (age, parity, education, antenatal classes, infant birthweight, first cervical assessment) and time-varying factors (start of midwifery care, spontaneous rupture of membranes) in labor were estimated with piecewise-constant exponential hazard models. RESULTS Of the characteristics immutable at the onset of labor, only parity had a strong effect on the duration of first stage labor. Cervical dilatation at first assessment and time-varying factors, such as the timing of spontaneous rupture of membranes and midwifery care, each had a strong influence on labor duration; however, the sequence in which they occurred exerted an even stronger influence. First stage labors were much shorter if the membranes ruptured before rather than after the start of care. CONCLUSION With the exception of parity, events occurring during labor and their timing have a greater influence on the duration of first stage spontaneous labor than elements which are immutable at the onset of labor. Trials of interventions to influence the duration of labor need to consider not only whether the intervention was applied or not, but also when it was applied, if cause-effect relationships are to become properly understood.
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Affiliation(s)
- Mechthild M Gross
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
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